▶Beta blockers, selectiveincrease the risk of hypertension and
bradycardia when given withsympathomimetics, inotropic
(dobutamine).oTheoretical
▶Beta blockers, selectiveare predicted to increase the risk of
hypertension and bradycardia when given with
sympathomimetics, vasoconstrictor(adrenaline/epinephrine,
noradrenaline/norepinephrine).rStudy
▶Terbinafineis predicted to increase the exposure tobeta
blockers, selective(metoprolol, nebivolol).oStudy
▶Beta blockers, selectiveare predicted to increase the risk of
bronchospasm when given withtheophylline. Avoid.r
Theoretical
Beta 2 agonists→seeTABLE 17p. 851 (reduced serum potassium)
bambuterol.formoterol.indacaterol.olodaterol.salbutamol.
salmeterol.terbutaline.vilanterol..▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure tosalmeterol. Avoid.
rStudy
▶Atomoxetineis predicted to increase the risk of cardiovascular
side-effects when given withbeta 2 agonists(high-dose).
oStudy
▶Cobicistatis predicted to increase the exposure tosalmeterol.
Avoid.rStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
tosalmeterol. Avoid.rStudy
▶Idelalisibis predicted to increase the exposure tosalmeterol.
Avoid.rStudy
▶Beta 2 agonistsare predicted to increase the risk of glaucoma
when given withipratropium.oAnecdotal
▶Beta 2 agonistsare predicted to increase the risk of elevated
blood pressure when given withlinezolid. Avoid.r
Theoretical
▶Macrolides(clarithromycin)are predicted to increase the
exposure tosalmeterol. Avoid.rStudy
▶Monoamine-oxidase A and B inhibitors, irreversibleare
predicted to increase the risk of cardiovascular side-effects
when given withbeta 2 agonists.oAnecdotal
▶Monoamine-oxidase B inhibitors(rasagiline, selegiline)are
predicted to increase the risk of severe hypertension when
given withbeta 2 agonists. Avoid.rTheoretical
▶Monoamine-oxidase B inhibitors(safinamide)are predicted to
increase the risk of severe hypertension when given withbeta 2
agonists.rTheoretical
Betahistine
▶Antihistamines, non-sedatingare predicted to decrease the
effects ofbetahistine.oTheoretical
▶Antihistamines, sedatingare predicted to decrease the effects
ofbetahistine.oTheoretical
Betamethasone→see corticosteroids
Betaxolol→see beta blockers, selective
Bevacizumab→see monoclonal antibodies
Bexarotene→see retinoids
Bezafibrate→see fibrates
Bicalutamide
▶Bicalutamideis predicted to increase the exposure to
lomitapide. Separate administration by 12 hours.o
Theoretical
Bilastine→see antihistamines, non-sedating
Bisoprolol→see beta blockers, selective
Bisphosphonates→seeTABLE 2p. 847 (nephrotoxicity)
alendronic acid.ibandronic acid.pamidronate.risedronate.
sodium clodronate.zoledronic acid..▶Aminoglycosidesincrease the risk of hypocalcaemia when
given withbisphosphonates.oAnecdotal→Also see
TABLE 2p. 847
▶Antacidsdecrease the absorption ofalendronic acid.Alendronic
acidshould be taken at least 30 minutes beforeantacids.
oStudy
▶Antacidsare predicted to decrease the absorption of
ibandronic acid. Avoidantacidsfor at least 6 hours before or
1 hour afteribandronic acid.oTheoretical
▶Antacidsdecrease the absorption ofrisedronate. Separate
administration by at least 2 hours.oStudy
▶Antacidsdecrease the absorption ofsodium clodronate. Avoid
antacidsfor 2 hours before or 1 hour aftersodium clodronate.
oStudy
▶Aspirin(high-dose) is predicted to increase the risk of
gastrointestinal irritation when given withbisphosphonates
(alendronic acid, ibandronic acid).oStudy
▶Aspirin(high-dose) is predicted to increase the risk of renal
impairment when given withsodium clodronate.r
Theoretical
▶Oralcalcium saltsdecrease the absorption ofalendronic acid.
