C1 inhibitor (Cinryze)
Breast-feeding [1], C1 inhibitor ---> SmPC of [1] of EMA
A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from Cinryze therapy taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.
C1 inhibitor [1], fertility ---> SmPC of [1] of EMA
No specific studies on fertility, early embryonic and postnatal development, or carcinogenicity studies were conducted (see section 5.3).
C1 inhibitor [1], pregnancy ---> SmPC of [1] of EMA
Cinryze should be given to pregnant women only if clearly indicated
CONTRAINDICATIONS of C1 inhibitor (Cinryze)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/cinryze-epar-product-information_en.pdf 26/09/2024
Other trade names: Berinert,
Cabazitaxel (Jevtana)
Ability to drive, cabazitaxel [2] ---> SmPC of [2] of EMA
Cabazitaxel may influence the ability to drive and use machines as it may cause fatigue and dizziness.
Aprepitant, cabazitaxel [2] ---> SmPC of [2] of EMA
Concomitant administration of aprepitant, a moderate CYP3A inhibitor, had no effect on cabazitaxel clearance.
Atazanavir [1], cabazitaxel ---> SmPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Breast-feeding, cabazitaxel [2] ---> SmPC of [2] of EMA
Available pharmacokinetics data in animals have shown excretion of cabazitaxel and its metabolites in milk (see section 5.3).
Cabazitaxel [1], carbamazepine ---> SmPC of [1] of EMA
Repeated administration of rifampin, a strong CYP3A inducer, resulted in an increase in cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inducers should be avoided as a decrease of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], clarithromycin ---> SmPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], dead vaccine ---> SmPC of [1] of EMA
Killed or inactivated vaccines may be administered; however, the response to such vaccines may be diminished.
Cabazitaxel [1], fertility ---> SmPC of [1] of EMA
Considering the pharmacological activity of taxanes, their genotoxic potential by an aneugenic mechanism and effect of several compounds of this class on fertility in animal studies, effect on male fertility could not be excluded in human.
Cabazitaxel [1], indinavir ---> SmPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], itraconazol ---> SmPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], ketoconazole ---> SmPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], men ---> SmPC of [1] of EMA
Due to the genotoxic risk of cabazitaxel (see section 5.3), men should use effective method of contraception during treatment and for 4 months after cessation of treatment with cabazitaxel.
Cabazitaxel [1], moderate CYP3A4 inhibitors ---> SmPC of [1] of EMA
Concomitant administration of aprepitant, a moderate CYP3A inhibitor, had no effect on cabazitaxel clearance.
Cabazitaxel [1], nefazodone ---> SmPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], nelfinavir ---> SmPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], OATP1B1 substrates ---> SmPC of [1] of EMA
The risk of interaction with OATP1B1 substrates is possible, notably during the infusion duration (1 hour) and up to 20 minutes after the end of the infusion.
Cabazitaxel [1], OATP1B1 substrates ---> SmPC of [1] of EMA
A time interval of 12 hours is recommended before the infusion and at least 3 hours after the end of infusion before administering the OATP1B1 substrates.
Cabazitaxel [1], phenobarbital ---> SmPC of [1] of EMA
Repeated administration of rifampin, a strong CYP3A inducer, resulted in an increase in cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inducers should be avoided as a decrease of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], phenytoin ---> SmPC of [1] of EMA
Repeated administration of rifampin, a strong CYP3A inducer, resulted in an increase in cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inducers should be avoided as a decrease of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], pregnancy ---> SmPC of [1] of EMA
Cabazitaxel crosses the placenta barrier (see section 5.3). As with other cytotoxic medicinal products, cabazitaxel may cause foetal harm in exposed pregnant women. Cabazitaxel is not indicated for use in women.
Cabazitaxel [1], repaglinide ---> SmPC of [1] of EMA
The risk of interaction with OATP1B1 substrates is possible, notably during the infusion duration (1 hour) and up to 20 minutes after the end of the infusion.
Cabazitaxel [1], rifabutin ---> SmPC of [1] of EMA
Repeated administration of rifampin, a strong CYP3A inducer, resulted in an increase in cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inducers should be avoided as a decrease of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], rifampicin ---> SmPC of [1] of EMA
Repeated administration of rifampin, a strong CYP3A inducer, resulted in an increase in cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inducers should be avoided as a decrease of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], rifampicin ---> SmPC of [1] of EMA
Repeated administration of rifampin, a strong CYP3A inducer, resulted in an increase in cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inducers should be avoided as a decrease of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], rifapentine ---> SmPC of [1] of EMA
Repeated administration of rifampin, a strong CYP3A inducer, resulted in an increase in cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inducers should be avoided as a decrease of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], ritonavir ---> SmPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], saquinavir ---> SmPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], St. John's wort ---> SmPC of [1] of EMA
Therefore concomitant administration of strong CYP3A inducers should be avoided as a decrease of plasma concentrations of cabazitaxel may occur. In addition, patients should also refrain from taking St. John's Wort.
Cabazitaxel [1], statins ---> SmPC of [1] of EMA
The risk of interaction with OATP1B1 substrates is possible, notably during the infusion duration (1 hour) and up to 20 minutes after the end of the infusion.
Cabazitaxel [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA
Repeated administration of rifampin, a strong CYP3A inducer, resulted in an increase in cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inducers should be avoided as a decrease of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], strong CYP3A4 inhibitors ---> SmPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], telithromycin ---> SmPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], vaccinations ---> SmPC of [1] of EMA
Killed or inactivated vaccines may be administered; however, the response to such vaccines may be diminished.
Cabazitaxel [1], vaccinations with live organism vaccines ---> SmPC of [1] of EMA
Administration of live or live-attenuated vaccines in patients immunocompromised by chemotherapeutic agents, may result in serious or fatal infections. Vaccination with a live attenuated vaccine should be avoided in patients receiving cabazitaxel.
Cabazitaxel [1], valsartan ---> SmPC of [1] of EMA
The risk of interaction with OATP1B1 substrates is possible, notably during the infusion duration (1 hour) and up to 20 minutes after the end of the infusion.
Cabazitaxel [1], voriconazole ---> SmPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Cabazitaxel [1], yellow fever vaccine ---> SmPC of [1] of EMA
Concomitant vaccination with yellow fever vaccine is contraindicated
Cabazitaxel, dabrafenib [2] ---> SmPC of [2] of EMA
Interactions with many medicinal products eliminated through metabolism or active transport is expected. These medicinal products are to be avoided or used with caution.
Cabazitaxel, enzalutamide [2] ---> SmPC of [2] of EMA
Enzalutamide, enzymatic inductor, may increase the metabolism of cabazitaxel and decrease its plasma levels and effect
Cabazitaxel, ketoconazole [2] ---> SmPC of [2] of EMA
Careful monitoring. Dose adjustment of each medicinal product may be required.
CONTRAINDICATIONS of Cabazitaxel (Jevtana)
- Hypersensitivity to cabazitaxel, to other taxanes, or polysorbate 80 or any excipients listed in section 6.1.
- Neutrophil counts less than 1,500/mmł.
- Severe hepatic impairment (total bilirubin > 3 x ULN)
- Concomitant vaccination with yellow fever vaccine
https://www.ema.europa.eu/en/documents/product-information/jevtana-epar-product-information_en.pdf 30/09/2025
Other trade names: Cabazitaxel Accord,
Cabergoline
Ability to drive, cabergoline [2] ---> SPC of [2] of eMC
Patients being treated with cabergoline and presenting with somnolence and/or sudden sleep onset episodes must be informed to refrain from driving or engaging in activities where impaired alertness may put themselves or others at risk
Alcohol, cabergoline [2] ---> SPC of [2] of eMC
The effects of alcohol on overall tolerability of cabergoline are currently unknown.
Antihypertensives, cabergoline
Hypotension
Breast-feeding, cabergoline [2] ---> SPC of [2] of eMC
Mothers should be advised not to breast-feed while being treated with cabergoline.
Butyrophenones, cabergoline [2] ---> SPC of [2] of eMC
Cabergoline should not be concurrently administered with drugs which have dopamine antagonist activity since these might reduce the therapeutic effect of cabergoline.
Cabergoline [1], dopamine antagonists ---> SPC of [1] of eMC
Cabergoline should not be concurrently administered with drugs which have dopamine antagonist activity since these might reduce the therapeutic effect of cabergoline.
Cabergoline [1], ergot derivatives ---> SPC of [1] of eMC
No information is available about interaction between cabergoline and other ergot alkaloids: therefore the concomitant use of these medications during long term treatment with cabergoline is not recommended.
Cabergoline [1], erythromycin ---> SPC of [1] of eMC
Cabergoline should not be used in association with macrolide antibiotics due to increase the systemic bioavailability.
Cabergoline [1], macrolide antibiotics ---> SPC of [1] of eMC
Cabergoline should not be used in association with macrolide antibiotics due to increase the systemic bioavailability.
Cabergoline [1], metoclopramide ---> SPC of [1] of eMC
Cabergoline should not be concurrently administered with drugs which have dopamine antagonist activity since these might reduce the therapeutic effect of cabergoline.
Cabergoline [1], phenothiazines ---> SPC of [1] of eMC
Cabergoline should not be concurrently administered with drugs which have dopamine antagonist activity since these might reduce the therapeutic effect of cabergoline.
Cabergoline [1], pregnancy ---> SPC of [1] of eMC
Cabergoline should only be used during pregnancy if clearly indicated and after an accurate benefit/risk evaluation.
Cabergoline [1], thioxanthenes ---> SPC of [1] of eMC
Cabergoline should not be concurrently administered with drugs which have dopamine antagonist activity since these might reduce the therapeutic effect of cabergoline.
Cabergoline, chlorpromazine [2] ---> SPC of [2] of eMC
Reciprocal antagonism of dopaminergic agent and neuroleptic. Association contraindicated except with dopaminergic antiparkinsonian agents
Cabergoline, desloratadine/pseudoephedrine [2] ---> SPC of [2] of EMA
The combination is not recommended
Cabergoline, ketoconazole
The strong CYP3A4 inhibition may increase the plasma concentrations of cabergoline. The co-administration is contraindicated
Cabergoline, levomepromazine
Due to the possibility of mutual antagonism, the co-administration is contraindicated except in case of Parkinson disease
Cabergoline, pseudoephedrine
Risk of vasoconstriction and increased blood pressure. Concomitant use not recommended
Cabergoline, sedatives
Additive effects
Cabergoline, strong CYP3A4 inhibitors
The strong CYP3A4 inhibition may increase the plasma concentrations of cabergoline. The co-administration is contraindicated
Cabergoline, tiapride
The combination of dopaminergic agonists, except in case of Parkinson disease, and tiapride is contraindicated due to mutual antagonism between dopaminergic agonists and neuroleptics
Cabergoline, tranylcypromine
Increased risk of serotonin syndrome.
Cabergoline, trimipramine
Increased risk of serotonin syndrome.
Cabergoline, venlafaxine
Increased risk of serotonin syndrome.
CONTRAINDICATIONS of Cabergoline
- Hypersensitivity to cabergoline or to any of the excipients listed in section 6.1, or any ergot alkaloid.
- History of pulmonary, pericardial and retroperitoneal fibrotic disorders.
- For long-term treatment: Evidence of cardiac valvulopathy as determined by pre-treatment echocardiography.
http://www.medicines.org.uk/emc/
Cabotegravir (Vocabria)
Ability to drive, cabotegravir [2] ---> SmPC of [2] of EMA
The clinical status of the patient and the adverse reaction profile of Vocabria injection should be borne in mind when considering the patient's ability to drive or operate machinery.
Antiretrovirals, cabotegravir [2] ---> SmPC of [2] of EMA
Vocabria and rilpivirine injections are intended for use as a complete regimen for the treatment of HIV-1 infection and should not be administered with other antiretroviral medicinal products for the treatment of HIV.
Atazanavir, cabotegravir [2] ---> SmPC of [2] of EMA
No dosing adjustments for Vocabria are, therefore, recommended in the presence of UGT1A1 inhibitors (e.g. atazanavir, erlotinib, sorafenib).
BCRP inhibitors, cabotegravir [2] ---> SmPC of [2] of EMA
Cabotegravir is a substrate of P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP), however, because of its high permeability, no alteration in absorption is expected when co- administered with either P-gp or BCRP inhibitors.
Breast-feeding, cabotegravir [2] ---> SmPC of [2] of EMA
Cabotegravir may be present in human milk for up to 12 months or longer after the last cabotegravir injection. It is recommended that women living with HIV do not breast-feed their infants in order to avoid transmission of HIV.
Cabotegravir [1], carbamazepine ---> SmPC of [1] of EMA
Metabolic inducers may significantly decrease cabotegravir plasma concentration. Concomitant use is contraindicated
Cabotegravir [1], erlotinib ---> SmPC of [1] of EMA
No dosing adjustments for Vocabria are, therefore, recommended in the presence of UGT1A1 inhibitors (e.g. atazanavir, erlotinib, sorafenib).
Cabotegravir [1], ethinyl estradiol/levonorgestrel ---> SmPC of [1] of EMA
Cabotegravir did not significantly change ethinyl estradiol and levonorgestrel plasma concentrations to a clinically relevant extent. No dose adjustment of oral contraceptives is necessary when co- administered with Vocabria.
Cabotegravir [1], etravirine ---> SmPC of [1] of EMA
Etravirine did not significantly change cabotegravir plasma concentration. No dose adjustment of Vocabria is necessary when initiating injections following etravirine use.
Cabotegravir [1], fertility ---> SmPC of [1] of EMA
There are no data on the effects of cabotegravir on human male or female fertility. Animal studies indicate no effects of cabotegravir on male or female fertility (see section 5.3).
Cabotegravir [1], foods ---> SmPC of [1] of EMA
When administered with rilpivirine, cabotegravir tablets should be taken with a meal
Cabotegravir [1], methotrexate ---> SmPC of [1] of EMA
In vitro cabotegravir inhibited organic anion transporters (OAT) 1 (IC50=0.81 然) and OAT3 (IC50=0.41 然). Therefore, caution is advised when co-dosing with narrow therapeutic index OAT1/3 substrate drugs (e.g. methotrexate).
Cabotegravir [1], midazolam ---> SmPC of [1] of EMA
In vivo, cabotegravir did not have an effect on midazolam, a cytochrome P450 (CYP) 3A4 probe. In vitro, cabotegravir did not induce CYP1A2, CYP2B6, or CYP3A4.
Cabotegravir [1], OAT1 substrates with narrow therapeutic window ---> SmPC of [1] of EMA
In vitro cabotegravir inhibited organic anion transporters (OAT) 1 (IC50=0.81 然) and OAT3 (IC50=0.41 然). Therefore, caution is advised when co-dosing with narrow therapeutic index OAT1/3 substrate drugs (e.g. methotrexate).
Cabotegravir [1], OAT3 substrates with narrow therapeutic window ---> SmPC of [1] of EMA
In vitro cabotegravir inhibited organic anion transporters (OAT) 1 (IC50=0.81 然) and OAT3 (IC50=0.41 然). Therefore, caution is advised when co-dosing with narrow therapeutic index OAT1/3 substrate drugs (e.g. methotrexate).
Cabotegravir [1], oral contraceptives ---> SmPC of [1] of EMA
Cabotegravir did not significantly change ethinyl estradiol and levonorgestrel plasma concentrations to a clinically relevant extent. No dose adjustment of oral contraceptives is necessary when co- administered with Vocabria.
Cabotegravir [1], oxcarbazepine ---> SmPC of [1] of EMA
Metabolic inducers may significantly decrease cabotegravir plasma concentration. Concomitant use is contraindicated
Cabotegravir [1], P-gp inhibitors ---> SmPC of [1] of EMA
Cabotegravir is a substrate of P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP), however, because of its high permeability, no alteration in absorption is expected when co- administered with either P-gp or BCRP inhibitors.
Cabotegravir [1], phenobarbital ---> SmPC of [1] of EMA
Metabolic inducers may significantly decrease cabotegravir plasma concentration. Concomitant use is contraindicated
Cabotegravir [1], phenytoin ---> SmPC of [1] of EMA
Metabolic inducers may significantly decrease cabotegravir plasma concentration. Concomitant use is contraindicated
Cabotegravir [1], pregnancy ---> SmPC of [1] of EMA
Vocabria injection is not recommended during pregnancy unless the expected benefit justifies the potential risk to the foetus. Cabotegravir has been detected in systemic circulation for up to 12 months or longer after an injection
Cabotegravir [1], rifabutin ---> SmPC of [1] of EMA
Rifabutin may decrease cabotegravir plasma concentration. Concomitant use should be avoided
Cabotegravir [1], rifampicin ---> SmPC of [1] of EMA
Rifampicin significantly decreased cabotegravir plasma concentration which is likely to result in loss of therapeutic effect. Co-administration of Vocabria with rifampicin is contraindicated
Cabotegravir [1], rifapentine ---> SmPC of [1] of EMA
Rifapentine may significantly decrease cabotegravir plasma concentrations. Concomitant use is contraindicated
Cabotegravir [1], rilpivirine ---> SmPC of [1] of EMA
Rilpivirine did not significantly change cabotegravir plasma concentration. No dose adjustment of Vocabria injection is necessary when co-administered with rilpivirine.
Cabotegravir [1], sorafenib ---> SmPC of [1] of EMA
No dosing adjustments for Vocabria are, therefore, recommended in the presence of UGT1A1 inhibitors (e.g. atazanavir, erlotinib, sorafenib).
Cabotegravir [1], systemic circulation ---> SmPC of [1] of EMA
Cabotegravir has been detected in systemic circulation for up to 12 months or longer after an injection (see section 4.4).
Cabotegravir [1], UGT1A1 inductors ---> SmPC of [1] of EMA
Medicinal products which are strong inducers of UGT1A1 or UGT1A9 are expected to decrease cabotegravir plasma concentrations leading to lack of efficacy
Cabotegravir [1], UGT1A1 inhibitors ---> SmPC of [1] of EMA
The impact of an UGT1A1 inhibitor may be slightly more pronounced, however, considering the safety margins of cabotegravir, this increase is not expected to be clinically relevant.
