▶SSRIs(fluoxetine, paroxetine)are predicted to moderately
increase the exposure topitolisant. Use with caution and
adjust dose.oStudy
▶Fluvoxaminemoderately increases the exposure to
pomalidomide. Adjustpomalidomidedose.oStudy
▶Paroxetineslightly increases the exposure toprocyclidine.
Monitor and adjust dose.oStudy
▶Proton pump inhibitors(esomeprazole)are predicted to slightly
to moderately increase the exposure toSSRIs(citalopram,
escitalopram). Monitor and adjust dose.rTheoretical
▶Proton pump inhibitors(omeprazole)slightly to moderately
increase the exposure toSSRIs(citalopram, escitalopram).
Monitor and adjust dose.rStudy
▶Fluvoxamineis predicted to increase the exposure toriluzole.
oTheoretical
▶SSRIs(fluoxetine, paroxetine)are predicted to increase the
exposure torisperidone. Adjust dose.oStudy
▶Fluvoxamineis predicted to increase the exposure to
roflumilast.oStudy
▶SSRIs(fluoxetine, paroxetine)are predicted to increase the
exposure toSSRIs(dapoxetine).oTheoretical→Also see
TABLE 18p. 851→Also seeTABLE 13p. 850→Also seeTABLE 4p. 847
▶SSRIspotentially increase the risk of prolonged
neuromuscular blockade when given withsuxamethonium.
qTheoretical
▶SSRIs(fluoxetine, paroxetine)are predicted to decrease the
efficacy oftamoxifen. Avoid.rStudy
▶Terbinafineis predicted to increase the exposure tofluoxetine.
Adjust dose.oTheoretical
▶Terbinafinemoderately increases the exposure toparoxetine.
oStudy
▶Terbinafineis predicted to increase the exposure toSSRIs
(citalopram, dapoxetine, escitalopram, fluvoxamine, sertraline).
oTheoretical
▶Fluvoxaminemoderately to markedly increases the exposure
totheophylline. Avoid.rStudy
▶Fluvoxaminevery markedly increases the exposure to
tizanidine. Avoid.rStudy
▶SSRIs(fluoxetine, paroxetine)are predicted to increase the
exposure totricyclic antidepressants. Monitor for toxicity and
adjust dose.rStudy→Also seeTABLE 18p. 851→Also see
TABLE 13p. 850
▶Fluvoxamineincreases the exposure totricyclic antidepressants
(amitriptyline, imipramine). Adjust dose.rStudy→Also see
TABLE 18p. 851→Also seeTABLE 13p. 850
▶Fluvoxaminemarkedly increases the exposure totricyclic
antidepressants(clomipramine). Adjust dose.rStudy→Also
seeTABLE 18p. 851→Also seeTABLE 13p. 850
▶SSRIs(fluoxetine, paroxetine)are predicted to increase the
exposure tovortioxetine. Monitor and adjust dose.o
Study→Also seeTABLE 13p. 850→Also seeTABLE 4p. 847
▶Fluvoxamineis predicted to increase the exposure to
zolmitriptan. Adjustzolmitriptandose,p. 292.r
Theoretical→Also seeTABLE 13p. 850
St John’sWort→seeTABLE 13p. 850 (serotonin syndrome)
▶St John’s Wortis predicted to decrease the exposure to
afatinib.oStudy
▶St John’s Wortis predicted to slightly decrease the exposure to
aldosterone antagonists(eplerenone). Avoid.oStudy
▶St John’s Wortdecreases the exposure toaliskiren.o
Study
▶St John’s Wortmoderately decreases the exposure to
alprazolam.oStudy
▶St John’s Wortis predicted to decrease the concentration of
aminophylline.rTheoretical
▶St John’s Wortis predicted to decrease the exposure to
antiarrhythmics(dronedarone). Avoid.rTheoretical
▶St John’s Wortis predicted to decrease the exposure to
antiepileptics(brivaracetam).oTheoretical
▶St John’s Wortis predicted to decrease the concentration of
antiepileptics(carbamazepine). Monitor and adjust dose.
