Antiepileptics(continued)
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
totoremifene. Adjust dose.oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
totrabectedin. Avoid.rTheoretical→Also seeTABLE 1p. 847
▶Carbamazepinedecreases the concentration oftrazodone.
Adjust dose.oAnecdotal
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the exposure totricyclic antidepressants.o
Study
▶Carbamazepinedecreases the exposure totricyclic
antidepressants. Adjust dose.oStudy→Also seeTABLE 18
p. 851
▶Tricyclic antidepressants(clomipramine, imipramine)potentially
increase the risk of overheating and dehydration when given
withzonisamide. Avoid in children.rTheoretical
▶Trimethoprimincreases the concentration ofantiepileptics
(fosphenytoin, phenytoin).oStudy
▶Antiepileptics(carbamazepine, eslicarbazepine, fosphenytoin,
oxcarbazepine, perampanel, phenobarbital, phenytoin,
primidone, rufinamide, topiramate)decrease the efficacy of
ulipristal. For FSRH guidance, seeContraceptives,
interactionsp. 497.rAnecdotal
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tovandetanib. Avoid.oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to moderately decrease
the exposure tovelpatasvir. Avoid.rStudy
▶Oxcarbazepineis predicted to decrease the exposure to
velpatasvir. Avoid.rTheoretical
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tovemurafenib. Avoid.rTheoretical
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tovenetoclax. Avoid.rStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tovinca alkaloids(vinblastine, vincristine, vindesine).r
Theoretical→Also seeTABLE 1p. 847→Also seeTABLE 12p. 850
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tovinca alkaloids(vinflunine). Avoid.rTheoretical→Also see
TABLE 12p. 850
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tovinca alkaloids(vinorelbine). Use with caution or avoid.
rTheoretical→Also seeTABLE 12p. 850
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tovismodegib. Avoid.oTheoretical
▶Antiepileptics(fosphenytoin, phenytoin)decrease the effects of
vitamin D substances.oStudy
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the effects ofvitamin D substances.o
Theoretical
▶Carbamazepineis predicted to decrease the effects ofvitamin D
substances.oStudy
▶Antiepileptics(phenobarbital, primidone)potentially increase
the risk of nephrotoxicity when given withvolatile halogenated
anaesthetics(methoxyflurane). Avoid.rTheoretical→Also
seeTABLE 11p. 849
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tovortioxetine. Monitor and adjust dose.oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the
concentration ofvoxilaprevir. Avoid.rStudy
▶Oxcarbazepineis predicted to decrease the concentration of
voxilaprevir. Avoid.rTheoretical
▶Valproateslightly increases the exposure tozidovudine.
oStudy▶Carbamazepinemoderately decreases the exposure to
zolpidem.oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tozopiclone. Adjust dose.oStudy→Also seeTABLE 11
p. 849
Antifungals, azoles→seeTABLE 1p. 847 (hepatotoxicity),TABLE 9
p. 849 (QT-interval prolongation)
clotrimazole.fluconazole.isavuconazole.itraconazole.
ketoconazole.miconazole.posaconazole.voriconazole..▶In general,fluconazoleinteractions relate to multiple-dose
treatment.
▶The use of carbonated drinks, such as cola, improves
itraconazole,ketoconazole,andposaconazole
bioavailability.
▶Since systemic absorption can follow topical application,
the possibility of interactions with topicalketoconazole
should be borne in mind.
▶Interactions ofmiconazoleapply to the oral gel
formulation, as a sufficient quantity can be absorbed to
cause systemic effects. Systemic absorption from
intravaginal and topical formulations might also occur.
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure toabiraterone.r
Theoretical
▶Antifungals, azoles(itraconazole, ketoconazole)are predicted to
increase the exposure toafatinib. Separate administration by
12 hours.oStudy
▶Alcohol (beverage)potentially causes a disulfiram-like
reaction when given withketoconazole. Avoid.o
Anecdotal
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure toaldosterone
antagonists(eplerenone). Adjusteplerenonedose.rStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to markedly increase the exposure toaldosterone
antagonists(eplerenone). Avoid.rStudy
▶Itraconazolemarkedly increases the exposure toaliskiren.
Avoid.rStudy
▶Ketoconazolemoderately increases the exposure toaliskiren.
oStudy
▶Itraconazoleincreases the risk of busulfan toxicity when given
withalkylating agents(busulfan). Monitor and adjust dose.
oStudy
▶Miconazoleis predicted to increase the concentration of
alkylating agents(busulfan). Use with caution and adjust dose.
oTheoretical
▶Isavuconazoleis predicted to increase the exposure to
alkylating agents(cyclophosphamide).oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)
increase the exposure toalmotriptan.nStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to moderately increase the exposure toalpha
blockers(alfuzosin, tamsulosin). Use with caution or avoid.
oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure toalpha blockers
(doxazosin).oStudy
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure toalpha blockers
(tamsulosin).oTheoretical
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure toalprazolam.r
Study
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)
moderately increase the exposure toalprazolam. Avoid.
oStudy
▶Miconazoleis predicted to increase the exposure to
alprazolam. Use with caution and adjust dose.o
Theoretical
▶Miconazolepotentially decreases the exposure to
aminoglycosides(tobramycin).oAnecdotal870 Antiepileptics—Antifungals, azoles BNFC 2018 – 2019
Interactions|Appendix 1A1