Combined hormonal contraceptives(continued)
▶Paritaprevir(with ritonavir and ombitasvir) increases the risk
of raised liver function tests when given withcombined
hormonal contraceptives. Avoid.rStudy
▶Combined hormonal contraceptivesare predicted to increase
the exposure topirfenidone. Use with caution and adjust dose.
oStudy
▶Pitolisantis predicted to decrease the efficacy ofcombined
hormonal contraceptives. Avoid.rTheoretical
▶Combined hormonal contraceptivesare predicted to increase
the risk of venous thromboembolism when given with
pomalidomide. Avoid.rTheoretical
▶Rifabutinis predicted to decrease the efficacy ofcombined
hormonal contraceptives. For FSRH guidance, see
Contraceptives, interactionsp. 497.rStudy
▶Rifampicinis predicted to decrease the efficacy ofcombined
hormonal contraceptives. For FSRH guidance, see
Contraceptives, interactionsp. 497.rStudy
▶Combined hormonal contraceptivesare predicted to increase
the exposure toroflumilast.oTheoretical
▶St John’s Wortdecreases the efficacy ofcombined hormonal
contraceptives. MHRA advises avoid. For FSRH guidance, see
Contraceptives, interactionsp. 497.rAnecdotal
▶Sugammadexis predicted to decrease the exposure to oral
combined hormonal contraceptives. Refer to patient
information leaflet for missed pill advice.rTheoretical
▶Combined hormonal contraceptivesare predicted to increase
the risk of venous thromboembolism when given with
thalidomide. Avoid.rStudy
▶Combined hormonal contraceptivesare predicted to increase
the exposure totheophylline. Monitor and adjust dose.
oTheoretical
▶Combined hormonal contraceptivesincrease the exposure to
tizanidine. Avoid.oStudy
▶Ulipristalis predicted to decrease the efficacy ofcombined
hormonal contraceptives. Avoid.rTheoretical
▶Combined hormonal contraceptivesare predicted to increase
the exposure tozolmitriptan. Adjustzolmitriptandose,p. 292.
oTheoretical
Corticosteroids→seeTABLE 17p. 851 (reduced serum potassium)
beclometasone.betamethasone.budesonide.ciclesonide.
deflazacort.dexamethasone.fludrocortisone.fluticasone.
hydrocortisone.methylprednisolone.mometasone.prednisolone.
prednisone.triamcinolone..▶Interactions do not generally apply to corticosteroids used
for topical action (including inhalation) unless specified.
▶With intravitreal use ofdexamethasonein adults: caution
with concurrent administration of anticoagulant or
antiplatelet drugs—increased risk of haemorrhagic events.
▶Antacidsare predicted to decrease the absorption of
deflazacort. Separate administration by 2 hours.o
Theoretical
▶Antacidsdecrease the absorption ofdexamethasone.o
Study
▶Antiarrhythmics(dronedarone)are predicted to increase the
exposure tomethylprednisolone. Monitor and adjust dose.
oStudy
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tofluticasone.qTheoretical
▶Antiepileptics(carbamazepine, fosphenytoin, phenobarbital,
phenytoin, primidone)are predicted to decrease the exposure
tocorticosteroids(budesonide, deflazacort, dexamethasone,
fludrocortisone, hydrocortisone, methylprednisolone,
prednisolone, prednisone, triamcinolone). Monitor and adjust
dose.oStudy
▶Antifungals, azoles(fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure tomethylprednisolone.
Monitor and adjust dose.oStudy
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure tobeclometasone(risk with
beclometasone is likely to be lower than with other
corticosteroids).oTheoretical▶Antifungals, azoles(miconazole)are predicted to increase the
concentration ofmethylprednisolone. Monitor and adjust
dose.oTheoretical
▶Antifungals, azoles(itraconazole, ketoconazole, voriconazole)are
predicted to increase the exposure tocorticosteroids
(betamethasone, budesonide, ciclesonide, deflazacort,
dexamethasone, fludrocortisone, fluticasone, hydrocortisone,
methylprednisolone, mometasone, prednisolone, prednisone,
triamcinolone). Avoid or monitor side effects.rStudy
▶Prednisonepotentially decreases the exposure toantifungals,
azoles(isavuconazole). Use with caution or avoid.o
Theoretical
▶Aprepitantmoderately increases the exposure to
dexamethasone. Monitor and adjust dose.oStudy
▶Aprepitantis predicted to increase the exposure to
methylprednisolone. Monitor and adjust dose.oStudy
▶Corticosteroidsare predicted to decrease the concentration of
aspirin(high-dose) andaspirin(high-dose) increases the risk
of gastrointestinal bleeding when given withcorticosteroids.
oStudy
▶Calcium channel blockers(diltiazem, verapamil)are predicted to
increase the exposure tomethylprednisolone. Monitor and
adjust dose.oStudy
▶Dexamethasoneis predicted to decrease the concentration of
caspofungin. Adjustcaspofungindose,p. 372.o
Theoretical
▶Corticosteroidsare predicted to decrease the concentration of
choline salicylate.oStudy
▶Cobicistatis predicted to increase the exposure to
beclometasone(risk with beclometasone is likely to be lower
than with other corticosteroids).oTheoretical
▶Cobicistatis predicted to increase the exposure to
corticosteroids(betamethasone, budesonide, ciclesonide,
deflazacort, dexamethasone, fludrocortisone, fluticasone,
hydrocortisone, methylprednisolone, mometasone,
prednisolone, prednisone, triamcinolone). Avoid or monitor
side effects.rStudy
▶Corticosteroidsare predicted to increase the effects of
coumarins.oStudy
▶Crizotinibis predicted to increase the exposure to
methylprednisolone. Monitor and adjust dose.oStudy
▶Enzalutamideis predicted to decrease the exposure to
corticosteroids(budesonide, deflazacort, dexamethasone,
fludrocortisone, hydrocortisone, methylprednisolone,
prednisolone, prednisone, triamcinolone). Monitor and adjust
dose.oStudy
▶Enzalutamideis predicted to decrease the exposure to
fluticasone.qTheoretical
▶Corticosteroidsincrease the risk of gastrointestinal
perforation when given witherlotinib.rTheoretical
▶Fosaprepitantis predicted to increase the exposure to
corticosteroids(dexamethasone, methylprednisolone). Monitor
and adjust dose.oTheoretical
▶Corticosteroidspotentially oppose the effects ofglycerol
phenylbutyrate.oTheoretical
▶Grapefruit juicemoderately increases the exposure to oral
budesonide. Avoid.oStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
tobeclometasone(risk with beclometasone is likely to be
lower than with other corticosteroids).oTheoretical
▶HIV-protease inhibitorsare predicted to increase the exposure
tocorticosteroids(betamethasone, budesonide, ciclesonide,
deflazacort, dexamethasone, fludrocortisone, fluticasone,
hydrocortisone, methylprednisolone, mometasone,
prednisolone, prednisone, triamcinolone). Avoid or monitor
side effects.rStudy
▶Idelalisibis predicted to increase the exposure to
beclometasone(risk with beclometasone is likely to be lower
than with other corticosteroids).oTheoretical
▶Idelalisibis predicted to increase the exposure to
corticosteroids(betamethasone, budesonide, ciclesonide,
deflazacort, dexamethasone, fludrocortisone, fluticasone,
hydrocortisone, methylprednisolone, mometasone,
prednisolone, prednisone, triamcinolone). Avoid or monitor
side effects.rStudy902 Combined hormonal contraceptives—Corticosteroids BNFC 2018 – 2019
Interactions|Appendix 1A1