slightly decrease the exposure to raltegravir. Avoid.
▶ Antacids decrease the absorption of rifampicin. Rifampicin
should be taken 1 hour before antacids.oStudy
▶ Antacids are predicted to decrease the exposure to rilpivirine.
Antacids should be taken 2 hours before or 4 hours after
▶ Antacids slightly decrease the exposure to riociguat. Antacids
should be taken 2 hours before or 1 hour after riociguat.n
▶ Antacids moderately decrease the absorption of statins
. Separate administration by 2 hours.o ▶ Antacids decrease the absorption of sulpiride. Separate
administration by 2 hours.oStudy
▶ Antacids decrease the absorption of tetracyclines. Separate
administration by 2 to 3 hours.oStudy
▶ Antacids are predicted to decrease the absorption of thyroid
hormones (levothyroxine). Separate administration by at least
▶ Antacids are predicted to decrease the absorption of
. Separate administration by 2 hours.
▶ Antacids are predicted to decrease the concentration of
. Separate administration by 4 hours.o
Antazoline → see antihistamines, sedating
Anthracyclines → see TABLE 15 p. 1378 (myelosuppression), TABLE 5
1386 Antacids — Anthracyclines BNF 78
daunorubicin . doxorubicin . epirubicin .idarubicin . mitoxantrone . pixantrone.
GENERAL INFORMATION Caution is necessary with concurrent
use of cardiotoxic drugs, or drugs that reduce cardiac
▶ Calcium channel blockers (verapamil) moderately increase the
exposure to doxorubicin.oStudy
▶ Ciclosporin increases the concentration of anthracyclines
(daunorubicin, doxorubicin, epirubicin, idarubicin,
▶ H2 receptor antagonists (cimetidine) slightly increase the
exposure to epirubicin. Avoid.oStudy
▶ Leflunomide is predicted to increase the exposure to
(daunorubicin, doxorubicin, mitoxantrone).
Theoretical → Also see TABLE 15 p. 1378
▶ Live vaccines are predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
anthracyclines. Public Health England advises avoid (refer to
▶ Anthracyclines are predicted to increase the risk of
cardiotoxicity when given with monoclonal antibodies
(trastuzumab, trastuzumab emtansine)
Theoretical → Also see TABLE 15 p. 1378
▶ Rolapitant is predicted to increase the exposure to
anthracyclines (doxorubicin, mitoxantrone). Avoid or monitor.
▶ Teriflunomide is predicted to increase the exposure to
(daunorubicin, doxorubicin, mitoxantrone).
Anti-D (Rh0) immunoglobulin → see immunoglobulins
Antiarrhythmics → see TABLE 6 p. 1376 (bradycardia), TABLE 12 p. 1378
(peripheral neuropathy), TABLE 9 p. 1377 (QT-interval prolongation),
TABLE 11 p. 1377 (CNS depressant effects), TABLE 10 p. 1377
adenosine . amiodarone . disopyramide . dronedarone . flecainide . lidocaine . propafenone.
▶ Amiodarone has a long half-life; there is potential for drug
interactions to occur for several weeks (or even months)
after treatment with it has been stopped.
▶ Since systemic absorption can follow topical application of
lidocaine, the possibility of interactions should be borne in
▶ Dronedarone is predicted to increase the exposure to
▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to
increase the exposure to afatinib. Separate administration by
▶ Amiodarone is predicted to decrease the effects of agalsidase.
▶ Amiodarone is predicted to increase the exposure to
aldosterone antagonists (eplerenone). Adjust eplerenone dose,
▶ Dronedarone is predicted to increase the exposure to
aldosterone antagonists (eplerenone). Adjust eplerenone dose,
▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to
increase the exposure to aliskiren.rStudy
▶ Dronedarone is predicted to increase the exposure to alpha
blockers (tamsulosin).oTheoretical
▶ Dronedarone is predicted to increase the exposure to
▶ Aminophylline is predicted to decrease the efficacy of
adenosine. Separate administration by 24 hours.n Theoretical
▶ Anaesthetics, local are predicted to increase the risk of
cardiodepression when given with
▶ Antiarrhythmics (propafenone) are predicted to increase the risk
of cardiodepression when given with antiarrhythmics
(amiodarone). Monitor and adjust dose.rTheoretical
▶ Antiarrhythmics (amiodarone) increase the concentration of
antiarrhythmics (flecainide). Adjust flecainide dose and monitor
side effects.rStudy → Also see TABLE 6 p. 1376 → Also see
▶ Antiarrhythmics (propafenone) are predicted to increase the risk
of cardiodepression when given with antiarrhythmics
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to antiarrhythmics (propafenone). Monitor and adjust
▶ Amiodarone increases the risk of bradycardia when given with
anticholinesterases, centrally acting.oAnecdotal → Also
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the efficacy of
▶ Antiepileptics (fosphenytoin, phenytoin) are predicted to
decrease the exposure to lidocaine.rAnecdotal
▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone) are predicted to decrease the exposure
antiarrhythmics (disopyramide, dronedarone). Avoid.r
▶ Amiodarone is predicted to slightly increase the concentration
of antiepileptics (fosphenytoin, phenytoin). Monitor and adjust
dose.rStudy → Also see TABLE 12 p. 1378
▶ Antifungals, azoles (fluconazole) are predicted to increase the
exposure to dronedarone.rTheoretical → Also see TABLE 9
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to propafenone.
