BNF for Children 2011-2012

BNFC 2011–2012 Appendix 1: Interactions 725Ranolazine (continued). Antibacterials: plasma concentration of ranolazinepossibly increased by .clarithromycin and.telithromycin—manufacturer of ranolazine advisesavoid concomitant use; plasma concentration ofranolazine reduced by .rifampicin—manufacturer ofranolazine advises avoid concomitant useAntidepressants: plasma concentration of ranolazineincreased by paroxetine. Antifungals: plasma concentration of ranolazineincreased by .ketoconazole—avoid concomitant use;plasma concentration of ranolazine possiblyincreased by .itraconazole, .posaconazole and.voriconazole—manufacturer of ranolazine advisesavoid concomitant use. Antivirals: plasma concentration of ranolazine possiblyincreased by .atazanavir, .darunavir, .fosamprenavir,.indinavir, .lopinavir, .nelfinavir, .ritonavir,.saquinavir and .tipranavir—manufacturer of ranolazineadvises avoid concomitant use. Beta-blockers: manufacturer of ranolazine advisesavoid concomitant use with .sotalolCalcium-channel Blockers: plasma concentration ofranolazine increased by diltiazem and verapamil(consider reducing dose of ranolazine)Cardiac Glycosides: ranolazine increases plasma concentrationof digoxinCiclosporin: plasma concentration of ranolazine possiblyincreased by ciclosporin. Grapefruit Juice: plasma concentration of ranolazinepossibly increased by .grapefruit juice—manufacturerof ranolazine advises avoid concomitant useLipid-regulating Drugs: ranolazine increases plasmaconcentration of simvastatin (consider reducing doseof simvastatin)RasagilineNote Rasagiline is a MAO-B inhibitor. Analgesics: avoid concomitant use of rasagiline with.dextromethorphan; risk of CNS toxicity whenrasagiline given with .pethidine (avoid pethidine for 2weeks after rasagiline)Antibacterials: plasma concentration of rasagilineincreased by ciprofloxacin. Antidepressants: after stopping rasagiline do not start.fluoxetine for 2 weeks, also rasagiline should not bestarted until at least 5 weeks after stopping fluoxetine;after stopping rasagiline do not start.fluvoxamine for 2 weeks; risk of hypertensive crisiswhen rasagiline given with .MAOIs, avoid MAOIs forat least 2 weeks after stopping rasagiline; increasedrisk of CNS toxicity when rasagiline given with.SSRIs or .tricyclicsDopaminergics: plasma concentration of rasagilinepossibly reduced by entacaponeMemantine: effects of dopaminergics possiblyenhanced by memantineMethyldopa: antiparkinsonian effect of dopaminergicsantagonised by methyldopa. Sympathomimetics: avoid concomitant use of rasagilinewith .sympathomimeticsReboxetine. Antibacterials: manufacturer of reboxetine advisesavoid concomitant use with .macrolides. Antidepressants: manufacturer of reboxetine advisesavoid concomitant use with .fluvoxamine; increasedrisk of hypertension and CNS excitation whenreboxetine given with .MAOIs (MAOIs should not bestarted until 1 week after stopping reboxetine, avoidreboxetine for 2 weeks after stopping MAOIs). Antifungals: manufacturer of reboxetine advises avoidconcomitant use with .imidazoles and .triazoles. Antimalarials: avoidance of antidepressants advised bymanufacturer of .artemether/lumefantrineAtomoxetine: possible increased risk of convulsionswhen antidepressants given with atomoxetineDiuretics: possible increased risk of hypokalaemiawhen reboxetine given with loop diuretics or thiazidesand related diureticsReboxetine (continued)Ergot Alkaloids: possible risk of hypertension whenreboxetine given with ergotamine and methysergideRemifentanil see Opioid AnalgesicsRepaglinide see AntidiabeticsRetinoids. Alcohol: etretinate formed from acitretin in presence of.alcohol (increased risk of teratogenecity in womenof child-bearing potential). Antibacterials: possible increased risk of benignintracranial hypertension when retinoids given with.tetracyclines (avoid concomitant use). Anticoagulants: acitretin possibly reduces anticoagulanteffect of .coumarinsAntiepileptics: isotretinoin possibly reduces plasmaconcentration of carbamazepineAntifungals: plasma concentration of alitretinoinincreased by ketoconazole. Cytotoxics: acitretin increases plasma concentration of.methotrexate (also increased risk of hepatotoxicity)—avoidconcomitant useLipid-regulating Drugs: alitretinoin reduces plasmaconcentration of simvastatinVitamins: risk of hypervitaminosis A when retinoidsgiven with vitamin ARibavirin. Antivirals: effects of ribavirin possibly reduced by.abacavir; increased risk of side-effects when ribaviringiven with .didanosine—avoid concomitantuse; increased risk of toxicity when ribavirin givenwith .stavudine; increased risk of anaemia whenribavirin given with .zidovudine—avoid concomitantuse. Azathioprine: ribavirin possibly enhances myelosuppressiveeffects of .azathioprineRifabutin see RifamycinsRifampicin see RifamycinsRifamycinsACE Inhibitors: rifampicin reduces plasma concentrationof active metabolite of imidapril (reduced antihypertensiveeffect)Analgesics: rifampicin reduces plasma concentrationof celecoxib, diclofenac and etoricoxib; rifampicinaccelerates metabolism of alfentanil, codeine,fentanyl, methadone and morphine (reduced effect);rifampicin possibly accelerates metabolism of oxycodoneAngiotensin-II Receptor Antagonists: rifampicinreduces plasma concentration of losartan and itsactive metaboliteAntacids: absorption of rifampicin reduced by antacids. Anti-arrhythmics: rifamycins accelerate metabolism of.disopyramide (reduced plasma concentration); rifampicinreduces plasma concentration of.dronedarone—avoid concomitant use; rifampicinaccelerates metabolism of .propafenone (reducedeffect). Antibacterials: rifamycins reduce plasma concentrationof clarithromycin and dapsone; plasma concentrationof rifabutin increased by .clarithromycin(increased risk of uveitis—reduce rifabutin dose);rifampicin reduces plasma concentration of doxycycline—considerincreasing dose of doxycycline; rifampicinaccelerates metabolism of chloramphenicol(reduced plasma concentration); rifampicin reducesplasma concentration of linezolid (possible therapeuticfailure of linezolid); plasma concentration ofrifabutin possibly increased by .macrolides(increased risk of uveitis—reduce rifabutin dose);rifampicin reduces plasma concentration of.telithromycin (avoid during and for 2 weeks afterrifampicin); rifampicin possibly reduces plasma concentrationof trimethoprim. Anticoagulants: rifamycins accelerate metabolism of.coumarins (reduced anticoagulant effect); rifampicinreduces plasma concentration of rivaroxaban. Antidiabetics: rifamycins accelerate metabolism of.tolbutamide (reduced effect); rifampicin reducesplasma concentration of nateglinide; rifampicinAppendix 1: Interactions