Antiarrhythmics(continued)
▶Dronedaroneis predicted to increase the exposure tovinca
alkaloids.rTheoretical→Also seeTABLE 9p. 849
▶Dronedaroneis predicted to increase the exposure to
zopiclone. Adjust dose.oStudy
Anticholinesterases, centrally acting→seeTABLE 6p. 848
(bradycardia)
donepezil.galantamine.rivastigmine..
▶Antiarrhythmics(amiodarone)increase the risk of bradycardia
when given withanticholinesterases, centrally acting.o
Anecdotal→Also seeTABLE 6p. 848
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
todonepezil.nStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure togalantamine. Monitor
and adjust dose.oStudy
▶Anticholinesterases, centrally actingare predicted to increase
the risk of bradycardia when given withbeta blockers, non-
selective.oAnecdotal→Also seeTABLE 6p. 848
▶Anticholinesterases, centrally actingare predicted to increase
the risk of bradycardia when given withbeta blockers,
selective.oAnecdotal→Also seeTABLE 6p. 848
▶Bupropionis predicted to increase the exposure to
galantamine. Monitor and adjust dose.oStudy
▶Calcium channel blockers(diltiazem, verapamil)increase the risk
of bradycardia when given withanticholinesterases, centrally
acting.oAnecdotal→Also seeTABLE 6p. 848
▶Cinacalcetis predicted to increase the exposure to
galantamine. Monitor and adjust dose.oStudy
▶Cobicistatis predicted to increase the exposure to
galantamine. Monitor and adjust dose.oStudy
▶Enzalutamideis predicted to decrease the exposure to
donepezil.nStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
togalantamine. Monitor and adjust dose.oStudy
▶Idelalisibis predicted to increase the exposure togalantamine.
Monitor and adjust dose.oStudy
▶Macrolides(clarithromycin)are predicted to increase the
exposure togalantamine. Monitor and adjust dose.o
Study
▶Mitotaneis predicted to decrease the exposure todonepezil.
nStudy
▶Anticholinesterases, centrally actingare predicted to decrease
the effects ofneuromuscular blocking drugs, non-depolarising.
oTheoretical→Also seeTABLE 6p. 848
▶Rifampicinis predicted to decrease the exposure todonepezil.
nStudy
▶SSRIs(fluoxetine, paroxetine)are predicted to increase the
exposure togalantamine. Monitor and adjust dose.o
Study
▶Anticholinesterases, centrally actingincrease the effects of
suxamethonium.oTheoretical
▶Terbinafineis predicted to increase the exposure to
galantamine. Monitor and adjust dose.oStudy
Antiepileptics→seeTABLE 1p. 847 (hepatotoxicity),TABLE 18p. 851
(hyponatraemia),TABLE 15p. 850 (myelosuppression),TABLE 12p. 850
(peripheral neuropathy),TABLE 11p. 849 (CNS depressant effects)
brivaracetam.carbamazepine.eslicarbazepine.ethosuximide.
fosphenytoin.gabapentin.lacosamide.lamotrigine.
levetiracetam.oxcarbazepine.paraldehyde.perampanel.
phenobarbital.phenytoin.pregabalin.primidone.retigabine.
rufinamide.stiripentol.tiagabine.topiramate.valproate.
vigabatrin.zonisamide..FOOD AND LIFESTYLEAvoiding milk or dairy products,
carbonated drinks, and fruit juices at the same time
as stiripentol.
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
toabacavir.oTheoretical
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
toabiraterone. Avoid.rTheoretical▶Acetazolamidepotentially increases the risk of toxicity when
given withvalproate.rStudy
▶Acetazolamidepotentially increases the risk of overheating
and dehydration when given withzonisamide. Avoid in
children.rTheoretical
▶Carbamazepineis predicted to decrease the exposure to
afatinib.oStudy
▶Antiepileptics(fosphenytoin, phenytoin)are predicted to
decrease the exposure toagomelatine.oTheoretical
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)decrease the concentration of
albendazole.oStudy
▶Alcohol (beverage)potentially increases the risk of visual
disturbances when given withretigabine.oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
toaldosterone antagonists(eplerenone). Avoid.o
Theoretical→Also seeTABLE 18p. 851
▶Carbamazepinedecreases the exposure toaliskiren.o
Study
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
toalprazolam. Adjust dose.oTheoretical→Also see
TABLE 11p. 849
▶Fosphenytoinis predicted to decrease the exposure to
aminophylline. Adjust dose.oStudy
▶Phenobarbitalis predicted to decrease the exposure to
aminophylline. Adjust dose.oTheoretical
▶Phenytoindecreases the exposure toaminophylline. Adjust
dose.oStudy
▶Primidoneis predicted to increase the clearance of
aminophylline. Adjust dose.oTheoretical
▶Stiripentolis predicted to increase the exposure to
aminophylline. Avoid.oTheoretical
▶Antiepileptics(fosphenytoin, phenobarbital, phenytoin,
primidone)are predicted to increase the risk of
methaemoglobinaemia when given with topicalanaesthetics,
local(prilocaine). Use with caution or avoid.r
Theoretical→Also seeTABLE 11p. 849
▶Phenytoinis predicted to decrease the exposure to
anaesthetics, local(ropivacaine).oTheoretical
▶Antacidsdecrease the absorption ofgabapentin.Gabapentin
should be taken 2 hours afterantacids.oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
toantiarrhythmics(disopyramide, dronedarone). Avoid.r
Study
▶Antiarrhythmics(amiodarone)are predicted to slightly increase
the concentration ofantiepileptics(fosphenytoin, phenytoin).
Monitor and adjust dose.rStudy→Also seeTABLE 12p. 850
▶Antiepileptics(fosphenytoin, phenytoin)are predicted to
decrease the exposure toantiarrhythmics(lidocaine).r
Anecdotal
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the efficacy of
antiarrhythmics(propafenone).oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
toanticholinesterases, centrally acting(donepezil).nStudy
▶Antiepileptics(carbamazepine)decrease the concentration of
antiepileptics(brivaracetam).oStudy
▶Antiepileptics(fosphenytoin, phenytoin)decrease the
concentration ofantiepileptics(brivaracetam).oStudy
▶Antiepileptics(lamotrigine)potentially increase the
concentration ofantiepileptics(carbamazepine)and
antiepileptics(carbamazepine)decrease the concentration of
antiepileptics(lamotrigine). Adjustlamotriginedose and
monitorcarbamazepineconcentration,p. 202, p. 196.o
Study
▶Antiepileptics(phenobarbital)affect the concentration of
antiepileptics(carbamazepine)andantiepileptics
(carbamazepine)increase the concentration ofantiepileptics
(phenobarbital). Adjust dose.oStudy862 Antiarrhythmics—Antiepileptics BNFC 2018 – 2019
Interactions|Appendix 1A1