CONTRAINDICATIONS of Cabotegravir (Vocabria)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Concomitant use with rifampicin, rifapentine, carbamazepine, oxcarbazepine, phenytoin or phenobarbital (see section 4.5).
https://www.ema.europa.eu/en/documents/product-information/vocabria-epar-product-information_en.pdf 22/03/2024
Cabozantinib (Cometriq)
Ability to drive, cabozantinib [2] ---> SmPC of [2] of EMA
Cabozantinib has minor influence on the ability to drive and use machines. Adverse reactions such as fatigue and weakness have been associated with cabozantinib. Therefore, caution should be recommended when driving or operating machines.
Aliskiren, cabozantinib [2] ---> SmPC of [2] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Ambrisentan, cabozantinib [2] ---> SmPC of [2] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Aneurysm, cabozantinib [2] ---> SmPC of [2] of EMA
The use of VEGF pathway inhibitors in patients with or without hypertension may promote the formation of aneurysms and/or artery dissections.
Antacids, cabozantinib [2] ---> SmPC of [2] of EMA
No dose adjustment is indicated when gastric pH modifying agents (i.e., PPIs, H2 receptor antagonists, and antacids) are co-administered with cabozantinib
Antiarrhythmics, cabozantinib [2] ---> SmPC of [2] of EMA
Cabozantinib should be used with caution in patients with a history of QT interval prolongation, patients who are taking antiarrhythmics, or patients with relevant pre-existing cardiac disease, bradycardia, or electrolyte disturbances.
Bile-acid sequestrants, cabozantinib [2] ---> SmPC of [2] of EMA
Bile salt-sequestering agents such as cholestyramine and cholestagel may interact with cabozantinib and may impact absorption (or reabsorption) resulting in potentially decreased exposure
Breast-feeding, cabozantinib [2] ---> SmPC of [2] of EMA
Because of the potential harm to the infant, mothers should discontinue breast-feeding during treatment with cabozantinib, and for at least 4 months after completing therapy.
Cabozantinib [1], carbamazepine ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inductors (decreased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], cholestyramine ---> SmPC of [1] of EMA
Bile salt-sequestering agents such as cholestyramine and cholestagel may interact with cabozantinib and may impact absorption (or reabsorption) resulting in potentially decreased exposure
Cabozantinib [1], clarithromycin ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inhibitors (increased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], colchicine ---> SmPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Cabozantinib [1], colesevelam ---> SmPC of [1] of EMA
Bile salt-sequestering agents such as cholestyramine and cholestagel may interact with cabozantinib and may impact absorption (or reabsorption) resulting in potentially decreased exposure
Cabozantinib [1], cyclosporine ---> SmPC of [1] of EMA
In vitro data demonstrate that cabozantinib is a substrate of MRP2. Therefore, administration of MRP2 inhibitors may result in increases in cabozantinib plasma concentrations.
Cabozantinib [1], dabigatran etexilate ---> SmPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Cabozantinib [1], digoxin ---> SmPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Cabozantinib [1], drugs inducing bradycardia ---> SmPC of [1] of EMA
Cabozantinib should be used with caution in patients with a history of QT interval prolongation, patients who are taking antiarrhythmics, or patients with relevant pre-existing cardiac disease, bradycardia, or electrolyte disturbances.
Cabozantinib [1], efavirenz ---> SmPC of [1] of EMA
In vitro data demonstrate that cabozantinib is a substrate of MRP2. Therefore, administration of MRP2 inhibitors may result in increases in cabozantinib plasma concentrations.
Cabozantinib [1], electrolyte imbalance ---> SmPC of [1] of EMA
Cabozantinib should be used with caution in patients with a history of QT interval prolongation, patients who are taking antiarrhythmics, or patients with relevant pre-existing cardiac disease, bradycardia, or electrolyte disturbances.
Cabozantinib [1], emtricitabine ---> SmPC of [1] of EMA
In vitro data demonstrate that cabozantinib is a substrate of MRP2. Therefore, administration of MRP2 inhibitors may result in increases in cabozantinib plasma concentrations.
Cabozantinib [1], erythromycin ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inhibitors (increased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], esomeprazole ---> SmPC of [1] of EMA
No dose adjustment is indicated when gastric pH modifying agents (i.e., PPIs, H2 receptor antagonists, and antacids) are co-administered with cabozantinib
Cabozantinib [1], fertility ---> SmPC of [1] of EMA
There are no data on human fertility. Based on non-clinical safety findings, male and female fertility may be compromised by treatment with cabozantinib (see section 5.3).
Cabozantinib [1], fexofenadine ---> SmPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Cabozantinib [1], gastrointestinal perforation ---> SmPC of [1] of EMA
Cabozantinib should be discontinued in patients who experience a GI perforation or a GI or non-GI fistula.
Cabozantinib [1], GI adverse reactions ---> SmPC of [1] of EMA
Dose interruption or reduction, or permanent discontinuation of cabozantinib should be considered in case of persistent or recurrent significant GI adverse reactions (see section 4.2).
Cabozantinib [1], grapefruit juice ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inhibitors (increased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], H2 antagonists ---> SmPC of [1] of EMA
No dose adjustment is indicated when gastric pH modifying agents (i.e., PPIs, H2 receptor antagonists, and antacids) are co-administered with cabozantinib
Cabozantinib [1], haemorrhage ---> SmPC of [1] of EMA
Patients who have evidence of involvement of the trachea or bronchi by tumour or a history of haemoptysis prior to treatment initiation should be carefully evaluated before initiating cabozantinib therapy.
Cabozantinib [1], hepatotoxic drugs ---> SmPC of [1] of EMA
Dose reductions and dose interruptions occurred in 79% and 72%, respectively, of cabozantinib-treated patients in the pivotal clinical study. Two dose reductions were required in 41% of patients.
Cabozantinib [1], hypertensive drugs ---> SmPC of [1] of EMA
Cabozantinib should be discontinued if hypertension is severe and persistent despite anti-hypertensive therapy and dose reduction of cabozantinib. In case of hypertensive crisis, cabozantinib should be discontinued.
Cabozantinib [1], itraconazol ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inhibitors (increased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], ketoconazole ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inhibitors (increased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], maraviroc ---> SmPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Cabozantinib [1], men ---> SmPC of [1] of EMA
Effective methods of contraception should be used by male and female patients and their partners during therapy, and for at least 4 months after completing therapy.
Cabozantinib [1], MRP2 inhibitors ---> SmPC of [1] of EMA
In vitro data demonstrate that cabozantinib is a substrate of MRP2. Therefore, administration of MRP2 inhibitors may result in increases in cabozantinib plasma concentrations.
Cabozantinib [1], oral contraceptives ---> SmPC of [1] of EMA
As unchanged contraceptive effect may not be guaranteed, an additional contraceptive method, such as a barrier method, is recommended.
Cabozantinib [1], osteonecrosis ---> SmPC of [1] of EMA
Cabozantinib treatment should be held at least 28 days prior to scheduled dental surgery or invasive dental procedures, if possible. Caution should be used in patients receiving agents associated with ONJ, such as bisphosphonates.
Cabozantinib [1], P-glycoprotein substrates ---> SmPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Cabozantinib [1], palmar-plantar erythrodysaesthesia syndrome ---> SmPC of [1] of EMA
Palmar-plantar erythrodysaesthesia syndrome (PPES) has been observed with cabozantinib. When PPES is severe, interruption of treatment with cabozantinib should be considered.
Cabozantinib [1], phenobarbital ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inductors (decreased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], phenytoin ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inductors (decreased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], posaconazole ---> SmPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Cabozantinib [1], pregnancy ---> SmPC of [1] of EMA
Cabozantinib should not be used during pregnancy unless the clinical condition of the woman requires treatment with cabozantinib.
Cabozantinib [1], proteinuria ---> SmPC of [1] of EMA
Proteinuria has been observed with cabozantinib. Urine protein should be monitored regularly during cabozantinib treatment. Cabozantinib should be discontinued in patients who develop nephrotic syndrome.
Cabozantinib [1], proton pump inhibitors ---> SmPC of [1] of EMA
No dose adjustment is indicated when gastric pH modifying agents (i.e., PPIs, H2 receptor antagonists, and antacids) are co-administered with cabozantinib
Cabozantinib [1], QT interval prolonging drugs ---> SmPC of [1] of EMA
Cabozantinib should be used with caution in patients with a history of QT interval prolongation, patients who are taking antiarrhythmics, or patients with relevant pre-existing cardiac disease, bradycardia, or electrolyte disturbances.
Cabozantinib [1], ranolazine ---> SmPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Cabozantinib [1], rifampicin ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inductors (decreased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], ritonavir ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inhibitors (increased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], saxagliptin ---> SmPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Cabozantinib [1], sitagliptin ---> SmPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Cabozantinib [1], St. John's wort ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inductors (decreased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inductors (decreased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], strong CYP3A4 inhibitors ---> SmPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inhibitors (increased plasma cabozantinib exposure (AUC) should be approached with caution.
Cabozantinib [1], talinolol ---> SmPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Cabozantinib [1], tolvaptan ---> SmPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Cabozantinib [1], warfarin ---> SmPC of [1] of EMA
The effect of cabozantinib on the pharmacokinetics of warfarin has not been investigated. An interaction with warfarin may be possible. In case of such combination, INR values should be monitored.
Cabozantinib [1], women of childbearing potential ---> SmPC of [1] of EMA
Women of childbearing potential must be advised to avoid pregnancy while on cabozantinib. Female partners of male patients taking cabozantinib must also avoid pregnancy.
Cabozantinib [1], wound healing ---> SmPC of [1] of EMA
The decision to resume cabozantinib therapy after surgery should be based on clinical judgment of adequate wound healing. Cabozantinib should be discontinued in patients with wound healing complications requiring medical intervention.
Cabozantinib, ketoconazole [2] ---> SmPC of [2] of EMA
Not recommended due to the risk of increased exposure to these medicinal products and QT prolongation.
Cabozantinib, voriconazole [2] ---> SmPC of [2] of EMA
Voriconazole may increase plasma concentrations of tyrosine kinase inhibitors metabolised by CYP3A4. If concomitant use cannot be avoided, dose reduction of the tyrosine kinase inhibitor is recommended (see section 4.4).
CONTRAINDICATIONS of Cabozantinib (Cometriq)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/cometriq-epar-product-information_en.pdf 16/04/2025
Other trade names: Cabometyx
Caelyx pegylated liposomal (Caelyx)
Antineoplastics, Caelyx pegylated liposomal [2] ---> SmPC of [2] of EMA
Caelyx pegylated liposomal, like other doxorubicin hydrochloride preparations, may potentiate the toxicity of other anti-cancer therapies.
Caelyx pegylated liposomal [1], cyclophosphamide ---> SmPC of [1] of EMA
During clinical trials in patients with solid tumours (including breast and ovarian cancer) who have received concomitant cyclophosphamide or taxanes, no new additive toxicities were noted.
Caelyx pegylated liposomal [1], cytotoxic agents ---> SmPC of [1] of EMA
Caution must be exercised when giving any other cytotoxic agents, especially myelotoxic agents, at the same time.
Caelyx pegylated liposomal [1], doxorubicine ---> SmPC of [1] of EMA
Exercise caution in the concomitant use of medicinal products known to interact with standard doxorubicin hydrochloride.
Caelyx pegylated liposomal [1], fertility ---> SmPC of [1] of EMA
The effect of doxorubicin hydrochloride on human fertility has not been evaluated (see section 5.3).
Caelyx pegylated liposomal [1], mercaptopurine ---> SmPC of [1] of EMA
In patients with AIDS, exacerbation of cyclophosphamide-induced haemorrhagic cystitis and enhancement of the hepatotoxicity of 6-mercaptopurine have been reported with standard doxorubicin hydrochloride.
Caelyx pegylated liposomal [1], pregnancy ---> SmPC of [1] of EMA
Doxorubicin hydrochloride is suspected to cause serious birth defects when administered during pregnancy. Therefore, Caelyx pegylated liposomal should not be used during pregnancy unless clearly necessary.
Caelyx pegylated liposomal [1], taxanes ---> SmPC of [1] of EMA
During clinical trials in patients with solid tumours (including breast and ovarian cancer) who have received concomitant cyclophosphamide or taxanes, no new additive toxicities were noted.
Caelyx pegylated liposomal [1], women of childbearing potential ---> SmPC of [1] of EMA
Due to the genotoxic potential of Doxorubicin hidrochloride, women of child-bearing potential should use effective contraceptive measures while being treated with Caelyx pegylated liposomal and for 8 months following completion of treatment.
CONTRAINDICATIONS of Caelyx pegylated liposomal
- Hypersensitivity to the active substance, peanut or soya, or to any of the excipients listed in section 6.1.
- Caelyx pegylated liposomal must not be used to treat AIDS-KS that may be treated effectively with local therapy or systemic alfa-interferon.
Caffeine (Peyona)
Acalabrutinib [1], caffeine ---> SmPC of [1] of EMA
In vitro studies indicate that acalabrutinib induces CYP1A2. Co-administration of acalabrutinib with CYP1A2 substrates (e.g. theophylline, caffeine) may decrease their exposure.
Adenosine [1], caffeine ---> SmPC of [1] of eMC
The caffeine, adenosine antagonist, decreases the adenosine effect. The co-administration should be avoided for 24 hours prior to use of adenosine.
Alcohol, caffeine
Caffeine does not compensate the adverse effects of alcohol on performance, in isolated cases there is a risk of accelerated absorption of alcohol.
Amfepramone, caffeine
Caffeine at high doses may increase the amfepramone effect
Aminophylline, caffeine
Aminophylline acts synergistic with caffeine and similar substances
Antihistamines, caffeine
Caffeine antagonizes the sedative effects of many substances, e.g. antihistamines.
Barbiturates, caffeine
Caffeine antagonizes the sedative effects. Increased caffeine elimination
Benzodiazepines, caffeine
Caffeine may decrease the effect of benzodiazepines
Breast-feeding, caffeine [2] ---> SmPC of [2] of EMA
Breast-feeding mothers of newborn infants treated with caffeine citrate should not ingest caffeine-containing foods, beverages or medicinal products containing caffeine.
Bromperidol, caffeine
The simultaneous take may decrease the bromperidol effect
Caffeine [1], cimetidine ---> SmPC of [1] of EMA
Lower doses of caffeine citrate may be needed following co-administration of active substances which are reported to decrease caffeine elimination in adults (e.g., cimetidine and ketoconazole)
Caffeine [1], CYP1A2 inductors ---> SmPC of [1] of EMA
Cytochrome P450 1A2 (CYP1A2) is the major enzyme involved in the metabolism of caffeine in humans. Therefore, caffeine has the potential to interact with active substances that induce CYP1A2
Caffeine [1], CYP1A2 inhibitors ---> SmPC of [1] of EMA
Cytochrome P450 1A2 (CYP1A2) is the major enzyme involved in the metabolism of caffeine in humans. Therefore, caffeine has the potential to interact with active substances that inhibit CYP1A2
Caffeine [1], doxapram ---> SmPC of [1] of EMA
Concurrent use of caffeine and doxapram might potentiate their stimulatory effects on the cardiorespiratory and central nervous system. If concurrent use is indicated, cardiac rhythm and blood pressure must be carefully monitored.
Caffeine [1], drugs primarily metabolised by CYP1A2 ---> SmPC of [1] of EMA
Cytochrome P450 1A2 (CYP1A2) is the major enzyme involved in the metabolism of caffeine in humans. Therefore, caffeine has the potential to interact with active substances that are substrates for CYP1A2
Caffeine [1], fertility ---> SmPC of [1] of EMA
Effects on reproductive performance observed in animals are not relevant to its indication in the preterm newborn infants (see section 5.3).
Caffeine [1], H2 antagonists ---> SmPC of [1] of EMA
Co-administration of caffeine citrate with medicinal products that suppress gastric acid secretion may in theory increase the risk of necrotising enterocolitis
Caffeine [1], ketoconazole ---> SmPC of [1] of EMA
Lower doses of caffeine citrate may be needed following co-administration of active substances which are reported to decrease caffeine elimination in adults (e.g., cimetidine and ketoconazole)
Caffeine [1], phenobarbital ---> SmPC of [1] of EMA
Higher caffeine citrate doses may be needed following co-administration of active substances that increase caffeine elimination (e.g., phenobarbital and phenytoin)
Caffeine [1], phenytoin ---> SmPC of [1] of EMA
Higher caffeine citrate doses may be needed following co-administration of active substances that increase caffeine elimination (e.g., phenobarbital and phenytoin)
Caffeine [1], pregnancy ---> SmPC of [1] of EMA
Caffeine in animal studies, at high doses, was shown to be embryotoxic and teratogenic. These effects are not relevant with regard to short term administration in the preterm infant population (see section 5.3).
Caffeine [1], proton pump inhibitors ---> SmPC of [1] of EMA
Co-administration of caffeine citrate with medicinal products that suppress gastric acid secretion may in theory increase the risk of necrotising enterocolitis
Caffeine [1], strong CYP1A2 inductors ---> SmPC of [1] of EMA
Cytochrome P450 1A2 (CYP1A2) is the major enzyme involved in the metabolism of caffeine in humans. Therefore, caffeine has the potential to interact with active substances that induce CYP1A2
Caffeine [1], strong CYP1A2 inhibitors ---> SmPC of [1] of EMA
Cytochrome P450 1A2 (CYP1A2) is the major enzyme involved in the metabolism of caffeine in humans. Therefore, caffeine has the potential to interact with active substances that inhibit CYP1A2
Caffeine [1], theophylline ---> SmPC of [1] of EMA
Inter-conversion between caffeine and theophylline occurs in preterm newborn infants. These active substances should not be used concurrently.
