BNF for Children 2011-2012

712 Appendix 1: Interactions BNFC 2011–2012Appendix 1: InteractionsNelfinavirAntimuscarinics (continued)odine product literature; nelfinavir increasesplasma concentration of solifenacin. Antipsychotics: nelfinavir possibly inhibits metabolismof .aripiprazole (reduce dose of aripiprazole); nelfinavirpossibly increases plasma concentration of.pimozide (increased risk of ventricular arrhythmias—avoidconcomitant use). Antivirals: plasma concentration of nelfinavir possiblyincreased by etravirine—avoid concomitant use;combination of nelfinavir with indinavir or ritonavirmay increase plasma concentration of either drug (orboth); nelfinavir reduces plasma concentration oflopinavir, also plasma concentration of active metaboliteof nelfinavir increased; nelfinavir possiblyincreases plasma concentration of .maraviroc (considerreducing dose of maraviroc); nelfinavirincreases plasma concentration of .saquinavir—manufacturer of saquinavir advises avoid concomitantuse. Anxiolytics and Hypnotics: nelfinavir possiblyincreases plasma concentration of .midazolam (riskof prolonged sedation—avoid concomitant use oforal midazolam). Ciclosporin: nelfinavir possibly increases plasma concentrationof .ciclosporinCorticosteroids: nelfinavir possibly increases plasmaconcentration of inhaled and intranasal fluticasone. Cytotoxics: nelfinavir possibly increases plasma concentrationof .everolimus—manufacturer of everolimusadvises avoid concomitant use; avoidance ofnelfinavir advised by manufacturer of .pazopanib;nelfinavir increases plasma concentration of paclitaxel. Diuretics: nelfinavir increases plasma concentration of.eplerenone—avoid concomitant use. Ergot Alkaloids: increased risk of ergotism whennelfinavir given with .ergotamine and methysergide—avoidconcomitant use. 5HT 1 Agonists: nelfinavir increases plasma concentrationof .eletriptan (risk of toxicity)—avoid concomitantuse. Ivabradine: nelfinavir possibly increases plasma concentrationof .ivabradine—avoid concomitant use. Lipid-regulating Drugs: possible increased risk ofmyopathy when nelfinavir given with atorvastatin;possible increased risk of myopathy when nelfinavirgiven with .rosuvastatin—manufacturer of rosuvastatinadvises avoid concomitant use; increased risk ofmyopathy when nelfinavir given with .simvastatin(avoid concomitant use). Oestrogens: nelfinavir accelerates metabolism of.oestrogens (reduced contraceptive effect—seep. 398)Progestogens: nelfinavir possibly reduces contraceptiveeffect of progestogens. Ranolazine: nelfinavir possibly increases plasma concentrationof .ranolazine—manufacturer of ranolazineadvises avoid concomitant useSildenafil: nelfinavir possibly increases plasma concentrationof sildenafil—reduce initial dose of sildenafil. Tacrolimus: nelfinavir possibly increases plasma concentrationof .tacrolimus. Ulcer-healing Drugs: plasma concentration of nelfinavirreduced by .omeprazole—avoid concomitant useNeomycin see AminoglycosidesNeostigmine see ParasympathomimeticsNevirapineAnalgesics: nevirapine possibly reduces plasma concentrationof methadone. Antibacterials: nevirapine reduces plasma concentrationof clarithromycin (but concentration of an activemetabolite increased), also plasma concentration ofnevirapine increased; nevirapine possibly increasesplasma concentration of rifabutin; plasma concen-Nevirapine. Antibacterials (continued)tration of nevirapine reduced by .rifampicin—avoid concomitant use. Anticoagulants: nevirapine may enhance or reduceanticoagulant effect of .warfarin. Antidepressants: plasma concentration of nevirapinereduced by .St John’s wort—avoid concomitant useAntiepileptics: plasma concentration of nevirapinereduced by carbamazepine. Antifungals: nevirapine reduces plasma concentrationof .ketoconazole—avoid concomitant use; plasmaconcentration of nevirapine increased by.fluconazole; nevirapine possibly reduces plasmaconcentration of caspofungin and itraconazole—consider increasing dose of caspofungin and itraconazole. Antipsychotics: nevirapine possibly reduces plasmaconcentration of .aripiprazole—increase dose ofaripiprazole. Antivirals: nevirapine possibly reduces plasma concentrationof .atazanavir and .etravirine—avoidconcomitant use; nevirapine reduces plasma concentrationof efavirenz and indinavir; nevirapinepossibly reduces plasma concentration of fosamprenavir;nevirapine possibly reduces plasma concentrationof .lopinavir—consider increasing dose oflopinavir. Oestrogens: nevirapine accelerates metabolism of.oestrogens (reduced contraceptive effect—seep. 398). Progestogens: nevirapine accelerates metabolism of.progestogens (reduced contraceptive effect—seep. 398)Nicardipine see Calcium-channel BlockersNicorandilAlcohol: hypotensive effect of nicorandil possiblyenhanced by alcoholAntidepressants: enhanced hypotensive effect whennicorandil given with MAOIs; hypotensive effect ofnicorandil possibly enhanced by tricyclics. Sildenafil: hypotensive effect of nicorandil significantlyenhanced by .sildenafil (avoid concomitant use). Tadalafil: hypotensive effect of nicorandil significantlyenhanced by .tadalafil (avoid concomitant use). Vardenafil: possible increased hypotensive effect whennicorandil given with .vardenafil—avoid concomitantuseVasodilator Antihypertensives: possible enhancedhypotensive effect when nicorandil given withhydralazine, minoxidil or sodium nitroprussideNicotineAnti-arrhythmics: nicotine possibly enhances effects ofadenosineNicotinic AcidNote Interactions apply to lipid-regulating doses of nicotinicacid. Lipid-regulating Drugs: increased risk of myopathywhen nicotinic acid given with .statins (applies tolipid regulating doses of nicotinic acid)Nifedipine see Calcium-channel BlockersNilotinib. Antibacterials: manufacturer of nilotinib advises avoidconcomitant use with .clarithromycin and.telithromycin; plasma concentration of nilotinibreduced by .rifampicin—avoid concomitant use. Antifungals: plasma concentration of nilotinibincreased by .ketoconazole—avoid concomitant use;manufacturer of nilotinib advises avoid concomitantuse with .itraconazole and .voriconazole. Antipsychotics: avoid concomitant use of cytotoxicswith .clozapine (increased risk of agranulocytosis). Antivirals: manufacturer of nilotinib advises avoidconcomitant use with .ritonavirAnxiolytics and Hypnotics: nilotinib increases plasmaconcentration of midazolam. Grapefruit Juice: manufacturer of nilotinib advisesavoid concomitant use with .grapefruit juice