BNF for Children 2011-2012

BNFC 2011–2012 Appendix 1: Interactions 661Amphotericin (continued). Cardiac Glycosides: hypokalaemia caused byamphotericin increases cardiac toxicity with .cardiacglycosides. Ciclosporin: increased risk of nephrotoxicity whenamphotericin given with .ciclosporin. Corticosteroids: increased risk of hypokalaemia whenamphotericin given with .corticosteroids—avoidconcomitant use unless corticosteroids needed tocontrol reactions. Cytotoxics: increased risk of ventricular arrhythmiaswhen amphotericin given with .arsenic trioxideDiuretics: increased risk of hypokalaemia whenamphotericin given with loop diuretics or thiazidesand related diureticsPentamidine Isetionate: possible increased risk ofnephrotoxicity when amphotericin given with pentamidineisetionate. Tacrolimus: increased risk of nephrotoxicity whenamphotericin given with .tacrolimusAmpicillin see PenicillinsAnabolic Steroids. Anticoagulants: anabolic steroids enhance anticoagulanteffect of .coumarins and .phenindioneAntidiabetics: anabolic steroids possibly enhancehypoglycaemic effect of antidiabeticsAnaesthetics, GeneralNote See also Surgery and Long-term Medication, p. 628ACE Inhibitors: enhanced hypotensive effect whengeneral anaesthetics given with ACE inhibitors. Adrenergic Neurone Blockers: enhanced hypotensiveeffect when general anaesthetics given with .adrenergicneurone blockers. Alpha-blockers: enhanced hypotensive effect whengeneral anaesthetics given with .alpha-blockersAnalgesics: metabolism of etomidate inhibited byfentanyl (consider reducing dose of etomidate);effects of thiopental possibly enhanced by aspirin;effects of intravenous general anaesthetics and volatileliquid general anaesthetics possibly enhanced byopioid analgesicsAngiotensin-II Receptor Antagonists: enhancedhypotensive effect when general anaesthetics givenwith angiotensin-II receptor antagonistsAntibacterials: effects of thiopental enhanced bysulfonamides; hypersensitivity-like reactions canoccur when general anaesthetics given with intravenousvancomycinAntidepressants: increased risk of arrhythmias andhypotension when general anaesthetics given withtricyclics. Antipsychotics: enhanced hypotensive effect whengeneral anaesthetics given with .antipsychotics;effects of thiopental enhanced by droperidolAnxiolytics and Hypnotics: increased sedative effectwhen general anaesthetics given with anxiolytics andhypnoticsBeta-blockers: enhanced hypotensive effect whengeneral anaesthetics given with beta-blockers. Calcium-channel Blockers: enhanced hypotensiveeffect when general anaesthetics or isoflurane givenwith calcium-channel blockers; general anaestheticsenhance hypotensive effect of .verapamil (also AVdelay)Clonidine: enhanced hypotensive effect when generalanaesthetics given with clonidine. Cytotoxics: nitrous oxide increases antifolate effect of.methotrexate—avoid concomitant useDiazoxide: enhanced hypotensive effect when generalanaesthetics given with diazoxideDiuretics: enhanced hypotensive effect when generalanaesthetics given with diuretics. Dopaminergics: increased risk of arrhythmias whenvolatile liquid general anaesthetics given with.levodopa. Doxapram: increased risk of arrhythmias when volatileliquid general anaesthetics given with .doxapram(avoid doxapram for at least 10 minutes after volatileliquid general anaesthetics)Anaesthetics, General (continued)Ergot Alkaloids: halothane reduces effects of ergometrineon the parturient uterus. Memantine: increased risk of CNS toxicity whenketamine given with .memantine (manufacturer ofmemantine advises avoid concomitant use)Methyldopa: enhanced hypotensive effect whengeneral anaesthetics given with methyldopaMetoclopramide: effects of thiopental enhanced bymetoclopramideMoxonidine: enhanced hypotensive effect whengeneral anaesthetics given with moxonidine. Muscle Relaxants: increased risk of myocardialdepression and bradycardia when propofol given with.suxamethonium; volatile liquid general anaestheticsenhance effects of non-depolarising musclerelaxants and suxamethonium; ketamine enhanceseffects of atracuriumNitrates: enhanced hypotensive effect when generalanaesthetics given with nitratesOxytocin: oxytocic effect possibly reduced, alsoenhanced hypotensive effect and risk of arrhythmiaswhen volatile liquid general anaesthetics given withoxytocinProbenecid: effects of thiopental possibly enhanced byprobenecid. Sympathomimetics: increased risk of arrhythmiaswhen volatile liquid general anaesthetics given with.adrenaline (epinephrine); increased risk of hypertensionwhen volatile liquid general anaestheticsgiven with .methylphenidateTheophylline: increased risk of convulsions whenketamine given with theophylline; increased risk ofarrhythmias when halothane given with theophyllineVasodilator Antihypertensives: enhanced hypotensiveeffect when general anaesthetics given with hydralazine,minoxidil or sodium nitroprussideAnaesthetics, General (intravenous) see Anaesthetics,GeneralAnaesthetics, General (volatile liquids) see Anaesthetics,GeneralAnaesthetics, Local see Bupivacaine, Levobupivacaine,Lidocaine, Prilocaine, and RopivacaineAnagrelide. Cilostazol: manufacturer of anagrelide advises avoidconcomitant use with .cilostazol. Phosphodiesterase Type-3 Inhibitors: manufacturerof anagrelide advises avoid concomitant use with.enoximone and .milrinoneAnakinra. Adalimumab: avoid concomitant use of anakinra with.adalimumab. Certolizumab pegol: avoid concomitant use of anakinrawith .certolizumab pegol. Etanercept: avoid concomitant use of anakinra with.etanercept. Golimumab: avoid concomitant use of anakinra with.golimumab. Infliximab: avoid concomitant use of anakinra with.infliximab. Vaccines: avoid concomitant use of anakinra with live.vaccines (see p. 599)Analgesics see Aspirin, Nefopam, NSAIDs, OpioidAnalgesics, and ParacetamolAngiotensin-II Receptor AntagonistsACE Inhibitors: increased risk of hyperkalaemia whenangiotensin-II receptor antagonists given with ACEinhibitorsAdrenergic Neurone Blockers: enhanced hypotensiveeffect when angiotensin-II receptor antagonists givenwith adrenergic neurone blockersAlcohol: enhanced hypotensive effect when angiotensin-IIreceptor antagonists given with alcoholAldesleukin: enhanced hypotensive effect whenangiotensin-II receptor antagonists given with aldesleukinAliskiren: irbesartan possibly reduces plasma concentrationof aliskirenAppendix 1: Interactions