Opioids(continued)
buprenorphine, fentanyl, oxycodone). Monitor and adjust dose.
oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure toopioids(alfentanil,
buprenorphine, fentanyl, oxycodone, sufentanil). Monitor and
adjust dose.rStudy
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure toopioids(methadone,
sufentanil).oTheoretical→Also seeTABLE 9p. 849
▶Aprepitantis predicted to increase the exposure toopioids
(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and
adjust dose.oStudy
▶Aprepitantis predicted to increase the exposure toopioids
(methadone, sufentanil).oTheoretical
▶Bosentandecreases the exposure tomethadone. Monitor and
adjust dose.rStudy
▶Bupropionis predicted to decrease the efficacy ofcodeine.
oTheoretical
▶Bupropionis predicted to decrease the efficacy oftramadol.
rStudy→Also seeTABLE 13p. 850
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure toopioids(alfentanil, buprenorphine,
fentanyl, oxycodone). Monitor and adjust dose.o
Study→Also seeTABLE 6p. 848
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure toopioids(methadone, sufentanil).
oTheoretical→Also seeTABLE 6p. 848
▶Ceritinibis predicted to increase the exposure toopioids
(alfentanil, fentanyl). Avoid.rTheoretical
▶Cinacalcetis predicted to decrease the efficacy ofcodeine.
oTheoretical
▶Cinacalcetis predicted to decrease the efficacy oftramadol.
rStudy
▶Cobicistatis predicted to increase the exposure toopioids
(alfentanil, buprenorphine, fentanyl, oxycodone, sufentanil).
Monitor and adjust dose.rStudy
▶Crizotinibis predicted to increase the exposure toopioids
(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and
adjust dose.oStudy→Also seeTABLE 6p. 848
▶Crizotinibis predicted to increase the exposure toopioids
(methadone, sufentanil).oTheoretical→Also seeTABLE 6
p. 848→Also seeTABLE 9p. 849
▶Efavirenzdecreases the exposure tomethadone. Monitor and
adjust dose.rStudy→Also seeTABLE 9p. 849
▶Enzalutamideis predicted to decrease the exposure to
buprenorphine. Monitor and adjust dose.oTheoretical
▶Enzalutamidedecreases the exposure tomethadone. Monitor
and adjust dose.rStudy
▶Enzalutamideis predicted to decrease the exposure toopioids
(alfentanil, fentanyl).oStudy
▶Enzalutamideis predicted to decrease the exposure to
oxycodone. Monitor and adjust dose.oStudy
▶H 2 receptor antagonists(cimetidine)increase the concentration
ofalfentanil. Use with caution and adjust dose.rStudy
▶H 2 receptor antagonists(cimetidine)increase the exposure to
fentanyl.oStudy
▶HIV-protease inhibitors(boosted with ritonavir) are predicted
to decrease the exposure tomethadone.oStudy→Also
seeTABLE 9p. 849
▶HIV-protease inhibitors(ritonavir)are predicted to decrease the
concentration ofmorphine.oTheoretical
▶HIV-protease inhibitors(ritonavir)increase the risk of CNS
toxicity when given withpethidine. Avoid.rStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
toopioids(alfentanil, buprenorphine, fentanyl, oxycodone,
sufentanil). Monitor and adjust dose.rStudy
▶Idelalisibis predicted to increase the exposure tomethadone.
rTheoretical
▶Idelalisibis predicted to increase the exposure toopioids
(alfentanil, buprenorphine, fentanyl, oxycodone, sufentanil).
