BNF for Children 2011-2012

BNFC 2011–2012 Appendix 1: Interactions 711Muscle Relaxants. Antidepressants (continued)methonium enhanced by phenelzine; musclerelaxant effect of baclofen enhanced by tricyclicsAntiepileptics: muscle relaxant effect of non-depolarisingmuscle relaxants antagonised bycarbamazepine and phenytoin (accelerated recoveryfrom neuromuscular blockade)Antimalarials: effects of suxamethonium possiblyenhanced by quinineAntipsychotics: effects of suxamethonium possiblyenhanced by promazineAnxiolytics and Hypnotics: increased sedative effectwhen baclofen or tizanidine given with anxiolyticsand hypnoticsBeta-blockers: enhanced hypotensive effect whenbaclofen given with beta-blockers; possible enhancedhypotensive effect and bradycardia when tizanidinegiven with beta-blockers; effects of muscle relaxantsenhanced by propranololCalcium-channel Blockers: enhanced hypotensiveeffect when baclofen or tizanidine given withcalcium-channel blockers; effects of non-depolarisingmuscle relaxants possibly enhanced by calciumchannelblockers; possible increased risk of ventriculararrhythmias when intravenous dantrolene givenwith diltiazem—manufacturer of diltiazem advisesavoid concomitant use; effects of non-depolarisingmuscle relaxants and suxamethonium enhanced byverapamil; avoidance of intravenous dantroleneadvised by manufacturer of verapamilCardiac Glycosides: possible increased risk of bradycardiawhen tizanidine given with cardiac glycosides;risk of ventricular arrhythmias when suxamethoniumgiven with cardiac glycosidesClonidine: enhanced hypotensive effect whenbaclofen or tizanidine given with clonidineCorticosteroids: effects of pancuronium and vecuroniumpossibly antagonised by corticosteroidsCytotoxics: effects of suxamethonium enhanced bycyclophosphamide and thiotepaDiazoxide: enhanced hypotensive effect whenbaclofen or tizanidine given with diazoxideDiuretics: enhanced hypotensive effect whenbaclofen or tizanidine given with diureticsDopaminergics: possible agitation, confusion andhallucinations when baclofen given with levodopaLithium: effects of muscle relaxants enhanced bylithium; baclofen possibly aggravates hyperkinesiscaused by lithiumMagnesium (parenteral): effects of non-depolarisingmuscle relaxants and suxamethonium enhanced byparenteral magnesiumMemantine: effects of baclofen and dantrolene possiblymodified by memantineMethyldopa: enhanced hypotensive effect whenbaclofen or tizanidine given with methyldopaMetoclopramide: effects of suxamethonium enhancedby metoclopramideMoxonidine: enhanced hypotensive effect whenbaclofen or tizanidine given with moxonidineNitrates: enhanced hypotensive effect whenbaclofen or tizanidine given with nitratesOestrogens: plasma concentration of tizanidine possiblyincreased by oestrogens (increased risk oftoxicity)Parasympathomimetics: effects of non-depolarisingmuscle relaxants possibly antagonised by donepezil;effects of suxamethonium possibly enhanced bydonepezil; effects of non-depolarising muscle relaxantsantagonised by edrophonium, neostigmine,pyridostigmine and rivastigmine; effects of suxamethoniumenhanced by edrophonium, galantamine,neostigmine, pyridostigmine and rivastigmineProgestogens: plasma concentration of tizanidinepossibly increased by progestogens (increased risk oftoxicity)Sympathomimetics, Beta 2 : effects of suxamethoniumenhanced by bambuterolMuscle Relaxants (continued)Vasodilator Antihypertensives: enhanced hypotensiveeffect when baclofen or tizanidine given withhydralazine; enhanced hypotensive effect whenbaclofen or tizanidine given with minoxidil; enhancedhypotensive effect when baclofen or tizanidine givenwith sodium nitroprussideMuscle Relaxants, depolarising see Muscle RelaxantsMuscle Relaxants, non-depolarising see MuscleRelaxantsMycophenolateAntacids: absorption of mycophenolate reduced byantacids. Antibacterials: bioavailability of mycophenolate possiblyreduced by metronidazole and norfloxacin;plasma concentration of active metabolite of mycophenolatereduced by .rifampicinAntivirals: mycophenolate increases plasma concentrationof aciclovir, also plasma concentration ofinactive metabolite of mycophenolate increased;mycophenolate possibly increases plasma concentrationof ganciclovir, also plasma concentration ofinactive metabolite of mycophenolate possiblyincreasedIron: absorption of mycophenolate reduced by oral ironLipid-regulating Drugs: absorption of mycophenolatereduced by colestyramineSevelamer: plasma concentration of mycophenolatepossibly reduced by sevelamerMycophenolate Mofetil see MycophenolateMycophenolate Sodium see MycophenolateMycophenolic Acid see MycophenolateNabumetone see NSAIDsNadolol see Beta-blockersNalidixic Acid see QuinolonesNandrolone see Anabolic SteroidsNaproxen see NSAIDsNaratriptan see 5HT 1 AgonistsNateglinide see AntidiabeticsNebivolol see Beta-blockersNefopam. Antidepressants: manufacturer of nefopam advisesavoid concomitant use with .MAOIs; side-effectspossibly increased when nefopam given with tricyclicsAntimuscarinics: increased risk of antimuscarinic sideeffectswhen nefopam given with antimuscarinicsNelfinavirAnalgesics: nelfinavir reduces plasma concentration ofmethadone. Anti-arrhythmics: increased risk of ventricular arrhythmiaswhen nelfinavir given with .amiodarone—avoid concomitant use. Antibacterials: nelfinavir increases plasma concentrationof azithromycin (increased risk of toxicity);nelfinavir increases plasma concentration of.rifabutin (halve dose of rifabutin); plasma concentrationof nelfinavir significantly reduced by.rifampicin—avoid concomitant use; avoidance ofconcomitant nelfinavir in severe renal and hepaticimpairment advised by manufacturer of.telithromycinAnticoagulants: avoidance of nelfinavir advised bymanufacturer of rivaroxaban. Antidepressants: plasma concentration of nelfinavirreduced by .St John’s wort—avoid concomitant use. Antiepileptics: plasma concentration of nelfinavirpossibly reduced by carbamazepine and.phenobarbital; nelfinavir reduces plasma concentrationof phenytoin. Antimalarials: caution with nelfinavir advised bymanufacturer of artemether/lumefantrine; nelfinavirpossibly increases plasma concentration of .quinine(increased risk of toxicity)Antimuscarinics: avoidance of nelfinavir advised bymanufacturer of darifenacin and tolterodine; manufacturerof fesoterodine advises dose reduction whennelfinavir given with fesoterodine—consult fesoter-Appendix 1: Interactions