Aldosterone antagonists(continued)
▶Rifampicinis predicted to decrease the exposure to
eplerenone. Avoid.oTheoretical
▶St John’s Wortis predicted to slightly decrease the exposure to
eplerenone. Avoid.oStudy
Alectinib→seeTABLE 6p. 848 (bradycardia),TABLE 1p. 847
(hepatotoxicity)
Alemtuzumab→see monoclonal antibodies
Alendronic acid→see bisphosphonates
Alfacalcidol→see vitamin D substances
Alfentanil→see opioids
Alfuzosin→see alpha blockers
Alimemazine→see antihistamines, sedating
Aliskiren→seeTABLE 8p. 848 (hypotension),TABLE 16p. 851 (increased
serum potassium)
FOOD AND LIFESTYLEAvoid apple juice and orange juice as
they greatly decrease aliskiren concentrations and plasma
renin activity.
▶ACE inhibitorsincrease the risk of renal impairment when
given withaliskiren. Use with caution or avoidaliskirenin
selected patients.rStudy→Also seeTABLE 8p. 848→Also
seeTABLE 16p. 851
▶Angiotensin-II receptor antagonistsincrease the risk of renal
impairment when given withaliskiren. Use with caution or
avoidaliskirenin selected patients.rStudy→Also see
TABLE 8p. 848→Also seeTABLE 16p. 851
▶Antiarrhythmics(amiodarone, dronedarone)are predicted to
increase the exposure toaliskiren.rStudy
▶Antiepileptics(carbamazepine)decrease the exposure to
aliskiren.oStudy
▶Antifungals, azoles(itraconazole)markedly increase the
exposure toaliskiren. Avoid.rStudy
▶Antifungals, azoles(ketoconazole)moderately increase the
exposure toaliskiren.oStudy
▶Calcium channel blockers(verapamil)moderately increase the
exposure toaliskiren.oStudy→Also seeTABLE 8p. 848
▶Ceritinibis predicted to increase the exposure toaliskiren.
oTheoretical
▶Ciclosporinmarkedly increases the exposure toaliskiren.
Avoid.rStudy→Also seeTABLE 16p. 851
▶Eliglustatis predicted to increase the exposure toaliskiren.
Adjust dose.oStudy
▶Grapefruit juicemoderately decreases the exposure to
aliskiren. Avoid.rStudy
▶HIV-protease inhibitors(ritonavir, saquinavir)are predicted to
increase the exposure toaliskiren.oTheoretical
▶Lapatinibis predicted to increase the exposure toaliskiren.
oTheoretical
▶Aliskirenslightly decreases the exposure toloop diuretics
(furosemide).oStudy→Also seeTABLE 8p. 848
▶Macrolides(azithromycin)are predicted to increase the
exposure toaliskiren.oTheoretical
▶Macrolides(clarithromycin, erythromycin)are predicted to
increase the exposure toaliskiren.oStudy
▶Mirabegronis predicted to increase the exposure toaliskiren.
nTheoretical
▶Ranolazineis predicted to increase the exposure toaliskiren.
oTheoretical
▶Rifampicindecreases the exposure toaliskiren.oStudy
▶St John’s Wortdecreases the exposure toaliskiren.o
Study
▶Statins(atorvastatin)slightly to moderately increase the
exposure toaliskiren.oStudy
▶Velpatasviris predicted to increase the exposure toaliskiren.
rTheoretical
▶Vemurafenibis predicted to increase the exposure toaliskiren.
Use with caution and adjust dose.oTheoretical
Alitretinoin→see retinoids
Alkylating agents→seeTABLE 15p. 850 (myelosuppression),TABLE 2
p. 847 (nephrotoxicity),TABLE 5p. 847 (thromboembolism)
bendamustine.busulfan.carmustine.chlorambucil.
cyclophosphamide.dacarbazine.estramustine.ifosfamide.
lomustine.melphalan.temozolomide.thiotepa.treosulfan..▶Antacidsare predicted to decrease the absorption of
estramustine. Avoid.oStudy
▶Antifungals, azoles(isavuconazole)are predicted to increase the
exposure tocyclophosphamide.oStudy
▶Antifungals, azoles(itraconazole)increase the risk of busulfan
toxicity when given withbusulfan. Monitor and adjust dose.
oStudy
▶Antifungals, azoles(miconazole)are predicted to increase the
concentration ofbusulfan. Use with caution and adjust dose.
oTheoretical
▶Oralcalcium saltsdecrease the absorption ofestramustine.
rStudy
▶Live vaccinesare predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
alkylating agents. Public Health England advises avoid (refer
to Green Book).rTheoretical
▶Metronidazoleincreases the risk of toxicity when given with
busulfan.rStudy
▶Paracetamolis predicted to decrease the clearance ofbusulfan.
oTheoretical
▶Cyclophosphamide(high-dose) increases the risk of toxicity
when given withpentostatin. Avoid.rAnecdotal→Also see
TABLE 15p. 850→Also seeTABLE 5p. 847
▶Rolapitantis predicted to increase the exposure to
bendamustine. Avoid or monitor.oStudy
▶Cyclophosphamideincreases the risk of prolonged
neuromuscular blockade when given withsuxamethonium.
oStudy
Allopurinol
▶ACE inhibitorsare predicted to increase the risk of
hypersensitivity and haematological reactions when given
withallopurinol.rAnecdotal
▶Allopurinolpotentially increases the risk of haematological
toxicity when given withazathioprine. Adjustazathioprine
dose,p. 518.rStudy
▶Allopurinolis predicted to decrease the effects ofcapecitabine.
Avoid.rStudy
▶Allopurinolmoderately increases the exposure todidanosine.
Avoid.rStudy
▶Allopurinolpotentially increases the risk of haematological
toxicity when given withmercaptopurine. Adjust
mercaptopurinedose,p. 543.rStudy
▶Allopurinolincreases the risk of skin rash when given with
penicillins(amoxicillin, ampicillin).oStudy
▶Allopurinolis predicted to increase the risk of hyperuricaemia
when given withpyrazinamide.oTheoretical
▶Thiazide diureticsare predicted to increase the risk of
hypersensitivity reactions when given withallopurinol.r
Theoretical
Almotriptan→seeTABLE 13p. 850 (serotonin syndrome)
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)
increase the exposure toalmotriptan.nStudy
▶Cobicistatincreases the exposure toalmotriptan.nStudy
▶Almotriptanis predicted to increase the risk of
vasoconstriction when given withergotamine.Ergotamine
should be taken at least 24 hours before or 6 hours after
almotriptan.rTheoretical
▶HIV-protease inhibitorsincrease the exposure toalmotriptan.
nStudy
▶Idelalisibincreases the exposure toalmotriptan.nStudy
▶Macrolides(clarithromycin)increase the exposure to
almotriptan.nStudy
Alogliptin→seeTABLE 14p. 850 (antidiabetic drugs)
Alpha blockers→seeTABLE 7p. 848 (first-dose hypotension),TABLE 8
p. 848 (hypotension)
alfuzosin.doxazosin.indoramin.prazosin.tamsulosin.terazosin..
▶Antiarrhythmics(dronedarone)are predicted to increase the
exposure totamsulosin.oTheoretical
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure totamsulosin.o
Theoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure todoxazosin.o
Study854 Aldosterone antagonists—Alpha blockers BNFC 2018 – 2019
Interactions|Appendix 1A1