▶Metronidazoleincreases the risk of toxicity when given with
alkylating agents(busulfan).rStudy
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the exposure tometronidazole.oStudy
▶Metronidazoleis predicted to increase the risk of capecitabine
toxicity when given withcapecitabine.rTheoretical
▶Metronidazoleincreases the anticoagulant effect ofcoumarins.
Monitor INR and adjust dose.rStudy
▶Disulfiramincreases the risk of acute psychoses when given
withmetronidazole.rStudy→Also seeTABLE 12p. 850
▶Metronidazoleincreases the risk of toxicity when given with
fluorouracil.rStudy
Metyrapone
▶Antiepileptics(fosphenytoin, phenobarbital, phenytoin,
primidone)are predicted to decrease the effects of
metyrapone. Avoid.oStudy
▶Antihistamines, sedating(cyproheptadine)decrease the effects of
metyrapone. Avoid.oStudy
▶Carbimazoledecreases the effects ofmetyrapone. Avoid.
oTheoretical
▶Combined hormonal contraceptivesdecrease the effects of
metyrapone. Avoid.oTheoretical
▶Phenothiazines(chlorpromazine)decrease the effects of
metyrapone. Avoid.oTheoretical
▶Propylthiouracilis predicted to decrease the effects of
metyrapone. Avoid.oTheoretical
▶Tricyclic antidepressants(amitriptyline)decrease the effects of
metyrapone. Avoid.oTheoretical
Mianserin→seeTABLE 13p. 850 (serotonin syndrome),TABLE 11p. 849
(CNS depressant effects)
▶Antiepileptics(carbamazepine)markedly decrease the exposure
tomianserin. Adjust dose.oStudy
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the exposure tomianserin.oStudy→Also see
TABLE 11p. 849
▶Mianserinis predicted to increase the risk of toxicity when
given withmoclobemide. Avoid and for 1 week after stopping
mianserin.rTheoretical→Also seeTABLE 13p. 850
▶Mianserinis predicted to increase the risk of toxicity when
given withmonoamine-oxidase A and B inhibitors, irreversible.
Avoid and for 14 days after stopping the MAOI.r
Theoretical→Also seeTABLE 13p. 850
▶Mianserinis predicted to decrease the efficacy ofpitolisant.
qTheoretical
▶Mianserindecreases the effects ofsympathomimetics,
vasoconstrictor(ephedrine).rAnecdotal
Micafungin→seeTABLE 1p. 847 (hepatotoxicity)
▶Micafunginslightly increases the exposure toamphotericin.
Avoid or monitor toxicity.oStudy
Miconazole→see antifungals, azoles
Midazolam→seeTABLE 11p. 849 (CNS depressant effects)
▶Antiarrhythmics(dronedarone)are predicted to increase the
exposure tomidazolam. Monitor side effects and adjust dose.
rStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tomidazolam. Monitor and adjust dose.oStudy→Also
seeTABLE 11p. 849
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure tomidazolam. Monitor
side effects and adjust dose.rStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to markedly to very markedly increase the exposure
tomidazolam. Avoid or adjust dose.rStudy
▶Antifungals, azoles(miconazole)are predicted to increase the
exposure to intravenousmidazolam. Use with caution and
adjust dose.oTheoretical
▶Antifungals, azoles(miconazole)are predicted to increase the
exposure to oralmidazolam. Avoid.oTheoretical
▶Aprepitantis predicted to increase the exposure tomidazolam.
Monitor side effects and adjust dose.rStudy
▶Bosentanis predicted to decrease the concentration of
midazolam. Monitor and adjust dose.oTheoretical
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure tomidazolam. Monitor side effects and
adjust dose.rStudy
▶Cobicistatis predicted to markedly to very markedly increase
the exposure tomidazolam. Avoid or adjust dose.rStudy
▶Crizotinibis predicted to increase the exposure tomidazolam.
Monitor side effects and adjust dose.rStudy
▶Dabrafenibdecreases the exposure tomidazolam. Monitor and
adjust dose.oStudy
▶Efavirenzis predicted to alter the effects ofmidazolam. Avoid.
oTheoretical
▶Enzalutamideis predicted to decrease the exposure to
midazolam. Monitor and adjust dose.oStudy
▶Fosaprepitantslightly increases the exposure tomidazolam.
oStudy
▶HIV-protease inhibitorsare predicted to markedly to very
markedly increase the exposure tomidazolam. Avoid or adjust
dose.rStudy
▶Idelalisibis predicted to markedly to very markedly increase
the exposure tomidazolam. Avoid or adjust dose.rStudy
▶Imatinibis predicted to increase the exposure tomidazolam.
Monitor side effects and adjust dose.rStudy
▶Lumacaftoris predicted to decrease the exposure to
midazolam. Avoid.rTheoretical
▶Macrolides(clarithromycin)are predicted to markedly to very
markedly increase the exposure tomidazolam. Avoid or adjust
dose.rStudy
▶Macrolides(erythromycin)are predicted to increase the
exposure tomidazolam. Monitor side effects and adjust dose.
rStudy
▶Mitotaneis predicted to decrease the exposure tomidazolam.
Monitor and adjust dose.oStudy
▶Monoclonal antibodies(tocilizumab)are predicted to decrease
the exposure tomidazolam. Monitor and adjust dose.o
Theoretical
▶Netupitantis predicted to increase the exposure tomidazolam.
Monitor side effects and adjust dose.rStudy
▶Nevirapinedecreases the concentration ofmidazolam. Monitor
and adjust dose.oStudy
▶Nilotinibis predicted to increase the exposure tomidazolam.
Monitor side effects and adjust dose.rStudy
▶Palbociclibincreases the exposure tomidazolam.o
Study
▶Ribociclibmoderately increases the exposure tomidazolam.
Avoid.oStudy
▶Rifampicinis predicted to decrease the exposure tomidazolam.
Monitor and adjust dose.oStudy
▶St John’sWortmoderately decreases the exposure to
midazolam. Monitor and adjust dose.oStudy
▶Telotristat ethyldecreases the exposure tomidazolam.
oStudy
Midodrine→see sympathomimetics, vasoconstrictor
Midostaurin
▶Antiarrhythmics(dronedarone)are predicted to increase the
exposure tomidostaurin.oTheoretical
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tomidostaurin. Avoid.rStudy
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure tomidostaurin.
oTheoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to very markedly increase the exposure to
midostaurin. Avoid or monitor for toxicity.rStudy
▶Aprepitantis predicted to increase the exposure to
midostaurin.oTheoretical
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure tomidostaurin.oTheoretical
▶Cobicistatis predicted to very markedly increase the exposure
tomidostaurin. Avoid or monitor for toxicity.rStudy
▶Crizotinibis predicted to increase the exposure tomidostaurin.
oTheoretical
▶Enzalutamideis predicted to decrease the exposure to
midostaurin. Avoid.rStudyBNFC 2018 – 2019 Metronidazole—Midostaurin 953
Interactions|Appendix 1A1