Monitor and adjust dose.oStudy
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to
Theoretical → Also see TABLE 9 p. 1377
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole)
very markedly increase the exposure to
Study → Also see TABLE 9 p. 1377
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to propafenone. Monitor
▶ Antifungals, azoles (miconazole) are predicted to increase the
disopyramide. Use with caution and adjust dose.
▶ Antifungals, azoles (posaconazole) are predicted to increase the
exposure to antiarrhythmics (disopyramide, dronedarone).
▶ Dronedarone is predicted to increase the exposure to
▶ Dronedarone is predicted to increase the exposure to
antihistamines, non-sedating (rupatadine). Avoid.oStudy
▶ Dronedarone is predicted to increase the concentration of
antimalarials (piperaquine).rTheoretical
▶ Dronedarone is predicted to increase the exposure to
increases the exposure to dronedarone.r
▶ Aprepitant is predicted to increase the exposure to
propafenone. Monitor and adjust dose.oStudy
is predicted to increase the exposure to axitinib.
▶ Dronedarone is predicted to increase the exposure to
bedaquiline. Avoid prolonged use.nTheoretical → Also see
▶ Antiarrhythmics (amiodarone, disopyramide, dronedarone,
flecainide, lidocaine) are predicted to increase the risk of
cardiovascular side-effects when given with beta blockers,
non-selective. Use with caution or avoid.rStudy → Also see
TABLE 6 p. 1376 → Also see TABLE 9 p. 1377
▶ Propafenone is predicted to increase the risk of cardiovascular
side-effects when given with beta blockers, non-selective
(labetalol, levobunolol, nadolol, pindolol, sotalol). Use with
▶ Propafenone increases the risk of cardiovascular side-effects
when given with beta blockers, non-selective (propranolol). Use
BNF 78 Anthracyclines — Antiarrhythmics 1387
▶ Propafenone is predicted to increase the exposure to beta
blockers, non-selective (timolol) and beta blockers, non-selective
(timolol) are predicted to increase the risk of cardiodepression
when given with propafenone.rAnecdotal
▶ Antiarrhythmics (amiodarone, disopyramide, dronedarone,
flecainide, lidocaine) are predicted to increase the risk of
cardiovascular side-effects when given with beta blockers,
selective. Use with caution or avoid.rStudy → Also see
▶ Propafenone is predicted to increase the risk of cardiovascular
side-effects when given with beta blockers, selective
(acebutolol, atenolol, betaxolol, bisoprolol, celiprolol, esmolol).
Use with caution or avoid.rStudy
▶ Propafenone is predicted to increase the exposure to beta
blockers, selective (metoprolol).oStudy
▶ Propafenone is predicted to increase the exposure to beta
blockers, selective (nebivolol) and beta blockers, selective
(nebivolol) are predicted to increase the risk of
cardiodepression when given with
▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to
increase the exposure to bictegravir. Use with caution or
▶ Bosentan is predicted to decrease the exposure to
▶ Dronedarone is predicted to increase the exposure to
bosutinib. Avoid or adjust dose.rTheoretical → Also see
▶ Dronedarone is predicted to increase the exposure to
buspirone. Use with caution and adjust dose.oStudy
▶ Dronedarone is predicted to increase the exposure to
cabozantinib.oTheoretical → Also see TABLE 9 p. 1377
▶ Caffeine citrate decreases the efficacy of adenosine. Separate
administration by 24 hours.nStudy
▶ Calcium channel blockers (diltiazem, verapamil) increase the
exposure to dronedarone and dronedarone increases the
calcium channel blockers (diltiazem, verapamil).
