BNF for Children 2011-2012

BNFC 2011–2012 Appendix 1: Interactions 691DiureticsAnxiolytics and Hypnotics (continued)hypnotics; administration of parenteral furosemidewith chloral may displace thyroid hormonefrom binding sites. Atomoxetine: hypokalaemia caused by diureticsincreases risk of ventricular arrhythmias with.atomoxetine. Beta-blockers: enhanced hypotensive effect whendiuretics given with beta-blockers; hypokalaemiacaused by loop diuretics or thiazides and relateddiuretics increases risk of ventricular arrhythmiaswith .sotalolCalcium Salts: increased risk of hypercalcaemia whenthiazides and related diuretics given with calciumsaltsCalcium-channel Blockers: enhanced hypotensiveeffect when diuretics given with calcium-channelblockers; plasma concentration of eplerenoneincreased by diltiazem and verapamil (reduce dose ofeplerenone). Cardiac Glycosides: hypokalaemia caused by acetazolamide,loop diuretics or thiazides and relateddiuretics increases cardiac toxicity with .cardiacglycosides; spironolactone increases plasma concentrationof .digoxin; potassium canrenoate possiblyincreases plasma concentration of digoxin. Ciclosporin: increased risk of nephrotoxicity andpossibly hypermagnesaemia when thiazides andrelated diuretics given with ciclosporin; increased riskof hyperkalaemia when potassium-sparing diureticsand aldosterone antagonists given with .ciclosporin;acetazolamide possibly increases plasma concentrationof .ciclosporinClonidine: enhanced hypotensive effect when diureticsgiven with clonidineCorticosteroids: diuretic effect of diuretics antagonisedby corticosteroids; increased risk of hypokalaemiawhen acetazolamide, loop diuretics or thiazides andrelated diuretics given with corticosteroids. Cytotoxics: alkaline urine due to acetazolamideincreases exceretion of methotrexate; hypokalaemiacaused by acetazolamide, loop diuretics or thiazidesand related diuretics increases risk of ventriculararrhythmias with .arsenic trioxide; avoidance ofspironolactone advised by manufacturer of mitotane(antagonism of effect); increased risk of nephrotoxicityand ototoxicity when diuretics given withplatinum compoundsDiazoxide: enhanced hypotensive and hyperglycaemiceffects when diuretics given with diazoxideDiuretics: increased risk of hypokalaemia when loopdiuretics or thiazides and related diuretics given withacetazolamide; profound diuresis possible whenmetolazone given with furosemide; increased risk ofhypokalaemia when thiazides and related diureticsgiven with loop diureticsDopaminergics: enhanced hypotensive effect whendiuretics given with levodopaHormone Antagonists: increased risk of hypercalcaemiawhen thiazides and related diuretics givenwith toremifene; increased risk of hyperkalaemiawhen potassium-sparing diuretics and aldosteroneantagonists given with trilostaneLipid-regulating Drugs: absorption of thiazides andrelated diuretics reduced by colestipol and colestyramine(give at least 2 hours apart). Lithium: loop diuretics and thiazides and relateddiuretics reduce excretion of .lithium (increasedplasma concentration and risk of toxicity)—loopdiuretics safer than thiazides; potassium-sparingdiuretics and aldosterone antagonists reduce excretionof .lithium (increased plasma concentration andrisk of toxicity); acetazolamide increases the excretionof .lithiumMethyldopa: enhanced hypotensive effect when diureticsgiven with methyldopaDiuretics (continued)Moxisylyte: enhanced hypotensive effect when diureticsgiven with moxisylyteMoxonidine: enhanced hypotensive effect when diureticsgiven with moxonidineMuscle Relaxants: enhanced hypotensive effect whendiuretics given with baclofen or tizanidineNitrates: enhanced hypotensive effect when diureticsgiven with nitratesOestrogens: diuretic effect of diuretics antagonised byoestrogens. Potassium Salts: increased risk of hyperkalaemiawhen potassium-sparing diuretics and aldosteroneantagonists given with .potassium saltsProgestogens: risk of hyperkalaemia when potassiumsparingdiuretics and aldosterone antagonists givenwith drospirenone (monitor serum potassium duringfirst cycle)Prostaglandins: enhanced hypotensive effect whendiuretics given with alprostadilSympathomimetics, Beta 2 : increased risk of hypokalaemiawhen acetazolamide, loop diuretics or thiazidesand related diuretics given with high doses ofbeta 2 sympathomimetics—see Hypokalaemia, p. 138. Tacrolimus: increased risk of hyperkalaemia whenpotassium-sparing diuretics and aldosterone antagonistsgiven with .tacrolimusTheophylline: increased risk of hypokalaemia whenacetazolamide, loop diuretics or thiazides and relateddiuretics given with theophyllineVasodilator Antihypertensives: enhanced hypotensiveeffect when diuretics given with hydralazine,minoxidil or sodium nitroprussideVitamins: increased risk of hypercalcaemia whenthiazides and related diuretics given with vitamin DDiuretics, Loop see DiureticsDiuretics, Potassium-sparing and AldosteroneAntagonists see DiureticsDiuretics, Thiazide and related see DiureticsDobutamine see SympathomimeticsDocetaxelAntibacterials: in vitro studies suggest a possibleinteraction between docetaxel and erythromycin(consult docetaxel product literature)Antifungals: in vitro studies suggest a possible interactionbetween docetaxel and ketoconazole (consultdocetaxel product literature). Antipsychotics: avoid concomitant use of cytotoxicswith .clozapine (increased risk of agranulocytosis). Antivirals: plasma concentration of docetaxel possiblyincreased by .ritonavir (increased risk of toxicity)Ciclosporin: in vitro studies suggest a possible interactionbetween docetaxel and ciclosporin (consultdocetaxel product literature)Cytotoxics: possible increased risk of neutropenia whendocetaxel given with lapatinib; plasma concentrationof docetaxel increased by sorafenibDomperidoneAnalgesics: effects of domperidone on gastro-intestinalactivity antagonised by opioid analgesics. Antifungals: risk of arrhythmias with domperidonepossibly increased by .ketoconazoleAntimuscarinics: effects of domperidone on gastrointestinalactivity antagonised by antimuscarinicsDopaminergics: domperidone possibly antagoniseshypoprolactinaemic effects of bromocriptine andcabergolineDonepezil see ParasympathomimeticsDopamine see SympathomimeticsDopaminergics see Amantadine, Apomorphine, Bromocriptine,Cabergoline, Entacapone, Levodopa,Pergolide, Pramipexole, Quinagolide, Rasagiline,Ropinirole, Rotigotine, Selegiline, and TolcaponeDopexamine see SympathomimeticsDoripenem. Antiepileptics: carbapenems reduce plasma concentrationof .valproate—avoid concomitant useAppendix 1: Interactions