p. 1377

▶ Amisulpride is predicted to decrease the effects of levodopa.

Avoid.rTheoretical

Amitriptyline → see tricyclic antidepressants

Amlodipine → see calcium channel blockers

Amoxicillin → see penicillins

Amphotericin → see TABLE 2 p. 1375 (nephrotoxicity), TABLE 17 p. 1379

(reduced serum potassium)

▶ Amphotericin increases the risk of toxicity when given with

flucytosine.rStudy

▶ Micafungin slightly increases the exposure to amphotericin.

Avoid or monitor toxicity.oStudy

▶ Sodium stibogluconate increases the risk of cardiovascular

side-effects when given with amphotericin. Separate

administration by 14 days.rStudy

Ampicillin → see penicillins

Amsacrine → see TABLE 15 p. 1378 (myelosuppression)

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

amsacrine. Public Health England advises avoid (refer to

Green Book).rTheoretical

Anaesthetics, local → see TABLE 11 p. 1377 (CNS depressant effects)

bupivacaine . levobupivacaine . mepivacaine . oxybuprocaine . prilocaine . proxymetacaine .ropivacaine .tetracaine.

ROUTE-SPECIFIC INFORMATION Since systemic absorption can

follow topical application, the possibility of interactions

should be borne in mind.

▶ Aminosalicylic acid is predicted to increase the risk of

methaemoglobinaemia when given with topical prilocaine.

Use with caution or avoid.rTheoretical

▶ Anaesthetics, local are predicted to increase the risk of

Theoretical

cardiodepression when given with

→ Also see TABLE 11 p. 1377

antiarrhythmics.r

▶ Antiepileptics (fosphenytoin, phenobarbital, phenytoin,

primidone) are predicted to increase the risk of

methaemoglobinaemia when given with topical prilocaine.

Use with caution or avoid.rTheoretical → Also see TABLE 11

p. 1377

▶ Antiepileptics (phenytoin) are predicted to decrease the

exposure to ropivacaine.oTheoretical

▶ Antimalarials (chloroquine, primaquine) are predicted to

increase the risk of methaemoglobinaemia when given with

topical prilocaine. Use with caution or avoid.rTheoretical

▶ Dapsone is predicted to increase the risk of

methaemoglobinaemia when given with topical prilocaine.

Use with caution or avoid.rTheoretical

▶ HIV-protease inhibitors (ritonavir) are predicted to decrease the

exposure to ropivacaine.oTheoretical

▶ Leflunomide is predicted to decrease the exposure to

ropivacaine.oTheoretical

▶ Metoclopramide is predicted to increase the risk of

methaemoglobinaemia when given with topical prilocaine.

Avoid.rTheoretical

▶ Nitrates are predicted to increase the risk of

methaemoglobinaemia when given with topical prilocaine.

Avoid.rTheoretical

▶ Nitrofurantoin is predicted to increase the risk of

methaemoglobinaemia when given with topical prilocaine.

Use with caution or avoid.rTheoretical

▶ Paracetamol is predicted to increase the risk of

methaemoglobinaemia when given with topical prilocaine.

Use with caution or avoid.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to

ropivacaine.oTheoretical

▶ Sodium nitroprusside is predicted to increase the risk of

methaemoglobinaemia when given with topical prilocaine.

Use with caution or avoid.rTheoretical

▶ SSRIs (fluvoxamine) decrease the clearance of ropivacaine.

Avoid prolonged use.oStudy

▶ Sulfonamides potentially increase the risk of

methaemoglobinaemia when given with topical prilocaine.

Use with caution or avoid.rAnecdotal

▶ Teriflunomide is predicted to decrease the exposure to

ropivacaine.oTheoretical

Anagrelide → see TABLE 9 p. 1377 (QT-interval prolongation), TABLE 4

p. 1375 (antiplatelet effects)

▶ Combined hormonal contraceptives are predicted to increase

the exposure to anagrelide.oTheoretical

▶ Mexiletine

o

is predicted to increase the exposure to anagrelide.

Theoretical

▶ Quinolones (ciprofloxacin) are predicted to increase the

exposure to anagrelide.oTheoretical

▶ SSRIs (fluvoxamine) are predicted to increase the exposure to

anagrelide.oTheoretical → Also see TABLE 4 p. 1375

Anakinra → see TABLE 15 p. 1378 (myelosuppression)

▶ Anakinra is predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

etanercept. Avoid.rTheoretical

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

anakinra. Public Health England advises avoid (refer to Green

Book).rTheoretical

▶ Anakinra is predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

monoclonal antibodies (golimumab). Avoid.rTheoretical

Angiotensin-II receptor antagonists → see TABLE 7 p. 1376 (firstdose hypotension), TABLE 8 p. 1376 (hypotension), TABLE 16 p. 1379

(increased serum potassium)

azilsartan . candesartan . eprosartan .irbesartan . losartan . olmesartan .telmisartan .valsartan. ▶ Angiotensin-II receptor antagonists increase the risk of renal

impairment when given with aliskiren. Use with caution or

avoid aliskiren in selected patients, p. 179.rStudy → Also

see TABLE 8 p. 1376 → Also see TABLE 16 p. 1379

▶ Angiotensin-II receptor antagonists potentially increase the

concentration of lithium. Monitor concentration and adjust

dose.rAnecdotal

BNF 78 Aminophylline — Angiotensin-II receptor antagonists 1385

Interactions | Appendix 1

A1

Antacids

aluminium hydroxide . magnesium carbonate . magnesium

trisilicate.

SEPARATION OF ADMINISTRATION Antacids should preferably

not be taken at the same time as other drugs since they might

impair absorption. Antacids might damage enteric coatings

designed to prevent dissolution in the stomach.