Caffeine, capmatinib [2] ---> SmPC of [2] of EMA
Moderate inhibition of CYP1A2 was observed when capmatinib was co-administered with the sensitive CYP1A2 substrate caffeine. Co-administration of capmatinib (400 mg twice daily) with caffeine increased caffeine AUCinf by 134%.
Caffeine, cathine
Caffeine at high doses may increase the cathine effect
Caffeine, central sympathomimetics
Increased dependence potential
Caffeine, ciprofloxacin [2] ---> SmPC of [2] of eMC
On concurrent administration of ciprofloxacin and caffeine raised serum concentrations of caffeine were reported.
Caffeine, clozapine [2] ---> SmPC of [2] of eMC
Concomitant administration of substances known to inhibit the activity of some cytochrome P450 isozymes (CYP1A2) may increase the levels of clozapine, and the dose of clozapine may need to be reduced to prevent undesirable effects.
Caffeine, dasabuvir with ombitasvir/paritaprevir/ritonavir ---> SmPC of [ombitasvir/paritaprevir/ritonavir] of EMA
Viekirax administered with or without dasabuvir. Exposures of cyclobenzaprine, a CYP1A2 substrate, were decreased. Clinical monitoring and dose adjustment may be needed for other CYP1A2 substrates (e.g. ciprofloxacin, theophylline and caffeine).
Caffeine, diazepam [2] ---> SmPC of [2] of eMC
Concurrent use of diazepam and caffeine may result in reduced sedative and anxiolytic effects of diazepam.
Caffeine, digitoxin
The co-administration may increase the digitoxin effect and promote heart rhythm disorders
Caffeine, dipyridamole
Xanthines may weaken the vasodilator efect of dipyridamole
Caffeine, disulfiram
Decreased caffeine elimination
Caffeine, enfuvirtide [2] ---> SmPC of [2] of EMA
In an in-vivo human metabolism study enfuvirtide, at the recommended dose of 90 mg twice daily, did not inhibit the metabolism of substrates by CYP3A4 (dapsone), CYP2D6 (debrisoquine), CYP1A2 (caffeine), CYP2C19 (mephenytoin), and CYP2E1 (chlorzoxazone).
Caffeine, enoxacin
Delayed elimination of caffeine
Caffeine, enzalutamide [2] ---> SmPC of [2] of EMA
Enzalutamide (160 mg once daily) did not cause a clinically relevant change in the AUC or Cmax of caffeine (CYP1A2 substrate). The AUC and Cmax of caffeine decreased by 11% and 4% respectively. No dose adjustment is indicated
Caffeine, fentanyl
The combination may increase the bioavailability of swallowed fentanyl and may decrease its systemic clearance
Caffeine, flupentixol
The co-administration may weaken the neuroleptic effect
Caffeine, fluphenazine
The co-administration may weaken the neuroleptic effect
Caffeine, fluvoxamine [2] ---> SmPC of [2] of eMC
Caffeine plasma levels are likely to be increased during co-administration with fluvoxamine.
Caffeine, givosiran [2] ---> SmPC of [2] of EMA
1.3-fold increase in Cmax and 3.1-fold increase in AUC0-inf of caffeine
Caffeine, gyrase inhibitors
Delayed caffeine elimination
Caffeine, isavuconazole [2] ---> SmPC of [2] of EMA
No isavuconazole dose adjustment necessary. Caffeine: no dose adjustment required.
Caffeine, leflunomide [2] ---> SmPC of [2] of EMA
Effect on caffeine (CYP1A2 substrate) Repeated doses of A771726 decreased mean Cmax and AUC of caffeine (CYP1A2 substrate) by 18% and 55%, respectively, suggesting that A771726 may be a weak inducer of CYP1A2 in vivo.
Caffeine, lorazepam [2] ---> SmPC of [2] of eMC
Concurrent use of caffeine may result in reduced sedative and anxiolytic effects of lorazepam.
Caffeine, methotrexate [2] ---> SmPC of [2] of EMA
Excessive consumption of beverages containing caffeine or theophylline should be avoided since the efficacy of methotrexate may be reduced due to possible interaction between methotrexate and methylxanthines at adenosine receptors.
Caffeine, methoxsalen
Decreased caffeine clearance
Caffeine, metildigoxin
Facilitation of cardiac adverse effects
Caffeine, mexiletine [2] ---> SmPC of [2] of EMA
Coadministration of mexiletine with metabolised by CYP1A2 (mainly with narrow therapeutic range) may increase plasma levels of the concomitant medicine that could increase/prolong the therapeutic efficacy and/or the adverse reactions
Caffeine, neuroleptics
The co-administration may weaken the neuroleptic effect
Caffeine, nicotine
Nicotine, strong CYP1A2 inductor, may decrease the plasma concentrations of caffeine
Caffeine, norfloxacin
Quinolone may inhibit the metabolism, decrease the elimination and prolong the plasma half-life of caffeine. The caffeine intake should be avoided.
Caffeine, norpseudoephedrine
Caffeine at high doses increases the norpseudoephedrine effect
Caffeine, ombitasvir/paritaprevir/ritonavir [2] ---> SmPC of [2] of EMA
Viekirax administered with or without dasabuvir. Exposures of cyclobenzaprine, a CYP1A2 substrate, were decreased. Clinical monitoring and dose adjustment may be needed for other CYP1A2 substrates (e.g. ciprofloxacin, theophylline and caffeine).
Caffeine, oral contraceptives
Decreased caffeine elimination
Caffeine, pantoprazole [2] ---> SmPC of [2] of EMA
No clinically significant interactions were observed
Caffeine, pazopanib [2] ---> SmPC of [2] of EMA
Pazopanib does not have a clinically relevant effect on the pharmacokinetics of caffeine (CYP1A2 probe substrate), warfarin (CYP2C9 probe substrate), or omeprazole (CYP2C19 probe substrate) in cancer patients.
Caffeine, peginterferon alfa-2b [2] ---> SmPC of [2] of EMA
When patients are administered PegIntron with medications metabolized by CYP1A2 or CYP2D6, the extent of the decrease in cytochrome P 450 activity is unlikely to have a clinical impact, except with medicines which have a narrow therapeutic margin
Caffeine, perphenazine
The co-administration may weaken the neuroleptic effect
Caffeine, pipemidic acid
Quinolone may inhibit the metabolism, decrease the elimination and prolong the plasma half-life of caffeine. The caffeine intake should be avoided.
Caffeine, prazepam
Caffeine may decrease the effect of benzodiazepines
Caffeine, protirelin
Enhancement of TSH-increase
Caffeine, quinolones ---> SmPC of [norfloxacin] of eMC
Quinolone may inhibit the metabolism, decrease the elimination and prolong the plasma half-life of caffeine. The caffeine intake should be avoided.
Caffeine, regadenoson [2] ---> SmPC of [2] of EMA
Methylxanthines are non-specific adenosine receptor antagonists and may interfere with the vasodilation activity of regadenoson.
Caffeine, ribociclib [2] ---> SmPC of [2] of EMA
At the clinically relevant dose of 600 mg, simulations using PBPK models predicted only weak inhibitory effects of ribociclib on CYP1A2 substrates (<2-fold increase in AUC).
Caffeine, riluzole [2] ---> SmPC of [2] of EMA
In vitro studies suggest that CYP1A2 is the principal isozyme involved in the initial oxidative metabolism of riluzole. Inhibitors of CYP1A2 could potentially decrease the rate of riluzole elimination
Caffeine, simeprevir [2] ---> SmPC of [2] of EMA
No dose adjustment is required.
Caffeine, stiripentol [2] ---> SmPC of [2] of EMA
Data on the potential for inhibition of CYP1A2 are limited. Interactions with theophylline and caffeine cannot be excluded because of the increased plasma levels of theophylline and caffeine may potentially lead to toxicity.
Caffeine, sympathomimetics
Increased tachycardic effect
Caffeine, terbinafine [2] ---> SmPC of [2] of eMC
Terbinafine decreased the clearance of caffeine administered intravenously by 21%.
Caffeine, teriflunomide [2] ---> SmPC of [2] of EMA
Medicinal products metabolised by CYP1A2 should be used with caution during treatment with teriflunomide, as it could lead to the reduction of the efficacy of these products.
Caffeine, terizidone
The co-administration may increase the neurotoxic adverse effects
Caffeine, thyroid hormones
Increased tachycardic effect
Caffeine, vemurafenib [2] ---> SmPC of [2] of EMA
Vemurafenib, CYP1A2 inhibitor, may increase the plasma concentrations of caffeine. Dose adjustments should be considered
Caffeine, voxelotor [2] ---> SmPC of [2] of EMA
Voxelotor did not change the systemic exposure of caffeine (CYP1A2 substrate) and metoprolol (CYP2D6 substrate).
CONTRAINDICATIONS of Caffeine (Peyona)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/peyona-epar-product-information_en.pdf 18/09/2024
Other trade names: Durvitan, Gencebok, Peyona (previously Nymusa),
Calcifediol
Barbiturates, calcifediol
Enzym inductors may decrease plasma levels of calcifediol
Breast-feeding, calcifediol
D vitamin is excreted in small quantity in human breast milk
Calcifediol, calcium
The uncontrolled intake of preparations with calcium should be avoided
Calcifediol, chloramphenicol
Cloramfenicol may increase the absorption of calcium
Calcifediol, cholestyramine
Medicinal products that reduce calcifediol absorption may reduce its effects. It is recommended to separate the times of administration by at least 2 hours
Calcifediol, colestipol
Medicinal products that reduce calcifediol absorption may reduce its effects. It is recommended to separate the times of administration by at least 2 hours
Calcifediol, corticosteroids
Corticosteroids counteract the effects of vitamin D analogues
Calcifediol, digital glycosides
The co-administration of calcifediol may increase the toxicity of digitalis glycosides (risk of heart rhythm disorders)
Calcifediol, digoxin
Calcifediol may cause hypercalcemia, which may enhance the inotropic effects and toxicity of digoxin
Calcifediol, enzyme inductors
Enzym inductors may decrease plasma levels of calcifediol
Calcifediol, hydrochlorothiazide
The co-administration may decrease the calcium elimination and cause hypercalcemia
Calcifediol, hypercalcemia
Increased effect of calcifediol
Calcifediol, magnesium
Magnesium compounds should not be administered to patients with renal insufficiency because they can cause hypermagnesemia
Calcifediol, neomycin
Neomycin may increase the absorption of calcium
Calcifediol, orlistat
Medicinal products that reduce calcifediol absorption may reduce its effects. It is recommended to separate the times of administration by at least 2 hours
Calcifediol, penicillins
Penicillins may increase the absorption of calcium
Calcifediol, phenobarbital
Enzym inductors may decrease plasma levels of calcifediol
Calcifediol, phenytoin
Enzym inductors may decrease plasma levels of calcifediol
Calcifediol, pregnancy
Strict indication
Calcifediol, primidone
Enzym inductors may decrease plasma levels of calcifediol
Calcifediol, thiazides
The co-administration may decrease the calcium elimination and cause hypercalcemia
Calcifediol, verapamil
There are studies which describe an inhibition of antianginal effect due to antagonism of actions
Calcifediol, vitamin D
Concomitant use of calcifediol with vitamin D analogues should be avoided due to additive positive effects and hypercalcemia may occur
Corticosteroids, vitamin D
Corticosteroids counteract the effects of vitamin D analogues
Calcipotriol
Aluminium hydroxide, calcipotriol
The absorption of aluminum may be increased
Breast-feeding, calcipotriol [2] ---> SPC of [2] of eMC
As a precautionary measure, it is preferable to avoid the use of calcipotriol during lactation.
Calcipotriol [1], pregnancy ---> SPC of [1] of eMC
As a precautionary measure, it is preferable to avoid the use of calcipotriol during pregnancy.
Calcipotriol, salicylic acid
The co-administration of calcipotriol and salicylic acid may inactivate calcipotriol
CONTRAINDICATIONS of Calcipotriol
- Hypersensitivity to the active substance calcipotriol or to any of the excipients
- Patients with severe renal or liver impairment
- Known disorders of calcium metabolism or treatment with other medicinal products which increase serum calcium level.
- Hypercalcaemia.
http://www.medicines.org.uk/emc/
Recombinant salmon calcitonin (Forcaltonin)
Ability to drive, recombinant salmon calcitonin [2] ---> SPC of [2] of EMA
Injectable calcitonin may cause transient dizziness
Biphosphonates, calcitonin ---> SPC of [recombinant salmon calcitonin] of EMA
The use of calcitonin in combination with bisphosphonates may result in an additive calcium-lowering effect.
Biphosphonates, recombinant salmon calcitonin [2] ---> SPC of [2] of EMA
The use of calcitonin in combination with bisphosphonates may result in an additive calcium-lowering effect.
Breast-feeding, recombinant salmon calcitonin [2] ---> SPC of [2] of EMA
Breast-feeding is not recommended during treatment.
Calcitonin, hypocalcemia ---> SPC of [recombinant salmon calcitonin] of EMA
Calcitonin is contraindicated in patients with hypocalcaemia
Calcium antagonists, recombinant salmon calcitonin [2] ---> SPC of [2] of EMA
Care should be exercised in patients receiving concurrent treatment of calcitonin with calcium channel blocking agents. Dosages of these drugs may require adjustment
Cardiac glycosides, recombinant salmon calcitonin [2] ---> SPC of [2] of EMA
Care should be exercised in patients receiving concurrent treatment of calcitonin with cardiac glycosides. Dosages of these drugs may require adjustment
Pregnancy, recombinant salmon calcitonin [2] ---> SPC of [2] of EMA
Calcitonin should be used during pregnancy only if treatment is considered absolutely essential by the physician.
CONTRAINDICATIONS of Recombinant salmon calcitonin (Forcaltonin)
- Hypersensitivity to the active substance or to any of the excipients.
- Calcitonin is also contraindicated in patients with hypocalcaemia.
https://www.ema.europa.eu/en/documents/product-information/forcaltonin-epar-product-information_en.pdf 21/11/2008 (withdrawn)
Calcitriol
Antacids, calcitriol [2] ---> SPC of [2] of eMC
Magnesium-containing drugs (e.g. antacids) may cause hypermagnesaemia and should therefore not be taken during therapy with calcitriol by patients on chronic renal dialysis.
Barbiturates, calcitriol
The enzymatic induction may decrease the levels of calcitriol.
Bile-acid sequestrants, calcitriol [2] ---> SPC of [2] of eMC
Bile acid sequestrants including cholestyramine and sevelamer can reduce intestinal absorption of fat-soluble vitamins and therefore may impair intestinal absorption of calcitriol.
Breast-feeding, calcitriol [2] ---> SPC of [2] of eMC
It should be assumed that exogenous calcitriol passes into breast milk. Mothers may breastfeed while taking calcitriol, provided that the serum calcium levels of the mother and infant are monitored.
Calcitriol [1], cholestyramine ---> SPC of [1] of eMC
Bile acid sequestrants including cholestyramine and sevelamer can reduce intestinal absorption of fat-soluble vitamins and therefore may impair intestinal absorption of calcitriol.
Calcitriol [1], corticosteroids ---> SPC of [1] of eMC
A relationship of functional antagonism exists between vitamin D analogues, which promote calcium absorption, and corticosteroids, which inhibit it.
Calcitriol [1], digital glycosides ---> SPC of [1] of eMC
Calcitriol dosage must be determined with care in patients undergoing treatment with digitalis, as hypercalcaemia in such patients may precipitate cardiac arrhythmias
Calcitriol [1], magnesium ---> SPC of [1] of eMC
Magnesium-containing drugs (e.g. antacids) may cause hypermagnesaemia and should therefore not be taken during therapy with calcitriol by patients on chronic renal dialysis.
Calcitriol [1], magnesium hydroxide ---> SPC of [1] of eMC
Magnesium-containing drugs (e.g. antacids) may cause hypermagnesaemia and should therefore not be taken during therapy with calcitriol by patients on chronic renal dialysis.
Calcitriol [1], phosphate binders ---> SPC of [1] of eMC
Since calcitriol has an effect on phosphate transport in the intestine, kidneys and bones, the dosage of phosphate-binding agents must be adjusted in accordance with the serum phosphate concentration
Calcitriol [1], pregnancy ---> SPC of [1] of eMC
Calcitriol should be used during pregnancy only if the benefits outweigh the potential risk to the foetus.
Calcitriol [1], sevelamer ---> SPC of [1] of eMC
Bile acid sequestrants including cholestyramine and sevelamer can reduce intestinal absorption of fat-soluble vitamins and therefore may impair intestinal absorption of calcitriol.
Calcitriol [1], thiazides ---> SPC of [1] of eMC
Concomitant treatment of calcitriol with a thiazide diuretic increases the risk of hypercalcaemia.
Calcitriol, calcium
The uncontrolled intake of preparations with calcium should be avoided
Calcitriol, calcium aspartate
The D vitamin analog increases the calcium absorption
Calcitriol, deflazacort
Functional antagonism. The D vitamin analog promotes the calcium absorption and the glucocorticoid inhibits it.
Calcitriol, enzyme inductors
The enzymatic induction may decrease the levels of calcitriol.
Calcitriol, etoposide
The co-administration may decrease the etoposide efficacy
Calcitriol, phenobarbital
The enzymatic induction may decrease the levels of calcitriol.
Calcitriol, phenytoin
The enzymatic induction may decrease the levels of calcitriol.
Calcitriol, phosphates
Calcitriol stimulates the uptake of phosphate from gut
Calcitriol, vitamin D and analogues
Vitamin D and its derivatives should not be co-administered with calcitriol in order to avoid possible additive effects and the appearence of hypercalcemia
CONTRAINDICATIONS of Calcitriol
Calcitriol is contraindicated:
- in all diseases associated with hypercalcaemia
- in patients with evidence of metastatic calcification
- in patients with known hypersensitivity to calcitriol (or drugs of the same class) and any of the constituent excipients
- if there is evidence of vitamin D toxicity.
http://www.medicines.org.uk/emc/
Calcium acetate
Adrenaline, calcium acetate [2] ---> SPC of [2] of eMC
If the calcium level is increased, use of adrenaline may lead to severe cardiac arrhythmia.