oTheoretical
▶St John’s Wortis predicted to decrease the concentration of
antiepileptics(fosphenytoin, phenobarbital, phenytoin,
primidone). Avoid.rTheoretical
▶St John’sWortis predicted to decrease the exposure to
antiepileptics(perampanel). Monitor and adjust dose.o
Theoretical
▶St John’sWortis predicted to decrease the exposure to
antiepileptics(tiagabine). Avoid.nTheoretical
▶St John’sWortis predicted to decrease the exposure to
antifungals, azoles(isavuconazole). Avoid.rTheoretical
▶St John’sWortmoderately decreases the exposure to
antifungals, azoles(voriconazole). Avoid.oStudy
▶St John’sWortis predicted to decrease the concentration of
antimalarials(piperaquine). Avoid.oTheoretical
▶St John’sWortis predicted to decrease the exposure to
apixaban. Use with caution or avoid.oTheoretical
▶St John’sWortis predicted to decrease the exposure to
apremilast. Avoid.rTheoretical
▶St John’sWortis predicted to decrease the exposure to
aprepitant. Avoid.oTheoretical
▶St John’sWortis predicted to decrease the exposure toaxitinib.
oTheoretical
▶St John’sWortis predicted to decrease the exposure to
bedaquiline. Avoid.rStudy
▶St John’sWortis predicted to decrease the exposure to
bosentan. Avoid.oTheoretical
▶St John’sWortis predicted to decrease the exposure to
bosutinib. Avoid.rTheoretical
▶St John’sWortis predicted to decrease the exposure to
cabozantinib.oTheoretical
▶St John’sWortis predicted to decrease the exposure tocalcium
channel blockers(amlodipine, felodipine, lacidipine,
lercanidipine, nicardipine, nifedipine, nimodipine). Monitor and
adjust dose.oTheoretical
▶St John’sWortis predicted to decrease the exposure tocalcium
channel blockers(diltiazem, verapamil).oTheoretical
▶St John’sWortis predicted to decrease the exposure to
ceritinib. Avoid.rTheoretical
▶St John’sWortdecreases the concentration ofciclosporin.
Avoid.oStudy
▶St John’sWortis predicted to alter the effects ofcilostazol.
oTheoretical
▶St John’sWortis predicted to decrease the exposure to
cobicistat. Avoid.rTheoretical
▶St John’sWortis predicted to decrease the exposure to
cobimetinib. Avoid.rTheoretical
▶St John’sWortdecreases the efficacy ofcombined hormonal
contraceptives. MHRA advises avoid. For FSRH guidance, see
Contraceptives, interactionsp. 497.rAnecdotal
▶St John’sWortdecreases the anticoagulant effect ofcoumarins.
Avoid.rAnecdotal
▶St John’sWortis predicted to decrease the exposure to
crizotinib. Avoid.rTheoretical
▶St John’sWortis predicted to decrease the exposure to
dabigatran. Avoid.rStudy
▶St John’sWortis predicted to decrease the exposure to
daclatasvir. Avoid.rTheoretical
▶St John’sWortis predicted to decrease the exposure to
darifenacin.oTheoretical
▶St John’sWortis predicted to decrease the exposure to
dasabuvir. Avoid.rTheoretical
▶St John’sWortis predicted to decrease the exposure to
dasatinib.rStudy
▶St John’sWortis predicted to decrease the efficacy of
desogestrel. MHRA advises avoid. For FSRH guidance, see
Contraceptives, interactionsp. 497.rTheoretical
▶St John’sWortdecreases the concentration ofdigoxin. Avoid.
rAnecdotal
▶St John’sWortdecreases the exposure todolutegravir. Adjust
dose.rStudy
▶St John’sWortis predicted to decrease the exposure to
edoxaban.oStudy
▶St John’sWortis predicted to decrease the concentration of
efavirenz. Avoid.rTheoretical
▶St John’sWortis predicted to moderately decrease the
exposure toelbasvir. Avoid.rStudy
▶St John’sWortis predicted to increase the exposure to
eliglustat. Avoid.rStudyBNFC 2018 – 2019 SSRIs—St John’s Wort 991
Interactions|Appendix 1A1