▶Calcium salts(calcium carbonate)are predicted to decrease the
absorption ofproguanil. Separate administration by at least
2 hours.oStudy
▶Chloroquinedecreases the efficacy of oralcholera vaccine.
oStudy
▶Cobicistatis predicted to increase the concentration of
piperaquine.rTheoretical
▶Crizotinibis predicted to increase the concentration of
piperaquine.rTheoretical
▶Antimalarials(chloroquine, primaquine)are predicted to
increase the risk of methaemoglobinaemia when given with
dapsone.rTheoretical
▶Mefloquineis predicted to increase the risk of bradycardia
when given withdigoxin.rTheoretical
▶Quinineincreases the concentration ofdigoxin. Monitor and
adjustdigoxindose,p. 81.rAnecdotal
▶Mefloquineis predicted to increase the risk of QT-
prolongation when given withdrugs that prolong the QT
interval.rTheoretical
▶Efavirenzdecreases the concentration ofartemether.r
Study→Also seeTABLE 9p. 849
▶Efavirenzmoderately decreases the exposure toatovaquone.
Avoid.oStudy
▶Efavirenzaffects the exposure toproguanil. Avoid.o
Study
▶Enzalutamideis predicted to decrease the exposure to
artemether(with lumafantrine). Avoid.rStudy
▶Enzalutamideis predicted to decrease the concentration of
piperaquine. Avoid.oTheoretical
▶Etravirinedecreases the exposure toartemether.o
Study
▶Grapefruit juiceincreases the exposure toartemether.
qStudy
▶Grapefruit juiceis predicted to increase the concentration of
piperaquine. Avoid.rTheoretical
▶H 2 receptor antagonists(cimetidine)decrease the clearance of
chloroquine.oStudy
▶H 2 receptor antagonists(cimetidine)slightly increase the
exposure toquinine.oStudy
▶HIV-protease inhibitorsdecrease the exposure toatovaquone.
Avoid if boosted with ritonavir.oStudy
▶HIV-protease inhibitorsare predicted to increase the
concentration ofpiperaquine.rTheoretical
▶HIV-protease inhibitorsare predicted to decrease the exposure
toproguanil. Avoid.oStudy
▶HIV-protease inhibitorsare predicted to affect the exposure to
quinine.rStudy→Also seeTABLE 9p. 849
▶Idelalisibis predicted to increase the concentration of
piperaquine.rTheoretical
▶Imatinibis predicted to increase the concentration of
piperaquine.rTheoretical
▶Lanthanumis predicted to decrease the absorption of
chloroquine. Separate administration by at least 2 hours.
oTheoretical
▶Chloroquineis predicted to decrease the exposure to
laronidase. Avoid simultaneous administration.r
Theoretical
▶Macrolides(clarithromycin, erythromycin)are predicted to
increase the concentration ofpiperaquine.rTheoretical
▶Mepacrineis predicted to increase the concentration of
primaquine. Avoid.oTheoretical
▶Pyrimethamineis predicted to increase the risk of side-effects
when given withmethotrexate.rTheoretical→Also see
TABLE 15p. 850
▶Metoclopramidedecreases the concentration ofatovaquone.
Avoid.oStudy
▶Mitotaneis predicted to decrease the exposure toartemether
(with lumafantrine). Avoid.rStudy
▶Mitotaneis predicted to decrease the concentration of
piperaquine. Avoid.oTheoretical
▶Netupitantis predicted to increase the concentration of
piperaquine.rTheoretical
▶Nilotinibis predicted to increase the concentration of
piperaquine.rTheoretical
▶Pyrimethamineis predicted to increase the risk of side-effects
when given withpemetrexed.rTheoretical→Also see
TABLE 15p. 850
▶Chloroquineis predicted to increase the risk of haematological
toxicity when given withpenicillamine. Avoid.r
Theoretical
▶Chloroquinemoderately decreases the exposure to
praziquantel. Use with caution and adjust dose.oStudy
▶Chloroquinedecreases the efficacy ofrabies vaccine. Avoid.
oStudy
▶Rifabutinslightly decreases the exposure toatovaquone.
Avoid.oStudy
▶Rifampicinis predicted to decrease the exposure toartemether
(with lumafantrine). Avoid.rStudy
▶Rifampicinmoderately decreases the exposure toatovaquone
andatovaquoneslightly increases the exposure torifampicin.
Avoid.oStudy
▶Rifampicinmoderately decreases the exposure tomefloquine.
rStudy
▶Rifampicinis predicted to decrease the concentration of
piperaquine. Avoid.oTheoretical
▶Rifampicindecreases the exposure toquinine.rStudy
▶St John’sWortis predicted to decrease the concentration of
piperaquine. Avoid.oTheoretical
▶Pyrimethamineincreases the risk of side-effects when given
withsulfonamides.rStudy→Also seeTABLE 15p. 850
▶Tetracyclines(tetracycline)decrease the concentration of
atovaquone.oStudy
▶Pyrimethamineincreases the risk of side-effects when given
withtrimethoprim.rStudy
▶Pyrimethamineis predicted to increase the risk of side-effects
when given withzidovudine.rTheoretical→Also see
TABLE 15p. 850
Apixaban→seeTABLE 3p. 847 (anticoagulant effects)
▶Antiarrhythmics(dronedarone)are predicted to increase the
exposure toapixaban.oTheoretical
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to moderately decrease
the exposure toapixaban. Use with caution or avoid.r
Study
▶Antifungals, azoles(itraconazole)are predicted to increase the
exposure toapixaban. Avoid.rTheoretical
▶Antifungals, azoles(ketoconazole)slightly to moderately
increase the exposure toapixaban. Avoid.rStudy
▶Calcium channel blockers(verapamil)are predicted to increase
the exposure toapixaban.oTheoretical
▶Enzalutamideis predicted to moderately decrease the
exposure toapixaban. Use with caution or avoid.rStudy
▶HIV-protease inhibitors(ritonavir)are predicted to increase the
exposure toapixaban. Avoid.rTheoretical
▶Macrolides(clarithromycin)are predicted to increase the
exposure toapixaban.rTheoretical
▶Macrolides(erythromycin)are predicted to increase the
exposure toapixaban.oTheoretical
▶Mitotaneis predicted to moderately decrease the exposure to
apixaban. Use with caution or avoid.rStudy
▶Rifampicinis predicted to moderately decrease the exposure
toapixaban. Use with caution or avoid.rStudy
▶St John’sWortis predicted to decrease the exposure to
apixaban. Use with caution or avoid.oTheoretical
Apomorphine→see dopamine receptor agonists
Apraclonidine→seeTABLE 6p. 848 (bradycardia),TABLE 8p. 848
(hypotension),TABLE 11p. 849 (CNS depressant effects)
▶Amfetaminesare predicted to decrease the effects of
apraclonidine. Avoid.rTheoretical
▶Methylphenidateis predicted to decrease the effects of
apraclonidine. Avoid.rTheoretical
▶Sympathomimetics, inotropicare predicted to decrease the
effects ofapraclonidine. Avoid.rTheoretical
▶Sympathomimetics, vasoconstrictorare predicted to decrease
the effects ofapraclonidine. Avoid.rTheoretical
Apremilast
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)moderately decrease the exposure to
apremilast. Avoid.rStudyBNFC 2018 – 2019 Antimalarials—Apremilast 879
Interactions|Appendix 1A1