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is predicted to increase the exposure to didanosine.

Study

▶ Leflunomide is predicted to increase the exposure to

ganciclovir.oTheoretical → Also see TABLE 15 p. 1378

▶ Mycophenolate is predicted to increase the risk of

Theoretical

haematological toxicity when given with

→ Also see TABLE 15 p. 1378

ganciclovir.o ▶ Teriflunomide is predicted to increase the exposure to

ganciclovir.oStudy

Gefitinib → see TABLE 15 p. 1378 (myelosuppression)

▶ Antacids are predicted to slightly decrease the exposure to

gefitinib.oTheoretical

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to gefitinib.oTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to gefitinib. Avoid.rStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Theoretical

gefitinib.o ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to gefitinib.oStudy

▶ Aprepitant

o

is predicted to increase the exposure to gefitinib.

Theoretical

▶ Bosentan is predicted to decrease the exposure to gefitinib.

Avoid.rTheoretical

▶ Calcium channel blockers (diltiazem, verapamil) are predicted to

increase the exposure to gefitinib.oTheoretical

▶ Cobicistat

o

is predicted to increase the exposure to gefitinib.

Study

▶ Gefitinib is predicted to increase the anticoagulant effect of

coumarins.rAnecdotal

▶ Crizotinib

o

is predicted to increase the exposure to gefitinib.

Theoretical → Also see TABLE 15 p. 1378

▶ Efavirenz is predicted to decrease the exposure to gefitinib.

Avoid.rTheoretical

▶ Enzalutamide is predicted to decrease the exposure to

gefitinib. Avoid.rStudy

▶ H2 receptor antagonists are predicted to slightly to moderately

decrease the exposure to gefitinib.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to gefitinib.oStudy

▶ Idelalisib

o

is predicted to increase the exposure to gefitinib.

Study → Also see TABLE 15 p. 1378

▶ Imatinib

o

is predicted to increase the exposure to gefitinib.

Theoretical → Also see TABLE 15 p. 1378

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to gefitinib.oStudy

▶ Macrolides (erythromycin) are predicted to increase the

exposure to gefitinib.oTheoretical

▶ Mitotane is predicted to decrease the exposure to gefitinib.

Avoid.rStudy → Also see TABLE 15 p. 1378

▶ Netupitant

o

is predicted to increase the exposure to gefitinib.

Theoretical

▶ Nevirapine is predicted to decrease the exposure to gefitinib.

Avoid.rTheoretical

▶ Nilotinib

o

is predicted to increase the exposure to gefitinib.

Theoretical → Also see TABLE 15 p. 1378

▶ Gefitinib is predicted to increase the risk of bleeding events

when given with phenindione.rTheoretical

▶ Proton pump inhibitors are predicted to decrease the exposure

to gefitinib.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to gefitinib.

Avoid.rStudy

▶ St John’s Wort is predicted to decrease the exposure to

gefitinib. Avoid.rTheoretical

Gemcitabine → see TABLE 15 p. 1378 (myelosuppression)

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

gemcitabine. Public Health England advises avoid (refer to

Green Book).rTheoretical

Gemfibrozil → see fibrates

Gentamicin → see aminoglycosides

Glecaprevir

▶ Antiarrhythmics (dronedarone) potentially increase the

exposure to glecaprevir.oTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to moderately decrease

the exposure to glecaprevir. Avoid.rStudy

▶ Antiepileptics (eslicarbazepine, oxcarbazepine) potentially

decrease the exposure to glecaprevir. Avoid.rTheoretical

▶ Antifungals, azoles (itraconazole, ketoconazole) potentially

increase the exposure to glecaprevir.oTheoretical

▶ Bosentan is predicted to decrease the exposure to glecaprevir.

Avoid.rStudy

▶ Ciclosporin increases the exposure to glecaprevir. Avoid or

monitor.rStudy

▶ Cobicistat

o

potentially increases the exposure to glecaprevir.

Theoretical

▶ Combined hormonal contraceptives (containing

ethinylestradiol) are predicted to increase the risk of

increased ALT concentrations when given with glecaprevir.

Avoid.rStudy

▶ Crizotinib potentially decreases the exposure to glecaprevir.