Anionic drugs, calcium acetate
The anionic medicinal product may cause changes in the absorption. It is recommended to administer the two substances at least 1-2 hours apart.
Anticholinergics, calcium acetate [2] ---> SPC of [2] of eMC
Decreased absorption of anticholinergic agent. It is recommended to administer the two substances at least 1-2 hours apart.
Biphosphonates, calcium acetate
Decreased absorption of bisphosphonate. Administer on empty stomach at least 1 hour before or 1-2 hours after food.
Breast-feeding, calcium acetate [2] ---> SPC of [2] of eMC
Harmful effects on humans due to calcium taken during lactation have not been reported.
Calcium acetate [1], calcium antagonists ---> SPC of [1] of eMC
The co-administration may decrease the effect of calcium antagonist
Calcium acetate [1], cardiac glycosides ---> SPC of [1] of eMC
The combination may increase the effect of cardiac glycosides
Calcium acetate [1], chenodeoxycholic acid ---> SPC of [1] of eMC
Decreased absorption of chenodeoxycholic acid
Calcium acetate [1], doxycycline ---> SPC of [1] of eMC
Decreased absorption of tetracycline. It is recommended to administer the two substances at least 1-2 hours apart.
Calcium acetate [1], fluoride ---> SPC of [1] of eMC
Decreased absorption of fluoride ion. It is recommended to administer the two substances at least 1-2 hours apart.
Calcium acetate [1], pregnancy ---> SPC of [1] of eMC
Harmful effects on humans due to calcium taken during pregnancy have not been reported.
Calcium acetate [1], quinolones ---> SPC of [1] of eMC
The co-administration may decrease the absorption of quinolone. Separate administration by at least 1-2 hours
Calcium acetate [1], tetracyclines ---> SPC of [1] of eMC
Decreased absorption of tetracycline. It is recommended to administer the two substances at least 1-2 hours apart.
Calcium acetate [1], thiazides ---> SPC of [1] of eMC
Concomitant administration of calcium acetate and thiazides results in an increased risk of hypercalcemia.
Calcium acetate [1], ursodeoxycholic acid ---> SPC of [1] of eMC
The co-administration may decrease the absorption of ursodeoxycholic acid. It is recommended to administer the two substances at least 2 hours apart.
Calcium acetate, ciprofloxacin [2] ---> SPC of [2] of eMC
Decreased absorption of ciprofloxacin. It is recommended to administer the two substances at least 1-2 hours apart.
Calcium acetate, elbasvir/grazoprevir [2] ---> SPC of [2] of EMA
No dose adjustment is required.
Calcium acetate, fat-soluble vitamins
The D vitamin analog increases the calcium absorption
CONTRAINDICATIONS of Calcium acetate
- hypersensitivity to the active substance or to any of the excipients.
- hypophosphatemia
- severe hypophosphatemia
- hypercalcemia
- hypercalciuria associated with calcium-containing kidney stones
- decalcifying tumors and skeletal metastases
- severe renal failure without dialysis treatment
- constipation
- known stenosis of the large intestine
- osteoporosis due to immobilization
http://www.medicines.org.uk/emc/
Calcium carbonate
Aluminium, calcium carbonate
The co-administration may increase the aluminium absorption
Antacids, calcium carbonate
Antacids may decrease the bioavailability of calcium carbonate and prolong the renal elimination due to urine alkalinization
Bictegravir/emtricitabine/tenofovir alafenamide [1], calcium carbonate ---> SPC of [1] of EMA
Chelation with polyvalent cations. Biktarvy and calcium-containing supplements can be taken together, without regard to food.
Biphosphonates, calcium carbonate [2] ---> SPC of [2] of eMC
Calcium salts may reduce the absorption of bisphosphonates. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Bismuth, calcium carbonate
The co-administration may increase the bismuth absorption
Breast-feeding, calcium carbonate [2] ---> SPC of [2] of eMC
During lactation treatment with calcium carbonate should be under the direction of a physician.
Calcium carbonate [1], cardiac glycosides ---> SPC of [1] of eMC
The effects of cardiac glycosides may be accentuated with the oral administration of calcium combined with Vitamin D. Strict medical control is needed and, if necessary monitoring of ECG and calcium.
Calcium carbonate [1], corticosteroids ---> SPC of [1] of eMC
Calcium absorption is reduced in patients receiving systemic corticosteroid therapy. This should be taken in to account when patients are receiving concomitant therapy.
Calcium carbonate [1], foods ---> SPC of [1] of eMC
Certain foods (e.g. those containing oxalic acid, phosphate or phytinic acid) may reduce the absorption of calcium.
Calcium carbonate [1], oxalic acid ---> SPC of [1] of eMC
Certain foods (e.g. those containing oxalic acid, phosphate or phytic acid) may reduce the absorption of calcium.
Calcium carbonate [1], phytic acid ---> SPC of [1] of eMC
Certain foods (e.g. those containing oxalic acid, phosphate or phytic acid) may reduce the absorption of calcium.
Calcium carbonate [1], pregnancy ---> SPC of [1] of eMC
During pregnancy treatment with calcium carbonate should be under the direction of a physician.
Calcium carbonate [1], rhubarb ---> SPC of [1] of eMC
Certain foods (e.g. those containing oxalic acid, phosphate or phytic acid) may reduce the absorption of calcium.
Calcium carbonate [1], sodium fluoride ---> SPC of [1] of eMC
Calcium salts may reduce the absorption of sodium fluoride. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium carbonate [1], spinach ---> SPC of [1] of eMC
Certain foods (e.g. those containing oxalic acid, phosphate or phytic acid) may reduce the absorption of calcium.
Calcium carbonate [1], tetracyclines ---> SPC of [1] of eMC
Calcium salts may reduce the absorption of tetracycline antibiotics. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium carbonate [1], thiazides ---> SPC of [1] of eMC
The risk of hypercalcaemia should be considered in patients taking thiazide diuretics since these drugs can reduce urinary calcium excretion.
Calcium carbonate, calcium chloride
Calcium salts may enhance the adverse/toxic effects of calcium chloride.
Calcium carbonate, cephalosporins
Decreased absorption of cephalosporin. It is recommended to administer the two substances at least 3 hours apart.
Calcium carbonate, cinacalcet [2] ---> SPC of [2] of EMA
Co-administration of calcium carbonate (single 1,500 mg dose) did not alter the pharmacokinetics of cinacalcet.
Calcium carbonate, darunavir/cobicistat [2] ---> SPC of [2] of EMA
No mechanistic interaction expected based on theoretical consideration. Darunavir/cobicistat and antacids can be used concomitantly without dose adjustment.
Calcium carbonate, dolutegravir/rilpivirine [2] ---> SPC of [2] of EMA
The combination of Juluca and antacids should be used with particular caution. Antacids should be taken well separated in time from the administration of Juluca (minimum 6 hours before or 4 hours after).
Calcium carbonate, elbasvir/grazoprevir [2] ---> SPC of [2] of EMA
No dose adjustment is required.
Calcium carbonate, emtricitabine/rilpivirine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Co-administration may cause significant decreases in rilpivirine plasma concentrations (reduced absorption, increase in gastric pH). Antacids should only be administered either at least 2 hours before or at least 4 hours after Odefsey.
Calcium carbonate, iron
Calcium salts may reduce the absorption of iron. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium carbonate, ketoconazole
Decreased absorption of ketoconazole. It is recommended to administer the two substances at least 3 hours apart.
Calcium carbonate, lamivudine/raltegravir [2] ---> SPC of [2] of EMA
Co-administration of raltegravir with a calcium carbonate antacid decreased raltegravir plasma levels; however, this interaction is not considered clinically meaningful.
Calcium carbonate, levofloxacin [2] ---> SPC of [2] of EMA
Clinical pharmacology studies have shown that the pharmacokinetics of levofloxacin were not affected to any clinically relevant extent when levofloxacin was administered together with calcium carbonate
Calcium carbonate, levothyroxine ---> SPC of [calcium carbonate/cholecalciferol] of eMC
Calcium salts may reduce the absorption of thyroxine. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium carbonate, liothyronine
The co-administration decreases the absorption of liothyronine. Separate administration by at least 2 hours
Calcium carbonate, quinolones ---> SPC of [calcium carbonate/cholecalciferol] of eMC
Calcium salts may reduce the absorption of quinolone. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium carbonate, raltegravir ---> SPC of [lamivudine/raltegravir] of EMA
Co-administration of raltegravir with a calcium carbonate antacid decreased raltegravir plasma levels; however, this interaction is not considered clinically meaningful.
Calcium carbonate, rilpivirine [2] ---> SPC of [2] of EMA
The increase of gastric pH decreases absorption, plasma level and effect of rilpivirine. The antacid should be administered at least 2 h before or 4 h after rilpivirine
Calcium carbonate, simeprevir [2] ---> SPC of [2] of EMA
No clinically relevant drug-drug interaction is expected. No dose adjustment is required
Calcium carbonate, sofosbuvir/velpatasvir [2] ---> SPC of [2] of EMA
Increase in gastric pH. It is recommended to separate antacid and Epclusa administration by 4 hours.
Calcium carbonate, sofosbuvir/velpatasvir/voxilaprevir [2] ---> SPC of [2] of EMA
Increase in gastric pH decreases velpatasvir solubility. It is recommended to separate antacid and Vosevi administration by 4 hours.
Calcium carbonate, triiodthyronine
The co-administration decreases the absorption of liothyronine. Separate administration by at least 2 hours
Calcium carbonate, vitamin D
The D vitamin analog increases the calcium absorption
Calcium carbonate, whole-grain bread
Certain foods (e.g. those containing oxalic acid, phosphate or phytic acid) may reduce the absorption of calcium.
Calcium, tetracyclines ---> SPC of [calcium carbonate] of eMC
Calcium salts may reduce the absorption of tetracycline antibiotics. It is advisable to allow a minimum period of 4 hours before taking the calcium.
CONTRAINDICATIONS of Calcium carbonate
- Absolute contra-indications are hypercalcaemia resulting for example from myeloma, bone metastases or other malignant bone disease, sarcoidosis; primary
hyperparathyroidism and vitamin D overdosage. Severe renal failure untreated by renal dialysis. Hypersensitivity to any of the tablet ingredients.
- Relative contra-indications are osteoporosis due to prolonged immobilisation, renal stones, severe hypercalciuria.
http://www.medicines.org.uk/emc/
Calcium carbonate/cholecalciferol
Barbiturates, calcium carbonate/cholecalciferol ---> SPC of [cholecalciferol] of eMC
The co-administration may increase the metabolism and decrease the effect of vitamin D3
Biphosphonates, calcium carbonate/cholecalciferol [2] ---> SPC of [2] of eMC
Calcium salts may reduce the absorption of bisphosphonates. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Breast-feeding, calcium carbonate/cholecalciferol [2] ---> SPC of [2] of eMC
Vitamin D and its metabolites pass into the breast milk. In humans, long term hypercalcaemia can lead to physical and mental retardation, aortic stenosis and retinopathy in a new born child.
Calcium carbonate, levothyroxine ---> SPC of [calcium carbonate/cholecalciferol] of eMC
Calcium salts may reduce the absorption of thyroxine. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium carbonate, quinolones ---> SPC of [calcium carbonate/cholecalciferol] of eMC
Calcium salts may reduce the absorption of quinolone. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium carbonate/cholecalciferol [1], cardiac glycosides ---> SPC of [1] of eMC
The effects of cardiac glycosides may be accentuated with the oral administration of calcium combined with Vitamin D. Strict medical control is needed and, if necessary monitoring of ECG and calcium.
Calcium carbonate/cholecalciferol [1], iron ---> SPC of [1] of eMC
Calcium salts may reduce the absorption of iron. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium carbonate/cholecalciferol [1], levothyroxine ---> SPC of [1] of eMC
Calcium salts may reduce the absorption of thyroxine. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium carbonate/cholecalciferol [1], pregnancy ---> SPC of [1] of eMC
There have been no studies on the use of this medicinal product in human pregnancy and lactation. In humans, long term hypercalcaemia can lead to physical and mental retardation in a new born child.
Calcium carbonate/cholecalciferol [1], quinolones ---> SPC of [1] of eMC
Calcium salts may reduce the absorption of quinolone. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium carbonate/cholecalciferol [1], tetracyclines ---> SPC of [1] of eMC
Calcium salts may reduce the absorption of tetracycline antibiotics. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium carbonate/cholecalciferol [1], thiazides ---> SPC of [1] of eMC
The risk of hypercalcaemia should be considered in patients taking thiazide diuretics since these drugs can reduce urinary calcium excretion.
Calcium carbonate/cholecalciferol, corticosteroids
Concomitant use of glucocorticoids can decrease the effect of vitamin D.
Calcium carbonate/cholecalciferol, oxalic acid
Certain foods (e.g. those containing oxalic acid, phosphate or phytic acid) may reduce the absorption of calcium.
Calcium carbonate/cholecalciferol, phenytoin ---> SPC of [cholecalciferol] of eMC
The co-administration may increase the metabolism and decrease the effect of vitamin D3
Calcium carbonate/cholecalciferol, phytic acid
Certain foods (e.g. those containing oxalic acid, phosphate or phytic acid) may reduce the absorption of calcium.
Calcium carbonate/cholecalciferol, rhubarb
Certain foods (e.g. those containing oxalic acid, phosphate or phytic acid) may reduce the absorption of calcium.
Calcium carbonate/cholecalciferol, sodium fluoride
Calcium salts may reduce the absorption of sodium fluoride. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium carbonate/cholecalciferol, spinach
Certain foods (e.g. those containing oxalic acid, phosphate or phytic acid) may reduce the absorption of calcium.
Calcium carbonate/cholecalciferol, strontium ranelate
Calcium salts may reduce the absorption of strontium ranelate. It is advisable to allow a minimum period of 2 hours before taking the calcium.
Calcium carbonate/cholecalciferol, whole-grain bread
Certain foods (e.g. those containing oxalic acid, phosphate or phytic acid) may reduce the absorption of calcium.
Calcium carbonate/cholecalciferol, zinc
Calcium salts may reduce the absorption of zinc. It is advisable to allow a minimum period of 2 hours before taking the calcium.
Calcium, levothyroxine ---> SPC of [calcium carbonate/cholecalciferol] of eMC
Calcium salts may reduce the absorption of thyroxine. It is advisable to allow a minimum period of 4 hours before taking the calcium.
Calcium, quinolones
Calcium salts may reduce the absorption of quinolone. It is advisable to allow a minimum period of 4 hours before taking the calcium.
CONTRAINDICATIONS of Calcium carbonate/cholecalciferol
- Absolute contra-indications are hypercalcaemia resulting for example from myeloma, bone metastases or other malignant bone disease, sarcoidosis; primary hyperparathyroidism
and vitamin D overdosage. Severe renal failure. Hypersensitivity to any of the tablet ingredients.
- Relative contra-indications are osteoporosis due to prolonged immobilisation, renal stones, severe hypercalciuria.
Adcal-D3 contains a small quantity of soya oil and is therefore contraindicated in patients who are allergic to peanuts
http://www.medicines.org.uk/emc/
Calcium folinate
Antiepileptics, calcium folinate
Folic acid in large amounts may counteract the effect of antiepileptic drugs and increase the frequency of seizures.
Breast-feeding, calcium folinate [2] ---> SPC of [2] of eMC
Calcium folinate can be used during breast feeding when considered necessary according to the therapeutic indications.
Calcium folinate [1], cotrimoxazole ---> SPC of [1] of eMC
Leucovorin should not be given simultaneously with a folic acid antagonist, for the purpose of reducing or preventing clinical toxicity, as the therapeutic effect of the antagonist may be nullified.
Calcium folinate [1], folic acid antagonists ---> SPC of [1] of eMC
Leucovorin should not be given simultaneously with a folic acid antagonist, for the purpose of reducing or preventing clinical toxicity, as the therapeutic effect of the antagonist may be nullified.
Calcium folinate [1], pregnancy ---> SPC of [1] of eMC
There are no indications that folic acid induces harmful effects if administered during pregnancy.
Calcium folinate [1], pyrimethamine ---> SPC of [1] of eMC
Leucovorin should not be given simultaneously with a folic acid antagonist, for the purpose of reducing or preventing clinical toxicity, as the therapeutic effect of the antagonist may be nullified.
Calcium folinate, methotrexate
The co-administration may decrease or neutralize the efficacy of methotrexate
Calcium folinate, phenobarbital
Folic acid in large amounts may counteract the effect of antiepileptic drugs and increase the frequency of seizures.
Calcium folinate, phenytoin
Folic acid in large amounts may counteract the effect of antiepileptic drugs and increase the frequency of seizures.
Calcium folinate, primidone
Folic acid in large amounts may counteract the effect of antiepileptic drugs and increase the frequency of seizures.
Calcium folinate, raltitrexed [2] ---> SPC of [2] of eMC
Leucovorin (folinic acid), folic acid or vitamin preparations containing these agents must not be given immediately prior to or during administration of raltitrexed, since they may interfere with its action.
Calcium folinate, succinimides
Folic acid in large amounts may counteract the effect of antiepileptic drugs and increase the frequency of seizures.
Calcium folinate, tegafur/gimeracil/oteracil [2] ---> SPC of [2] of EMA
Metabolites of folinate/folinic acid form a ternary structure with thymidylate synthase and fluorodeoxyuridine monophosphate (FdUMP), potentially increasing the cytotoxicity of 5-FU. Caution is advised as folinic acid enhances the activity of 5-FU.
