Lenalidomide (continued)

▶ Hormone replacement therapy is predicted to increase the risk

of venous thromboembolism when given with

r

lenalidomide.

Theoretical

Lenvatinib → see TABLE 9 p. 1377 (QT-interval prolongation)

Lercanidipine → see calcium channel blockers

Letermovir

▶ Letermovir is predicted to increase the concentration of

antiarrhythmics (amiodarone).oTheoretical

▶ Antiepileptics (carbamazepine, phenobarbital, primidone) are

predicted to decrease the concentration of

o

letermovir.

Theoretical

▶ Letermovir is predicted to decrease the concentration of

antiepileptics (fosphenytoin, phenytoin) and antiepileptics

(fosphenytoin, phenytoin) are predicted to decrease the

concentration of letermovir.oTheoretical

▶ Letermovir slightly decreases the exposure to antifungals,

azoles (voriconazole).oStudy

▶ Letermovir is predicted to increase the concentration of

antihistamines, non-sedating (fexofenadine).oTheoretical

▶ Letermovir is predicted to increase the concentration of

bosentan.oTheoretical

▶ Letermovir increases the exposure to ciclosporin and

ciclosporin increases the exposure to letermovir. Monitor and

adjust letermovir dose, p. 639.rStudy

▶ Letermovir is predicted to decrease the concentration of

Theoretical

coumarins (warfarin). Monitor and adjust dose.o ▶ Letermovir is predicted to decrease the concentration of

dabigatran. Avoid.rTheoretical

▶ Efavirenz is predicted to decrease the concentration of

letermovir.oTheoretical

▶ Eltrombopag is predicted to increase the concentration of

letermovir.oStudy

▶ Letermovir is predicted to increase the concentration of

ergometrine. Avoid.rTheoretical

▶ Letermovir is predicted to increase the concentration of

ergotamine. Avoid.rTheoretical

▶ Etravirine

o

is predicted to decrease the exposure to letermovir.

Theoretical

▶ Letermovir is predicted to increase the concentration of

everolimus. Monitor and adjust dose.rStudy

▶ Fibrates (gemfibrozil) are predicted to increase the

concentration of letermovir.oStudy

▶ HIV-protease inhibitors (atazanavir, lopinavir) (boosted with

ritonavir) are predicted to increase the concentration of

letermovir.oStudy

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

concentration of letermovir.oTheoretical

▶ Leflunomide is predicted to increase the concentration of

letermovir.oStudy

▶ Macrolides (clarithromycin, erythromycin) are predicted to

increase the concentration of letermovir.oStudy

▶ Letermovir slightly to moderately increases the exposure to

midazolam. Monitor and adjust dose.oStudy

▶ Modafinil is predicted to decrease the concentration of

letermovir.oTheoretical

▶ Letermovir is predicted to increase the exposure to opioids

(alfentanil, fentanyl). Monitor and adjust dose.oStudy

▶ Letermovir is predicted to increase the concentration of

pimozide. Avoid.rTheoretical

▶ Letermovir is predicted to increase the concentration of

repaglinide. Avoid.oTheoretical

▶ Rifabutin is predicted to decrease the concentration of

letermovir.oTheoretical

▶ Rifampicin is predicted to affect the concentration of

letermovir.rTheoretical

▶ Letermovir moderately increases the exposure to sirolimus.

Monitor and adjust dose.rStudy

▶ St John’s Wort is predicted to decrease the concentration of

letermovir.oTheoretical

▶ Letermovir moderately increases the exposure to statins

(atorvastatin)

Study

. Avoid or adjust atorvastatin dose, p. 202.r

▶ Letermovir is predicted to increase the exposure to statins

(fluvastatin). Monitor and adjust dose.oTheoretical

▶ Letermovir is predicted to increase the exposure to statins

(pravastatin). Avoid or adjust dose.oTheoretical

▶ Letermovir is predicted to increase the exposure to statins

(rosuvastatin, simvastatin). Avoid.rStudy

▶ Letermovir is predicted to increase the concentration of

sulfonylureas (glibenclamide).oTheoretical

▶ Letermovir moderately increases the exposure to tacrolimus.

