BNF for Children 2011-2012

BNFC 2011–2012 Appendix 1: Interactions 709MetoclopramideDopaminergics (continued)advised by manufacturer of ropinirole and rotigotine(antagonism of effect)Muscle Relaxants: metoclopramide enhances effectsof suxamethoniumTetrabenazine: increased risk of extrapyramidal sideeffectswhen metoclopramide given with tetrabenazineMetolazone see DiureticsMetoprolol see Beta-blockersMetronidazoleNote Interactions do not apply to topical metronidazolepreparationsAlcohol: disulfiram-like reaction when metronidazolegiven with alcohol. Anticoagulants: metronidazole enhances anticoagulanteffect of .coumarinsAntiepileptics: metabolism of metronidazole acceleratedby phenobarbital (reduced effect); metronidazolepossibly inhibits metabolism of phenytoin(increased plasma concentration). Cytotoxics: metronidazole increases plasma concentrationof .busulfan (increased risk of toxicity);metronidazole inhibits metabolism of fluorouracil(increased toxicity)Disulfiram: psychotic reaction reported when metronidazolegiven with disulfiramLithium: metronidazole increases risk of lithiumtoxicityMycophenolate: metronidazole possibly reduces bioavailabilityof mycophenolateUlcer-healing Drugs: metabolism of metronidazoleinhibited by cimetidine (increased plasma concentration)Vaccines: antibacterials inactivate oral typhoidvaccine—see p. 620Mianserin see Antidepressants, Tricyclic (related)MicafunginAntifungals: micafungin possibly increases plasmaconcentration of amphotericin; micafungin increasesplasma concentration of itraconazole (considerreducing dose of itraconazole)Calcium-channel Blockers: micafungin increasesplasma concentration of nifedipineCiclosporin: micafungin possibly increases plasmaconcentration of ciclosporinSirolimus: micafungin increases plasma concentrationof sirolimusMiconazole see Antifungals, ImidazoleMidazolam see Anxiolytics and HypnoticsMifamurtideAnalgesics: manufacturer of mifamurtide advises avoidconcomitant use with high doses of NSAIDsCiclosporin: manufacturer of mifamurtide advisesavoid concomitant use with ciclosporinCorticosteroids: manufacturer of mifamurtide advisesavoid concomitant use with corticosteroidsTacrolimus: manufacturer of mifamurtide advises avoidconcomitant use with tacrolimusMifepristoneCorticosteroids: mifepristone may reduce effect ofcorticosteroids (including inhaled corticosteroids) for3–4 daysMilrinone see Phosphodiesterase InhibitorsMinocycline see TetracyclinesMinoxidil see Vasodilator AntihypertensivesMirtazapine. Alcohol: increased sedative effect when mirtazapinegiven with .alcoholAnalgesics: possible increased serotonergic effectswhen mirtazapine given with tramadolAnticoagulants: mirtazapine enhances anticoagulanteffect of warfarin. Antidepressants: possible increased serotonergiceffects when mirtazapine given with fluoxetine,fluvoxamine or venlafaxine; mirtazapine should notbe started until 2 weeks after stopping .MAOIs, alsoMirtazapine. Antidepressants (continued)MAOIs should not be started until at least 2weeks after stopping mirtazapine; after stoppingmirtazapine do not start .moclobemide for atleast 1 weekAntiepileptics: plasma concentration of mirtazapinereduced by carbamazepine and phenytoinAntifungals: plasma concentration of mirtazapineincreased by ketoconazole. Antimalarials: avoidance of antidepressants advised bymanufacturer of .artemether/lumefantrineAnxiolytics and Hypnotics: increased sedative effectwhen mirtazapine given with anxiolytics and hypnoticsAtomoxetine: possible increased risk of convulsionswhen antidepressants given with atomoxetineClonidine: mirtazapine possibly antagonises hypotensiveeffect of clonidineUlcer-healing Drugs: plasma concentration of mirtazapineincreased by cimetidineMitomycin. Antipsychotics: avoid concomitant use of cytotoxicswith .clozapine (increased risk of agranulocytosis)Mitotane. Anticoagulants: mitotane possibly reduces anticoagulanteffect of .coumarins. Antipsychotics: avoid concomitant use of cytotoxicswith .clozapine (increased risk of agranulocytosis)Diuretics: manufacturer of mitotane advises avoidconcomitant use of spironolactone (antagonism ofeffect)Mitoxantrone. Antipsychotics: avoid concomitant use of cytotoxicswith .clozapine (increased risk of agranulocytosis)Ciclosporin: excretion of mitoxantrone reduced byciclosporin (increased plasma concentration)Mivacurium see Muscle RelaxantsMizolastine see AntihistaminesMoclobemide. Analgesics: possible CNS excitation or depression(hypertension or hypotension) when moclobemidegiven with .dextromethorphan or .pethidine—avoidconcomitant use; possible CNS excitation or depression(hypertension or hypotension) when moclobemidegiven with .opioid analgesics—manufacturer ofmoclobemide advises consider reducing dose ofopioid analgesics. Antidepressants: moclobemide should not be startedfor at least 1 week after stopping .MAOIs, .SSRIrelatedantidepressants, .citalopram, .fluvoxamine,.mirtazapine, .paroxetine, .sertraline, .tricyclicrelatedantidepressants or .tricyclics; increased riskof CNS toxicity when moclobemide given with.escitalopram, preferably avoid concomitant use;moclobemide should not be started until 5 weeksafter stopping .fluoxetine; possible increased serotonergiceffects when moclobemide given with.duloxetine. Antimalarials: avoidance of antidepressants advised bymanufacturer of .artemether/lumefantrineAtomoxetine: possible increased risk of convulsionswhen antidepressants given with atomoxetine. Bupropion: avoidance of moclobemide advised bymanufacturer of .bupropion. Clopidogrel: moclobemide possibly reduces antiplateleteffect of .clopidogrel. Dopaminergics: caution with moclobemide advised bymanufacturer of entacapone; increased risk of sideeffectswhen moclobemide given with levodopa;avoid concomitant use of moclobemide with.selegiline. 5HT 1 Agonists: risk of CNS toxicity when moclobemidegiven with .rizatriptan or .sumatriptan (avoidrizatriptan or sumatriptan for 2 weeks after moclobemide);risk of CNS toxicity when moclobemidegiven with .zolmitriptan (reduce dose of zolmitriptan)Appendix 1: Interactions