CONTRAINDICATIONS of Calcium folinate
- Leucovorin calcium should not be used in patients who have a known hypersensitivity to any of the constituents of the product.
- Calcium folinate should not be used for the treatment of pernicious anaemia or other megaloblastic anaemia where vitamin B12 is deficient.
http://www.medicines.org.uk/emc/
Canagliflozin (Invokana)
Ability to drive, canagliflozin [2] ---> SmPC of [2] of EMA
Patients should be alerted to the risk of hypoglycaemia when canagliflozin is used as add-on therapy with insulin or an insulin secretagogue, and to the elevated risk of adverse reactions related to volume depletion, such as postural dizziness
Barbiturates, canagliflozin [2] ---> SmPC of [2] of EMA
Enzyme inducers (such as St. John's wort [Hypericum perforatum], rifampicin, barbiturates, phenytoin, carbamazepine, ritonavir, efavirenz) may decrease the exposure to canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
BCRP substrates, canagliflozin [2] ---> SmPC of [2] of EMA
Inhibition of BCRP by canagliflozin cannot be excluded at an intestinal level and increased exposure may therefore occur for medicinal products transported by BCRP, e.g. certain statins like rosuvastatin and some anti-cancer medicinal products.
Bile-acid sequestrants, canagliflozin [2] ---> SmPC of [2] of EMA
Cholestyramine may potentially reduce canagliflozin exposure. Dosing of canagliflozin should occur at least 1 hour before or 4-6 hours after administration of a bile acid sequestrant to minimise possible interference with their absorption.
Breast-feeding, canagliflozin [2] ---> SmPC of [2] of EMA
A risk to newborns/infants cannot be excluded. Canagliflozin should not be used during breast-feeding.
Canagliflozin [1], carbamazepine ---> SmPC of [1] of EMA
Enzyme inducers (such as St. John's wort [Hypericum perforatum], rifampicin, barbiturates, phenytoin, carbamazepine, ritonavir, efavirenz) may decrease the exposure to canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin [1], cardiac glycosides ---> SmPC of [1] of EMA
Canagliflozin has been observed to inhibit P-gp in vitro. Patients taking digoxin or other cardiac glycosides (e.g., digitoxin) should be monitored appropriately.
Canagliflozin [1], cholestyramine ---> SmPC of [1] of EMA
Cholestyramine may potentially reduce canagliflozin exposure. Canagliflozin should be taken at least 1 hour prior to or 4-6 hours after taking the bile-acid sequestrant
Canagliflozin [1], cyclosporine ---> SmPC of [1] of EMA
Interaction studies suggest that the pharmacokinetics of canagliflozin are not altered by metformin, hydrochlorothiazide, oral contraceptives (ethinyl estradiol and levonorgestrol), ciclosporin, and/or probenecid.
Canagliflozin [1], dabigatran ---> SmPC of [1] of EMA
The inhibition of P-glycoprotein by canagliflozin may increase the bioavailability of dabigatran. Monitoring: looking for signs of bleeding or anaemia
Canagliflozin [1], digitoxin ---> SmPC of [1] of EMA
Canagliflozin has been observed to inhibit P-gp in vitro. Patients taking digoxin or other cardiac glycosides (e.g., digitoxin) should be monitored appropriately.
Canagliflozin [1], digoxin ---> SmPC of [1] of EMA
Canagliflozin has been observed to inhibit P-gp in vitro. Patients taking digoxin or other cardiac glycosides (e.g., digitoxin) should be monitored appropriately.
Canagliflozin [1], diuretics ---> SmPC of [1] of EMA
Canagliflozin may add to the effect of diuretics and may increase the risk of dehydration and hypotension
Canagliflozin [1], efavirenz ---> SmPC of [1] of EMA
Enzyme inducers (such as St. John's wort [Hypericum perforatum], rifampicin, barbiturates, phenytoin, carbamazepine, ritonavir, efavirenz) may decrease the exposure to canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin [1], enzyme inductors ---> SmPC of [1] of EMA
Enzyme inducers (such as St. John's wort [Hypericum perforatum], rifampicin, barbiturates, phenytoin, carbamazepine, ritonavir, efavirenz) may decrease the exposure to canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin [1], fertility ---> SmPC of [1] of EMA
The effect of canagliflozin on fertility in humans has not been studied. No effects on fertility were observed in animal studies (see section 5.3).
Canagliflozin [1], foods ---> SmPC of [1] of EMA
Invokana should be taken orally once a day, preferably before the first meal of the day. Tablets should be swallowed whole.
Canagliflozin [1], hydrochlorothiazide ---> SmPC of [1] of EMA
Interaction studies suggest that the pharmacokinetics of canagliflozin are not altered by metformin, hydrochlorothiazide, oral contraceptives (ethinyl estradiol and levonorgestrol), ciclosporin, and/or probenecid.
Canagliflozin [1], insulin ---> SmPC of [1] of EMA
Insulin and insulin secretagogues, such as sulphonylureas, can cause hypoglycaemia. Therefore, a lower dose of insulin or an insulin secretagogue may be required to reduce the risk of hypoglycaemia when used in combination with canagliflozin
Canagliflozin [1], insulin secretagogues ---> SmPC of [1] of EMA
Insulin and insulin secretagogues, such as sulphonylureas, can cause hypoglycaemia. Therefore, a lower dose of insulin or an insulin secretagogue may be required to reduce the risk of hypoglycaemia when used in combination with canagliflozin
Canagliflozin [1], metformin ---> SmPC of [1] of EMA
Interaction studies suggest that the pharmacokinetics of canagliflozin are not altered by metformin, hydrochlorothiazide, oral contraceptives (ethinyl estradiol and levonorgestrol), ciclosporin, and/or probenecid.
Canagliflozin [1], oral contraceptives ---> SmPC of [1] of EMA
Interaction studies suggest that the pharmacokinetics of canagliflozin are not altered by metformin, hydrochlorothiazide, oral contraceptives (ethinyl estradiol and levonorgestrol), ciclosporin, and/or probenecid.
Canagliflozin [1], pharmacokinetics ---> SmPC of [1] of EMA
Interaction studies suggest that the pharmacokinetics of canagliflozin are not altered by metformin, hydrochlorothiazide, oral contraceptives (ethinyl estradiol and levonorgestrol), ciclosporin, and/or probenecid.
Canagliflozin [1], pharmacokinetics ---> SmPC of [1] of EMA
In interaction studies, canagliflozin at steady-state had no clinically relevant effect on the pharmacokinetics of metformin, oral contraceptives (ethinyl estradiol and levonorgestrel), glibenclamide, paracetamol, hydrochlorothiazide, or warfarin.
Canagliflozin [1], phenytoin ---> SmPC of [1] of EMA
Enzyme inducers (such as St. John's wort [Hypericum perforatum], rifampicin, barbiturates, phenytoin, carbamazepine, ritonavir, efavirenz) may decrease the exposure to canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin [1], pregnancy ---> SmPC of [1] of EMA
Canagliflozin should not be used during pregnancy. When pregnancy is detected, treatment with canagliflozin should be discontinued.
Canagliflozin [1], probenecide ---> SmPC of [1] of EMA
Interaction studies suggest that the pharmacokinetics of canagliflozin are not altered by metformin, hydrochlorothiazide, oral contraceptives (ethinyl estradiol and levonorgestrol), ciclosporin, and/or probenecid.
Canagliflozin [1], rifampicin ---> SmPC of [1] of EMA
Enzyme inducers (such as St. John's wort [Hypericum perforatum], rifampicin, barbiturates, phenytoin, carbamazepine, ritonavir, efavirenz) may decrease the exposure to canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin [1], ritonavir ---> SmPC of [1] of EMA
Enzyme inducers (such as St. John's wort [Hypericum perforatum], rifampicin, barbiturates, phenytoin, carbamazepine, ritonavir, efavirenz) may decrease the exposure to canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin [1], rosuvastatin ---> SmPC of [1] of EMA
Inhibition of BCRP by canagliflozin cannot be excluded at an intestinal level and increased exposure may therefore occur for medicinal products transported by BCRP, e.g. certain statins like rosuvastatin and some anti-cancer medicinal products.
Canagliflozin [1], simvastatine ---> SmPC of [1] of EMA
The increases in simvastatin and simvastatin acid exposures are not considered clinically relevant.
Canagliflozin [1], St. John's wort ---> SmPC of [1] of EMA
Enzyme inducers (such as St. John's wort [Hypericum perforatum], rifampicin, barbiturates, phenytoin, carbamazepine, ritonavir, efavirenz) may decrease the exposure to canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin [1], steady state ---> SmPC of [1] of EMA
In interaction studies, canagliflozin at steady-state had no clinically relevant effect on the pharmacokinetics of metformin, oral contraceptives (ethinyl estradiol and levonorgestrol), glibenclamide, paracetamol, hydrochlorothiazide, or warfarin.
Canagliflozin [1], sulfonylureas ---> SmPC of [1] of EMA
Insulin and insulin secretagogues, such as sulphonylureas, can cause hypoglycaemia. Therefore, a lower dose of insulin or an insulin secretagogue may be required to reduce the risk of hypoglycaemia when used in combination with canagliflozin
Canagliflozin, doravirine [2] ---> SmPC of [2] of EMA
No dose adjustment is required.
Canagliflozin, doravirine/lamivudine/tenofovir disoproxil [2] ---> SmPC of [2] of EMA
No dose adjustment is required.
Canagliflozin, loop diuretics ---> SmPC of [canagliflozin/metformin] of EMA
Canagliflozin is not recommended for use in patients receiving loop diuretics.
Canagliflozin, patiromer [2] ---> SmPC of [2] of EMA
In vitro studies have shown no potential interaction of patiromer with the other active substances
Lithium, SGLT2 inhibitors ---> SmPC of [canagliflozin] of EMA
The concomitant use of an SGLT2 inhibitor with lithium may decrease serum lithium concentrations. Monitor serum lithium concentration more closely during treatment with canagliflozin, especially during initiation and dosage changes.
CONTRAINDICATIONS of Canagliflozin (Invokana)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/invokana-epar-product-information_en.pdf 18/12/2025
Canagliflozin/metformin (Vokanamet)
1,5-AG assay, canagliflozin/metformin ---> SmPC of [2] of EMA
Therefore, 1,5-AG assays should not be used for assessment of glycaemic control in patients on Vokanamet. For further detail, it may be advisable to contact the specific manufacturer of the 1,5-AG assay.
Ability to drive, canagliflozin/metformin [2] ---> SmPC of [2] of EMA
Patients should be alerted to the risk of hypoglycaemia when Vokanamet is used as add-on therapy with insulin or an insulin secretagogue, and to the elevated risk of adverse reactions related to volume depletion, such as postural dizziness
ACE inhibitors, canagliflozin/metformin [2] ---> SmPC of [2] of EMA
Some medicinal products can adversely affect renal function which may increase the risk of lactic acidosis
AIIRA, canagliflozin/metformin [2] ---> SmPC of [2] of EMA
Some medicinal products can adversely affect renal function which may increase the risk of lactic acidosis
Alcohol, canagliflozin/metformin [2] ---> SmPC of [2] of EMA
There is increased risk of lactic acidosis in acute alcohol intoxication due to the metformin active substance of this medicinal product. Consumption of alcohol and medicinal products containing alcohol should be avoided.
Barbiturates, canagliflozin/metformin [2] ---> SmPC of [2] of EMA
Enzyme inducers may give rise to decreased exposure of canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
BCRP substrates, canagliflozin/metformin [2] ---> SmPC of [2] of EMA
Inhibition of BCRP by canagliflozin cannot be excluded at an intestinal level and increased exposure may therefore occur for medicinal products transported by BCRP, e.g., certain statins like rosuvastatin and some anti-cancer medicinal products.
Beta2-adrenergic agonists, canagliflozin/metformin [2] ---> SmPC of [2] of EMA
Beta-2 agonists have intrinsic hyperglycaemic activity. Should be more frequent blood glucose monitoring performed
Breast-feeding, canagliflozin/metformin [2] ---> SmPC of [2] of EMA
Vokanamet should not be used during breast-feeding.
Canagliflozin/metformin [1], carbamazepine ---> SmPC of [1] of EMA
Enzyme inducers may give rise to decreased exposure of canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin/metformin [1], cationic substances eliminated by renal tubular secretion ---> SmPC of [1] of EMA
Cationic active substances that are eliminated by renal tubular secretion may interact with metformin by competing for common renal tubular transport systems and hence delay the elimination of metformin
Canagliflozin/metformin [1], cholestyramine ---> SmPC of [1] of EMA
Cholestyramine may potentially reduce canagliflozin exposure. Canagliflozin should be taken at least 1 hour prior to or 4-6 hours after taking the bile-acid sequestrant
Canagliflozin/metformin [1], cimetidine ---> SmPC of [1] of EMA
Cationic substances that are eliminated by renal tubular secretion may interact with metformin by competing for common renal tubular transport systems.
Canagliflozin/metformin [1], coxibs ---> SmPC of [1] of EMA
Some medicinal products can adversely affect renal function which may increase the risk of lactic acidosis
Canagliflozin/metformin [1], dabigatran ---> SmPC of [1] of EMA
As dabigatran concentrations may be increased in the presence of canagliflozin, monitoring (looking for signs of bleeding or anaemia) should be exercised when dabigatran is combined with canagliflozin.
Canagliflozin/metformin [1], digoxin ---> SmPC of [1] of EMA
Canagliflozin has been observed to inhibit P-gp in vitro. Patients taking digoxin or other cardiac glycosides (e.g., digitoxin) should be monitored appropriately.
Canagliflozin/metformin [1], diuretics ---> SmPC of [1] of EMA
Canagliflozin may add to the effect of diuretics and may increase the risk of dehydration and hypotension. Diuretics (especially loop diuretics) may increase the risk of lactic acidosis associated with metformin.
Canagliflozin/metformin [1], efavirenz ---> SmPC of [1] of EMA
Enzyme inducers may give rise to decreased exposure of canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin/metformin [1], enzyme inductors ---> SmPC of [1] of EMA
Enzyme inducers may give rise to decreased exposure of canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin/metformin [1], fertility ---> SmPC of [1] of EMA
The effect of Vokanamet on fertility in humans has not been studied. No effects of canagliflozin or metformin on fertility were observed in animal studies (see section 5.3).
Canagliflozin/metformin [1], glucocorticoids ---> SmPC of [1] of EMA
Glucocorticoids have intrinsic hyperglycaemic activity. Should be more frequent blood glucose monitoring performed
Canagliflozin/metformin [1], insulin ---> SmPC of [1] of EMA
Insulin causes hypoglycaemia. Therefore, a lower dose of insulin may be required to reduce the risk of hypoglycaemia when used in combination with Vokanamet
Canagliflozin/metformin [1], insulin secretagogues ---> SmPC of [1] of EMA
Insulin secretagogues cause hypoglycaemia. Therefore, a lower dose of an insulin secretagogue may be required to reduce the risk of hypoglycaemia when used in combination with Vokanamet
Canagliflozin/metformin [1], iodinated contrast media ---> SmPC of [1] of EMA
The intravascular administration of iodinated contrast agents may lead to renal failure, resulting in metformin accumulation and a risk of lactic acidosis.
Canagliflozin/metformin [1], lithium ---> SmPC of [1] of EMA
The concomitant use of an SGLT2 inhibitor with lithium may decrease serum lithium concentrations. Monitor serum lithium concentration more closely during treatment with canagliflozin, especially during initiation and dosage changes.
Canagliflozin/metformin [1], loop diuretics ---> SmPC of [1] of EMA
Canagliflozin is not recommended for use in patients receiving loop diuretics.
Canagliflozin/metformin [1], NSAID ---> SmPC of [1] of EMA
Some medicinal products can adversely affect renal function which may increase the risk of lactic acidosis
Canagliflozin/metformin [1], pharmacokinetics ---> SmPC of [1] of EMA
Interaction studies suggest that the pharmacokinetics of canagliflozin are not altered by metformin, hydrochlorothiazide, oral contraceptives (ethinyl estradiol and levonorgestrel), ciclosporin, and/or probenecid.
Canagliflozin/metformin [1], pharmacokinetics ---> SmPC of [1] of EMA
In interaction studies, canagliflozin at steady-state had no clinically relevant effect on the pharmacokinetics of metformin, oral contraceptives (ethinyl estradiol and levonorgestrol), glibenclamide, paracetamol, hydrochlorothiazide, or warfarin.
Canagliflozin/metformin [1], phenytoin ---> SmPC of [1] of EMA
Enzyme inducers may give rise to decreased exposure of canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin/metformin [1], pregnancy ---> SmPC of [1] of EMA
Vokanamet should not be used during pregnancy. When pregnancy is detected, treatment with Vokanamet should be discontinued.
Canagliflozin/metformin [1], rifampicin ---> SmPC of [1] of EMA
Enzyme inducers may give rise to decreased exposure of canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin/metformin [1], ritonavir ---> SmPC of [1] of EMA
Enzyme inducers may give rise to decreased exposure of canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin/metformin [1], rosuvastatin ---> SmPC of [1] of EMA
Inhibition of BCRP by canagliflozin cannot be excluded at an intestinal level and increased exposure may therefore occur for medicinal products transported by BCRP, e.g., certain statins like rosuvastatin and some anti-cancer medicinal products.
Canagliflozin/metformin [1], simvastatine ---> SmPC of [1] of EMA
The increases in simvastatin and simvastatin acid exposures are not considered clinically relevant.