Monitor and adjust dose.rStudy

▶ Teriflunomide is predicted to increase the concentration of

letermovir.oStudy

Levamisole

▶ Albendazole slightly decreases the exposure to levamisole and

levamisole

o

moderately decreases the exposure to albendazole.

Study

▶ Alcohol (beverage) potentially causes a disulfiram-like

reaction when given with levamisole.oStudy

▶ Levamisole

Study

increases the exposure to ivermectin.o

Levetiracetam → see antiepileptics

Levobunolol → see beta blockers, non-selective

Levobupivacaine → see anaesthetics, local

Levocetirizine → see antihistamines, non-sedating

Levodopa → see TABLE 8 p. 1376 (hypotension)

GENERAL INFORMATION Drugs with antimuscarinic effects

might reduce the absorption of levodopa, see TABLE 10 p. 1377.

▶ Amisulpride is predicted to decrease the effects of levodopa.

Avoid.rTheoretical

▶ Antiepileptics (fosphenytoin, phenytoin) decrease the effects of

levodopa.oStudy

▶ Aripiprazole

r

is predicted to decrease the effects of levodopa.

Theoretical → Also see TABLE 8 p. 1376

▶ Asenapine is predicted to decrease the effects of levodopa.

Adjust dose.rTheoretical → Also see TABLE 8 p. 1376

▶ Baclofen is predicted to increase the risk of side-effects when

given with levodopa.rAnecdotal → Also see TABLE 8 p. 1376

▶ Benperidol

r

is predicted to decrease the effects of levodopa.

Study → Also see TABLE 8 p. 1376

▶ Bupropion increases the risk of side-effects when given with

levodopa.oStudy

▶ Clozapine

r

is predicted to decrease the effects of levodopa.

Theoretical → Also see TABLE 8 p. 1376

▶ Droperidol decreases the effects of levodopa.rStudy →

Also see TABLE 8 p. 1376

▶ Entacapone increases the exposure to levodopa. Monitor side

effects and adjust dose.oStudy

▶ Flupentixol decreases the effects of levodopa. Avoid or monitor

worsening parkinsonian symptoms.rTheoretical → Also

see TABLE 8 p. 1376

▶ Haloperidol decreases the effects of levodopa.rStudy →

Also see TABLE 8 p. 1376

▶ Iron (oral)

Study

decreases the absorption of levodopa.o ▶ Isoniazid decreases the effects of levodopa.oStudy

▶ Levodopa is predicted to increase the risk of elevated blood

pressure when given with linezolid. Avoid.rTheoretical

▶ Loxapine

r

is predicted to decrease the effects of levodopa.

Theoretical → Also see TABLE 8 p. 1376

▶ Lurasidone

r

is predicted to decrease the effects of levodopa.

Theoretical → Also see TABLE 8 p. 1376

▶ Memantine

o

is predicted to increase the effects of levodopa.

Theoretical

▶ Metoclopramide

o

decreases the effects of levodopa. Avoid.

Study

▶ Levodopa increases the risk of side-effects when given with

moclobemide.oStudy

▶ Levodopa increases the risk of a hypertensive crisis when

given with monoamine-oxidase A and B inhibitors, irreversible.

Avoid and for 14 days after stopping the MAOI.rStudy →

Also see TABLE 8 p. 1376

▶ Monoamine-oxidase B inhibitors are predicted to increase the

effects of levodopa. Adjust dose.nStudy → Also see TABLE 8

p. 1376

1478 Lenalidomide — Levodopa BNF 78

Interactions | Appendix 1

A1

▶ Olanzapine decreases the effects of levodopa. Avoid or monitor

worsening parkinsonian symptoms.rAnecdotal → Also see

TABLE 8 p. 1376

▶ Opicapone

o

increases the exposure to levodopa. Adjust dose.

Study

▶ Paliperidone

r

is predicted to decrease the effects of levodopa.