Alendronic acidshould be taken at least 30 minutes before
calcium salts.oStudy
▶Oralcalcium saltsare predicted to decrease the absorption of
oralibandronic acid. Avoidcalcium saltsfor at least 6 hours
before or 1 hour afteribandronic acid.oTheoretical
▶Oralcalcium saltsdecrease the absorption ofrisedronate.
Separate administration by at least 2 hours.oStudy
▶Oralcalcium saltsdecrease the absorption ofsodium
clodronate. Avoidcalcium saltsfor 2 hours before or 1 hour
aftersodium clodronate.oStudy
▶Iron (oral)is predicted to decrease the absorption of oral
ibandronic acid. Avoidiron (oral)for at least 6 hours before or
1 hour afteribandronic acid.oTheoretical
▶Iron (oral)decreases the absorption ofrisedronate. Separate
administration by at least 2 hours.oStudy
▶Iron (oral)decreases the absorption ofsodium clodronate.
Avoidiron (oral)for 2 hours before or 1 hour aftersodium
clodronate.oStudy
▶Bisphosphonatesare predicted to increase the risk of
gastrointestinal bleeding when given withiron chelators
(deferasirox).rTheoretical
▶Oralmagnesiumdecreases the absorption ofalendronic acid.
Alendronic acidshould be taken at least 30 minutes before
magnesium.oStudy
▶Oralmagnesiumis predicted to decrease the absorption of oral
ibandronic acid. Avoidmagnesiumfor at least 6 hours before or
1 hour afteribandronic acid.oTheoretical
▶Oralmagnesiumdecreases the absorption ofrisedronate.
Separate administration by at least 2 hours.oStudy
▶Oralmagnesiumdecreases the absorption ofsodium
clodronate. Avoidmagnesiumfor 2 hours before or 1 hour after
sodium clodronate.oStudy
▶NSAIDsare predicted to increase the risk of gastrointestinal
irritation when given withbisphosphonates(alendronic acid,
ibandronic acid).oStudy
▶NSAIDsare predicted to increase the risk of renal impairment
when given withsodium clodronate.rTheoretical
▶Bisphosphonatesare predicted to decrease the effects of
parathyroid hormone. Avoid.oStudy
▶Oralzincdecreases the absorption of oralalendronic acid.Zinc
should be taken at least 30 minutes beforealendronic acid.
oStudy
▶Oralzincis predicted to decrease the absorption of oral
ibandronic acid. Avoidzincfor at least 6 hours before or 1 hour
afteribandronic acid.oTheoretical
▶Oralzincdecreases the absorption of oralrisedronate.
Separate administration by at least 2 hours.oStudy
▶Oralzincdecreases the absorption of oralsodium clodronate.
Avoidzincfor 2 hours before or 1 hour aftersodium
clodronate.oStudy
Bivalirudin→seeTABLE 3p. 847 (anticoagulant effects)
▶Ranibizumabis predicted to increase the risk of bleeding
events when given withbivalirudin.oTheoretical
Bleomycin→seeTABLE 15p. 850 (myelosuppression),TABLE 5p. 847
(thromboembolism)
▶Live vaccinesare predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
bleomycin. Public Health England advises avoid (refer to
Green Book).rTheoretical
▶Monoclonal antibodies(brentuximab vedotin)increase the risk of
pulmonary toxicity when given withbleomycin. Avoid.r
Study→Also seeTABLE 15p. 850
▶Platinum compounds(cisplatin)increase the risk of pulmonary
toxicity when given withbleomycin.rStudy→Also see
TABLE 15p. 850BNFC 2018 – 2019 Beta blockers, selective—Bleomycin 885
Interactions|Appendix 1A1