BNF for Children 2011-2012

704 Appendix 1: Interactions BNFC 2011–2012Appendix 1: InteractionsLopinavirNote In combination with ritonavir as Kaletra c (ritonavir ispresent to inhibit lopinavir metabolism and increase plasmalopinavirconcentration)—see also Ritonavir. Anti-arrhythmics: lopinavir possibly increases plasmaconcentration of .flecainide (increased risk ofventricular arrhythmias—avoid concomitant use);lopinavir possibly increases plasma concentration oflidocaine. Antibacterials: plasma concentration of lopinavirreduced by .rifampicin—avoid concomitant use;avoidance of concomitant lopinavir in severe renaland hepatic impairment advised by manufacturer of.telithromycinAnticoagulants: avoidance of lopinavir advised bymanufacturer of rivaroxaban. Antidepressants: plasma concentration of lopinavirreduced by .St John’s wort—avoid concomitant use. Antiepileptics: plasma concentration of lopinavirpossibly reduced by carbamazepine,.phenobarbital and phenytoinAntihistamines: lopinavir possibly increases plasmaconcentration of chlorphenamineAntimalarials: caution with lopinavir advised bymanufacturer of artemether/lumefantrineAntimuscarinics: avoidance of lopinavir advised bymanufacturer of darifenacin and tolterodine. Antipsychotics: lopinavir possibly inhibits metabolismof .aripiprazole (reduce dose of aripiprazole). Antivirals: lopinavir reduces plasma concentration of.darunavir, also plasma concentration of lopinavirincreased (avoid concomitant use); plasma concentrationof lopinavir reduced by .efavirenz—considerincreasing dose of lopinavir; lopinavir reducesplasma concentration of fosamprenavir, effect onlopinavir plasma concentration not predictable—avoid concomitant use; lopinavir increases plasmaconcentration of .maraviroc (consider reducing doseof maraviroc); plasma concentration of lopinavirreduced by nelfinavir, also plasma concentration ofactive metabolite of nelfinavir increased; plasmaconcentration of lopinavir possibly reduced by.nevirapine—consider increasing dose of lopinavir;increased risk of ventricular arrhythmias whenlopinavir given with .saquinavir—avoid concomitantuse; lopinavir increases plasma concentration oftenofovir; plasma concentration of lopinavir reducedby .tipranavirCorticosteroids: plasma concentration of lopinavirpossibly reduced by dexamethasoneEltrombopag: lopinavir possibly reduces plasma concentrationof eltrombopag. Lipid-regulating Drugs: possible increased risk ofmyopathy when lopinavir given with atorvastatin;possible increased risk of myopathy when lopinavirgiven with .rosuvastatin—manufacturer of rosuvastatinadvises avoid concomitant use; possibleincreased risk of myopathy when lopinavir given with.simvastatin—avoid concomitant use. Ranolazine: lopinavir possibly increases plasma concentrationof .ranolazine—manufacturer of ranolazineadvises avoid concomitant useSirolimus: lopinavir possibly increases plasma concentrationof sirolimusLoprazolam see Anxiolytics and HypnoticsLoratadine see AntihistaminesLorazepam see Anxiolytics and HypnoticsLormetazepam see Anxiolytics and HypnoticsLosartan see Angiotensin-II Receptor AntagonistsLumefantrine see Artemether with LumefantrineLymecycline see TetracyclinesMacrolidesNote See also TelithromycinNote Interactions do not apply to small amounts oferythromycin used topicallyAnalgesics: erythromycin increases plasma concentrationof alfentanilAntacids: absorption of azithromycin reduced byantacidsMacrolides (continued). Anti-arrhythmics: increased risk of ventricular arrhythmiaswhen parenteral erythromycin given with.amiodarone—avoid concomitant use; clarithromycinpossibly increases plasma concentration of.disopyramide (increased risk of toxicity); erythromycinincreases plasma concentration of.disopyramide (increased risk of toxicity); avoidanceof clarithromycin advised by manufacturer of.dronedarone (risk of ventricular arrhythmias);erythromycin possibly increases plasma concentrationof .dronedarone (increased risk of ventriculararrhythmias—avoid concomitant use). Antibacterials: increased risk of ventricular arrhythmiaswhen parenteral erythromycin given with.moxifloxacin—avoid concomitant use; macrolidespossibly increase plasma concentration of .rifabutin(increased risk of uveitis—reduce rifabutin dose);clarithromycin increases plasma concentration of.rifabutin (increased risk of uveitis—reduce rifabutindose); plasma concentration of clarithromycinreduced by rifamycins. Anticoagulants: clarithromycin and erythromycinenhance anticoagulant effect of .coumarins; azithromycinpossibly enhances anticoagulant effect of.coumarins. Antidepressants: avoidance of macrolides advised bymanufacturer of .reboxetineAntidiabetics: clarithromycin enhances effects ofrepaglinide. Antiepileptics: clarithromycin and erythromycinincrease plasma concentration of .carbamazepine;clarithromycin inhibits metabolism of phenytoin(increased plasma concentration); erythromycinpossibly inhibits metabolism of valproate (increasedplasma concentration)Antifungals: clarithromycin increases plasma concentrationof itraconazole. Antihistamines: manufacturer of loratadine adviseserythromycin possibly increases plasma concentrationof loratadine; macrolides possibly inhibitmetabolism of .mizolastine (avoid concomitant use);erythromycin inhibits metabolism of .mizolastine—avoid concomitant use; erythromycin increasesplasma concentration of rupatadine. Antimalarials: avoidance of macrolides advised bymanufacturer of .artemether/lumefantrineAntimuscarinics: erythromycin possibly increasesplasma concentration of darifenacin; manufacturer offesoterodine advises dose reduction when clarithromycingiven with fesoterodine—consult fesoterodineproduct literature; avoidance of clarithromycin anderythromycin advised by manufacturer of tolterodine. Antipsychotics: avoidance of macrolides advised bymanufacturer of .droperidol (risk of ventriculararrhythmias); increased risk of ventricular arrhythmiaswhen parenteral erythromycin given with.zuclopenthixol—avoid concomitant use; increasedrisk of ventricular arrhythmias when erythromycingiven with .amisulpride—avoid concomitant use;erythromycin possibly increases plasma concentrationof .clozapine (possible increased risk of convulsions);possible increased risk of ventriculararrhythmias when erythromycin given with.pimozide—avoid concomitant use; increased risk ofventricular arrhythmias when clarithromycin givenwith .pimozide—avoid concomitant use; macrolidespossibly increase plasma concentration of quetiapine(reduce dose of quetiapine); increased risk of ventriculararrhythmias when parenteral erythromycingiven with .sulpiride. Antivirals: plasma concentration of both drugsincreased when clarithromycin given with atazanavir;increased risk of rash when clarithromycin given withefavirenz; clarithromycin increases plasma concentrationof .etravirine, also plasma concentration ofclarithromycin reduced; clarithromycin possiblyincreases plasma concentration of .maraviroc (considerreducing dose of maraviroc); plasma concen-