▶Idelalisibis predicted to increase the exposure toalitretinoin.
Adjustalitretinoindose.oTheoretical
▶Macrolides(clarithromycin)are predicted to increase the
exposure toalitretinoin. Adjustalitretinoindose.o
Theoretical
▶Acitretinis predicted to increase the concentration of
methotrexate. Avoid.oAnecdotal
▶Sulfinpyrazoneis predicted to increase the exposure to
alitretinoin. Adjustalitretinoindose.oTheoretical
▶Retinoids(acitretin, alitretinoin, isotretinoin, tretinoin)increase
the risk of benign intracranial hypertension when given with
tetracyclines. Avoid.rAnecdotal
▶Bexaroteneis predicted to increase the risk of toxicity when
given withvitamin A. Adjust dose.oTheoretical
▶Retinoids(acitretin, alitretinoin, isotretinoin)are predicted to
increase the risk of vitamin A toxicity when given with
vitamin A. Avoid.rTheoretical
▶Tretinoinis predicted to increase the risk of vitamin A toxicity
when given withvitamin A. Avoid.rStudy
Ribavirin
▶Ribavirinis predicted to increase the exposure todidanosine.
Avoid.rStudy
▶Ribavirinincreases the risk of toxicity when given with
stavudine. Avoid.rStudy
▶Ribavirinincreases the risk of anaemia and/or leucopenia
when given withzidovudine. Avoid.rStudy
Ribociclib→seeTABLE 9p. 849 (QT-interval prolongation)
FOOD AND LIFESTYLEAvoid concomitant use of pomegranate
or pomegranate juice as it is predicted to increase ribociclib
exposure.▶Ribociclib(high-dose) is predicted to increase the exposure to
alpha blockers(alfuzosin). Avoid.oTheoretical
▶Antiarrhythmics(dronedarone)are predicted to increase the
exposure toribociclib.oStudy→Also seeTABLE 9p. 849
▶Ribociclib(high-dose) is predicted to increase the exposure to
antiarrhythmics(amiodarone). Avoid.oTheoretical→Also
seeTABLE 9p. 849
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to markedly decrease the
exposure toribociclib. Avoid.rStudy
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure toribociclib.o
Study→Also seeTABLE 9p. 849
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure toribociclib. Avoid or
adjustribociclibdose.oStudy→Also seeTABLE 9p. 849
▶Aprepitantis predicted to increase the exposure toribociclib.
oStudy
▶Bosentanis predicted to decrease the exposure toribociclib.
oStudy
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure toribociclib.oStudy
▶Ribociclibis predicted to increase the exposure tociclosporin.
Use with caution and adjust dose.oTheoretical
▶Cobicistatis predicted to increase the exposure toribociclib.
Avoid or adjustribociclibdose.oStudy
▶Crizotinibis predicted to increase the exposure toribociclib.
oStudy→Also seeTABLE 9p. 849
▶Efavirenzis predicted to decrease the exposure toribociclib.
oStudy→Also seeTABLE 9p. 849
▶Enzalutamideis predicted to markedly decrease the exposure
toribociclib. Avoid.rStudy
▶Ribociclib(high-dose) is predicted to increase the exposure to
ergotamine. Avoid.oTheoretical
▶Ribociclibis predicted to increase the exposure toeverolimus.
Use with caution and adjust dose.oTheoretical
▶Grapefruit juiceis predicted to increase the exposure to
ribociclib. Avoid.oTheoretical
▶HIV-protease inhibitorsare predicted to increase the exposure
toribociclib. Avoid or adjustribociclibdose.oStudy→
Also seeTABLE 9p. 849
▶Idelalisibis predicted to increase the exposure toribociclib.
Avoid or adjustribociclibdose.oStudy
▶Imatinibis predicted to increase the exposure toribociclib.
oStudy
▶Macrolides(clarithromycin)are predicted to increase the
exposure toribociclib. Avoid or adjustribociclibdose.o
Study→Also seeTABLE 9p. 849
▶Macrolides(erythromycin)are predicted to increase the
exposure toribociclib.oStudy→Also seeTABLE 9p. 849
▶Ribociclibmoderately increases the exposure tomidazolam.
