BNF for Children 2011-2012

BNFC 2011–2012 Appendix 1: Interactions 729St John’s WortAnalgesics: St John’s wort possibly reduces plasmaconcentration of methadone. Anti-arrhythmics: St John’s wort possibly reducesplasma concentration of .dronedarone—avoid concomitantuse. Antibacterials: St John’s wort reduces plasma concentrationof .telithromycin (avoid during and for 2weeks after St John’s wort). Anticoagulants: St John’s wort reduces anticoagulanteffect of .coumarins (avoid concomitant use). Antidepressants: possible increased serotonergiceffects when St John’s wort given with duloxetine orvenlafaxine; St John’s wort reduces plasma concentrationof amitriptyline; increased serotonergic effectswhen St John’s wort given with .SSRIs—avoidconcomitant use. Antiepileptics: avoid concomitant use of St John’s wortwith .antiepileptics. Antifungals: St John’s wort reduces plasma concentrationof .voriconazole—avoid concomitant use. Antimalarials: avoidance of antidepressants advised bymanufacturer of .artemether/lumefantrine. Antipsychotics: St John’s wort possibly reduces plasmaconcentration of .aripiprazole—increase dose ofaripiprazole. Antivirals: St John’s wort reduces plasma concentrationof .atazanavir, .darunavir, .efavirenz,.fosamprenavir, .indinavir, .lopinavir, .nelfinavir,.nevirapine, .ritonavir and .saquinavir—avoid concomitantuse; avoidance of St John’s wort advised bymanufacturer of etravirine; St John’s wort possiblyreduces plasma concentration of .maraviroc and.tipranavir—avoid concomitant useAnxiolytics and Hypnotics: St John’s wort possiblyreduces plasma concentration of oral midazolam. Aprepitant: avoidance of St John’s wort advised bymanufacturer of .aprepitantAtomoxetine: possible increased risk of convulsionswhen antidepressants given with atomoxetine. Calcium-channel Blockers: St John’s wort possiblyreduces plasma concentration of amlodipine; StJohn’s wort reduces plasma concentration of nifedipine;St John’s wort significantly reduces plasmaconcentration of .verapamil. Cardiac Glycosides: St John’s wort reduces plasmaconcentration of .digoxin—avoid concomitant use. Ciclosporin: St John’s wort reduces plasma concentrationof .ciclosporin—avoid concomitant use. Cytotoxics: St John’s wort possibly reduces plasmaconcentration of everolimus and .vinflunine—manufacturerof everolimus and vinflunine advises avoidconcomitant use; avoidance of St John’s wort advisedby manufacturer of gefitinib and .lapatinib; St John’swort reduces plasma concentration of .imatinib—avoid concomitant use; St John’s wort acceleratesmetabolism of .irinotecan (reduced plasma concentration—avoidconcomitant use). Diuretics: St John’s wort reduces plasma concentrationof .eplerenone—avoid concomitant use. 5HT 1 Agonists: increased serotonergic effects when StJohn’s wort given with .5HT 1 agonists—avoid concomitantuseIvabradine: St John’s wort reduces plasma concentrationof ivabradine—avoid concomitant useLipid-regulating Drugs: St John’s wort reduces plasmaconcentration of simvastatin. Oestrogens: St John’s wort reduces contraceptiveeffect of .oestrogens (avoid concomitant use). Progestogens: St John’s wort reduces contraceptiveeffect of .progestogens (avoid concomitant use). Tacrolimus: St John’s wort reduces plasma concentrationof .tacrolimus—avoid concomitant use. Theophylline: St John’s wort reduces plasma concentrationof .theophylline—avoid concomitant useUlcer-healing Drugs: St John’s wort possibly reducesplasma concentration of omeprazoleSt John’s Wort (continued). Ulipristal: avoidance of St John’s wort advised bymanufacturer of .ulipristal (contraceptive effect ofulipristal possibly reduced)Salbutamol see Sympathomimetics, Beta 2Salmeterol see Sympathomimetics, Beta 2Saquinavir. Analgesics: increased risk of ventricular arrhythmiaswhen saquinavir given with .alfentanil, .fentanyl or.methadone—avoid concomitant use. Anti-arrhythmics: increased risk of ventricular arrhythmiaswhen saquinavir given with .amiodarone,.disopyramide, .dronedarone, .flecainide,.lidocaine or .propafenone—avoid concomitant use. Antibacterials: increased risk of ventricular arrhythmiaswhen saquinavir given with .clarithromycin,.dapsone or .erythromycin—avoid concomitant use;saquinavir increases plasma concentration of.rifabutin (also plasma concentration of saquinavirreduced); plasma concentration of saquinavir significantlyreduced by .rifampicin, also risk of hepatotoxicity—avoidconcomitant use; avoidance ofconcomitant saquinavir in severe renal and hepaticimpairment advised by manufacturer of.telithromycinAnticoagulants: saquinavir possibly enhances anticoagulanteffect of warfarin; avoidance of saquinaviradvised by manufacturer of rivaroxaban. Antidepressants: increased risk of ventricular arrhythmiaswhen saquinavir given with .trazodone or.tricyclics—avoid concomitant use; plasma concentrationof saquinavir reduced by .St John’s wort—avoid concomitant use. Antiepileptics: plasma concentration of saquinavirpossibly reduced by carbamazepine,.phenobarbital and phenytoinAntifungals: plasma concentration of saquinavirincreased by ketoconazole; plasma concentration ofsaquinavir possibly increased by imidazoles andtriazoles. Antihistamines: increased risk of ventricular arrhythmiaswhen saquinavir given with .mizolastine—avoidconcomitant use. Antimalarials: caution with saquinavir advised bymanufacturer of artemether/lumefantrine; increasedrisk of ventricular arrhythmias when saquinavir givenwith .quinine—avoid concomitant useAntimuscarinics: avoidance of saquinavir advised bymanufacturer of darifenacin and tolterodine; manufacturerof fesoterodine advises dose reduction whensaquinavir given with fesoterodine—consult fesoterodineproduct literature. Antipsychotics: increased risk of ventricular arrhythmiaswhen saquinavir given with .clozapine,.haloperidol or .phenothiazines—avoid concomitantuse; saquinavir possibly inhibits metabolism of.aripiprazole (reduce dose of aripiprazole); saquinavirpossibly increases plasma concentration of.pimozide (increased risk of ventricular arrhythmias—avoidconcomitant use). Antivirals: increased risk of ventricular arrhythmiaswhen saquinavir given with .atazanavir or.lopinavir—avoid concomitant use; saquinavirreduces plasma concentration of darunavir; plasmaconcentration of saquinavir significantly reduced byefavirenz; plasma concentration of saquinavirincreased by indinavir and .ritonavir; saquinavirincreases plasma concentration of .maraviroc (considerreducing dose of maraviroc); plasma concentrationof saquinavir increased by .nelfinavir—manufacturer of saquinavir advises avoid concomitantuse; plasma concentration of saquinavir reducedby .tipranavir. Anxiolytics and Hypnotics: saquinavir increasesplasma concentration of .midazolam (risk of prolongedsedation—avoid concomitant use of oralmidazolam)Appendix 1: Interactions