Theoretical → Also see TABLE 8 p. 1376

▶ Phenothiazines decrease the effects of levodopa. Avoid or

monitor worsening parkinsonian symptoms.rStudy →

Also see TABLE 8 p. 1376

▶ Pimozide decreases the effects of levodopa.rTheoretical →

Also see TABLE 8 p. 1376

▶ Quetiapine

Anecdotal →

decreases the effects of

Also see TABLE 8 p. 1376

levodopa.r

▶ Risperidone is predicted to decrease the effects of levodopa.

Avoid or adjust dose.rAnecdotal → Also see TABLE 8 p. 1376

▶ Sulpiride is predicted to decrease the effects of levodopa.

Avoid.rTheoretical → Also see TABLE 8 p. 1376

▶ Tetrabenazine is predicted to decrease the effects of levodopa.

Use with caution or avoid.oTheoretical

▶ Tolcapone increases the exposure to levodopa. Monitor and

adjust dose.oStudy

▶ Tryptophan

o

greatly decreases the concentration of levodopa.

Study

▶ Zuclopenthixol is predicted to decrease the effects of levodopa.

Avoid or monitor worsening parkinsonian symptoms.

Theoretical → Also see TABLE 8 p. 1376

r

Levofloxacin → see quinolones

Levofolinic acid → see folates

Levomepromazine → see phenothiazines

Levonorgestrel

▶ Antiepileptics (carbamazepine, eslicarbazepine, fosphenytoin,

oxcarbazepine, perampanel, phenobarbital, phenytoin,

primidone, rufinamide, topiramate) are predicted to decrease

the efficacy of levonorgestrel. For FSRH guidance, see

Contraceptives, interactions p. 794.rTheoretical

▶ Aprepitant is predicted to decrease the efficacy of

levonorgestrel. For FSRH guidance, see Contraceptives,

interactions p. 794.rTheoretical

▶ Bosentan is predicted to decrease the efficacy of

levonorgestrel. For FSRH guidance, see Contraceptives,

interactions p. 794.rTheoretical

▶ Efavirenz is predicted to decrease the efficacy of

levonorgestrel. For FSRH guidance, see Contraceptives,

interactions p. 794.rTheoretical

▶ Fosaprepitant is predicted to decrease the efficacy of

levonorgestrel. For FSRH guidance, see Contraceptives,

interactions p. 794.rTheoretical

▶ Griseofulvin potentially decreases the efficacy of oral

levonorgestrel. For FSRH guidance, see Contraceptives,

interactions p. 794.rAnecdotal

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

efficacy of levonorgestrel. For FSRH guidance, see

Contraceptives, interactions p. 794.rTheoretical

▶ Lumacaftor is predicted to decrease the efficacy of

levonorgestrel

r

. Use additional contraceptive precautions.

Theoretical

▶ Modafinil is predicted to decrease the efficacy of

levonorgestrel. For FSRH guidance, see Contraceptives,

interactions p. 794.rTheoretical

▶ Nevirapine is predicted to decrease the efficacy of

levonorgestrel. For FSRH guidance, see Contraceptives,

interactions p. 794.rTheoretical

▶ Rifabutin is predicted to decrease the efficacy of

levonorgestrel. For FSRH guidance, see Contraceptives,

interactions p. 794.rTheoretical

▶ Rifampicin is predicted to decrease the efficacy of

levonorgestrel. For FSRH guidance, see Contraceptives,

interactions p. 794.rTheoretical

▶ St John’s Wort is predicted to decrease the efficacy of

levonorgestrel. MHRA advises avoid. For FSRH guidance, see

Contraceptives, interactions p. 794.rTheoretical

▶ Sugammadex is predicted to decrease the exposure to

levonorgestrel

r

. Use additional contraceptive precautions.

Theoretical

▶ Ulipristal is predicted to decrease the efficacy of

levonorgestrel. Avoid.rTheoretical

Levothyroxine → see thyroid hormones

Lidocaine → see antiarrhythmics

Linagliptin → see TABLE 14 p. 1378 (antidiabetic drugs)

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to linagliptin.oStudy

▶ Enzalutamide is predicted to decrease the exposure to

linagliptin.oStudy

▶ Linagliptin is predicted to increase the exposure to lomitapide.