Canagliflozin/metformin [1], St. John's wort ---> SmPC of [1] of EMA
Enzyme inducers may give rise to decreased exposure of canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin/metformin [1], sulfonylureas ---> SmPC of [1] of EMA
Insulin secretagogues cause hypoglycaemia. Therefore, a lower dose of an insulin secretagogue may be required to reduce the risk of hypoglycaemia when used in combination with dapagliflozin
CONTRAINDICATIONS of Canagliflozin/metformin (Vokanamet)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Diabetic ketoacidosis, diabetic pre-coma;
- Moderate and severe renal impairment (patients with eGFR < 60 mL/min/1.73 m² or CrCl < 60 mL/min),
- Acute conditions with the potential to alter renal function such as: dehydration, severe infection, shock
- Acute or chronic disease which may cause tissue hypoxia such as: cardiac or respiratory failure, recent myocardial infarction, shock;
- Hepatic impairment, acute alcohol intoxication, alcoholism
https://www.ema.europa.eu/en/documents/product-information/vokanamet-epar-product-information_en.pdf 17/06/2024
Canakinumab (Ilaris)
Ability to drive, canakinumab [2] ---> SmPC of [2] of EMA
Ilaris has minor influence on the ability to drive and use machines. Treatment with Ilaris may result in dizziness/vertigo or asthenia
Antibodies response, canakinumab [2] ---> SmPC of [2] of EMA
A single dose of canakinumab 300 mg did not affect the induction and persistence of antibody responses after vaccination with influenza or glycosylated protein based meningococcus vaccines.
Breast-feeding, canakinumab [2] ---> SmPC of [2] of EMA
The decision whether to breast-feed during therapy with Ilaris should therefore only be taken after a thorough benefit-risk evaluation
Canakinumab [1], CYP450 ---> SmPC of [1] of EMA
The expression of hepatic CYP450 enzymes may be suppressed by the cytokines that stimulate chronic inflammation, such as interleukin-1 beta (IL-1 beta).
Canakinumab [1], CYP450 ---> SmPC of [1] of EMA
Thus, CYP450 expression may be reversed when potent cytokine inhibitory therapy, such as canakinumab, is introduced.
Canakinumab [1], CYP450 substrates with narrow therapeutic index ---> SmPC of [1] of EMA
This is clinically relevant for CYP450 substrates with a narrow therapeutic index where the dose is individually adjusted.
Canakinumab [1], fertility ---> SmPC of [1] of EMA
Canakinumab had no effect on male fertility parameters in marmosets (C. jacchus). A murine anti-murine IL-1 beta antibody had no undesirable effects on fertility in male or female mice (see section 5.3).
Canakinumab [1], pregnancy ---> SmPC of [1] of EMA
Women who are pregnant or who desire to become pregnant should therefore only be treated after a thorough benefit-risk evaluation
Canakinumab [1], pregnancy ---> SmPC of [1] of EMA
Women who received canakinumab during pregnancy should be instructed to inform the baby's healthcare professional before any vaccinations are given to their newborn infant.
Canakinumab [1], TNF inhibitors ---> SmPC of [1] of EMA
Use of canakinumab with TNF inhibitors is not recommended because this may increase the risk of serious infections.
Canakinumab [1], vaccinations with live organism vaccines ---> SmPC of [1] of EMA
Live vaccines should not be given concurrently with canakinumab unless the benefits clearly outweigh the risks
Canakinumab [1], vaccinations with live organism vaccines ---> SmPC of [1] of EMA
Should vaccination with live vaccines be indicated after initiation of canakinumab treatment, the recommendation is to wait for at least 3 months after the last canakinumab injection and before the next one (see section 4.4).
Canakinumab [1], women of childbearing potential ---> SmPC of [1] of EMA
Women should use effective contraceptives during treatment with canakinumab and for up to 3 months after the last dose.
CONTRAINDICATIONS of Canakinumab (Ilaris)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Active, severe infections
https://www.ema.europa.eu/en/documents/product-information/ilaris-epar-product-information_en.pdf 05/02/2025
Candesartan cilexetil
Ability to drive, candesartan cilexetil [2] ---> SPC of [2] of eMC
It should be taken into account that occasionally dizziness or weariness may occur during treatment with candesartan cilexetil.
ACE inhibitors, candesartan cilexetil [2] ---> SPC of [2] of eMC
Dual blockade with ACE inhibitor and angiotensin-receptor blocker is associated with a higher frequency of hypotension, syncope, hyperkalaemia, and worsening renal function (including acute renal failure). Concomitant use not recommended
Acetylsalicylic acid, candesartan ---> SPC of [candesartan cilexetil] of eMC
The combination of AIIRAs and AIIRAs (selective COX-2 inhibitors, ASA (> 3 g/day) and non-selective NSAIDs) may decrease the antihypertensive effect, increase the renal failure risk and cause hypercaliemia
Acetylsalicylic acid, candesartan cilexetil [2] ---> SPC of [2] of eMC
The combination of AIIRAs and AIIRAs (selective COX-2 inhibitors, ASA (> 3 g/day) and non-selective NSAIDs) may decrease the antihypertensive effect, increase the renal failure risk and cause hypercaliemia
Antihypertensives, candesartan cilexetil [2] ---> SPC of [2] of eMC
The antihypertensive effect of candesartan may be enhanced by other medicinal products with blood pressure lowering properties, whether prescribed as an antihypertensive or prescribed for other indications.
Breast-feeding, candesartan ---> SPC of [candesartan cilexetil] of eMC
Candesartan is not recommended during breast-feeding and alternative treatments with better established safety profiles are preferable
Breast-feeding, candesartan cilexetil [2] ---> SPC of [2] of eMC
Candesartan cilexetil is not recommended during breast-feeding and alternative treatments with better established safety profiles are preferable
Candesartan cilexetil [1], coxibs ---> SPC of [1] of eMC
The combination of AIIRAs and AIIRAs (selective COX-2 inhibitors, ASA (> 3 g/day) and non-selective NSAIDs) may decrease the antihypertensive effect, increase the renal failure risk and cause hypercaliemia
Candesartan cilexetil [1], heparin ---> SPC of [1] of eMC
Concomitant use of potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium, or other medicinal products (e.g. heparin) may increase potassium levels.
Candesartan cilexetil [1], lithium ---> SPC of [1] of eMC
Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with ACE inhibitors. A similar effect may occur with AIIRAs.
Candesartan cilexetil [1], NSAID ---> SPC of [1] of eMC
The combination of AIIRAs and AIIRAs (selective COX-2 inhibitors, ASA (> 3 g/day) and non-selective NSAIDs) may decrease the antihypertensive effect, increase the renal failure risk and cause hypercaliemia
Candesartan cilexetil [1], potassium ---> SPC of [1] of eMC
Concomitant use of potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium, or other medicinal products (e.g. heparin) may increase potassium levels.
Candesartan cilexetil [1], potassium supplements ---> SPC of [1] of eMC
Concomitant use of potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium, or other medicinal products (e.g. heparin) may increase potassium levels.
Candesartan cilexetil [1], potassium-sparing diuretics ---> SPC of [1] of eMC
Concomitant use of potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium, or other medicinal products (e.g. heparin) may increase potassium levels.
Candesartan cilexetil [1], pregnancy ---> SPC of [1] of eMC
The use of AIIRAs is not recommended during the first trimester of pregnancy. The use of AIIRAs is contraindicated during the second and third trimesters of pregnancy
Candesartan cilexetil [1], salt substitutes containing potassium ---> SPC of [1] of eMC
Concomitant use of potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium, or other medicinal products (e.g. heparin) may increase potassium levels.
CONTRAINDICATIONS of Candesartan cilexetil
- Hypersensitivity to candesartan cilexetil or to any of the excipients.
- Second and third trimesters of pregnancy
- Severe hepatic impairment and/or cholestasis.
http://www.medicines.org.uk/emc/
Cangrelor (Kengrexal)
Abciximab, cangrelor [2] ---> SmPC of [2] of EMA
In clinical studies, cangrelor has been co-administered with bivalirudin, low molecular weight heparin, fondaparinux, and GP IIb/IIIa inhibitors with no apparent effect upon the pharmacokinetics or pharmacodynamics of cangrelor.
Acetylsalicylic acid, cangrelor [2] ---> SmPC of [2] of EMA
No pharmacokinetic or pharmacodynamic interaction with cangrelor was observed in an interaction study with acetylsalicylic acid, heparin, or nitroglycerin.
BCRP substrates, cangrelor [2] ---> SmPC of [2] of EMA
In vitro inhibition of BCRP by the metabolite ARC-69712XX at clinically relevant concentrations has been observed. Caution is advised when cangrelor is to be combined with a BCRP substrate.
Bivalirudin, cangrelor [2] ---> SmPC of [2] of EMA
In clinical studies, cangrelor has been co-administered with bivalirudin, low molecular weight heparin, fondaparinux, and GP IIb/IIIa inhibitors with no apparent effect upon the pharmacokinetics or pharmacodynamics of cangrelor.
Breast-feeding, cangrelor [2] ---> SmPC of [2] of EMA
It is not known whether Kengrexal is excreted in human milk. A risk to the suckling child cannot be excluded.
Cangrelor [1], clopidogrel ---> SmPC of [1] of EMA
When clopidogrel is administered during infusion of cangrelor, the expected inhibitory effect of clopidogrel on platelets is not achieved.
Cangrelor [1], cytochrome P450 ---> SmPC of [1] of EMA
Metabolism of cangrelor is not dependent on CYPs and CYP isoenzymes are not inhibited by therapeutic concentrations of cangrelor or its major metabolites.
Cangrelor [1], eptifibatide ---> SmPC of [1] of EMA
In clinical studies, cangrelor has been co-administered with bivalirudin, low molecular weight heparin, fondaparinux, and GP IIb/IIIa inhibitors with no apparent effect upon the pharmacokinetics or pharmacodynamics of cangrelor.
Cangrelor [1], fertility ---> SmPC of [1] of EMA
No effect on female fertility parameters were observed in animal studies of Kengrexal. A reversible effect on fertility was observed in male rats treated with Kengrexal (see section 5.3).
Cangrelor [1], fondaparinux ---> SmPC of [1] of EMA
In clinical studies, cangrelor has been co-administered with bivalirudin, low molecular weight heparin, fondaparinux, and GP IIb/IIIa inhibitors with no apparent effect upon the pharmacokinetics or pharmacodynamics of cangrelor.
Cangrelor [1], GP IIb/IIIa inhibitors ---> SmPC of [1] of EMA
In clinical studies, cangrelor has been co-administered with bivalirudin, low molecular weight heparin, fondaparinux, and GP IIb/IIIa inhibitors with no apparent effect upon the pharmacokinetics or pharmacodynamics of cangrelor.
Cangrelor [1], heparin ---> SmPC of [1] of EMA
No pharmacokinetic or pharmacodynamic interaction with cangrelor was observed in an interaction study with acetylsalicylic acid, heparin, or nitroglycerin.
Cangrelor [1], low molecular weight heparins ---> SmPC of [1] of EMA
In clinical studies, cangrelor has been co-administered with bivalirudin, low molecular weight heparin, fondaparinux, and GP IIb/IIIa inhibitors with no apparent effect upon the pharmacokinetics or pharmacodynamics of cangrelor.
Cangrelor [1], nitroglycerine ---> SmPC of [1] of EMA
No pharmacokinetic or pharmacodynamic interaction with cangrelor was observed in an interaction study with acetylsalicylic acid, heparin, or nitroglycerin.
Cangrelor [1], prasugrel ---> SmPC of [1] of EMA
A pharmacodynamic interaction study has been conducted with cangrelor and prasugrel, which demonstrated that cangrelor and prasugrel can be administered concomitantly.
Cangrelor [1], pregnancy ---> SmPC of [1] of EMA
Kengrexal should not be used during pregnancy.
Cangrelor [1], ticagrelor ---> SmPC of [1] of EMA
A pharmacodynamic interaction study has been conducted with cangrelor and ticagrelor. No interaction on cangrelor was observed. Patients can be transitioned from cangrelor to ticagrelor without interruption of antiplatelet effect.
Cangrelor [1], tirofiban ---> SmPC of [1] of EMA
In clinical studies, cangrelor has been co-administered with bivalirudin, low molecular weight heparin, fondaparinux, and GP IIb/IIIa inhibitors with no apparent effect upon the pharmacokinetics or pharmacodynamics of cangrelor.
CONTRAINDICATIONS of Cangrelor (Kengrexal)
- Active bleeding or increased risk of bleeding, because of impaired haemostasis and/or irreversible coagulation disorders or due to recent major surgery/trauma or uncontrolled severe hypertension.
- Any history of stroke or transient ischaemic attack (TIA).
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/kengrexal-epar-product-information_en.pdf 06/08/2025
Cannabidiol (Epidyolex)
Ability to drive, cannabidiol [2] ---> SmPC of [2] of EMA
Cannabidiol has major influence on the ability to drive and operate machines because it may cause somnolence and sedation
Alcohol, cannabidiol [2] ---> SmPC of [2] of EMA
Other CNS depressants, including alcohol, can potentiate the somnolence and sedation effect.
Antiepileptics, cannabidiol [2] ---> SmPC of [2] of EMA
Cannabidiol and/or concomitant AED treatment should therefore be adjusted during regular medical supervision and the patient should be closely monitored for adverse drug reactions.
Breast-feeding, cannabidiol [2] ---> SmPC of [2] of EMA
Given that cannabidiol is highly protein bound and will likely pass freely from plasma into milk, as a precaution, breast-feeding should be discontinued during treatment
Brivaracetam [1], cannabidiol ---> SmPC of [1] of EMA
Limited clinical data are available implying that coadministration of cannabidiol may increase the plasma exposure of brivaracetam, possibly through CYP2C19 inhibition, but the clinical relevance is uncertain.
Bupropion, cannabidiol [2] ---> SmPC of [2] of EMA
In vitro data predict drug-drug interactions with CYP2B6 substrates (e.g., bupropion, efavirenz), 1A9 (UGT1A9) (e.g., diflunisal, propofol, fenofibrate), and UGT2B7 (e.g., gemfibrozil, morphine, lorazepam) when co-administered with cannabidiol.
Caffeine, cannabidiol [2] ---> SmPC of [2] of EMA
In vivo data from steady-state dosing with cannabidiol (750 mg twice daily) when co-administered with a single dose of caffeine (200 mg), a sensitive CYP1A2 substrate, showed increased caffeine exposure by 15%
Cannabidiol [1], carbamazepine ---> SmPC of [1] of EMA
Other strong inducers of CYP3A4 and/or CYP2C19 when administered concomitantly with cannabidiol, may also cause a decrease in the plasma concentrations of cannabidiol and of 7-OH-CBD by a similar amount.
Cannabidiol [1], clobazam ---> SmPC of [1] of EMA
Reduction in dose of clobazam should be considered if somnolence or sedation are experienced when clobazam is co-administered with cannabidiol.
Cannabidiol [1], CNS depressants ---> SmPC of [1] of EMA
Other CNS depressants, including alcohol, can potentiate the somnolence and sedation effect.
Cannabidiol [1], CYP2C19 substrates with narrow therapeutic index ---> SmPC of [1] of EMA
Dose reduction should be considered for concomitant medicinal products that are sensitive CYP2C19 substrates or that have a narrow therapeutic index.
Cannabidiol [1], digoxin ---> SmPC of [1] of EMA
Increases in exposure of other orally administered sensitive P-gp substrates (e.g., sirolimus, tacrolimus, digoxin) may occur on coadministration with cannabidiol.
Cannabidiol [1], drugs primarily metabolised by CYP2C19 ---> SmPC of [1] of EMA
Dose reduction should be considered for concomitant medicinal products that are sensitive CYP2C19 substrates or that have a narrow therapeutic index.
Cannabidiol [1], drugs primarily metabolised by UGT ---> SmPC of [1] of EMA
Dose reduction of the substrates may be necessary when cannabidiol is administered concomitantly with substrates of the UGTs.
Cannabidiol [1], enzalutamide ---> SmPC of [1] of EMA
Other strong inducers of CYP3A4 and/or CYP2C19 when administered concomitantly with cannabidiol, may also cause a decrease in the plasma concentrations of cannabidiol and of 7-OH-CBD by a similar amount.
Cannabidiol [1], ethanol ---> SmPC of [1] of EMA
For an adult weighing 70 kg, this is equivalent to 17 ml of beer, or 7 ml of wine per dose.
Cannabidiol [1], everolimus ---> SmPC of [1] of EMA
When initiating cannabidiol in patients taking everolimus, monitor therapeutic drug levels of everolimus and adjust the dosage accordingly.
Cannabidiol [1], everolimus ---> SmPC of [1] of EMA
When initiating everolimus in patients taking a stable dosage of cannabidiol, a lower starting dose of everolimus is recommended, with therapeutic drug monitoring.
Cannabidiol [1], everolimus ---> SmPC of [1] of EMA
Coadministration of cannabidiol with orally administered everolimus, a P-gp and CYP3A4 substrate, has increased everolimus bioavailability likely due to inhibition of intestinal P-gp efflux of everolimus.
Cannabidiol [1], fertility ---> SmPC of [1] of EMA
No human data on the effect of cannabidiol on fertility are available. No effect on reproductive ability of male or female rats was noted with an oral dose of up to 150 mg/kg/day cannabidiol (see section 5.3).
Cannabidiol [1], foods ---> SmPC of [1] of EMA
Food may increase cannabidiol levels and therefore it should be taken consistently either with or without food, including the ketogenic diet
Cannabidiol [1], hepatotoxic drugs ---> SmPC of [1] of EMA
Dose adjustment of any co-administered medicinal product that is known to affect the liver should be considered (e.g., valproate and clobazam)
Cannabidiol [1], lamotrigine ---> SmPC of [1] of EMA
Lamotrigine is a substrate for UGT enzymes including UGT2B7 which is inhibited by cannabidiol in vitro. There have not been any clinical studies formally investigating this interaction.
Cannabidiol [1], lorazepam ---> SmPC of [1] of EMA
and UGT2B7 (e.g., gemfibrozil, morphine, lorazepam) when co-administered with cannabidiol.
Cannabidiol [1], mitotane ---> SmPC of [1] of EMA
Other strong inducers of CYP3A4 and/or CYP2C19 when administered concomitantly with cannabidiol, may also cause a decrease in the plasma concentrations of cannabidiol and of 7-OH-CBD by a similar amount.