Avoid.rTheoretical

▶ Glecaprevir (with pibrentasvir) increases the exposure to

dabigatran. Avoid.oStudy

▶ Glecaprevir (with pibrentasvir) increases the exposure to

digoxin.oStudy

▶ Efavirenz is predicted to decrease the exposure to glecaprevir.

Avoid.rStudy

▶ Enzalutamide is predicted to greatly decrease the

concentration of glecaprevir. Avoid.rStudy

▶ HIV-protease inhibitors (atazanavir, darunavir, lopinavir)

(boosted with ritonavir) increase the exposure to glecaprevir.

Avoid.rStudy

▶ HIV-protease inhibitors (ritonavir) increase the exposure to

glecaprevir. Avoid.rStudy

▶ Lumacaftor potentially decreases the exposure to glecaprevir.

Avoid.rTheoretical

▶ Mitotane is predicted to greatly decrease the concentration of

glecaprevir. Avoid.rStudy

▶ Nevirapine is predicted to decrease the exposure to

glecaprevir. Avoid.rStudy

▶ Rifampicin markedly affects the exposure to glecaprevir.

Avoid.rStudy

▶ St John’s Wort is predicted to decrease the exposure to

glecaprevir. Avoid.rStudy

▶ Glecaprevir (with pibrentasvir) markedly increases the

exposure to statins (atorvastatin). Avoid.rStudy

▶ Glecaprevir (with pibrentasvir) is predicted to increase the

exposure to statins (fluvastatin).oTheoretical

▶ Glecaprevir (with pibrentasvir) increases the exposure to

statins (pravastatin). Use with caution and adjust pravastatin

dose.oStudy

▶ Glecaprevir (with pibrentasvir) increases the exposure to

statins (rosuvastatin). Use with caution and adjust rosuvastatin

dose, p. 204.oStudy

▶ Glecaprevir (with pibrentasvir) increases the exposure to

statins (simvastatin). Avoid.oStudy

BNF 78 Frovatriptan — Glecaprevir 1459

Interactions | Appendix 1

A1

Glecaprevir (continued)

▶ Glecaprevir (with pibrentasvir) slightly increases the exposure

to tacrolimus. Monitor and adjust dose.nStudy

Glibenclamide → see sulfonylureas

Gliclazide → see sulfonylureas

Glimepiride → see sulfonylureas

Glipizide → see sulfonylureas

Glucagon

▶ Glucagon increases the anticoagulant effect of coumarins

(warfarin).rStudy

Glucosamine

▶ Glucosamine potentially decreases the anticoagulant effect of

coumarins (acenocoumarol).oAnecdotal

▶ Glucosamine potentially increases the anticoagulant effect of

coumarins (warfarin). Avoid.oAnecdotal

Glycerol phenylbutyrate

▶ Antiepileptics (valproate) potentially oppose the effects of

glycerol phenylbutyrate.oTheoretical

▶ Corticosteroids potentially oppose the effects of glycerol

phenylbutyrate.oTheoretical

▶ Haloperidol potentially opposes the effects of glycerol

phenylbutyrate.oTheoretical

Glyceryl trinitrate → see nitrates

Glycopyrronium → see TABLE 10 p. 1377 (antimuscarinics)

ROUTE-SPECIFIC INFORMATION Since systemic absorption can

follow topical application, the possibility of interactions

should be borne in mind.

Golimumab → see monoclonal antibodies

Granisetron → see TABLE 9 p. 1377 (QT-interval prolongation), TABLE 13

p. 1378 (serotonin syndrome)

▶ Dopamine receptor agonists (apomorphine) are predicted to

increase the risk of severe hypotension when given with

granisetron.rTheoretical

Grapefruit juice

▶ Grapefruit juice is predicted to increase the exposure to

abemaciclib. Avoid.oTheoretical

▶ Grapefruit juice moderately decreases the exposure to

aliskiren. Avoid.rStudy

▶ Grapefruit juice increases the exposure to antiarrhythmics

(amiodarone). Avoid.oStudy

▶ Grapefruit juice moderately increases the exposure to

antiarrhythmics (dronedarone). Avoid.rStudy

▶ Grapefruit juice increases the exposure to antiarrhythmics

(propafenone). Monitor and adjust dose.oStudy

▶ Grapefruit juice slightly increases the exposure to antiepileptics

(carbamazepine). Monitor and adjust dose.oStudy

▶ Grapefruit juice slightly decreases the exposure to

antihistamines, non-sedating (bilastine). Bilastine should be

taken 1 hour before or 2 hours after

Study

grapefruit juice.o ▶ Grapefruit juice increases the exposure to antihistamines, nonsedating (rupatadine). Avoid.oStudy

