BNF for Children (BNFC) 2018-2019

▶Pibrentasvir(with glecaprevir) increases the exposure to
statins(rosuvastatin). Use with caution and adjustrosuvastatin
dose,p. 133.oStudy
Pilocarpine

ROUTE-SPECIFIC INFORMATIONSince systemic absorption can

follow topical application, the possibility of interactions

should be borne in mind.

Pimecrolimus
▶Alcohol (beverage)increases the risk of facialflushing and skin
irritation when given with topicalpimecrolimus.o
Study
▶Pimecrolimusis predicted to decrease the efficacy of
mifamurtide. Avoid.rTheoretical
Pimozide→seeTABLE 8p. 848 (hypotension),TABLE 9p. 849 (QT-
interval prolongation),TABLE 11p. 849 (CNS depressant effects),
TABLE 10p. 849 (antimuscarinics)
▶Antiarrhythmics(dronedarone)are predicted to increase the
exposure topimozide. Avoid.rTheoretical→Also see
TABLE 9p. 849
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure topimozide. Avoid.
rTheoretical→Also seeTABLE 9p. 849
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure topimozide. Avoid.r
Study→Also seeTABLE 9p. 849
▶Antifungals, azoles(miconazole)are predicted to increase the
exposure topimozide. Avoid.oTheoretical
▶Aprepitantis predicted to increase the exposure topimozide.
Avoid.rTheoretical
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure topimozide. Avoid.rTheoretical→
Also seeTABLE 8p. 848
▶Ceritinibis predicted to increase the exposure topimozide.
Avoid.rTheoretical→Also seeTABLE 9p. 849
▶Cobicistatis predicted to increase the exposure topimozide.
Avoid.rStudy
▶Crizotinibis predicted to increase the exposure topimozide.
Avoid.rTheoretical→Also seeTABLE 9p. 849
▶Pimozideis predicted to decrease the effects ofdopamine
receptor agonists. Avoid.oTheoretical→Also seeTABLE 8
p. 848→Also seeTABLE 9p. 849→Also seeTABLE 10p. 849
▶Fosaprepitantis predicted to increase the exposure to
pimozide. Avoid.rTheoretical
▶Grapefruit juiceincreases the exposure topimozide. Avoid.
rTheoretical
▶HIV-protease inhibitorsare predicted to increase the exposure
topimozide. Avoid.rStudy→Also seeTABLE 9p. 849
▶Idelalisibis predicted to increase the exposure topimozide.
Avoid.rStudy
▶Imatinibis predicted to increase the exposure topimozide.
Avoid.rTheoretical
▶Pimozidedecreases the effects oflevodopa.rTheoretical→
Also seeTABLE 8p. 848
▶Macrolides(clarithromycin)are predicted to increase the
exposure topimozide. Avoid.rStudy→Also seeTABLE 9
p. 849
▶Macrolides(erythromycin)are predicted to increase the
exposure topimozide. Avoid.rTheoretical→Also see
TABLE 9p. 849
▶Netupitantis predicted to increase the exposure topimozide.
Avoid.rTheoretical
▶Nilotinibis predicted to increase the exposure topimozide.
Avoid.rTheoretical→Also seeTABLE 9p. 849
▶Palbociclibis predicted to increase the exposure topimozide.
Adjust dose.oTheoretical
▶Panobinostatis predicted to increase the exposure to
pimozide. Avoid.rTheoretical→Also seeTABLE 9p. 849
▶Pitolisantis predicted to decrease the exposure topimozide.
Avoid.rTheoretical
▶Ribociclib(high-dose) is predicted to increase the exposure to
pimozide. Avoid.oTheoretical→Also seeTABLE 9p. 849
▶Rolapitantis predicted to increase the exposure topimozide.
rStudy
Pindolol→see beta blockers, non-selective
Pioglitazone→seeTABLE 14p. 850 (antidiabetic drugs)

▶Pioglitazonepotentially decreases the exposure toantifungals,

azoles(isavuconazole). Use with caution or avoid.o

Theoretical

▶Clopidogrelincreases the exposure topioglitazone. Monitor

blood glucose and adjust dose.rStudy

▶Fibrates(gemfibrozil)increase the exposure topioglitazone.

Monitor blood glucose and adjust dose.rStudy

▶Leflunomideis predicted to increase the exposure to

pioglitazone.oStudy

▶Opicaponeis predicted to increase the exposure to

pioglitazone. Avoid.oStudy

▶Rifampicinmoderately decreases the exposure topioglitazone.

Monitor and adjust dose.oStudy

▶St John’sWortslightly decreases the exposure topioglitazone.

nStudy

▶Teriflunomideis predicted to increase the exposure to

pioglitazone.oStudy

Piperacillin→see penicillins

Piperaquine→see antimalarials

Pirfenidone

FOOD AND LIFESTYLESmoking increases pirfenidone

clearance; patients should be encouraged to stop smoking

before and during treatment with pirfenidone.

▶Antiepileptics(fosphenytoin, phenytoin)are predicted to

decrease the exposure topirfenidone.oTheoretical

▶Combined hormonal contraceptivesare predicted to increase

the exposure topirfenidone. Use with caution and adjust dose.

oStudy

▶HIV-protease inhibitors(ritonavir)are predicted to decrease the

exposure topirfenidone.oTheoretical

▶Leflunomideis predicted to decrease the exposure to

pirfenidone.oTheoretical

▶Quinolones(ciprofloxacin)are predicted to increase the

exposure topirfenidone. Use with caution and adjust dose.

oStudy

▶Rifampicinis predicted to decrease the exposure to

pirfenidone. Avoid.oTheoretical

▶SSRIs(fluvoxamine)are predicted to moderately increase the

exposure topirfenidone. Avoid.oStudy

▶Teriflunomideis predicted to decrease the exposure to

pirfenidone.oTheoretical

Piroxicam→see NSAIDs

Pitolisant

▶Abirateroneis predicted to increase the exposure topitolisant.

Use with caution and adjust dose.oStudy

▶Antiarrhythmics(propafenone)are predicted to increase the

exposure topitolisant. Use with caution and adjust dose.

oStudy

▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone)are predicted to moderately decrease

the exposure topitolisant.oStudy

▶Antihistamines, sedatingare predicted to decrease the efficacy

ofpitolisant.qTheoretical

▶Pitolisantis predicted to decrease the exposure tobosutinib.

Avoid.rTheoretical

▶Bupropionis predicted to moderately increase the exposure to

pitolisant. Use with caution and adjust dose.oStudy

▶Pitolisantis predicted to decrease the exposure tociclosporin.

Avoid.rTheoretical

▶Cinacalcetis predicted to moderately increase the exposure to

pitolisant. Use with caution and adjust dose.oStudy

▶Pitolisantis predicted to decrease the efficacy ofcombined

hormonal contraceptives. Avoid.rTheoretical

▶Pitolisantis predicted to decrease the exposure tocoumarins

(warfarin).qTheoretical

▶Pitolisantis predicted to decrease the exposure tocrizotinib.

Avoid.rTheoretical

▶Pitolisantis predicted to decrease the exposure todabigatran.

qTheoretical

▶Pitolisantis predicted to decrease the exposure todasatinib.

Avoid.rTheoretical

▶Pitolisantis predicted to decrease the exposure todigoxin.

qTheoretical

▶Duloxetineis predicted to increase the exposure topitolisant.

Use with caution and adjust dose.oStudy

BNFC 2018 – 2019 Pibrentasvir—Pitolisant 975

Interactions

|Appendix 1

A1