BNF for Children 2011-2012

BNFC 2011–2012 Appendix 1: Interactions 663Anticoagulants see Coumarins, Dabigatran etexilate,Heparins, Phenindione, and RivaroxabanAntidepressants see Agomelatine; Antidepressants,SSRI; Antidepressants, Tricyclic; Antidepressants,Tricyclic (related); MAOIs; Mirtazapine; Moclobemide;Reboxetine; St John’s Wort; Tryptophan;VenlafaxineAntidepressants, Noradrenaline Re-uptake Inhibitorssee ReboxetineAntidepressants, SSRIAlcohol: sedative effects possibly increased whenSSRIs given with alcoholAnaesthetics, Local: fluvoxamine inhibits metabolismof ropivacaine—avoid prolonged administration ofropivacaine. Analgesics: increased risk of bleeding when SSRIsgiven with .NSAIDs or .aspirin; fluoxetine, fluvoxamine,paroxetine and sertraline possibly increaseplasma concentration of methadone; increased risk ofCNS toxicity when SSRIs given with .tramadolAnti-arrhythmics: fluoxetine increases plasma concentrationof flecainide; paroxetine possibly inhibitsmetabolism of propafenone (increased risk of toxicity). Anticoagulants: SSRIs possibly enhance anticoagulanteffect of .coumarins. Antidepressants: avoidance of fluvoxamine advised bymanufacturer of .reboxetine; possible increasedserotonergic effects when SSRIs given with duloxetine;fluvoxamine inhibits metabolism of.duloxetine—avoid concomitant use; CNS effects ofSSRIs increased by .MAOIs (risk of serious toxicity);citalopram, escitalopram, fluvoxamine, paroxetine orsertraline should not be started until 2 weeks afterstopping .MAOIs, also MAOIs should not be starteduntil at least 1 week after stopping citalopram,escitalopram, fluvoxamine, paroxetine or sertraline;fluoxetine should not be started until 2 weeks afterstopping .MAOIs, also MAOIs should not be starteduntil at least 5 weeks after stopping fluoxetine;increased risk of CNS toxicity when escitalopramgiven with .moclobemide, preferably avoid concomitantuse; after stopping citalopram, fluvoxamine,paroxetine or sertraline do not start .moclobemidefor at least 1 week; after stopping fluoxetine do notstart .moclobemide for 5 weeks; increased serotonergiceffects when SSRIs given with .St John’swort—avoid concomitant use; fluvoxamine inhibitsmetabolism of .agomelatine (increased plasma concentration);possible increased serotonergic effectswhen fluoxetine or fluvoxamine given with mirtazapine;SSRIs increase plasma concentration of some.tricyclics; CNS toxicity reported when fluoxetinegiven with tryptophan; agitation and nausea mayoccur when SSRIs given with .tryptophan. Antiepileptics: SSRIs antagonise anticonvulsant effectof .antiepileptics (convulsive threshold lowered);fluoxetine and fluvoxamine increase plasma concentrationof .carbamazepine; plasma concentrationof paroxetine reduced by phenobarbital and phenytoin;plasma concentration of sertraline possiblyreduced by phenytoin, also plasma concentration ofphenytoin possibly increased; fluoxetine and fluvoxamineincrease plasma concentration of .phenytoinAntihistamines: antidepressant effect of SSRIs possiblyantagonised by cyproheptadine. Antimalarials: avoidance of antidepressants advised bymanufacturer of .artemether/lumefantrineAntimuscarinics: paroxetine increases plasma concentrationof darifenacin and procyclidine. Antipsychotics: avoidance of fluoxetine,fluvoxamine or sertraline advised by manufacturer of.droperidol (risk of ventricular arrhythmias); fluoxetineincreases plasma concentration of .clozapine,.haloperidol and risperidone; fluvoxamine possiblyincreases plasma concentration of haloperidol; paroxetineinhibits metabolism of perphenazine (reducedose of perphenazine); fluoxetine and paroxetineAntidepressants, SSRI. Antipsychotics (continued)possibly inhibit metabolism of .aripiprazole(reduce dose of aripiprazole); citalopram possiblyincreases plasma concentration of clozapine(increased risk of toxicity); fluvoxamine,paroxetine and sertraline increase plasma concentrationof .clozapine; fluvoxamine increasesplasma concentration of olanzapine; SSRIs possiblyincrease plasma concentration of .pimozide(increased risk of ventricular arrhythmias—avoidconcomitant use); paroxetine possibly increasesplasma concentration of risperidone (increasedrisk of toxicity). Antivirals: plasma concentration of paroxetine andsertraline possibly reduced by darunavir; plasmaconcentration of SSRIs possibly increased by.ritonavir; plasma concentration of paroxetine possiblyreduced by ritonavir. Anxiolytics and Hypnotics: fluoxetine increasesplasma concentration of alprazolam; fluvoxamineincreases plasma concentration of some benzodiazepines;fluvoxamine increases plasma concentrationof .melatonin—avoid concomitant use; sedativeeffects possibly increased when sertraline given withzolpidemAtomoxetine: possible increased risk of convulsionswhen antidepressants given with atomoxetine;fluoxetine and paroxetine possibly inhibit metabolismof atomoxetineBeta-blockers: citalopram and escitalopram increaseplasma concentration of metoprolol; paroxetinepossibly increases plasma concentration ofmetoprolol (enhanced effect); fluvoxamine increasesplasma concentration of propranololBupropion: plasma concentration of citalopram possiblyincreased by bupropionCalcium-channel Blockers: fluoxetine possibly inhibitsmetabolism of nifedipine (increased plasma concentration). Clopidogrel: fluoxetine and fluvoxamine possiblyreduce antiplatelet effect of .clopidogrel. Dopaminergics: caution with paroxetine advised bymanufacturer of entacapone; fluoxetine should not bestarted until 2 weeks after stopping .rasagiline, alsorasagiline should not be started until at least 5 weeksafter stopping fluoxetine; increased risk of CNStoxicity when SSRIs given with .rasagiline; fluvoxamineshould not be started until 2 weeks afterstopping .rasagiline; increased risk of hypertensionand CNS excitation when fluvoxamine or sertralinegiven with .selegiline (selegiline should not bestarted until 1 week after stopping fluvoxamine orsertraline, avoid fluvoxamine or sertraline for 2 weeksafter stopping selegiline); increased risk of hypertensionand CNS excitation when paroxetine givenwith .selegiline (selegiline should not be started until2 weeks after stopping paroxetine, avoid paroxetinefor 2 weeks after stopping selegiline); increased riskof hypertension and CNS excitation when fluoxetinegiven with .selegiline (selegiline should not bestarted until 5 weeks after stopping fluoxetine, avoidfluoxetine for 2 weeks after stopping selegiline);avoidance of citalopram and escitalopram advised bymanufacturer of selegiline. Hormone Antagonists: fluoxetine and paroxetinepossibly inhibit metabolism of .tamoxifen to activemetabolite (avoid concomitant use). 5HT 1 Agonists: fluvoxamine inhibits the metabolism offrovatriptan; CNS toxicity reported when sertralinegiven with sumatriptan; increased risk of CNS toxicitywhen citalopram, escitalopram, fluoxetine,fluvoxamine or paroxetine given with .sumatriptan;fluvoxamine possibly inhibits metabolism of zolmitriptan(reduce dose of zolmitriptan). Lithium: Increased risk of CNS effects when SSRIsgiven with .lithium (lithium toxicity reported)Appendix 1: Interactions