Avoid.oStudy
▶Mitotaneis predicted to markedly decrease the exposure to
ribociclib. Avoid.rStudy
▶Netupitantis predicted to increase the exposure toribociclib.
oStudy
▶Nevirapineis predicted to decrease the exposure toribociclib.
oStudy
▶Nilotinibis predicted to increase the exposure toribociclib.
oStudy→Also seeTABLE 9p. 849
▶Ribociclibis predicted to increase the exposure toopioids
(alfentanil, fentanyl). Use with caution and adjust dose.
oTheoretical
▶Ribociclibis predicted to increase the exposure to
phosphodiesterase type-5 inhibitors(sildenafil). Avoid.o
Theoretical→Also seeTABLE 9p. 849
▶Ribociclib(high-dose) is predicted to increase the exposure to
pimozide. Avoid.oTheoretical→Also seeTABLE 9p. 849
▶Ribociclib(high-dose) is predicted to increase the exposure to
quetiapine. Avoid.oTheoretical
▶Rifampicinis predicted to markedly decrease the exposure to
ribociclib. Avoid.rStudy
▶Ribociclibis predicted to increase the exposure tosirolimus.
Use with caution and adjust dose.oTheoretical
▶St John’sWortis predicted to decrease the exposure to
ribociclib. Avoid.rStudy
▶Ribociclib(high-dose) is predicted to increase the exposure to
statins(simvastatin). Avoid.oTheoretical
▶Ribociclibis predicted to increase the exposure totacrolimus.
Use with caution and adjust dose.oTheoretical
Rifabutin
GENERAL INFORMATIONAlthough some manufacturers class
rifabutin as a potent inducer of CYP3A4, clinical data suggests
it is potentially a weak inducer, and therefore the BNF does
not extrapolate the interactions of potent CYP3A4 inducers to
rifabutin. For those who wish to err on the side of caution, see
the interactions of rifampicin but bear in mind other
mechanisms might be involved.
▶Antifungals, azoles(fluconazole)increase the risk of uveitis
when given withrifabutin. Adjust dose.rStudy
▶Antifungals, azoles(itraconazole, posaconazole)increase the
concentration ofrifabutinandrifabutindecreases the
concentration ofantifungals, azoles(itraconazole,
posaconazole). Avoid.rStudy
▶Antifungals, azoles(ketoconazole)are predicted to increase the
concentration ofrifabutinandrifabutinis predicted to
decrease the concentration ofantifungals, azoles
(ketoconazole). Avoid.rTheoretical
▶Antifungals, azoles(miconazole)are predicted to increase the
concentration ofrifabutin. Use with caution and adjust dose.
oTheoretical
▶Rifabutinis predicted to decrease the exposure toantifungals,
azoles(isavuconazole). Avoid.rTheoretical
▶Rifabutindecreases the concentration ofantifungals, azoles
(voriconazole)andantifungals, azoles(voriconazole)increase
the concentration ofrifabutin. Avoid or adjustvoriconazole
dose,p. 377.rStudy
▶Rifabutinslightly decreases the exposure toantimalarials
(atovaquone). Avoid.oStudy
▶Rifabutindecreases the concentration ofcobicistatand
cobicistatincreases the exposure torifabutin. Avoid or adjust
dose.rStudy
▶Rifabutinis predicted to decrease the efficacy ofcombined
hormonal contraceptives. For FSRH guidance, see
Contraceptives, interactionsp. 497.rStudy
▶Rifabutindecreases the exposure todapsone.oStudy
▶Rifabutinis predicted to decrease the efficacy ofdesogestrel.
For FSRH guidance, seeContraceptives, interactionsp. 497.
rTheoreticalBNFC 2018 – 2019 Retinoids—Rifabutin 981
Interactions|Appendix 1A1