Silver sulfadiazine
PHARMACOLOGYSilver might inactivate enzymatic debriding
agents—concurrent use might not be appropriate.
Simeprevir
▶Antiarrhythmics(dronedarone)are predicted to increase the
exposure tosimeprevir. Avoid.rStudy
▶Simepreviris predicted to increase the concentration of
antiarrhythmics(amiodarone). Refer to specialist literature.
rAnecdotal
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tosimeprevir. Avoid.rStudy
▶Antiepileptics(oxcarbazepine)are predicted to decrease the
exposure tosimeprevir. Avoid.rTheoretical
▶Antifungals, azoles(fluconazole, isavuconazole, itraconazole,
ketoconazole, posaconazole, voriconazole)are predicted to
increase the exposure tosimeprevir. Avoid.rStudy
▶Aprepitantis predicted to increase the exposure tosimeprevir.
Avoid.rStudy
▶Bosentanis predicted to decrease the exposure tosimeprevir.
Avoid.rStudy
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure tosimeprevir. Avoid.rStudy
▶Cobicistatis predicted to increase the exposure tosimeprevir.
Avoid.rStudy
▶Crizotinibis predicted to increase the exposure tosimeprevir.
Avoid.rStudy
▶Efavirenzis predicted to decrease the exposure tosimeprevir.
Avoid.rStudy
▶Enzalutamideis predicted to decrease the exposure to
simeprevir. Avoid.rStudy
▶Etravirineis predicted to decrease the exposure tosimeprevir.
Avoid.oStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
tosimeprevir. Avoid.rStudy
▶Idelalisibis predicted to increase the exposure tosimeprevir.
Avoid.rStudy
▶Imatinibis predicted to increase the exposure tosimeprevir.
Avoid.rStudy
▶Ledipasvirmoderately increases the exposure tosimeprevir
andsimeprevirslightly increases the exposure toledipasvir.
Avoid.rStudy
▶Macrolides(clarithromycin, erythromycin)are predicted to
increase the exposure tosimeprevir. Avoid.rStudy
▶Mitotaneis predicted to decrease the exposure tosimeprevir.
Avoid.rStudy
▶Netupitantis predicted to increase the exposure tosimeprevir.
Avoid.rStudy
▶Nevirapineis predicted to decrease the exposure tosimeprevir.
Avoid.rStudy
▶Nilotinibis predicted to increase the exposure tosimeprevir.
Avoid.rStudy
▶Rifabutinis predicted to decrease the exposure tosimeprevir.
Avoid.oTheoretical
▶Rifampicinis predicted to decrease the exposure tosimeprevir.
Avoid.rStudy
▶St John’s Wortis predicted to decrease the exposure to
simeprevir. Avoid.rStudy
▶Simeprevirmoderately increases the exposure tostatins
(atorvastatin). Monitor and adjust dose.oStudy
▶Simepreviris predicted to increase the exposure tostatins
(pravastatin). Monitor and adjust dose.rTheoretical
▶Simeprevirmoderately increases the exposure tostatins
(rosuvastatin). Adjustrosuvastatindose,p. 133.oStudy
▶Simeprevirslightly increases the exposure tostatins
(simvastatin). Monitor and adjust dose.oStudy
Simvastatin→see statins
Sirolimus
▶Antiarrhythmics(amiodarone)are predicted to increase the
concentration ofsirolimus.rAnecdotal
▶Antiarrhythmics(dronedarone)increase the concentration of
sirolimus. Monitor and adjust dose.oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the
concentration ofsirolimus. Avoid.rStudy▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
increase the concentration ofsirolimus. Monitor and adjust
dose.oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the concentration ofsirolimus. Avoid.
rStudy
▶Antifungals, azoles(miconazole)are predicted to increase the
concentration ofsirolimus. Monitor and adjust dose.o
Study
▶Aprepitantincreases the concentration ofsirolimus. Monitor
and adjust dose.oStudy
▶Bosentanis predicted to decrease the concentration of
sirolimusandsirolimuspotentially increases the
concentration ofbosentan. Avoid.rTheoretical
▶Calcium channel blockers(diltiazem, verapamil)increase the
concentration ofsirolimus. Monitor and adjust dose.o
Study
▶Ceritinibis predicted to increase the exposure tosirolimus.
Avoid.rTheoretical
▶Sirolimusis predicted to affect the efficacy ofchenodeoxycholic
acid. Monitor and adjust dose.oTheoretical
▶Ciclosporinmoderately increases the exposure tosirolimus.
Separate administration by 4 hours.rStudy
▶Cobicistatis predicted to increase the concentration of
sirolimus. Avoid.rStudy
▶Crizotinibincreases the concentration ofsirolimus. Monitor
and adjust dose.oStudy
▶Efavirenzis predicted to decrease the concentration of
sirolimus. Monitor and adjust dose.oTheoretical
▶Eliglustatis predicted to increase the exposure tosirolimus.
Adjust dose.oStudy
▶Enzalutamideis predicted to decrease the concentration of
sirolimus. Avoid.rStudy
▶Grapefruit juiceincreases the concentration ofsirolimus.
Avoid.oStudy
▶HIV-protease inhibitorsare predicted to increase the
concentration ofsirolimus. Avoid.rStudy
▶Idelalisibis predicted to increase the concentration of
sirolimus. Avoid.rStudy
▶Imatinibincreases the concentration ofsirolimus. Monitor and
adjust dose.oStudy
▶Lapatinibis predicted to increase the exposure tosirolimus.
oTheoretical
▶Live vaccinesare predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
sirolimus. Public Health England advises avoid (refer to Green
Book).rTheoretical
▶Lumacaftoris predicted to decrease the exposure tosirolimus.
Avoid.rTheoretical
▶Macrolides(clarithromycin)are predicted to increase the
concentration ofsirolimus. Avoid.rStudy
▶Macrolides(erythromycin)increase the concentration of
sirolimus. Monitor and adjust dose.oStudy
▶Sirolimusis predicted to decrease the efficacy ofmifamurtide.
Avoid.rTheoretical
▶Mirabegronis predicted to increase the exposure tosirolimus.
nTheoretical
▶Mitotaneis predicted to decrease the concentration of
sirolimus. Avoid.rStudy
▶Monoclonal antibodies(sarilumab)potentially affect the
exposure tosirolimus. Monitor and adjust dose.o
Theoretical
▶Netupitantincreases the concentration ofsirolimus. Monitor
and adjust dose.oStudy
▶Nevirapineis predicted to decrease the concentration of
sirolimus. Monitor and adjust dose.oTheoretical
▶Nilotinibincreases the concentration ofsirolimus. Monitor and
adjust dose.oStudy
▶Palbociclibis predicted to increase the exposure tosirolimus.
Adjust dose.oTheoretical
▶Pitolisantis predicted to decrease the exposure tosirolimus.
Avoid.rTheoretical
▶Ribociclibis predicted to increase the exposure tosirolimus.
Use with caution and adjust dose.oTheoretical988 Silver sulfadiazine—Sirolimus BNFC 2018 – 2019
Interactions|Appendix 1A1