▶Rifampicinis predicted to decrease the concentration of
sirolimus. Avoid.rStudy
▶St John’s Wortis predicted to decrease the concentration of
sirolimus. Monitor and adjust dose.rTheoretical
▶Sirolimusis predicted to decrease the concentration of
tacrolimusandtacrolimusincreases the exposure tosirolimus.
rStudy
▶Velpatasviris predicted to increase the exposure tosirolimus.
rTheoretical
Sitagliptin→seeTABLE 14p. 850 (antidiabetic drugs)
Sodium aurothiomalate
▶ACE inhibitorsare predicted to increase the risk of
hypersensitivity when given withsodium aurothiomalate.
rAnecdotal
▶Sodium aurothiomalatepotentially increases the risk of side-
effects when given withpenicillamine(in those who have had
previous adverse reactions to gold). Avoid.rStudy
Sodium bicarbonate
▶Oralsodium bicarbonatedecreases the absorption of
antifungals, azoles(ketoconazole).oStudy
▶Sodium bicarbonatedecreases the concentration oflithium.
rAnecdotal
▶Sodium bicarbonateis predicted to decrease the efficacy of
methenamine. Avoid.oTheoretical
Sodium citrate
▶Sodium citrateis predicted to decrease the efficacy of
methenamine. Avoid.oTheoretical
▶Sodium citrateis predicted to increase the risk of side-effects
when given withsucralfate. Avoid.oTheoretical
Sodium clodronate→see bisphosphonates
Sodium feredetate→see iron (oral)
Sodium nitroprusside→seeTABLE 8p. 848 (hypotension)
▶Sodium nitroprussideis predicted to increase the risk of
methaemoglobinaemia when given with topicalanaesthetics,
local(prilocaine). Use with caution or avoid.rTheoretical
▶Sodium nitroprussideis predicted to increase the risk of
methaemoglobinaemia when given withdapsone.r
Theoretical
Sodium oxybate→seeTABLE 8p. 848 (hypotension),TABLE 11p. 849
(CNS depressant effects)
▶Antiepileptics(valproate)increase the exposure tosodium
oxybate. Adjustsodium oxybatedose.oStudy
Sodium phenylbutyrate
▶Antiepileptics(valproate)potentially decrease the effects of
sodium phenylbutyrate.oAnecdotal
▶Corticosteroidspotentially decrease the effects ofsodium
phenylbutyrate.oAnecdotal
▶Haloperidolpotentially decreases the effects ofsodium
phenylbutyrate.oAnecdotal
Sodium picosulfate→seeTABLE 18p. 851 (hyponatraemia)
Sodium stibogluconate
▶Sodium stibogluconateincreases the risk of cardiovascular
side-effects when given withamphotericin. Separate
administration by 14 days.rStudy
Sofosbuvir
▶Sofosbuviris predicted to increase the risk of severe
bradycardia or heart block when given withantiarrhythmics
(amiodarone). Refer to specialist literature.rAnecdotal
▶Antiepileptics(carbamazepine)are predicted to decrease the
exposure tosofosbuvir. Avoid.rStudy
▶Antiepileptics(fosphenytoin, oxcarbazepine, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tosofosbuvir. Avoid.rTheoretical
▶H 2 receptor antagonistspotentially decrease the exposure to
sofosbuvir. Adjust dose, seeledipasvir with sofosbuvirp. 401,
sofosbuvir with velpatasvir, and sofosbuvir with velpatasvir and
voxilaprevir.oStudy
▶HIV-protease inhibitors(tipranavir)are predicted to decrease the
exposure tosofosbuvir. Avoid.rTheoretical
▶Proton pump inhibitorspotentially decrease the exposure to
sofosbuvir. Adjust dose, seeledipasvir with sofosbuvirp. 401,
sofosbuvir with velpatasvir, and sofosbuvir with velpatasvir and
voxilaprevir.oStudy
▶Rifampicinis predicted to decrease the exposure tosofosbuvir.
