Antacids(continued)
▶Antacidsare predicted to decrease the absorption ofHIV-
protease inhibitors(tipranavir). Separate administration by
2 hours.oStudy
▶Antacidsdecrease the absorption ofhydroxychloroquine.
Separate administration by at least 4 hours.oStudy
▶Antacidsdecrease the absorption ofiron (oral).Iron (oral)
should be taken 1 hour before or 2 hours afterantacids.
oStudy
▶Aluminium hydroxideis predicted to decrease the exposure to
iron chelators(deferasirox). Avoid.oTheoretical
▶Antacidsare predicted to decrease the absorption oflapatinib.
Avoid.oTheoretical
▶Antacidsare predicted to decrease the exposure toledipasvir.
Separate administration by 4 hours.oTheoretical
▶Antacidsdecrease the exposure tomycophenolate.o
Study
▶Antacidsare predicted to decrease the absorption ofnilotinib.
Separate administration by at least 2 hours.o
Theoretical
▶Magnesium trisilicatedecreases the absorption of
nitrofurantoin.oStudy
▶Antacidsare predicted to decrease the absorption of
pazopanib.Pazopanibshould be taken 1 hour before or 2 hours
afterantacids.oTheoretical
▶Antacidsdecrease the absorption ofpenicillamine. Separate
administration by 2 hours.nStudy
▶Antacidsdecrease the absorption ofphenothiazines.o
Anecdotal
▶Antacidsincrease the risk of metabolic alkalosis when given
withpolystyrene sulfonate.rAnecdotal
▶Antacidsdecrease the absorption ofquinolones.Quinolones
should be taken 2 hours before or 4 hours afterantacids.
oStudy
▶Antacidsslightly decrease the exposure toraltegravir. Avoid.
oStudy
▶Antacidsdecrease the absorption ofrifampicin.Rifampicin
should be taken 1 hour beforeantacids.oStudy
▶Antacidsare predicted to decrease the exposure torilpivirine.
Antacidsshould be taken 2 hours before or 4 hours after
rilpivirine.rTheoretical
▶Antacidsslightly decrease the exposure toriociguat.Antacids
should be taken 2 hours before or 1 hour afterriociguat.n
Study
▶Antacidsmoderately decrease the absorption ofstatins
(rosuvastatin). Separate administration by 2 hours.o
Study
▶Antacidsdecrease the absorption ofsulpiride. Separate
administration by 2 hours.oStudy
▶Antacidsdecrease the absorption oftetracyclines. Separate
administration by 2 to 3 hours.oStudy
▶Antacidsare predicted to decrease the absorption ofthyroid
hormones(levothyroxine). Separate administration by at least
4 hours.oAnecdotal
▶Antacidsare predicted to decrease the absorption of
ursodeoxycholic acid. Separate administration by 2 hours.
oTheoretical
▶Antacidsare predicted to decrease the concentration of
velpatasvir. Separate administration by 4 hours.o
Theoretical
Antazoline→see antihistamines, sedating
Anthracyclines→seeTABLE 15p. 850 (myelosuppression),TABLE 5
p. 847 (thromboembolism)
daunorubicin.doxorubicin.epirubicin.idarubicin.mitoxantrone.
pixantrone..GENERAL INFORMATIONCaution is necessary with concurrent
use of cardiotoxic drugs, or drugs that reduce cardiac
contractility.
▶Calcium channel blockers(verapamil)moderately increase the
exposure todoxorubicin.oStudy
▶Ciclosporinincreases the concentration ofanthracyclines
(daunorubicin, doxorubicin, epirubicin, idarubicin,
mitoxantrone).rStudy▶H 2 receptor antagonists(cimetidine)slightly increase the
exposure toepirubicin. Avoid.oStudy
▶Live vaccinesare predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
anthracyclines. Public Health England advises avoid (refer to
Green Book).rTheoretical
▶Anthracyclinesare predicted to increase the risk of
cardiotoxicity when given withmonoclonal antibodies
(trastuzumab, trastuzumab emtansine). Avoid.r
Theoretical→Also seeTABLE 15p. 850
▶Rolapitantis predicted to increase the exposure to
anthracyclines(doxorubicin, mitoxantrone). Avoid or monitor.
oStudy
Antiarrhythmics→seeTABLE 6p. 848 (bradycardia),TABLE 12p. 850
(peripheral neuropathy),TABLE 9p. 849 (QT-interval prolongation),
TABLE 11p. 849 (CNS depressant effects),TABLE 10p. 849
(antimuscarinics)
adenosine.amiodarone.disopyramide.dronedarone.flecainide.
lidocaine.propafenone..▶Amiodarone has a long half-life; there is potential for drug
interactions to occur for several weeks (or even months)
after treatment with it has been stopped.
▶Since systemic absorption can follow topical application of
lidocaine, the possibility of interactions should be borne in
mind.
▶Antiarrhythmics(amiodarone, dronedarone)are predicted to
increase the exposure toafatinib. Separate administration by
12 hours.oStudy
▶Amiodaroneis predicted to decrease the effects ofagalsidase.
Avoid.oTheoretical
▶Amiodaroneis predicted to increase the exposure to
aldosterone antagonists(eplerenone). Adjusteplerenonedose.
rTheoretical
▶Dronedaroneis predicted to increase the exposure to
aldosterone antagonists(eplerenone). Adjusteplerenonedose.
rStudy
▶Antiarrhythmics(amiodarone, dronedarone)are predicted to
increase the exposure toaliskiren.rStudy
▶Dronedaroneis predicted to increase the exposure toalpha
blockers(tamsulosin).oTheoretical
▶Dronedaroneis predicted to increase the exposure to
alprazolam.rStudy
▶Aminophyllineis predicted to decrease the efficacy of
adenosine. Separate administration by 24 hours.n
Theoretical
▶Anaesthetics, localare predicted to increase the risk of
cardiodepression when given withantiarrhythmics.r
Theoretical→Also seeTABLE 11p. 849
▶Antiarrhythmics(propafenone)are predicted to increase the risk
of cardiodepression when given withantiarrhythmics
(amiodarone). Monitor and adjust dose.rTheoretical
▶Antiarrhythmics(amiodarone)increase the concentration of
antiarrhythmics(flecainide). Adjustflecainidedose and monitor
side effects.rStudy→Also seeTABLE 6p. 848→Also see
TABLE 9p. 849
▶Antiarrhythmics(propafenone)are predicted to increase the risk
of cardiodepression when given withantiarrhythmics
(lidocaine).oStudy
▶Antiarrhythmics(dronedarone)are predicted to increase the
exposure toantiarrhythmics(propafenone). Monitor and adjust
dose.oStudy
▶Amiodaroneincreases the risk of bradycardia when given with
anticholinesterases, centrally acting.oAnecdotal→Also
seeTABLE 6p. 848
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the efficacy of
propafenone.oStudy
▶Antiepileptics(fosphenytoin, phenytoin)are predicted to
decrease the exposure tolidocaine.rAnecdotal
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
toantiarrhythmics(disopyramide, dronedarone). Avoid.r
Study858 Antacids—Antiarrhythmics BNFC 2018 – 2019
Interactions|Appendix 1A1