▶ Antacids are predicted to decrease the absorption of alkylating

agents (estramustine). Avoid.oStudy

▶ Antacids decrease the absorption of antiepileptics (gabapentin).

Gabapentin

Study

should be taken 2 hours after antacids.o ▶ Antacids decrease the absorption of antifungals, azoles

(itraconazole) (capsule). Antacids should be taken 1 hour

before or 2 hours after itraconazole.oStudy

▶ Antacids decrease the absorption of antifungals, azoles

(ketoconazole)

o

. Separate administration by at least 2 hours.

Study

▶ Antacids decrease the absorption of antihistamines, non-sedating

(fexofenadine). Separate administration by 2 hours.nStudy

▶ Antacids decrease the absorption of antimalarials (chloroquine).

Separate administration by at least 4 hours.oStudy

▶ Antacids are predicted to decrease the absorption of

antimalarials (proguanil). Separate administration by at least

2 hours.oStudy

▶ Antacids

o

decrease the absorption of aspirin (high-dose).

Study

▶ Antacids decrease the exposure to bictegravir. Separate

administration by at least 2 hours.oStudy

▶ Antacids decrease the absorption of bisphosphonates

(alendronic acid). Alendronic acid should be taken at least

30 minutes before antacids.oStudy

▶ Antacids are predicted to decrease the absorption of

bisphosphonates (ibandronic acid). Avoid antacids for at least

6 hours before or 1 hour after

Theoretical

ibandronic acid.o ▶ Antacids decrease the absorption of bisphosphonates

(risedronate)

o

. Separate administration by at least 2 hours.

Study

▶ Antacids decrease the absorption of bisphosphonates (sodium

clodronate). Avoid antacids for 2 hours before or 1 hour after

sodium clodronate.oStudy

▶ Antacids are predicted to decrease the absorption of bosutinib.

Bosutinib

o

should be taken at least 12 hours before antacids.

Theoretical

▶ Antacids are predicted to decrease the absorption of ceritinib.

Separate administration by 2 hours.oTheoretical

▶ Oral aluminium hydroxide decreases the absorption of

chenodeoxycholic acid.oStudy

▶ Antacids are predicted to decrease the absorption of cholic

acid. Separate administration by 5 hours.nTheoretical

▶ Antacids are predicted to decrease the absorption of

corticosteroids (deflazacort). Separate administration by

2 hours.oTheoretical

▶ Antacids decrease the absorption of corticosteroids

(dexamethasone).oStudy

▶ Antacids decrease the absorption of dasatinib. Separate

administration by at least 2 hours.oStudy

▶ Aluminium hydroxide is predicted to decrease the absorption

of deferiprone. Avoid.oTheoretical

▶ Antacids decrease the absorption of digoxin. Separate

administration by 2 hours.nStudy

▶ Antacids are predicted to decrease the absorption of

dipyridamole (immediate release tablets).oTheoretical

▶ Antacids moderately decrease the exposure to dolutegravir.

Dolutegravir should be taken 2 hours before or 6 hours after

antacids.oStudy

▶ Antacids decrease the absorption of eltrombopag. Eltrombopag

should be taken 2 hours before or 4 hours after

r

antacids.

Study

▶ Antacids moderately decrease the exposure to elvitegravir.

Separate administration by at least 4 hours.oStudy

▶ Aluminium hydroxide increases the risk of blocked enteral or

nasogastric tubes when given with

Study

enteral feeds.o ▶ Antacids are predicted to decrease the absorption of erlotinib.

Antacids should be taken 4 hours before or 2 hours after

erlotinib.oTheoretical

▶ Antacids slightly to moderately decrease the exposure to

fibrates (gemfibrozil).oStudy

▶ Antacids are predicted to slightly decrease the exposure to

gefitinib.oTheoretical

▶ Antacids are predicted to decrease the absorption of HIVprotease inhibitors (atazanavir). Atazanavir should be taken

2 hours before or 1 hour after antacids.rTheoretical

▶ Antacids are predicted to decrease the absorption of HIVprotease inhibitors (tipranavir). Separate administration by

2 hours.oStudy

▶ Antacids decrease the absorption of hydroxychloroquine.

Separate administration by at least 4 hours.oStudy

▶ Antacids decrease the absorption of iron (oral). Iron (oral)

should be taken 1 hour before or 2 hours after

o

antacids.

Study

▶ Aluminium hydroxide is predicted to decrease the exposure to

iron chelators (deferasirox). Avoid.oTheoretical

▶ Antacids are predicted to decrease the absorption of lapatinib.

Avoid.oTheoretical

▶ Antacids are predicted to decrease the exposure to ledipasvir.

Separate administration by 4 hours.oTheoretical

▶ Antacids

Study

decrease the exposure to mycophenolate.o ▶ Antacids are predicted to decrease the absorption of nilotinib.

Separate administration by at least 2 hours.

Theoretical

o ▶ Magnesium trisilicate decreases the absorption of

nitrofurantoin.oStudy

▶ Antacids are predicted to decrease the absorption of

pazopanib. Pazopanib should be taken 1 hour before or 2 hours

after antacids.oTheoretical

▶ Antacids decrease the absorption of penicillamine. Separate

administration by 2 hours.nStudy

▶ Antacids

Anecdotal

decrease the absorption of phenothiazines.o ▶ Antacids increase the risk of metabolic alkalosis when given

with polystyrene sulfonate.rAnecdotal

▶ Antacids decrease the absorption of quinolones. Quinolones

should be taken 2 hours before or 4 hours after

o

antacids.

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