Clopidogrel(continued)
▶Clopidogrelincreases the exposure torepaglinide. Avoid.
rStudy
▶Clopidogrelis predicted to increase the exposure toretinoids
(alitretinoin). Adjustalitretinoindose.oTheoretical
▶Clopidogrelis predicted to increase the exposure toselexipag.
Adjust dose.oStudy
▶SSRIs(fluoxetine, fluvoxamine)are predicted to decrease the
efficacy ofclopidogrel. Avoid.rTheoretical→Also see
TABLE 4p. 847
▶Clopidogrelincreases the exposure tostatins(rosuvastatin).
Adjustrosuvastatindose,p. 133.oStudy
▶Clopidogrelis predicted to increase the concentration of
taxanes(paclitaxel).rAnecdotal
Clotrimazole→see antifungals, azoles
Clozapine→seeTABLE 8p. 848 (hypotension),TABLE 15p. 850
(myelosuppression),TABLE 11p. 849 (CNS depressant effects),TABLE 10
p. 849 (antimuscarinics)
▶Dose adjustment might be necessary if smoking started or
stopped during treatment.
▶Avoid concomitant use of clozapine with drugs that have a
substantial potential for causing agranulocytosis.
▶Antiepileptics(carbamazepine)are predicted to increase the risk
of myelosuppression when given withclozapine. Avoid.r
Anecdotal
▶Antiepileptics(fosphenytoin, phenobarbital, phenytoin,
primidone)are predicted to decrease the exposure to
clozapine.oAnecdotal→Also seeTABLE 11p. 849
▶Combined hormonal contraceptivesincrease the concentration
ofclozapine. Monitor side effects and adjust dose.rStudy
▶Clozapineis predicted to decrease the effects ofdopamine
receptor agonists.oTheoretical→Also seeTABLE 8
p. 848→Also seeTABLE 10p. 849
▶Enzalutamideis predicted to decrease the exposure to
clozapine.oTheoretical
▶HIV-protease inhibitors(ritonavir)are predicted to affect the
exposure toclozapine. Avoid.rTheoretical
▶Iron chelators(deferasirox)are predicted to increase the
exposure toclozapine. Avoid.oTheoretical
▶Leflunomideis predicted to decrease the exposure toclozapine.
oTheoretical→Also seeTABLE 15p. 850
▶Clozapineis predicted to decrease the effects oflevodopa.
rTheoretical→Also seeTABLE 8p. 848
▶Macrolides(erythromycin)potentially increase the risk of
toxicity when given withclozapine.rAnecdotal
▶Quinolones(ciprofloxacin)increase the concentration of
clozapine. Monitor side effects and adjust dose.rStudy
▶Rifampicindecreases the exposure toclozapine.r
Anecdotal
▶SSRIs(fluvoxamine)increase the concentration ofclozapine.
Monitor side effects and adjust dose.rStudy
▶Teriflunomideis predicted to decrease the exposure to
clozapine.oTheoretical
Co-trimoxazole→see sulfonamides
Cobicistat
▶Cobicistatis predicted to increase the exposure toabiraterone.
rTheoretical
▶Cobicistatis predicted to markedly increase the exposure to
aldosterone antagonists(eplerenone). Avoid.rStudy
▶Cobicistatincreases the exposure toalmotriptan.nStudy
▶Cobicistatis predicted to moderately increase the exposure to
alpha blockers(alfuzosin, tamsulosin). Use with caution or
avoid.oStudy
▶Cobicistatis predicted to increase the exposure toalpha
blockers(doxazosin).oStudy
▶Cobicistatmoderately increases the exposure toalprazolam.
