BNF for Children 2011-2012

658 Appendix 1: Interactions BNFC 2011–2012Appendix 1: InteractionsAlcohol (continued)Antidiabetics: alcohol enhances hypoglycaemic effectof antidiabetics; increased risk of lactic acidosis whenalcohol given with metforminAntiepileptics: alcohol possibly increases CNS sideeffectsof carbamazepine; increased sedative effectwhen alcohol given with phenobarbital; chronicheavy consumption of alcohol possibly reducesplasma concentration of phenytoinAntifungals: effects of alcohol possibly enhanced bygriseofulvinAntihistamines: increased sedative effect whenalcohol given with antihistamines (possibly less effectwith non-sedating antihistamines)Antimuscarinics: increased sedative effect whenalcohol given with hyoscineAntipsychotics: increased sedative effect when alcoholgiven with antipsychoticsAnxiolytics and Hypnotics: increased sedative effectwhen alcohol given with anxiolytics and hypnoticsBeta-blockers: enhanced hypotensive effect whenalcohol given with beta-blockersCalcium-channel Blockers: enhanced hypotensiveeffect when alcohol given with calcium-channelblockers; plasma concentration of alcohol possiblyincreased by verapamilClonidine: enhanced hypotensive effect when alcoholgiven with clonidineCytotoxics: disulfiram-like reaction when alcohol givenwith procarbazineDiazoxide: enhanced hypotensive effect when alcoholgiven with diazoxideDisulfiram: disulfiram reaction when alcohol given withdisulfiram (see BNF section 4.10.1)Diuretics: enhanced hypotensive effect when alcoholgiven with diureticsDopaminergics: alcohol reduces tolerance to bromocriptineLevamisole: possibility of disulfiram-like reaction whenalcohol given with levamisoleLofexidine: increased sedative effect when alcoholgiven with lofexidineMethyldopa: enhanced hypotensive effect whenalcohol given with methyldopaMetoclopramide: absorption of alcohol possiblyincreased by metoclopramideMoxonidine: enhanced hypotensive effect whenalcohol given with moxonidineMuscle Relaxants: increased sedative effect whenalcohol given with baclofen, methocarbamol ortizanidineNicorandil: alcohol possibly enhances hypotensiveeffect of nicorandilNitrates: enhanced hypotensive effect when alcoholgiven with nitrates. Paraldehyde: increased sedative effect when alcoholgiven with .paraldehyde. Retinoids: presence of alcohol causes etretinate to beformed from .acitretin (increased risk of teratogenecityin women of child-bearing potential)Sympathomimetics: alcohol possibly enhances effectsof methylphenidateVasodilator Antihypertensives: enhanced hypotensiveeffect when alcohol given with hydralazine,minoxidil or sodium nitroprussideAldesleukinACE Inhibitors: enhanced hypotensive effect whenaldesleukin given with ACE inhibitorsAlpha-blockers: enhanced hypotensive effect whenaldesleukin given with alpha-blockersAngiotensin-II Receptor Antagonists: enhancedhypotensive effect when aldesleukin given withangiotensin-II receptor antagonistsAntivirals: aldesleukin possibly increases plasma concentrationof indinavirBeta-blockers: enhanced hypotensive effect whenaldesleukin given with beta-blockersAldesleukin (continued)Calcium-channel Blockers: enhanced hypotensiveeffect when aldesleukin given with calcium-channelblockersClonidine: enhanced hypotensive effect when aldesleukingiven with clonidine. Corticosteroids: manufacturer of aldesleukin advisesavoid concomitant use with .corticosteroids. Cytotoxics: manufacturer of aldesleukin advises avoidconcomitant use with .cisplatin, .dacarbazine and.vinblastineDiazoxide: enhanced hypotensive effect when aldesleukingiven with diazoxideDiuretics: enhanced hypotensive effect when aldesleukingiven with diureticsMethyldopa: enhanced hypotensive effect whenaldesleukin given with methyldopaMoxonidine: enhanced hypotensive effect whenaldesleukin given with moxonidineNitrates: enhanced hypotensive effect when aldesleukingiven with nitratesVasodilator Antihypertensives: enhanced hypotensiveeffect when aldesleukin given with hydralazine,minoxidil or sodium nitroprussideAlendronic Acid see BisphosphonatesAlfentanil see Opioid AnalgesicsAlfuzosin see Alpha-blockersAlimemazine see AntihistaminesAliskirenAnalgesics: hypotensive effect of aliskiren possiblyantagonised by NSAIDsAngiotensin-II Receptor Antagonists: plasma concentrationof aliskiren possibly reduced by irbesartanAnticoagulants: increased risk of hyperkalaemia whenaliskiren given with heparinsAntifungals: plasma concentration of aliskirenincreased by ketoconazoleCalcium-channel Blockers: manufacturer of aliskirenadvises avoid concomitant use with verapamil. Ciclosporin: plasma concentration of aliskirenincreased by .ciclosporin—avoid concomitant useDiuretics: aliskiren reduces plasma concentration offurosemide; increased risk of hyperkalaemia whenaliskiren given with potassium-sparing diuretics andaldosterone antagonistsPotassium Salts: increased risk of hyperkalaemiawhen aliskiren given with potassium saltsAlitretinoin see RetinoidsAlkylating Drugs see Bendamustine, Busulfan, Carmustine,Cyclophosphamide, Estramustine, Ifosfamide,Lomustine, Melphalan, and ThiotepaAllopurinolACE Inhibitors: increased risk of leucopenia andhypersensitivity reactions when allopurinol givenwith ACE inhibitors especially in renal impairmentAntibacterials: increased risk of rash when allopurinolgiven with amoxicillin or ampicillinAnticoagulants: allopurinol possibly enhances anticoagulanteffect of coumarins. Antivirals: allopurinol increases plasma concentrationof .didanosine (risk of toxicity)—avoid concomitantuse. Azathioprine: allopurinol enhances effects andincreases toxicity of .azathioprine (reduce dose ofazathioprine to one quarter of usual dose)Ciclosporin: allopurinol possibly increases plasmaconcentration of ciclosporin (risk of nephrotoxicity). Cytotoxics: allopurinol enhances effects and increasestoxicity of .mercaptopurine (reduce dose ofmercaptopurine to one quarter of usual dose);avoidance of allopurinol advised by manufacturer of.capecitabineDiuretics: increased risk of hypersensitivity whenallopurinol given with thiazides and related diureticsespecially in renal impairmentTheophylline: allopurinol possibly increases plasmaconcentration of theophyllineAlmotriptan see 5HT 1 Agonists