Separate administration by 12 hours.oTheoretical

▶ Mitotane

o

is predicted to decrease the exposure to linagliptin.

Study

▶ Rifampicin

o

is predicted to decrease the exposure to linagliptin.

Study

Linezolid → see TABLE 15 p. 1378 (myelosuppression), TABLE 13 p. 1378

(serotonin syndrome)

FOOD AND LIFESTYLE Patients taking linezolid should avoid

consuming large amounts of tyramine-rich foods (such as

mature cheese, salami, pickled herring, Bovril ®, Oxo ®,

Marmite ® or any similar meat or yeast extract or fermented

soya bean extract, and some beers, lagers or wines).

▶ Beta2 agonists are predicted to increase the risk of elevated

blood pressure when given with

Theoretical

linezolid. Avoid.r

▶ Bupropion is predicted to increase the risk of intraoperative

hypertension when given with linezolid.rAnecdotal → Also

see TABLE 13 p. 1378

▶ Buspirone is predicted to increase the risk of elevated blood

pressure when given with linezolid. Avoid.rTheoretical →

Also see TABLE 13 p. 1378

▶ Levodopa is predicted to increase the risk of elevated blood

pressure when given with linezolid. Avoid.rTheoretical

▶ Macrolides

o

(clarithromycin) increase the exposure to linezolid.

Anecdotal

▶ Methylphenidate is predicted to increase the risk of elevated

blood pressure when given with

Theoretical

linezolid. Avoid.r

▶ Moclobemide is predicted to increase the risk of side-effects

when given with linezolid. Avoid and for 14 days after

stopping moclobemide.rTheoretical → Also see TABLE 13

p. 1378

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of side-effects when given with

linezolid

r

. Avoid and for 14 days after stopping the MAOI.

Theoretical → Also see TABLE 13 p. 1378

▶ Monoamine-oxidase B inhibitors (rasagiline, selegiline) are

predicted to increase the risk of side-effects when given with

linezolid

r

. Avoid and for 14 days after stopping the MAOI.

Theoretical → Also see TABLE 13 p. 1378

▶ Monoamine-oxidase B inhibitors (safinamide) are predicted to

increase the risk of side-effects when given with linezolid.

Avoid and for 1 week after stopping

Theoretical → Also see TABLE 13 p. 1378

safinamide.r

▶ Reboxetine is predicted to increase the risk of a hypertensive

crisis when given with linezolid. Avoid.rTheoretical

▶ Rifampicin

o

slightly decreases the exposure to linezolid.

Study

▶ Sympathomimetics, inotropic are predicted to increase the risk

of elevated blood pressure when given with

r

linezolid. Avoid.

Theoretical

▶ Sympathomimetics, vasoconstrictor (adrenaline/epinephrine,

ephedrine, isometheptene, noradrenaline/norepinephrine,

phenylephrine) are predicted to increase the risk of elevated

blood pressure when given with

Theoretical

linezolid. Avoid.r

▶ Sympathomimetics, vasoconstrictor (pseudoephedrine) increase

the risk of elevated blood pressure when given with linezolid.

Avoid.rStudy

Liothyronine → see thyroid hormones

Liraglutide → see TABLE 14 p. 1378 (antidiabetic drugs)

Lisdexamfetamine → see amfetamines

Lisinopril → see ACE inhibitors

BNF 78 Levodopa — Lisinopril 1479

Interactions | Appendix 1

A1

Lithium → see TABLE 13 p. 1378 (serotonin syndrome), TABLE 9 p. 1377

(QT-interval prolongation)

▶ ACE inhibitors are predicted to increase the concentration of

lithium. Monitor and adjust dose.rAnecdotal

▶ Acetazolamide

Anecdotal

alters the concentration of lithium.r

▶ Aldosterone antagonists (eplerenone) potentially increase the

concentration of lithium. Avoid.oTheoretical

▶ Aldosterone antagonists (spironolactone) potentially increase

the concentration of lithium.oStudy

▶ Aminophylline is predicted to decrease the concentration of

lithium.oTheoretical

▶ Angiotensin-II receptor antagonists potentially increase the

concentration of lithium. Monitor concentration and adjust

dose.rAnecdotal

▶ Antiepileptics (carbamazepine, oxcarbazepine) are predicted to

increase the risk of neurotoxicity when given with

r

lithium.

