BNF for Children 2011-2012

656 Appendix 1: Interactions BNFC 2011–2012Appendix 1: Interactionsshould be avoided (or only undertaken with caution andappropriate monitoring).Interactions that have no symbol do not usually haveserious consequences.List of drug interactionsThe following is an alphabetical list of drugs and theirinteractions; to avoid excessive cross-referencing eachdrug or group is listed twice: in the alphabetical list andalso against the drug or group with which it interacts.For explanation of symbol . see aboveAbacavirAnalgesics: abacavir possibly reduces plasma concentrationof methadoneAntibacterials: plasma concentration of abacavir possiblyreduced by rifampicinAntiepileptics: plasma concentration of abacavir possiblyreduced by phenobarbital and phenytoin. Antivirals: abacavir possibly reduces effects of.ribavirin; plasma concentration of abacavir reducedby .tipranavirAbataceptAdalimumab: increased risk of side-effects whenabatacept given with adalimumab. Certolizumab pegol: avoid concomitant use of abataceptwith .certolizumab pegol. Etanercept: avoid concomitant use of abatacept with.etanercept. Golimumab: avoid concomitant use of abatacept with.golimumab. Infliximab: avoid concomitant use of abatacept with.infliximab. Vaccines: avoid concomitant use of abatacept with live.vaccines (see p. 599)Acarbose see AntidiabeticsACE InhibitorsAlcohol: enhanced hypotensive effect when ACE inhibitorsgiven with alcoholAldesleukin: enhanced hypotensive effect when ACEinhibitors given with aldesleukinAllopurinol: increased risk of leucopenia and hypersensitivityreactions when ACE inhibitors given withallopurinol especially in renal impairmentAlpha-blockers: enhanced hypotensive effect whenACE inhibitors given with alpha-blockersAnaesthetics, General: enhanced hypotensive effectwhen ACE inhibitors given with general anaestheticsAnalgesics: increased risk of renal impairment whenACE inhibitors given with NSAIDs, also hypotensiveeffect antagonisedAngiotensin-II Receptor Antagonists: increased risk ofhyperkalaemia when ACE inhibitors given withangiotensin-II receptor antagonistsAntacids: absorption of ACE inhibitors possiblyreduced by antacids; absorption of captopril,enalapril and fosinopril reduced by antacidsAntibacterials: plasma concentration of active metaboliteof imidapril reduced by rifampicin (reducedantihypertensive effect); quinapril tablets reduceabsorption of tetracyclines (quinapril tablets containmagnesium carbonate); possible increased risk ofhyperkalaemia when ACE inhibitors given withtrimethoprimAnticoagulants: increased risk of hyperkalaemia whenACE inhibitors given with heparinsAntidepressants: hypotensive effect of ACE inhibitorspossibly enhanced by MAOIsAntidiabetics: ACE inhibitors possibly enhance hypoglycaemiceffect of insulin, metformin and sulfonylureasAntipsychotics: enhanced hypotensive effect whenACE inhibitors given with antipsychoticsAnxiolytics and Hypnotics: enhanced hypotensiveeffect when ACE inhibitors given with anxiolytics andhypnoticsACE Inhibitors (continued)Azathioprine: increased risk of anaemia or leucopeniawhen captopril given with azathioprine especially inrenal impairment; increased risk of anaemia whenenalapril given with azathioprine especially in renalimpairmentBeta-blockers: enhanced hypotensive effect when ACEinhibitors given with beta-blockersCalcium-channel Blockers: enhanced hypotensiveeffect when ACE inhibitors given with calciumchannelblockersCardiac Glycosides: captopril possibly increasesplasma concentration of digoxin. Ciclosporin: increased risk of hyperkalaemia whenACE inhibitors given with .ciclosporinClonidine: enhanced hypotensive effect when ACEinhibitors given with clonidine; antihypertensiveeffect of captopril possibly delayed by previoustreatment with clonidineCorticosteroids: hypotensive effect of ACE inhibitorsantagonised by corticosteroidsDiazoxide: enhanced hypotensive effect when ACEinhibitors given with diazoxide. Diuretics: enhanced hypotensive effect when ACEinhibitors given with .diuretics; increased risk ofsevere hyperkalaemia when ACE inhibitors givenwith .potassium-sparing diuretics and aldosteroneantagonists (monitor potassium concentration withlow-dose spironolactone in heart failure)Dopaminergics: enhanced hypotensive effect whenACE inhibitors given with levodopa. Gold: flushing and hypotension reported when ACEinhibitors given with .sodium aurothiomalate. Lithium: ACE inhibitors reduce excretion of .lithium(increased plasma concentration)Methyldopa: enhanced hypotensive effect when ACEinhibitors given with methyldopaMoxisylyte: enhanced hypotensive effect when ACEinhibitors given with moxisylyteMoxonidine: enhanced hypotensive effect when ACEinhibitors given with moxonidineMuscle Relaxants: enhanced hypotensive effect whenACE inhibitors given with baclofen or tizanidineNitrates: enhanced hypotensive effect when ACEinhibitors given with nitratesOestrogens: hypotensive effect of ACE inhibitorsantagonised by oestrogens. Potassium Salts: increased risk of severe hyperkalaemiawhen ACE inhibitors given with .potassiumsaltsProbenecid: excretion of captopril reduced by probenecidProstaglandins: enhanced hypotensive effect whenACE inhibitors given with alprostadilVasodilator Antihypertensives: enhanced hypotensiveeffect when ACE inhibitors given with hydralazine,minoxidil or sodium nitroprussideAcebutolol see Beta-blockersAceclofenac see NSAIDsAcemetacin see NSAIDsAcenocoumarol see CoumarinsAcetazolamide see DiureticsAciclovirNote Interactions do not apply to topical aciclovir preparationsNote Valaciclovir interactions as for aciclovirCiclosporin: increased risk of nephrotoxicity whenaciclovir given with ciclosporinMycophenolate: plasma concentration of aciclovirincreased by mycophenolate, also plasma concentrationof inactive metabolite of mycophenolateincreasedProbenecid: excretion of aciclovir reduced by probenecid(increased plasma concentration)Tacrolimus: possible increased risk of nephrotoxicitywhen aciclovir given with tacrolimusTheophylline: aciclovir possibly increases plasmaconcentration of theophyllineAcitretin see Retinoids