▶ Amisulpride is predicted to decrease the effects of levodopa.
Amitriptyline → see tricyclic antidepressants
Amlodipine → see calcium channel blockers
Amphotericin → see TABLE 2 p. 1375 (nephrotoxicity), TABLE 17 p. 1379
▶ Amphotericin increases the risk of toxicity when given with
▶ 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
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
Anaesthetics, local → see TABLE 11 p. 1377 (CNS depressant effects)
ROUTE-SPECIFIC INFORMATION Since systemic absorption can
follow topical application, the possibility of interactions
▶ 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
cardiodepression when given with
▶ 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
▶ 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
▶ Metoclopramide is predicted to increase the risk of
methaemoglobinaemia when given with topical prilocaine.
▶ Nitrates are predicted to increase the risk of
methaemoglobinaemia when given with topical prilocaine.
▶ 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
▶ 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.
▶ 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
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
is predicted to increase the exposure to anagrelide.
▶ 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
▶ Anakinra is predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
monoclonal antibodies (golimumab). Avoid.rTheoretical
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
BNF 78 Aminophylline — Angiotensin-II receptor antagonists 1385
aluminium hydroxide . magnesium carbonate . magnesium
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).
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
. Separate administration by at least 2 hours.
▶ 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
decrease the absorption of aspirin (high-dose).
▶ 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
ibandronic acid.o ▶ Antacids decrease the absorption of bisphosphonates
. Separate administration by at least 2 hours.
▶ Antacids decrease the absorption of bisphosphonates (sodium
clodronate). Avoid antacids for 2 hours before or 1 hour after
▶ Antacids are predicted to decrease the absorption of bosutinib.
should be taken at least 12 hours before antacids.
▶ Antacids are predicted to decrease the absorption of ceritinib.
Separate administration by 2 hours.oTheoretical
▶ Oral aluminium hydroxide decreases the absorption of
▶ 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
▶ Antacids decrease the absorption of corticosteroids
▶ 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 decrease the absorption of eltrombopag. Eltrombopag
should be taken 2 hours before or 4 hours after
▶ 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
enteral feeds.o ▶ Antacids are predicted to decrease the absorption of erlotinib.
Antacids should be taken 4 hours before or 2 hours after
▶ Antacids slightly to moderately decrease the exposure to
▶ Antacids are predicted to slightly decrease the exposure to
2 hours before or 1 hour after antacids.rTheoretical
▶ 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
▶ Aluminium hydroxide is predicted to decrease the exposure to
iron chelators (deferasirox). Avoid.oTheoretical
▶ Antacids are predicted to decrease the absorption of lapatinib.
▶ Antacids are predicted to decrease the exposure to ledipasvir.
Separate administration by 4 hours.oTheoretical
Separate administration by at least 2 hours.
o ▶ Magnesium trisilicate decreases the absorption of
▶ Antacids are predicted to decrease the absorption of
pazopanib. Pazopanib should be taken 1 hour before or 2 hours
▶ Antacids decrease the absorption of penicillamine. Separate
administration by 2 hours.nStudy
with polystyrene sulfonate.rAnecdotal
▶ Antacids decrease the absorption of quinolones. Quinolones
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