Anecdotal

▶ Calcitonin (salmon) decreases the concentration of lithium.

Monitor concentration and adjust dose.oStudy

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

increase the risk of neurotoxicity when given with

r

lithium.

Anecdotal

▶ Loop diuretics increase the concentration of lithium. Monitor

and adjust dose.rStudy

▶ Methyldopa increases the risk of neurotoxicity when given

with lithium.rAnecdotal

▶ Mexiletine

q

potentially affects the exposure to lithium. Avoid.

Theoretical

▶ NSAIDs increase the concentration of lithium. Monitor and

adjust dose.rStudy

▶ Phenothiazines potentially increase the risk of neurotoxicity

when given with lithium.rAnecdotal → Also see TABLE 9

p. 1377

▶ Potassium-sparing diuretics (triamterene) potentially increase

the clearance of lithium.oStudy

▶ Quetiapine potentially increases the risk of neurotoxicity

when given with lithium.rAnecdotal

▶ Risperidone potentially increases the risk of neurotoxicity

when given with lithium.rAnecdotal → Also see TABLE 9

p. 1377

▶ Sodium bicarbonate

r

decreases the concentration of lithium.

Anecdotal

▶ Sulpiride potentially increases the risk of neurotoxicity when

given with lithium.rAnecdotal → Also see TABLE 9 p. 1377

▶ Theophylline is predicted to decrease the concentration of

lithium

Anecdotal

. Monitor concentration and adjust dose.o ▶ Thiazide diuretics increase the concentration of lithium. Avoid

or adjust dose and monitor concentration.rStudy

▶ Tricyclic antidepressants potentially increase the risk of

neurotoxicity when given with lithium.rAnecdotal → Also

see TABLE 13 p. 1378 → Also see TABLE 9 p. 1377

▶ Zuclopenthixol potentially increases the risk of neurotoxicity

when given with lithium.rAnecdotal → Also see TABLE 9

p. 1377

Live vaccines

Bacillus Calmette-Guérin vaccine .influenza vaccine (live) . measles,

mumps and rubella vaccine, live .rotavirus vaccine .typhoid

vaccine, oral .varicella-zoster vaccine .yellow fever vaccine, live.

GENERAL INFORMATION Oral typhoid vaccine is inactivated by

concurrent administration of antibacterials or

antimalarials: antibacterials should be avoided for 3 days

before and after oral typhoid vaccination; mefloquine should

be avoided for at least 12 hours before or after oral typhoid

vaccination; for other antimalarials oral typhoid vaccine

vaccination should be completed at least 3 days before the

first dose of the antimalarial (except proguanil hydrochloride

with atovaquone, which can be given concurrently).

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

abatacept. Public Health England advises avoid (refer to Green

Book).rTheoretical

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

alkylating agents. Public Health England advises avoid (refer

to Green Book).rTheoretical

▶ 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

▶ 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

▶ 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

Green Book).rTheoretical

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given wi

 

is predicted to increase the exposure to aliskiren.

Theoretical

▶ Antacids are predicted to decrease the absorption of lapatinib.

Avoid.oTheoretical

▶ Antiarrhythmics (dronedarone) are predicted to increase the

exposure to lapatinib.oStudy → Also see TABLE 9 p. 1377

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to lapatinib. Avoid.rStudy

▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)

are predicted to increase the exposure to

Study → Also see TABLE 9 p. 1377

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

predicted to increase the exposure to

o

lapatinib. Avoid.

Study → Also see TABLE 9 p. 1377

▶ Lapatinib is predicted to increase the exposure to

antihistamines, non-sedating (fexofenadine).oTheoretical

▶ Aprepitant

o

is predicted to increase the exposure to lapatinib.