Avoid.oStudy
▶Cobicistatvery markedly increases the exposure to
antiarrhythmics(dronedarone). Avoid.rStudy
▶Cobicistatis predicted to increase the exposure to
antiarrhythmics(propafenone). Monitor and adjust dose.r
Study▶Cobicistatis predicted to increase the exposure to
anticholinesterases, centrally acting(galantamine). Monitor and
adjust dose.oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tocobicistat. Avoid.rTheoretical
▶Antiepileptics(oxcarbazepine)are predicted to decrease the
concentration ofcobicistat.rTheoretical
▶Cobicistatis predicted to very slightly increase the exposure to
antiepileptics(perampanel).nStudy
▶Cobicistatis predicted to increase the exposure toantifungals,
azoles(fluconazole, posaconazole).oTheoretical
▶Cobicistatis predicted to increase the exposure toantifungals,
azoles(isavuconazole). Avoid or monitor side effects.r
Study
▶Cobicistatis predicted to increase the exposure toantifungals,
azoles(itraconazole, ketoconazole). Adjust dose.o
Theoretical
▶Cobicistatis predicted to affect the exposure toantifungals,
azoles(voriconazole). Avoid.oTheoretical
▶Cobicistatis predicted to increase the exposure to
antihistamines, non-sedating(mizolastine). Avoid.rStudy
▶Cobicistatis predicted to increase the exposure to
antihistamines, non-sedating(rupatadine). Avoid.oStudy
▶Cobicistatis predicted to increase the concentration of
antimalarials(piperaquine).rTheoretical
▶Cobicistatis predicted to markedly increase the exposure to
aprepitant.oStudy
▶Cobicistatis predicted to slightly increase the exposure to
aripiprazole. Adjustaripiprazoledose,p. 249.oStudy
▶Cobicistatis predicted to increase the exposure toaxitinib.
Avoid or adjust dose.oStudy
▶Cobicistatis predicted to increase the exposure tobedaquiline.
Avoid prolonged use.nStudy
▶Cobicistatis predicted to increase the exposure tobeta 2
agonists(salmeterol). Avoid.rStudy
▶Cobicistatslightly increases the exposure tobortezomib.
oStudy
▶Bosentanis predicted to decrease the exposure tocobicistat.
Avoid.rTheoretical
▶Cobicistatis predicted to markedly increase the exposure to
bosutinib. Avoid or adjust dose.rStudy
▶Cobicistatis predicted to increase the exposure tobuspirone.
Adjustbuspironedose.rStudy
▶Cobicistatslightly increases the exposure tocabozantinib.
oStudy
▶Cobicistatis predicted to increase the exposure tocalcium
channel blockers(amlodipine, felodipine, lacidipine, nicardipine,
nifedipine, nimodipine). Monitor and adjust dose.o
Study
▶Cobicistatis predicted to increase the exposure tocalcium
channel blockers(diltiazem, verapamil).rStudy
▶Cobicistatis predicted to markedly increase the exposure to
calcium channel blockers(lercanidipine). Avoid.rStudy
▶Cobicistatis predicted to increase the exposure tocannabis
extract. Use with caution and adjust dose.oTheoretical
▶Cobicistatis predicted to increase the exposure toceritinib.
Avoid or adjustceritinibdose.rStudy
▶Cobicistatincreases the concentration ofciclosporin.r
Study
▶Cobicistatis predicted to moderately increase the exposure to
cilostazol. Adjustcilostazoldose.oStudy
▶Cobicistatis predicted to moderately increase the exposure to
cinacalcet. Adjust dose.oStudy
▶Cobicistatis predicted to markedly increase the exposure to
cobimetinib. Avoid or monitor for toxicity.rStudy
▶Cobicistatis predicted to increase the exposure tocolchicine.
Avoid potent inhibitors of CYP3A4 or adjustcolchicinedose.
rStudy
▶Cobicistatis predicted to decrease the efficacy ofcombined
hormonal contraceptives. Avoid.rStudy
▶Cobicistatis predicted to increase the exposure to
corticosteroids(beclometasone)(risk with beclometasone is
likely to be lower than with other corticosteroids).o
Theoretical898 Clopidogrel—Cobicistat BNFC 2018 – 2019
Interactions|Appendix 1A1