BNF for Children 2011-2012

BNFC 2011–2012 Appendix 1: Interactions 713Nimodipine see Calcium-channel BlockersNitratesACE Inhibitors: enhanced hypotensive effect whennitrates given with ACE inhibitorsAdrenergic Neurone Blockers: enhanced hypotensiveeffect when nitrates given with adrenergic neuroneblockersAlcohol: enhanced hypotensive effect when nitratesgiven with alcoholAldesleukin: enhanced hypotensive effect whennitrates given with aldesleukinAlpha-blockers: enhanced hypotensive effect whennitrates given with alpha-blockersAnaesthetics, General: enhanced hypotensive effectwhen nitrates given with general anaestheticsAnalgesics: hypotensive effect of nitrates antagonisedby NSAIDsAngiotensin-II Receptor Antagonists: enhancedhypotensive effect when nitrates given with angiotensin-IIreceptor antagonistsAnti-arrhythmics: effects of sublingual tablets ofnitrates reduced by disopyramide (failure to dissolveunder tongue owing to dry mouth). Anticoagulants: infusion of glyceryl trinitrate reducesanticoagulant effect of .heparinsAntidepressants: enhanced hypotensive effect whennitrates given with MAOIs; effects of sublingualtablets of nitrates possibly reduced by tricyclicrelatedantidepressants (failure to dissolve undertongue owing to dry mouth); effects of sublingualtablets of nitrates reduced by tricyclics (failure todissolve under tongue owing to dry mouth)Antimuscarinics: effects of sublingual tablets ofnitrates possibly reduced by antimuscarinics (failureto dissolve under tongue owing to dry mouth)Antipsychotics: enhanced hypotensive effect whennitrates given with phenothiazinesAnxiolytics and Hypnotics: enhanced hypotensiveeffect when nitrates given with anxiolytics andhypnoticsBeta-blockers: enhanced hypotensive effect whennitrates given with beta-blockersCalcium-channel Blockers: enhanced hypotensiveeffect when nitrates given with calcium-channelblockersClonidine: enhanced hypotensive effect when nitratesgiven with clonidineCorticosteroids: hypotensive effect of nitrates antagonisedby corticosteroidsDiazoxide: enhanced hypotensive effect when nitratesgiven with diazoxideDiuretics: enhanced hypotensive effect when nitratesgiven with diureticsDopaminergics: enhanced hypotensive effect whennitrates given with levodopaMethyldopa: enhanced hypotensive effect whennitrates given with methyldopaMoxisylyte: enhanced hypotensive effect when nitratesgiven with moxisylyteMoxonidine: enhanced hypotensive effect whennitrates given with moxonidineMuscle Relaxants: enhanced hypotensive effect whennitrates given with baclofen or tizanidineOestrogens: hypotensive effect of nitrates antagonisedby oestrogensProstaglandins: enhanced hypotensive effect whennitrates given with alprostadil. Sildenafil: hypotensive effect of nitrates significantlyenhanced by .sildenafil (avoid concomitant use). Tadalafil: hypotensive effect of nitrates significantlyenhanced by .tadalafil (avoid concomitant use). Vardenafil: possible increased hypotensive effect whennitrates given with .vardenafil—avoid concomitantuseVasodilator Antihypertensives: enhanced hypotensiveeffect when nitrates given with hydralazine,minoxidil or sodium nitroprussideNitrazepam see Anxiolytics and HypnoticsNitrofurantoinAntacids: absorption of nitrofurantoin reduced by oralmagnesium salts (as magnesium trisilicate)Antibacterials: nitrofurantoin possibly antagoniseseffects of nalidixic acidProbenecid: excretion of nitrofurantoin reduced byprobenecid (increased risk of side-effects)Sulfinpyrazone: excretion of nitrofurantoin reduced bysulfinpyrazone (increased risk of toxicity)Vaccines: antibacterials inactivate oral typhoidvaccine—see p. 620Nitroimidazoles see Metronidazole and TinidazoleNitrous Oxide see Anaesthetics, GeneralNizatidine see Histamine H 2 -antagonistsNoradrenaline (norepinephrine) see SympathomimeticsNorelgestromin see ProgestogensNorepinephrine (noradrenaline) see SympathomimeticsNorethisterone see ProgestogensNorfloxacin see QuinolonesNorgestimate see ProgestogensNorgestrel see ProgestogensNortriptyline see Antidepressants, TricyclicNSAIDsNote See also Aspirin. Interactions do not generally apply totopical NSAIDsACE Inhibitors: increased risk of renal impairmentwhen NSAIDs given with ACE inhibitors, alsohypotensive effect antagonisedAdrenergic Neurone Blockers: NSAIDs antagonisehypotensive effect of adrenergic neurone blockersAliskiren: NSAIDs possibly antagonise hypotensiveeffect of aliskirenAlpha-blockers: NSAIDs antagonise hypotensive effectof alpha-blockers. Analgesics: avoid concomitant use of NSAIDs with.NSAIDs or .aspirin (increased side-effects); avoidconcomitant use of NSAIDs with .ketorolac(increased side-effects and haemorrhage); ibuprofenpossibly reduces antiplatelet effect of aspirinAngiotensin-II Receptor Antagonists: increased risk ofrenal impairment when NSAIDs given with angiotensin-IIreceptor antagonists, also hypotensive effectantagonised. Antibacterials: indometacin possibly increases plasmaconcentration of amikacin and gentamicin in neonates;plasma concentration of celecoxib,diclofenac and etoricoxib reduced by rifampicin;possible increased risk of convulsions when NSAIDsgiven with .quinolones. Anticoagulants: increased risk of haemorrhage whenintravenous diclofenac given with .anticoagulants(avoid concomitant use, including low-dose heparins);increased risk of haemorrhage when ketorolacgiven with .anticoagulants (avoid concomitant use,including low-dose heparins); NSAIDs possiblyenhance anticoagulant effect of .coumarins and.phenindione; possible increased risk of bleedingwhen NSAIDs given with .dabigatran etexilate orheparins. Antidepressants: increased risk of bleeding whenNSAIDs given with .SSRIs or .venlafaxine. Antidiabetics: NSAIDs possibly enhance effects of.sulfonylureasAntifungals: plasma concentration of parecoxibincreased by fluconazole (reduce dose of parecoxib);plasma concentration of celecoxib increased byfluconazole (halve dose of celecoxib); plasma concentrationof flurbiprofen and ibuprofen increased byfluconazole; plasma concentration of diclofenac andibuprofen increased by voriconazoleAntipsychotics: possible severe drowsiness whenindometacin given with haloperidol. Antivirals: plasma concentration of piroxicamincreased by .ritonavir (risk of toxicity)—avoidconcomitant use; plasma concentration of NSAIDspossibly increased by ritonavir; increased risk ofAppendix 1: Interactions