▶Imatinibis predicted to increase the exposure to
methylprednisolone. Monitor and adjust dose.oStudy
▶Corticosteroidsare predicted to increase the risk of
gastrointestinal bleeding when given withiron chelators
(deferasirox).rTheoretical
▶Live vaccinesare predicted to increase the risk of generalised
infection (possibly life-threatening) when given with
corticosteroids(high-dose). Public Health England advises
avoid (refer to Green Book).rTheoretical
▶Lumacaftoris predicted to decrease the exposure to
corticosteroids(methylprednisolone, prednisone). Adjust dose.
rTheoretical
▶Macrolides(clarithromycin)are predicted to increase the
exposure tobeclometasone(risk with beclometasone is likely
to be lower than with other corticosteroids).o
Theoretical
▶Macrolides(clarithromycin)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
▶Macrolides(erythromycin)are predicted to increase the
exposure tomethylprednisolone. Monitor and adjust dose.
oStudy
▶Corticosteroidsare predicted to decrease the efficacy of
mifamurtide. Avoid.rTheoretical
▶Mifepristoneis predicted to decrease the efficacy of
corticosteroids. Use with caution and adjust dose.o
Theoretical
▶Mitotaneis predicted to decrease the exposure to
corticosteroids(budesonide, deflazacort, dexamethasone,
fludrocortisone, hydrocortisone, methylprednisolone,
prednisolone, prednisone, triamcinolone). Monitor and adjust
dose.oStudy
▶Mitotaneis predicted to decrease the exposure tofluticasone.
qTheoretical
▶Corticosteroids(betamethasone, deflazacort, dexamethasone,
hydrocortisone, methylprednisolone, prednisolone, prednisone)
are predicted to decrease the efficacy ofmonoclonal antibodies
(atezolizumab, ipilimumab, nivolumab, pembrolizumab). Use
with caution or avoid.rTheoretical
▶Monoclonal antibodies(tocilizumab)are predicted to decrease
the exposure tocorticosteroids(dexamethasone,
methylprednisolone). Monitor and adjust dose.o
Theoretical
▶Netupitantis predicted to increase the exposure to
dexamethasone. Adjust dose.oStudy
▶Netupitantis predicted to increase the exposure to
methylprednisolone. Monitor and adjust dose.oStudy
▶Corticosteroidsare predicted to decrease the effects of
neuromuscular blocking drugs, non-depolarising.r
Anecdotal
▶Corticosteroidsincrease the risk of gastrointestinal
perforation when given withnicorandil.rAnecdotal
▶Nilotinibis predicted to increase the exposure to
methylprednisolone. Monitor and adjust dose.oStudy
▶NSAIDsincrease the risk of gastrointestinal bleeding when
given withcorticosteroids.rStudy
▶Corticosteroidsare predicted to increase the effects of
phenindione.oAnecdotal
▶Dexamethasonedecreases the exposure topraziquantel.
oStudy
▶Rifampicinis predicted to decrease the exposure to
corticosteroids(budesonide, deflazacort, dexamethasone,
fludrocortisone, hydrocortisone, methylprednisolone,
prednisolone, prednisone, triamcinolone). Monitor and adjust
dose.oStudy
▶Rifampicinis predicted to decrease the exposure tofluticasone.
qTheoretical
▶Corticosteroidspotentially decrease the effects ofsodium
phenylbutyrate.oAnecdotal
▶Corticosteroidsare predicted to decrease the effects of
somatropin.oTheoretical
▶Corticosteroidsare predicted to decrease the effects of
suxamethonium.rAnecdotal
Coumarins→seeTABLE 3p. 847 (anticoagulant effects)
acenocoumarol.warfarin..FOOD AND LIFESTYLEThe effects of coumarins can be reduced
or abolished by vitamin K, including that found in health
foods, food supplements, enteral feeds, or large amounts of
some green vegetables or green tea. Major changes in diet
(especially involving salads and vegetables) and in alcohol
consumption can affect anticoagulant control. Pomegranate
increases the INR in response towarfarinand is predicted to
increase the INR in response toacenocoumarol.▶Alcohol (beverage)(in those who drink heavily) potentially
decreases the anticoagulant effect ofcoumarins.rStudy
▶Antiarrhythmics(amiodarone)increase the anticoagulant effect
ofcoumarins.rStudy
▶Antiarrhythmics(propafenone)increase the anticoagulant
effect ofcoumarins. Monitor INR and adjust dose.o
Study
▶Antiepileptics(carbamazepine)decrease the effects of
coumarins. Monitor and adjust dose.rStudy
▶Antiepileptics(fosphenytoin, phenytoin)are predicted to alter
the anticoagulant effect ofcoumarins.oAnecdotal
▶Antiepileptics(phenobarbital, primidone)decrease the
anticoagulant effect ofcoumarins. Monitor INR and adjust
dose.oStudy
▶Antifungals, azoles(fluconazole)increase the anticoagulant
effect ofcoumarins. Monitor INR and adjust dose.rStudy
▶Antifungals, azoles(itraconazole)potentially increase the
anticoagulant effect ofcoumarins.rAnecdotal
▶Antifungals, azoles(ketoconazole)potentially increase the
anticoagulant effect ofwarfarin. Monitor INR and adjust dose.
rAnecdotal
▶Antifungals, azoles(miconazole)greatly increase the
anticoagulant effect ofcoumarins. MHRA advises avoid unless
INR can be monitored closely; monitor for signs of bleeding.
rStudy
▶Antifungals, azoles(voriconazole)increase the anticoagulant
effect ofcoumarins. Monitor INR and adjust dose.o
Study
▶Aprepitantdecreases the anticoagulant effect ofcoumarins.
oStudy
▶Axitinibis predicted to increase the risk of bleeding events
when given withcoumarins.rTheoretical
▶Azathioprinedecreases the anticoagulant effect ofcoumarins.
oStudy
▶Bosentandecreases the anticoagulant effect ofcoumarins.
oStudy
▶Bosutinibis predicted to increase the risk of bleeding events
when given withcoumarins.rTheoretical
▶Cabozantinibis predicted to increase the risk of bleeding
events when given withcoumarins.rTheoretical
▶Capecitabineincreases the effects ofcoumarins. Monitor INR
and adjust dose.oAnecdotal
▶Cephalosporins(ceftriaxone)potentially increase the risk of
bleeding events when given withcoumarins.rAnecdotal
▶Ceritinibis predicted to increase the exposure towarfarin.
Avoid.rTheoretical
▶Chloramphenicolpotentially increases the anticoagulant effect
ofcoumarins.oAnecdotal
▶Corticosteroidsare predicted to increase the effects of
coumarins.oStudy
▶Cranberry juicepotentially increases the anticoagulant effect
ofwarfarin. Avoid.rAnecdotal
▶Crizotinibis predicted to increase the risk of bleeding events
when given withcoumarins.rTheoretical
▶Dabrafenibis predicted to decrease the anticoagulant effect of
coumarins.rTheoretical
▶Danazolpotentially increases the anticoagulant effect of
coumarins.rAnecdotal
▶Dasatinibis predicted to increase the risk of bleeding events
when given withcoumarins.rTheoreticalBNFC 2018 – 2019 Corticosteroids—Coumarins 903
Interactions|Appendix 1A1