Monitor and adjust dose.rStudy
▶Imatinibis predicted to increase the exposure toopioids
(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and
adjust dose.oStudy▶Imatinibis predicted to increase the exposure toopioids
(methadone, sufentanil).oTheoretical
▶Macrolides(clarithromycin)are predicted to increase the
concentration ofmethadone.rTheoretical→Also see
TABLE 9p. 849
▶Macrolides(erythromycin)are predicted to increase the
exposure toopioids(alfentanil, buprenorphine, fentanyl,
oxycodone). Monitor and adjust dose.oStudy
▶Macrolides(clarithromycin)are predicted to increase the
exposure toopioids(alfentanil, buprenorphine, fentanyl,
oxycodone, sufentanil). Monitor and adjust dose.rStudy
▶Macrolides(erythromycin)are predicted to increase the
exposure toopioids(methadone, sufentanil).o
Theoretical→Also seeTABLE 9p. 849
▶Mitotaneis predicted to decrease the exposure to
buprenorphine. Monitor and adjust dose.oTheoretical
▶Mitotanedecreases the exposure tomethadone. Monitor and
adjust dose.rStudy
▶Mitotaneis predicted to decrease the exposure toopioids
(alfentanil, fentanyl).oStudy
▶Mitotaneis predicted to decrease the exposure tooxycodone.
Monitor and adjust dose.oStudy
▶Opioidsare predicted to increase the risk of CNS excitation or
depression when given withmonoamine-oxidase A and B
inhibitors, irreversible. Avoid.rStudy→Also seeTABLE 13
p. 850
▶Monoamine-oxidase B inhibitors(rasagiline)are predicted to
increase the risk of side-effects when given withpethidine.
Avoid and for 14 days after stoppingrasagiline.r
Theoretical→Also seeTABLE 13p. 850
▶Monoamine-oxidase B inhibitors(safinamide)are predicted to
increase the risk of side-effects when given withpethidine.
Avoid and for 1 week after stoppingsafinamide.r
Theoretical→Also seeTABLE 13p. 850
▶Monoamine-oxidase B inhibitors(selegiline)increase the risk of
side-effects when given withpethidine. Avoid.r
Anecdotal→Also seeTABLE 13p. 850
▶Nalmefeneis predicted to decrease the efficacy ofopioids.
Avoid.rTheoretical
▶Netupitantis predicted to increase the exposure toopioids
(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and
adjust dose.oStudy
▶Netupitantis predicted to increase the exposure toopioids
(methadone, sufentanil).oTheoretical
▶Nevirapinedecreases the exposure tomethadone. Monitor and
adjust dose.rStudy
▶Nilotinibis predicted to increase the exposure toopioids
(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and
adjust dose.oStudy
▶Nilotinibis predicted to increase the exposure toopioids
(methadone, sufentanil).oTheoretical→Also seeTABLE 9
p. 849
▶Opioids(buprenorphine)are predicted to increase the risk of
opiate withdrawal when given withopioids(alfentanil).r
Theoretical→Also seeTABLE 11p. 849
▶Opioids(pentazocine)are predicted to increase the risk of
opiate withdrawal when given withopioids(alfentanil, codeine,
diamorphine, dihydrocodeine, dipipanone, fentanyl,
hydromorphone, meptazinol, methadone, morphine, oxycodone,
papaveretum).rTheoretical→Also seeTABLE 13p. 850→Also
seeTABLE 11p. 849
▶Opioids(buprenorphine)are predicted to increase the risk of
opiate withdrawal when given withopioids(codeine,
diamorphine, dihydrocodeine, dipipanone, fentanyl,
hydromorphone, meptazinol, methadone, morphine, oxycodone,
papaveretum, pentazocine, pethidine, remifentanil, sufentanil,
tapentadol, tramadol).rTheoretical→Also seeTABLE 11
p. 849→Also seeTABLE 13p. 850
▶Opioids(pentazocine)are predicted to increase the risk of
opiate withdrawal when given withopioids(pethidine,
remifentanil, tapentadol, tramadol).rTheoretical→Also see
TABLE 11p. 849→Also seeTABLE 13p. 850
▶Opioids(pentazocine)are predicted to increase the risk of
opiate withdrawal when given withopioids(sufentanil).r
Anecdotal→Also seeTABLE 11p. 849968 Opioids—Opioids BNFC 2018 – 2019
Interactions|Appendix 1A1