Study

▶ Lapatinib is predicted to increase the exposure to beta blockers,

non-selective (nadolol).oStudy

▶ Lapatinib is predicted to increase the exposure to bictegravir.

Use with caution or avoid.oTheoretical

▶ Bosentan is predicted to decrease the exposure to lapatinib.

Avoid.rStudy

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

increase the exposure to lapatinib.oStudy

▶ Lapatinib

o

is predicted to increase the exposure to ceritinib.

Theoretical → Also see TABLE 9 p. 1377

▶ Cobicistat is predicted to increase the exposure to lapatinib.

Avoid.oStudy

▶ Lapatinib is predicted to increase the exposure to colchicine.

Avoid or adjust colchicine dose, p. 1120.oTheoretical

▶ Lapatinib is predicted to increase the risk of bleeding events

when given with coumarins.rTheoretical

▶ Crizotinib

o

is predicted to increase the exposure to lapatinib.

Study → Also see TABLE 9 p. 1377

▶ Lapatinib

r

is predicted to increase the exposure to dabigatran.

Theoretical

▶ Lapatinib

o

is predicted to increase the exposure to digoxin.

Theoretical

▶ Lapatinib is predicted to slightly increase the exposure to

edoxaban.rTheoretical

▶ Efavirenz is predicted to decrease the exposure to lapatinib.

Avoid.rStudy → Also see TABLE 9 p. 1377

▶ Enzalutamide is predicted to decrease the exposure to

lapatinib. Avoid.rStudy

▶ Lapatinib

o

is predicted to increase the exposure to erlotinib.

Theoretical

▶ Lapatinib

o

is predicted to increase the exposure to everolimus.

Theoretical

▶ Lapatinib is predicted to increase the exposure to fidaxomicin.

Avoid.oStudy

▶ Grapefruit juice is predicted to increase the exposure to

lapatinib. Avoid.oTheoretical

▶ H2 receptor antagonists are predicted to decrease the

absorption of lapatinib. Avoid.oTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to lapatinib. Avoid.oStudy → Also see TABLE 9 p. 1377

▶ Idelalisib is predicted to increase the exposure to lapatinib.

Avoid.oStudy

▶ Imatinib

o

is predicted to increase the exposure to lapatinib.

Study

▶ Lapatinib is predicted to increase the exposure to lomitapide.

Separate administration by 12 hours.oTheoretical

▶ Lapatinib

o

is predicted to increase the exposure to loperamide.

Theoretical

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to lapatinib. Avoid.oStudy → Also see TABLE 9

p. 1377

▶ Macrolides (erythromycin) are predicted to increase the

exposure to lapatinib.oStudy → Also see TABLE 9 p. 1377

▶ Mitotane is predicted to decrease the exposure to lapatinib.

Avoid.rStudy

▶ Netupitant

o

is predicted to increase the exposure to lapatinib.

Study

▶ Nevirapine is predicted to decrease the exposure to lapatinib.

Avoid.rStudy

▶ Nilotinib

o

is predicted to increase the exposure to lapatinib.

Study → Also see TABLE 9 p. 1377

▶ Lapatinib

o

is predicted to increase the exposure to nintedanib.

Study

▶ Lapatinib is predicted to increase the exposure to

panobinostat. Adjust dose.oTheoretical → Also see

TABLE 9 p. 1377

▶ Lapatinib is predicted to increase the risk of bleeding events

when given with phenindione.rTheoretical

▶ Lapatinib

o

is predicted to increase the exposure to pibrentasvir.

Theoretical

▶ Pitolisant is predicted to decrease the exposure to lapatinib.

Avoid.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to lapatinib.

Avoid.rStudy

▶ Lapatinib

o

is predicted to increase the exposure to sirolimus.

Theoretical

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

lapatinib. Avoid.rStudy

▶ Lapatinib slightly increases the exposure to taxanes

(paclitaxel).rStudy

▶ Tedizolid is predicted to increase the exposure to lapatinib.