▶ Grapefruit juice increases the exposure to antimalarials

(artemether).qStudy

▶ Grapefruit juice is predicted to increase the concentration of

antimalarials (piperaquine). Avoid.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

axitinib.oTheoretical

▶ Grapefruit juice greatly decreases the exposure to beta blockers,

selective (celiprolol).oStudy

▶ Grapefruit juice is predicted to increase the exposure to

bosutinib. Avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the concentration of

brigatinib. Avoid.rStudy

▶ Grapefruit juice increases the exposure to buspirone. Avoid.

nStudy

▶ Grapefruit juice is predicted to increase the exposure to

cabozantinib.oTheoretical

▶ Grapefruit juice very slightly increases the exposure to calcium

channel blockers (amlodipine). Avoid.nStudy

▶ Grapefruit juice increases the exposure to calcium channel

blockers (felodipine). Avoid.oStudy

▶ Grapefruit juice is predicted to increase the exposure to calcium

channel blockers (lercanidipine). Avoid.oTheoretical

▶ Grapefruit juice increases the exposure to calcium channel

blockers (nicardipine).nStudy

▶ Grapefruit juice increases the exposure to calcium channel

blockers (nifedipine, verapamil). Avoid.nStudy

▶ Grapefruit juice is predicted to increase the exposure to

cariprazine. Avoid.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

ceritinib. Avoid.rTheoretical

▶ Grapefruit juice increases the concentration of ciclosporin.

Avoid.rStudy

▶ Grapefruit juice markedly decreases the exposure to

clopidogrel.rStudy

▶ Grapefruit juice is predicted to increase the exposure to

cobimetinib. Avoid.rTheoretical

▶ Grapefruit juice moderately increases the exposure to oral

corticosteroids (budesonide). Avoid.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

crizotinib. Avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

darifenacin.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

dasatinib. Avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

eliglustat. Avoid.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

encorafenib. Avoid.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

ergometrine.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

ergotamine.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

erlotinib.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

everolimus. Avoid.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

guanfacine. Avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

ibrutinib. Avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

imatinib.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

ivabradine. Avoid.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

ivacaftor. Avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

lapatinib. Avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

lomitapide

Theoretical

. Separate administration by 12 hours.o ▶ Grapefruit juice is predicted to increase the exposure to

lurasidone. Avoid.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

naloxegol. Avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

nilotinib. Avoid.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

olaparib. Avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

palbociclib. Avoid.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

pazopanib. Avoid.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors

o

. Use with caution or avoid.

Study

▶ Grapefruit juice

r

increases the exposure to pimozide. Avoid.

Theoretical

▶ Grapefruit juice is predicted to increase the exposure to

ponatinib.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

praziquantel.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

quetiapine. Avoid.rTheoretical

▶ Grapefruit juice is predicted to increase the concentration of

ranolazine. Avoid.rTheoretical

1460 Glecaprevir — Grapefruit juice BNF 78

Interactions | Appendix 1

A1

▶ Grapefruit juice is predicted to increase the exposure to

regorafenib. Avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

ribociclib. Avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

ruxolitinib.rTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

saxagliptin.nTheoretical

▶ Grapefruit juice increases the concentration of sirolimus.

Avoid.oStudy

▶ Grapefruit juice moderately increases the exposure to SSRIs

(sertraline). Avoid.oStudy

▶ Grapefruit juice increases the exposure to statins (atorvastatin).

nStudy

▶ Grapefruit juice increases the exposure to statins (simvastatin).

Avoid.rStudy

▶ Grapefruit juice is predicted to increase the exposure to

sunitinib. Avoid.oTheoretical

▶ Grapefruit juice greatly increases the concentration of

tacrolimus. Avoid.rStudy

▶ Grapefruit juice is predicted to increase the concentration of

temsirolimus. Use with caution or avoid.oTheoretical

▶ Grapefruit juice is predicted to increase the exposure to

tezacaftor. Avoid.rStudy

▶ Grapefruit juice moderately increases the exposure to

ticagrelor.oStudy

▶ Grapefruit juice

o

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