Cannabidiol [1], omeprazole ---> SmPC of [1] of EMA
Dose reduction should be considered for concomitant medicinal products that are sensitive CYP2C19 substrates or that have a narrow therapeutic index.
Cannabidiol [1], P-glycoprotein substrates ---> SmPC of [1] of EMA
Increases in exposure of other orally administered sensitive P-gp substrates (e.g., sirolimus, tacrolimus, digoxin) may occur on coadministration with cannabidiol.
Cannabidiol [1], phenytoin ---> SmPC of [1] of EMA
Phenytoin has a narrow therapeutic index, so combining cannabidiol with phenytoin should be initiated with caution and if tolerability issues arise, dose reduction of phenytoin should be considered.
Cannabidiol [1], pregnancy ---> SmPC of [1] of EMA
As a precautionary measure, cannabidiol should not be used during pregnancy unless the potential benefit to the mother clearly outweighs the potential risk to the foetus.
Cannabidiol [1], repaglinide ---> SmPC of [1] of EMA
Co-administration of cannabidiol is also predicted to cause clinically significant interactions with CYP2C8 (repaglinide) and CYP2C9 (e.g., warfarin) substrates.
Cannabidiol [1], rifampicin ---> SmPC of [1] of EMA
Der starke CYP3A4/2C19-induzierende Wirkstoff Rifampicin (600 mg einmal täglich angewendet) senkte die Plasmakonzentrationen von Cannabidiol und von 7-Hydroxy-Cannabidiol (7-OH-CBD, ein aktiver Metabolit von Cannabidiol) um etwa 30 % bzw. 60 %.
Cannabidiol [1], St. John's wort ---> SmPC of [1] of EMA
Other strong inducers of CYP3A4 and/or CYP2C19 when administered concomitantly with cannabidiol, may also cause a decrease in the plasma concentrations of cannabidiol and of 7-OH-CBD by a similar amount.
Cannabidiol [1], stiripentol ---> SmPC of [1] of EMA
When cannabidiol was combined with stiripentol in a healthy volunteer trial there was an increase in stiripentol levels of 28% for maximum measured plasma concentration (Cmax) and 55% for AUC.
Cannabidiol [1], strong CYP2C19 inductors ---> SmPC of [1] of EMA
Strong inducers of CYP2C19 administered concomitantly with cannabidiol may decrease the plasma concentrations of cannabidiol and decrease the effectiveness of cannabidiol. Dose adjustment may be necessary.
Cannabidiol [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA
Strong inducers of CYP3A4 administered concomitantly with cannabidiol may decrease the plasma concentrations of cannabidiol and decrease the effectiveness of cannabidiol. Dose adjustment may be necessary.
Cannabidiol [1], strong glucuronidation inhibitors ---> SmPC of [1] of EMA
Therefore caution should be taken when co-administering drugs that are known inhibitors of these UGTs. Dose reduction of cannabidiol and/or the inhibitor may be necessary when given in combination.
Cannabidiol [1], theophylline ---> SmPC of [1] of EMA
Similar modest increases in exposure may be observed with other sensitive CYP1A2 substrates (e.g., theophylline or tizanidine). The clinical importance of these findings has not been studied.
Cannabidiol [1], tizanidine ---> SmPC of [1] of EMA
Similar modest increases in exposure may be observed with other sensitive CYP1A2 substrates (e.g., theophylline or tizanidine). The clinical importance of these findings has not been studied.
Cannabidiol [1], valproate ---> SmPC of [1] of EMA
If clinically significant increases of transaminases occur, cannabidiol and/or concomitant valproate should be reduced or discontinued
Cannabidiol [1], valproate ---> SmPC of [1] of EMA
Concomitant use of cannabidiol and valproate increases the incidence of diarrhoea and events of decreased appetite. The mechanism of this interaction is unknown.
Cannabidiol [1], warfarin ---> SmPC of [1] of EMA
Co-administration of cannabidiol is also predicted to cause clinically significant interactions with CYP2C8 (repaglinide) and CYP2C9 (e.g., warfarin) substrates.
Cannabidiol, everolimus [2] ---> SmPC of [2] of EMA
Use caution when co-administration of moderate CYP3A4 inhibitors or PgP inhibitors cannot be avoided.
Cannabidiol, fenfluramine [2] ---> SmPC of [2] of EMA
No dose adjustment is necessary when fenfluramine is co-administered with cannabidiol.
Cannabidiol, mTOR inhibitors ---> SmPC of [sirolimus] of EMA
Co-administration of cannabidiol with another orally administered mTOR inhibitor in a healthy volunteer study led to an increase in exposure to the mTOR inhibitor, due to inhibition of intestinal P-gp efflux by cannabidiol.
Cannabidiol, sirolimus [2] ---> SmPC of [2] of EMA
Increases in exposure of other orally administered sensitive P-gp substrates (e.g., sirolimus, tacrolimus, digoxin) may occur on coadministration with cannabidiol.
Cannabidiol, tacrolimus [2] ---> SmPC of [2] of EMA
Increases in exposure of other orally administered sensitive P-gp substrates (e.g., sirolimus, tacrolimus, digoxin) may occur on coadministration with cannabidiol.
Cannabidiol, temsirolimus [2] ---> SmPC of [2] of EMA
Caution should be used when cannabidiol and temsirolimus are co-administered, closely monitoring for side effects and adjusting the temsirolimus dose as needed (see sections 4.2 and 4 4).
CONTRAINDICATIONS of Cannabidiol (Epidyolex)
- Hypersensitivity to the active substance, to sesame oil, or to any of the excipients listed in section 6.1.
- Patients with transaminase elevations greater than 3 times the upper limit of normal (ULN) and bilirubin greater than 2 times the ULN (see section 4.4).
https://www.ema.europa.eu/en/documents/product-information/epidyolex-epar-product-information_en.pdf 27/09/2024
Capecitabine (Capecitabine Teva)
Ability to drive, capecitabine [2] ---> SmPC of [2] of EMA
Capecitabine has minor or moderate influence on the ability to drive and use machines. Capecitabine may cause dizziness, fatigue and nausea.
Allopurinol, capecitabine [2] ---> SmPC of [2] of EMA
Interactions with allopurinol have been observed for 5-FU; with possible decreased efficacy of 5-FU. Concomitant use of allopurinol with capecitabine should be avoided.
Aluminium hydroxide, capecitabine [2] ---> SmPC of [2] of EMA
The effect of an aluminium hydroxide and magnesium hydroxide-containing antacid on the pharmacokinetics of capecitabine was investigated. There was a small increase in plasma concentrations of capecitabine and one metabolite (5'-DFCR)
Antacids, capecitabine [2] ---> SmPC of [2] of EMA
The effect of an aluminium hydroxide and magnesium hydroxide-containing antacid on the pharmacokinetics of capecitabine was investigated. There was a small increase in plasma concentrations of capecitabine and one metabolite (5'-DFCR)
Bevacizumab [1], capecitabine ---> SmPC of [1] of EMA
Results from one trial in metastatic colorectal cancer patients demonstrated no significant effect of bevacizumab on the pharmacokinetics of capecitabine and its metabolites
Bevacizumab, capecitabine [2] ---> SmPC of [2] of EMA
There was no clinically significant effect of bevacizumab on the pharmacokinetic parameters of capecitabine or its metabolites in the presence of oxaliplatin.
Breast-feeding, capecitabine [2] ---> SmPC of [2] of EMA
As the potential for harm to the nursing infant is unknown, breast-feeding should be discontinued while receiving treatment with capecitabine and for 2 weeks after the final dose.
Brivudine, capecitabine [2] ---> SmPC of [2] of EMA
This interaction, which leads to increased fluoropyrimidine toxicity, is potentially fatal. Therefore, brivudine must not be administered concomitantly with capecitabine
Brivudine, capecitabine [2] ---> SmPC of [2] of EMA
There must be at least a 4-week waiting period between end of treatment with brivudine and start of capecitabine therapy. Treatment with brivudine can be started 24 hours after the last dose of capecitabine.
Brivudine, capecitabine [2] ---> SmPC of [2] of EMA
A clinically significant interaction has been described between brivudine and fluoropyrimidines, resulting from the dihydropyrimidine dehydrogenase inhibition by brivudine. The interaction potentially fatal leads to increased fluoropyrimidine toxicity
Brivudine, fluoropyrimidines ---> SmPC of [capecitabine] of EMA
A clinically significant interaction has been described between brivudine and fluoropyrimidines, resulting from the dihydropyrimidine dehydrogenase inhibition by brivudine. The interaction potentially fatal leads to increased fluoropyrimidine toxicity
Brivudine, fluorouracil ---> SmPC of [capecitabine] of EMA
A clinically significant interaction has been described between brivudine and fluoropyrimidines, resulting from the dihydropyrimidine dehydrogenase inhibition by brivudine. The interaction potentially fatal leads to increased fluoropyrimidine toxicity
Brivudine, tegafur ---> SmPC of [capecitabine] of EMA
A clinically significant interaction has been described between brivudine and fluoropyrimidines, resulting from the dihydropyrimidine dehydrogenase inhibition by brivudine. The interaction potentially fatal leads to increased fluoropyrimidine toxicity
Capecitabine [1], CNS disease ---> SmPC of [1] of EMA
Caution must be exercised in patients with central or peripheral nervous system disease, e.g. brain metastasis or neuropathy (see section 4.8).
Capecitabine [1], coumarin anticoagulants ---> SmPC of [1] of EMA
Altered coagulation parameters and/or bleeding have been reported in patients taking capecitabine concomitantly with coumarin-derivative anticoagulants such as warfarin and phenprocoumon.
Capecitabine [1], coumarin anticoagulants ---> SmPC of [1] of EMA
Patients taking coumarin-derivative anticoagulants concomitantly with capecitabine should be monitored regularly for alterations in their coagulation parameters (PT or INR) and the anticoagulant dose adjusted accordingly.
Capecitabine [1], diabetes ---> SmPC of [1] of EMA
Caution must be exercised in patients with diabetes mellitus or electrolyte disturbances, as these may be aggravated during capecitabine treatment.
Capecitabine [1], DPD deficiency ---> SmPC of [1] of EMA
Patients with DPD deficiency are therefore at increased risk of fluoropyrimidines-related toxicity, including for example stomatitis, diarrhoea, mucosal inflammation, neutropenia and neurotoxicity.
Capecitabine [1], drugs primarily metabolised by CYP2C9 ---> SmPC of [1] of EMA
Other than warfarin, no formal interaction studies between capecitabine and other CYP2C9 substrates have been conducted. Care should be exercised when capecitabine is co-administered with 2C9 substrates (e.g., phenytoin).
Capecitabine [1], fertility ---> SmPC of [1] of EMA
There is no data on capecitabine and impact on fertility. In animal studies effects on fertility were observed
Capecitabine [1], folic acid ---> SmPC of [1] of EMA
Folinic acid has an effect on the pharmacodynamics of capecitabine and its toxicity may be enhanced by folinic acid. This may also be relevant with folic acid supplementation for folate deficiency due to the similarity between folinic acid and folic acid
Capecitabine [1], folinic acid ---> SmPC of [1] of EMA
Folinic acid has an effect on the pharmacodynamics of capecitabine and its toxicity may be enhanced by folinic acid
Capecitabine [1], foods ---> SmPC of [1] of EMA
Since current safety and efficacy data are based upon administration with food, it is recommended that capecitabine be administered with food. Administration with food decreases the rate of capecitabine absorption (see section 5.2).
Capecitabine [1], haematology ---> SmPC of [1] of EMA
Patients with baseline neutrophil counts of <1.5 x 109/L and/or thrombocyte counts of <100 x 109/L should not be treated with capecitabine.
Capecitabine [1], hypo-or hypercalcaemia ---> SmPC of [1] of EMA
Hypo-or hypercalcaemia has been reported during capecitabine treatment. Caution must be exercised in patients with pre-existing hypo-or hypercalcaemia (see section 4.8).
Capecitabine [1], interferon alfa-2a ---> SmPC of [1] of EMA
The MTD of capecitabine was 2000 mg/m² per day when combined with interferon alpha- 2a (3 MIU/m² per day) compared to 3000 mg/m² per day when capecitabine was used alone.
Capecitabine [1], liver insufficiency ---> SmPC of [1] of EMA
Treatment with capecitabine monotherapy may be resumed when bilirubin decreases to ≤3.0 x ULN or hepatic aminotransferases decrease to ≤2.5 x ULN.
Capecitabine [1], magnesium hydroxide ---> SmPC of [1] of EMA
The effect of an aluminium hydroxide and magnesium hydroxide-containing antacid on the pharmacokinetics of capecitabine was investigated. There was a small increase in plasma concentrations of capecitabine and one metabolite (5'-DFCR)
Capecitabine [1], men ---> SmPC of [1] of EMA
Based on genetic toxicity findings, male patients with female partners of reproductive potential should use effective contraception during treatment and for 3 months following the last dose of capecitabine.
Capecitabine [1], oxaliplatin ---> SmPC of [1] of EMA
No clinically significant differences in exposure to capecitabine or its metabolites, free platinum or total platinum occurred when capecitabine was administered in combination with oxaliplatin or in combination with oxaliplatin and bevacizumab.
Capecitabine [1], phenprocoumon ---> SmPC of [1] of EMA
Altered coagulation parameters and/or bleeding have been reported in patients taking capecitabine concomitantly with coumarin-derivative anticoagulants such as warfarin and phenprocoumon.
Capecitabine [1], phenytoin ---> SmPC of [1] of EMA
Increased phenytoin plasma concentrations resulting in symptoms of phenytoin intoxication in single cases have been reported during concomitant use of capecitabine with phenytoin.
Capecitabine [1], pregnancy ---> SmPC of [1] of EMA
In reproductive toxicity studies in animals, capecitabine administration caused embryolethality and teratogenicity. These findings are expected effects of fluoropyrimidine derivatives. Capecitabine is contraindicated during pregnancy.
Capecitabine [1], radiotherapy ---> SmPC of [1] of EMA
The MTD of capecitabine alone using the intermittent regimen is 3000 mg/m2 per day, whereas, when combined with radiotherapy for rectal cancer, the MTD of capecitabine is 2000 mg/m2 per day
Capecitabine [1], skin reaction ---> SmPC of [1] of EMA
Capecitabine Teva should be permanently discontinued in patients who experience a severe skin reaction during treatment.
Capecitabine [1], tablets ---> SmPC of [1] of EMA
Capecitabine Teva tablets should not be crushed or cut. In case of exposure of either patient or caregiver to crushed or cut Capecitabine Teva tablets adverse drug reactions could occur (see section 4.8).
Capecitabine [1], toxicity ---> SmPC of [1] of EMA
DPD-deficiency related toxicity usually occurs during the first cycle of treatment or after dose increase.
Capecitabine [1], warfarin ---> SmPC of [1] of EMA
Altered coagulation parameters and/or bleeding have been reported in patients taking capecitabine concomitantly with coumarin-derivative anticoagulants such as warfarin and phenprocoumon.
Capecitabine [1], women of childbearing potential ---> SmPC of [1] of EMA
Women of childbearing potential should be advised to avoid becoming pregnant while receiving treatment with capecitabine. If the patient becomes pregnant while receiving capecitabine, the potential hazard to the foetus must be explained.
Capecitabine [1], women of childbearing potential ---> SmPC of [1] of EMA
An effective method of contraception should be used during treatment and for 6 months after the last dose of capecitabine.
Capecitabine, cetuximab [2] ---> SmPC of [2] of EMA
The combination may increase the frequency of severe diarrhoea
Capecitabine, dihydropyrimidine dehydrogenase inhibitors
A clinically significant interaction has been described between brivudine and fluoropyrimidines, resulting from the dihydropyrimidine dehydrogenase inhibition by brivudine. The interaction potentially fatal leads to increased fluoropyrimidine toxicity
Capecitabine, erlotinib [2] ---> SmPC of [2] of EMA
Capecitabine may increase erlotinib concentrations. There were no significant effects of erlotinib on the pharmacokinetics of capecitabine.
Capecitabine, hydantoins
Increased hydantoin plasma concentrations. Regular monitoring
Capecitabine, lapatinib [2] ---> SmPC of [2] of EMA
Concomitant administration of Tyverb with capecitabine, letrozole or trastuzumab did not meaningfully alter the pharmacokinetics of these medicinal products (or the metabolites of capecitabine) or lapatinib.
Capecitabine, nucleoside analogues
The co-administration may increase the effect and toxicity of the fluoropyrimidine
Capecitabine, pertuzumab [2] ---> SmPC of [2] of EMA
There was no evidence of any PK interaction between pertuzumab and capecitabine. The PK of pertuzumab in these studies was comparable to those observed in single-agent studies.
Capecitabine, pertuzumab/trastuzumab [2] ---> SmPC of [2] of EMA
Capecitabine itself showed higher concentrations and a longer half-life when combined with trastuzumab.
Capecitabine, sorafenib [2] ---> SmPC of [2] of EMA
Co-administration of capecitabine (750-1050 mg/m2 twice daily, Days 1-14 every 21 days) and sorafenib (200 or 400 mg twice daily, continuous uninterrupted administration) resulted in no significant change in sorafenib exposure
Capecitabine, tamoxifen
Capecitabine may increase the plasma levels of tamoxifen.
Capecitabine, tegafur/gimeracil/oteracil [2] ---> SmPC of [2] of EMA
Co-administration of other fluoropyrimidines can lead to additive toxicities, and is contraindicated. A minimum washout period of 7 days is recommended between administration of tegafur/gimeracil/oteracil and other fluoropyrimidines.
Capecitabine, trastuzumab [2] ---> SmPC of [2] of EMA
However, capecitabine itself showed higher concentrations and a longer half-life when combined with Herceptin.