Avoid.oTheoretical

▶ Lapatinib

r

is predicted to increase the exposure to topotecan.

Study

▶ Lapatinib is predicted to increase the concentration of

trametinib.oTheoretical

▶ Lapatinib is predicted to increase the exposure to venetoclax.

Avoid or monitor for toxicity.rTheoretical

Laronidase

▶ Antimalarials (chloroquine) are predicted to decrease the

exposure to

r

laronidase. Avoid simultaneous administration.

Theoretical

▶ Hydroxychloroquine is predicted to decrease the exposure to

laronidase

Theoretical

. Avoid simultaneous administration.r

1476 Lamivudine — Laronidase BNF 78

Interactions | Appendix 1

A1

Ledipasvir

▶ Antacids are predicted to decrease the exposure to ledipasvir.

Separate administration by 4 hours.oTheoretical

▶ Ledipasvir increases the risk of severe bradycardia or heart

block when given with antiarrhythmics (amiodarone). Refer to

specialist literature.rAnecdotal

▶ Antiepileptics (carbamazepine) are predicted to decrease the

exposure to ledipasvir. Avoid.rStudy

▶ Antiepileptics (fosphenytoin, oxcarbazepine, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to ledipasvir. Avoid.rTheoretical

▶ Calcium salts (calcium carbonate) are predicted to decrease the

exposure to

o

ledipasvir. Separate administration by 4 hours.

Theoretical

▶ Ledipasvir

o

is predicted to increase the exposure to dabigatran.

Theoretical

▶ Ledipasvir is predicted to increase the exposure to digoxin.

Monitor and adjust dose.oTheoretical

▶ H2 receptor antagonists are predicted to decrease the exposure

oto ledipasvir. Adjust dose, see ledipasvir with sofosbuvir p. 628.

Study

▶ HIV-protease inhibitors (tipranavir boosted with ritonavir) are

predicted to decrease the exposure to

Theoretical

ledipasvir. Avoid.r

▶ Proton pump inhibitors are predicted to decrease the exposure

oto ledipasvir. Adjust dose, see ledipasvir with sofosbuvir p. 628.

Theoretical

▶ Rifabutin is predicted to decrease the exposure to ledipasvir.

Avoid.rTheoretical

▶ Rifampicin is predicted to decrease the exposure to ledipasvir.

Avoid.rStudy

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

ledipasvir. Avoid.rStudy

▶ Ledipasvir is predicted to increase the exposure to statins

(atorvastatin, fluvastatin, pravastatin, simvastatin). Monitor

and adjust dose.oTheoretical

▶ Ledipasvir is predicted to increase the exposure to statins

(rosuvastatin). Avoid.rTheoretical

▶ Ledipasvir (with sofosbuvir) slightly increases the exposure to

tenofovir disoproxil.oStudy

Leflunomide → see TABLE 1 p. 1375 (hepatotoxicity), TABLE 15 p. 1378

(myelosuppression)

PHARMACOLOGY Leflunomide has a long half-life; washout

procedure recommended before switching to other DMARDs

(consult product literature).

▶ Leflunomide

o

is predicted to increase the exposure to adefovir.

Theoretical

▶ Leflunomide is predicted to decrease the exposure to

agomelatine.oTheoretical

▶ Leflunomide decreases the exposure to aminophylline. Adjust

dose.oStudy

▶ Leflunomide is predicted to decrease the exposure to

anaesthetics, local (ropivacaine).oTheoretical

▶ Leflunomide is predicted to increase the exposure to

anthracyclines

o

(daunorubicin, doxorubicin, mitoxantrone).

Theoretical → Also see TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the exposure to

antihistamines, non-sedating (fexofenadine).oStudy

▶ Leflunomide

o

potentially increases the exposure to baricitinib.

Theoretical

▶ Leflunomide

o

is predicted to increase the exposure to bosentan.

Study

▶ Leflunomide is predicted to moderately increase the clearance

of caffeine citrate. Monitor and adjust dose.oStudy

▶ Leflunomide is predicted to increase the exposure to

cephalosporins (cefaclor).oTheoretical

▶ Leflunomide

o

is predicted to decrease the exposure to clozapine.