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to propafenone. Monitor and adjust
▶ Calcium channel blockers (verapamil) increase the risk of
cardiodepression when given with
Anecdotal → Also see TABLE 6 p. 1376
▶ Dronedarone is predicted to increase the exposure to calcium
channel blockers (amlodipine, felodipine, lacidipine,
lercanidipine, nicardipine, nifedipine, nimodipine). Monitor and
▶ Amiodarone is predicted to increase the risk of
cardiodepression when given with calcium channel blockers
(diltiazem, verapamil). Avoid.rTheoretical → Also see
▶ Disopyramide is predicted to increase the risk of
cardiodepression when given with calcium channel blockers
▶ Dronedarone is predicted to increase the exposure to
▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to
increase the exposure to ceritinib.oTheoretical → Also
▶ Amiodarone increases the concentration of ciclosporin.
Monitor concentration and adjust dose.rStudy
▶ Dronedarone is predicted to increase the concentration of
▶ Cobicistat potentially increases the concentration of
antiarrhythmics (amiodarone, disopyramide, flecainide,
▶ Cobicistat very markedly increases the exposure to
▶ Cobicistat is predicted to increase the exposure to
propafenone. Monitor and adjust dose.rStudy
▶ Dronedarone is predicted to increase the exposure to
▶ Dronedarone is predicted to increase the exposure to
colchicine. Adjust colchicine dose with moderate inhibitors of
▶ Dronedarone is predicted to increase the exposure to
(methylprednisolone). Monitor and adjust dose.
increases the anticoagulant effect of coumarins.
▶ Propafenone increases the anticoagulant effect of coumarins.
Monitor INR and adjust dose.oStudy
▶ Crizotinib is predicted to increase the exposure to
propafenone. Monitor and adjust dose.oStudy
▶ Amiodarone increases the exposure to dabigatran. Adjust
dabigatran dose, p. 136.oStudy
▶ Dronedarone slightly increases the exposure to dabigatran.
▶ Dronedarone is predicted to slightly increase the exposure to
▶ Darifenacin is predicted to increase the concentration of
▶ Dronedarone is predicted to increase the exposure to
dasatinib.rStudy → Also see TABLE 9 p. 1377
▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to
moderately increase the exposure to digoxin. Monitor and
adjust digoxin dose, p. 109.rStudy → Also see TABLE 6 p. 1376
▶ Propafenone increases the concentration of digoxin. Monitor
▶ Dipyridamole increases the exposure to adenosine. Avoid or
▶ Dronedarone increases the risk of QT-prolongation when
given with domperidone. Avoid.rStudy
▶ Dronedarone is predicted to increase the exposure to dopamine
receptor agonists (bromocriptine).rTheoretical
▶ Dronedarone is predicted to increase the concentration of
dopamine receptor agonists (cabergoline).rAnecdotal
▶ Dronedarone is predicted to moderately increase the exposure
slightly increases the exposure to edoxaban.
▶ Dronedarone slightly increases the exposure to edoxaban.
Adjust edoxaban dose, p. 126.rStudy
▶ Efavirenz is predicted to decrease the exposure to
dronedarone.rTheoretical → Also see TABLE 9 p. 1377
▶ Antiarrhythmics (dronedarone, propafenone) are predicted to
increase the exposure to eliglustat. Avoid or adjust dose—
consult product literature.rStudy
▶ Dronedarone is predicted to moderately increase the exposure
to encorafenib.oStudy → Also see TABLE 9 p. 1377
▶ Enzalutamide is predicted to decrease the exposure to
antiarrhythmics (disopyramide, dronedarone). Avoid.r
▶ Enzalutamide is predicted to decrease the efficacy of
▶ Dronedarone is predicted to increase the risk of ergotism when
given with ergometrine.rTheoretical
▶ Dronedarone is predicted to increase the risk of ergotism when
given with ergotamine.rTheoretical
▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to
increase the exposure to erlotinib.oTheoretical
▶ Dronedarone is predicted to increase the concentration of
everolimus. Avoid or adjust dose.oStudy
▶ Dronedarone is predicted to increase the exposure to
fesoterodine. Adjust fesoterodine dose with moderate
inhibitors of CYP3A4 in hepatic and renal impairment, p. 777.
▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to
increase the exposure to fidaxomicin. Avoid.oStudy
is predicted to increase the exposure to gefitinib.
potentially increases the exposure to glecaprevir.
increases the exposure to amiodarone. Avoid.
▶ Grapefruit juice moderately increases the exposure to
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