Avoid.rStudy
▶St John’sWortis predicted to decrease the exposure to
sofosbuvir. Avoid.rStudy
Solifenacin→seeTABLE 10p. 849 (antimuscarinics)
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tosolifenacin.oTheoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure tosolifenacin. Adjust
solifenacinortamsulosin with solifenacindose; avoid in
hepatic and renal impairment.rStudy
▶Cobicistatis predicted to increase the exposure tosolifenacin.
Adjustsolifenacinortamsulosin with solifenacindose; avoid in
hepatic and renal impairment.rStudy
▶Enzalutamideis predicted to decrease the exposure to
solifenacin.oTheoretical
▶HIV-protease inhibitorsare predicted to increase the exposure
tosolifenacin. Adjustsolifenacinortamsulosin with solifenacin
dose; avoid in hepatic and renal impairment.rStudy
▶Idelalisibis predicted to increase the exposure tosolifenacin.
Adjustsolifenacinortamsulosin with solifenacindose; avoid in
hepatic and renal impairment.rStudy
▶Macrolides(clarithromycin)are predicted to increase the
exposure tosolifenacin. Adjustsolifenacinortamsulosin with
solifenacindose; avoid in hepatic and renal impairment.
rStudy
▶Mitotaneis predicted to decrease the exposure tosolifenacin.
oTheoretical
▶Rifampicinis predicted to decrease the exposure tosolifenacin.
oTheoretical
Somatropin
▶Corticosteroidsare predicted to decrease the effects of
somatropin.oTheoretical
Sorafenib→seeTABLE 15p. 850 (myelosuppression),TABLE 9p. 849
(QT-interval prolongation)
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tosorafenib.oTheoretical
▶Sorafenibincreases the anticoagulant effect ofcoumarins.
rAnecdotal
▶Enzalutamideis predicted to decrease the exposure to
sorafenib.oTheoretical
▶Mitotaneis predicted to decrease the exposure tosorafenib.
oTheoretical→Also seeTABLE 15p. 850
▶Neomycinmoderately decreases the exposure tosorafenib.
oStudy
▶Sorafenibis predicted to increase the risk of bleeding events
when given withphenindione.rTheoretical
▶Rifampicinis predicted to decrease the exposure tosorafenib.
oTheoretical
Sotalol→see beta blockers, non-selective
Spironolactone→see aldosterone antagonists
SSRIs→seeTABLE 18p. 851 (hyponatraemia),TABLE 13p. 850 (serotonin
syndrome),TABLE 9p. 849 (QT-interval prolongation),TABLE 4p. 847
(antiplatelet effects)
citalopram.dapoxetine.escitalopram.fluoxetine.fluvoxamine.
paroxetine.sertraline..
▶Fluvoxaminevery markedly increases the exposure to
agomelatine. Avoid.rStudy
▶Fluvoxaminemoderately increases the exposure toalprazolam.
Adjust dose.oStudy
▶SSRIs(fluoxetine, paroxetine)are predicted to increase the
exposure toamfetamines.rTheoretical→Also seeTABLE 13
p. 850
▶Fluvoxaminemoderately to markedly increases the exposure
toaminophylline. Avoid.rStudy
▶Fluvoxaminedecreases the clearance ofanaesthetics, local
(ropivacaine). Avoid prolonged use.oStudy
▶Fluvoxamineis predicted to increase the exposure to
anagrelide.oTheoretical→Also seeTABLE 4p. 847
▶Antiarrhythmics(dronedarone)are predicted to increase the
exposure todapoxetine. Adjustdapoxetinedose with moderate
inhibitors of CYP3A4.oTheoretical
▶Antiarrhythmics(dronedarone)are predicted to increase the
exposure toSSRIs(citalopram, escitalopram, fluoxetine,BNFC 2018 – 2019 Sirolimus—SSRIs 989
Interactions|Appendix 1A1