Theoretical → Also see TABLE 15 p. 1378

▶ Leflunomide

r

increases the anticoagulant effect of coumarins.

Anecdotal

▶ Leflunomide is predicted to decrease the exposure to

duloxetine.oTheoretical

▶ Leflunomide is predicted to increase the exposure to

ganciclovir.oTheoretical → Also see TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the exposure to H2

receptor antagonists

Theoretical

(cimetidine, famotidine).o ▶ Leflunomide is predicted to increase the concentration of

letermovir.oStudy

▶ Live vaccines are predicted to increase the risk of generalised

infection (possibly life-threatening) when given with

leflunomide. Public Health England advises avoid (refer to

Green Book).rTheoretical

▶ Leflunomide is predicted to increase the exposure to loop

diuretics (furosemide).oTheoretical

▶ Leflunomide is predicted to decrease the exposure to

melatonin.oTheoretical

▶ Leflunomide is predicted to increase the exposure to

methotrexate.oTheoretical → Also see TABLE 1 p. 1375 →

Also see TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the clearance of

mexiletine. Monitor and adjust dose.oStudy

▶ Leflunomide is predicted to increase the exposure to

montelukast.oTheoretical

▶ Leflunomide is predicted to increase the exposure to

nateglinide.oTheoretical

▶ Leflunomide is predicted to increase the exposure to NSAIDs

(indometacin, ketoprofen).oTheoretical

▶ Leflunomide is predicted to decrease the exposure to

olanzapine. Monitor and adjust dose.oStudy → Also see

TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the exposure to

oseltamivir.oTheoretical

▶ Leflunomide is predicted to increase the exposure to penicillins

(benzylpenicillin).oTheoretical

▶ Leflunomide is predicted to increase the exposure to

pioglitazone.oStudy

▶ Leflunomide is predicted to decrease the exposure to

pirfenidone.oTheoretical

▶ Leflunomide is predicted to increase the exposure to quinolones

(ciprofloxacin).oTheoretical

▶ Leflunomide is predicted to increase the exposure to

repaglinide.oStudy

▶ Leflunomide is predicted to increase the exposure to

rifampicin.oTheoretical

▶ Leflunomide is predicted to increase the exposure to selexipag.

Adjust dose.oTheoretical

▶ Leflunomide is predicted to increase the exposure to statins

(atorvastatin, fluvastatin, pravastatin, simvastatin)

Study → Also see TABLE 1 p. 1375

.o ▶ Leflunomide is predicted to increase the exposure to statins

(rosuvastatin). Adjust dose.oStudy → Also see TABLE 1

p. 1375

▶ Leflunomide is predicted to increase the exposure to

sulfasalazine.oStudy → Also see TABLE 1 p. 1375 → Also see

TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the exposure to

sulfonylureas (glibenclamide).oStudy

▶ Leflunomide is predicted to increase the concentration of

taxanes (paclitaxel).rAnecdotal → Also see TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the exposure to tenofovir

alafenamide.oTheoretical

▶ Leflunomide is predicted to increase the exposure to tenofovir

disoproxil.oTheoretical

▶ Leflunomide is predicted to decrease the exposure to

theophylline. Adjust dose.oStudy

▶ Leflunomide moderately decreases the exposure to tizanidine.

nStudy

▶ Leflunomide is predicted to increase the exposure to

topotecan.oStudy → Also see TABLE 15 p. 1378

▶ Leflunomide is predicted to increase the exposure to

zidovudine.oTheoretical → Also see TABLE 15 p. 1378

Lenalidomide → see TABLE 1 p. 1375 (hepatotoxicity), TABLE 15 p. 1378

(myelosuppression), TABLE 5 p. 1375 (thromboembolism)

▶ Combined hormonal contraceptives are predicted to increase

the risk of venous thromboembolism when given with

lenalidomide. Avoid.rTheoretical

BNF 78 Ledipasvir — Lenalidomide 1477

Interactions | Appendix 1

A1