Dihydropyrimidine dehydrogenase inhibitors, fluorouracil ---> SmPC of [capecitabine] of EMA
The inhibition of dihydropyrimidine dehydrogenase increases the plasma levels of fluorouracil. Contraindicated. A period of at least 4 weeks should elapse between them.
CONTRAINDICATIONS of Capecitabine (Capecitabine Teva)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 or fluorouracil,
- History of severe and unexpected reactions to fluoropyrimidine therapy,
- Known complete dihydropyrimidine dehydrogenase (DPD) deficiency (see section 4.4),
- During pregnancy and lactation,
- In patients with severe leukopenia, neutropenia, or thrombocytopenia,
- In patients with severe hepatic impairment,
- In patients with severe renal impairment (creatinine clearance below 30 ml/min),
- Recent or concomitant treatment with brivudine (see section 4.4 and 4.5 for drug-drug interaction),
- If contraindications exist to any of the medicinal products in the combination regimen, that medicinal product should not be used.
Other trade names: Capecitabine accord, Capecitabine Medac, Ecansya (previously Capecitabine Krka), Xeloda,
Caplacizumab (Cablivi)
Anticoagulants, caplacizumab [2] ---> SmPC of [2] of EMA
No interaction studies evaluating use of caplacizumab with anticoagulants
Breast-feeding, caplacizumab [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breastfeeding or to abstain/discontinue from therapy, taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman.
Caplacizumab [1], fertility ---> SmPC of [1] of EMA
The effects of caplacizumab on fertility in humans are unknown. In animal toxicology studies, no impact of caplacizumab on male and female fertility parameters was observed (see section 5.3).
Caplacizumab [1], pregnancy ---> SmPC of [1] of EMA
As a precautionary measure, it is preferable to avoid the use of Cablivi during pregnancy.
CONTRAINDICATIONS of Caplacizumab (Cablivi)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/cablivi-epar-product-information_en.pdf 20/03/2024
Capivasertib (Truqap)
Ability to drive, capivasertib [2] ---> SmPC of [2] of EMA
TRUQAP may have a minor influence on the ability to drive and use machines because fatigue, dizziness and syncope have been reported during treatment with capivasertib (see section 4.8).
Aprepitant, capivasertib [2] ---> SmPC of [2] of EMA
Co-administration of TRUQAP with moderate CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. TRUQAP dose should be reduced when co-administered with moderate CYP3A4 inhibitor
BCRP inhibitors, capivasertib [2] ---> SmPC of [2] of EMA
Depending on their therapeutic window, dose adjustment may be required for medicinal products that are sensitive to inhibition of BCRP, OATP1B1 and/or OATP1B3 if they are metabolised by CYP3A4 (e.g. simvastatin).
Boceprevir, capivasertib [2] ---> SmPC of [2] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Bosentan, capivasertib [2] ---> SmPC of [2] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Breast-feeding, capivasertib [2] ---> SmPC of [2] of EMA
A risk to the breast-fed child cannot be excluded (see section 5.3). Breast-feeding should be discontinued during treatment with TRUQAP.
Bupropion, capivasertib [2] ---> SmPC of [2] of EMA
Capivasertib should be used with caution in combination with sensitive substrates of CYP2B6 enzymes which exhibit a narrow therapeutic index (e.g. bupropion) because capivasertib may decrease the systemic exposure of these substrates.
Capivasertib [1], carbamazepine ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inducers (e.g. carbamazepine, phenytoin, rifampicin, St. John's wort) should be avoided.
Capivasertib [1], cenobamate ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], ceritinib ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], ciprofloxacin ---> SmPC of [1] of EMA
Co-administration of TRUQAP with moderate CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. TRUQAP dose should be reduced when co-administered with moderate CYP3A4 inhibitor
Capivasertib [1], clarithromycin ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], cobicistat ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], conivaptan ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], cyclosporine ---> SmPC of [1] of EMA
Co-administration of TRUQAP with moderate CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. TRUQAP dose should be reduced when co-administered with moderate CYP3A4 inhibitor
Capivasertib [1], dabrafenib ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], diltiazem ---> SmPC of [1] of EMA
Co-administration of TRUQAP with moderate CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. TRUQAP dose should be reduced when co-administered with moderate CYP3A4 inhibitor
Capivasertib [1], drugs primarily metabolised by CYP3A4 ---> SmPC of [1] of EMA
Concentration of medicinal products that are primarily eliminated via CYP3A metabolism may increase when co-administered with TRUQAP which may then lead to increased toxicity depending on their therapeutic window
Capivasertib [1], drugs primarily metabolised by CYP3A4 with narrow therapeutic index ---> SmPC of [1] of EMA
Dose adjustment may be required for medicinal products that are primarily eliminated via CYP3A metabolism and have narrow therapeutic window (e.g. carbamazepine, cyclosporine, fentanyl, pimozide, simvastatin, tacrolimus).
Capivasertib [1], elagolix ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], enzalutamide ---> SmPC of [1] of EMA
Co-administration of capivasertib with strong CYP3A4 inducer enzalutamide decreased the capivasertib AUC by approximately 40% to 50%.
Capivasertib [1], erythromycin ---> SmPC of [1] of EMA
Co-administration of TRUQAP with moderate CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. TRUQAP dose should be reduced when co-administered with moderate CYP3A4 inhibitor
Capivasertib [1], etravirine ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], fentanyl ---> SmPC of [1] of EMA
Dose adjustment may be required for medicinal products that are primarily eliminated via CYP3A metabolism and have narrow therapeutic window (e.g. carbamazepine, cyclosporine, fentanyl, pimozide, simvastatin, tacrolimus).
Capivasertib [1], fertility ---> SmPC of [1] of EMA
In animal studies, no adverse effect on female reproductive organs was observed, but the effect on female fertility in rats was not studied. Capivasertib has resulted in testicular toxicity and may impair fertility in males of reproductive potential
Capivasertib [1], fluconazole ---> SmPC of [1] of EMA
Co-administration of TRUQAP with moderate CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. TRUQAP dose should be reduced when co-administered with moderate CYP3A4 inhibitor
Capivasertib [1], fluvoxamine ---> SmPC of [1] of EMA
Co-administration of TRUQAP with moderate CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. TRUQAP dose should be reduced when co-administered with moderate CYP3A4 inhibitor
Capivasertib [1], grapefruit ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], grapefruit juice ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], idelalisib ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], indinavir ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], irinotecan ---> SmPC of [1] of EMA
Capivasertib should be used with caution in combination with sensitive substrates of UGT1A1 enzymes which exhibit a narrow therapeutic index (e.g. irinotecan) because capivasertib may increase the systemic exposure of these substrates.
Capivasertib [1], itraconazol ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], josamycin ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], ketoconazole ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], lesinurad ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], lonafarnib ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], lopinavir ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], lorlatinib ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], MATE1 inhibitors ---> SmPC of [1] of EMA
The exposure of medicinal products that are sensitive to inhibition of MATE1, MATE2K and/or OCT2 may increase by co-administration with TRUQAP. This may lead to increased toxicity.
Capivasertib [1], MATE2K inhibitors ---> SmPC of [1] of EMA
The exposure of medicinal products that are sensitive to inhibition of MATE1, MATE2K and/or OCT2 may increase by co-administration with TRUQAP. This may lead to increased toxicity.
Capivasertib [1], men ---> SmPC of [1] of EMA
Patients should be advised to use effective contraception during the use of TRUQAP and for the following periods after completion of treatment with TRUQAP: at least 4 weeks for females and 16 weeks for males.
Capivasertib [1], metabolized by CYP2D6 with narrow therapeutic index ---> SmPC of [1] of EMA
Capivasertib should be used with caution in combination with sensitive substrates of CYP2D6 enzymes which exhibit a narrow therapeutic index because capivasertib may increase the systemic exposure of these substrates.
Capivasertib [1], metabolized by CYP2D6 with narrow therapeutic index ---> SmPC of [1] of EMA
Capivasertib should be used with caution in combination with sensitive substrates of CYP2B6 enzymes which exhibit a narrow therapeutic index (e.g. bupropion) because capivasertib may decrease the systemic exposure of these substrates.
Capivasertib [1], metamizole ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], mibefradil ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], midazolam ---> SmPC of [1] of EMA
Capivasertib increased the midazolam AUC by 15% to 77% and is therefore a weak CYP3A inhibitor (see section 5.2).
Capivasertib [1], mifepristone ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], mitapivat ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], modafinil ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], moderate CYP3A4 inductors ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], moderate CYP3A4 inhibitors ---> SmPC of [1] of EMA
Co-administration of TRUQAP with moderate CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. TRUQAP dose should be reduced when co-administered with moderate CYP3A4 inhibitor
Capivasertib [1], nafcillin ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], nefazodone ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], nelfinavir ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], OATP1B1 inhibitors ---> SmPC of [1] of EMA
Depending on their therapeutic window, dose adjustment may be required for medicinal products that are sensitive to inhibition of BCRP, OATP1B1 and/or OATP1B3 if they are metabolised by CYP3A4 (e.g. simvastatin).
Capivasertib [1], OATP1B3 inhibitors ---> SmPC of [1] of EMA
Depending on their therapeutic window, dose adjustment may be required for medicinal products that are sensitive to inhibition of BCRP, OATP1B1 and/or OATP1B3 if they are metabolised by CYP3A4 (e.g. simvastatin).
Capivasertib [1], OCT2 inhibitors ---> SmPC of [1] of EMA
The exposure of medicinal products that are sensitive to inhibition of MATE1, MATE2K and/or OCT2 may increase by co-administration with TRUQAP. This may lead to increased toxicity.
Capivasertib [1], phenobarbital ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], phenytoin ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inducers (e.g. carbamazepine, phenytoin, rifampicin, St. John's wort) should be avoided.
Capivasertib [1], pimozide ---> SmPC of [1] of EMA
Dose adjustment may be required for medicinal products that are primarily eliminated via CYP3A metabolism and have narrow therapeutic window (e.g. carbamazepine, cyclosporine, fentanyl, pimozide, simvastatin, tacrolimus).
Capivasertib [1], posaconazole ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], pregnancy ---> SmPC of [1] of EMA
There are no data from the use of TRUQAP in pregnant women. Studies in animals have shown reproductive toxicity (see section 5.3). Therefore, TRUQAP is not recommended during pregnancy and in women of childbearing potential not using contraception.
Capivasertib [1], ribociclib ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], rifabutin ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], rifampicin ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inducers (e.g. carbamazepine, phenytoin, rifampicin, St. John's wort) should be avoided.
Capivasertib [1], ritonavir ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], saquinavir ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], simvastatine ---> SmPC of [1] of EMA
Dose adjustment may be required for medicinal products that are primarily eliminated via CYP3A metabolism and have narrow therapeutic window (e.g. carbamazepine, cyclosporine, fentanyl, pimozide, simvastatin, tacrolimus).
Capivasertib [1], sotorasib ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], St. John's wort ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inducers (e.g. carbamazepine, phenytoin, rifampicin, St. John's wort) should be avoided.
Capivasertib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inducers (e.g. carbamazepine, phenytoin, rifampicin, St. John's wort) should be avoided.
Capivasertib [1], strong CYP3A4 inhibitors ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], tacrolimus ---> SmPC of [1] of EMA
Dose adjustment may be required for medicinal products that are primarily eliminated via CYP3A metabolism and have narrow therapeutic window (e.g. carbamazepine, cyclosporine, fentanyl, pimozide, simvastatin, tacrolimus).
Capivasertib [1], talviraline ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], telaprevir ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], telithromycin ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], telotristat ethyl ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], thioridazine ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Capivasertib [1], tofisopam ---> SmPC of [1] of EMA
Co-administration of TRUQAP with moderate CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. TRUQAP dose should be reduced when co-administered with moderate CYP3A4 inhibitor
Capivasertib [1], troleandomycin ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], tucatinib ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], UGT1A1 substrate with a narrow therapeutic index ---> SmPC of [1] of EMA
Capivasertib should be used with caution in combination with sensitive substrates of UGT1A1 enzymes which exhibit a narrow therapeutic index (e.g. irinotecan) because capivasertib may increase the systemic exposure of these substrates.
Capivasertib [1], verapamil ---> SmPC of [1] of EMA
Co-administration of TRUQAP with moderate CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. TRUQAP dose should be reduced when co-administered with moderate CYP3A4 inhibitor
Capivasertib [1], voriconazole ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Capivasertib [1], women of childbearing potential ---> SmPC of [1] of EMA
Women of childbearing potential should be advised to avoid becoming pregnant while receiving TRUQAP. A pregnancy test should be performed on women of childbearing potential prior to initiating treatment and verified as negative.
CONTRAINDICATIONS of Capivasertib (Truqap)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/truqap-epar-product-information_en.pdf 11/07/2024
Capmatinib (Tabrecta)
BCRP substrates with narrow therapeutic range, capmatinib [2] ---> SmPC of [2] of EMA
If capmatinib is co-administered with narrow therapeutic index P-gp or BCRP substrates, dose reduction of the co-administered medicinal product may be required.
BCRP substrates, capmatinib [2] ---> SmPC of [2] of EMA
Co-administration of Tabrecta with a P-gp or BCRP substrate may increase the incidence and severity of adverse reactions of these substrates.
Breast-feeding, capmatinib [2] ---> SmPC of [2] of EMA
Because of the potential for serious adverse reactions in breast-fed infants, breast-feeding should be discontinued during treatment with Tabrecta and for at least 7 days after the last dose.
Caffeine, capmatinib [2] ---> SmPC of [2] of EMA
Moderate inhibition of CYP1A2 was observed when capmatinib was co-administered with the sensitive CYP1A2 substrate caffeine. Co-administration of capmatinib (400 mg twice daily) with caffeine increased caffeine AUCinf by 134%.
Capmatinib [1], carbamazepine ---> SmPC of [1] of EMA
Decreases in capmatinib exposure may decrease Tabrecta anti-tumour activity. Co-administration of Tabrecta with strong CYP3A inducers, should be avoided
Capmatinib [1], clarithromycin ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], colchicine ---> SmPC of [1] of EMA
Caution should be exercised during co-administration of Tabrecta with P-gp (digoxin, dabigatran etexilate, colchicine, sitagliptin, saxagliptin and posaconazole)
Capmatinib [1], CYP1A2 substrates with narrow therapeutic index ---> SmPC of [1] of EMA
If capmatinib is co-administered with narrow therapeutic index CYP1A2 substrates, such as theophylline and tizanidine, dose reduction of the co-administered medicinal product may be required.
Capmatinib [1], dabigatran etexilate ---> SmPC of [1] of EMA
Caution should be exercised during co-administration of Tabrecta with P-gp (digoxin, dabigatran etexilate, colchicine, sitagliptin, saxagliptin and posaconazole)
Capmatinib [1], digoxin ---> SmPC of [1] of EMA
Caution should be exercised during co-administration of Tabrecta with P-gp (digoxin, dabigatran etexilate, colchicine, sitagliptin, saxagliptin and posaconazole)
Capmatinib [1], drugs primarily metabolised by CYP3A4 ---> SmPC of [1] of EMA
Clinically relevant drug-drug interactions between capmatinib and CYP3A substrates are unlikely to occur as co-administration of capmatinib had no clinically meaningful effect on exposure of midazolam (a CYP3A substrate).
Capmatinib [1], efavirenz ---> SmPC of [1] of EMA
Decreases in capmatinib exposure may decrease Tabrecta anti-tumour activity. Caution should be exercised during co-administration of Tabrecta with moderate CYP3A inducers.
Capmatinib [1], fertility ---> SmPC of [1] of EMA
No human fertility data on capmatinib are available. Fertility studies with capmatinib were not conducted in animals.
Capmatinib [1], foods ---> SmPC of [1] of EMA
Tabrecta should be taken orally twice daily with or without food. Patients with swallowing difficulties are recommended to take Tabrecta with food. The tablets should be swallowed whole
Capmatinib [1], indinavir ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], itraconazol ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], ketoconazole ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], lopinavir/ritonavir ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], men ---> SmPC of [1] of EMA
Male patients with sexual partners who are pregnant, possibly pregnant, or who could become pregnant should use condoms during treatment with Tabrecta and for at least 7 days after the last dose.
Capmatinib [1], methotrexate ---> SmPC of [1] of EMA
Caution should be exercised during co-administration of Tabrecta with BCRP (methotrexate, rosuvastatin, pravastatin, mitoxantrone and sulphasalazine) substrates.
Capmatinib [1], midazolam ---> SmPC of [1] of EMA
Clinically relevant drug-drug interactions between capmatinib and CYP3A substrates are unlikely to occur as co-administration of capmatinib had no clinically meaningful effect on exposure of midazolam (a CYP3A substrate).
Capmatinib [1], mitoxantrone ---> SmPC of [1] of EMA
Caution should be exercised during co-administration of Tabrecta with BCRP (methotrexate, rosuvastatin, pravastatin, mitoxantrone and sulphasalazine) substrates.
Capmatinib [1], moderate CYP3A4 inductors ---> SmPC of [1] of EMA
Decreases in capmatinib exposure may decrease Tabrecta anti-tumour activity. Caution should be exercised during co-administration of Tabrecta with moderate CYP3A inducers.
Capmatinib [1], nefazodone ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], nelfinavir ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], P-glycoprotein substrates ---> SmPC of [1] of EMA
Co-administration of Tabrecta with a P-gp or BCRP substrate may increase the incidence and severity of adverse reactions of these substrates.
Capmatinib [1], P-glycoprotein substrates with small therapeutic index ---> SmPC of [1] of EMA
If capmatinib is co-administered with narrow therapeutic index P-gp or BCRP substrates, dose reduction of the co-administered medicinal product may be required.
Capmatinib [1], phenobarbital ---> SmPC of [1] of EMA
Decreases in capmatinib exposure may decrease Tabrecta anti-tumour activity. Co-administration of Tabrecta with strong CYP3A inducers, should be avoided
Capmatinib [1], phenytoin ---> SmPC of [1] of EMA
Decreases in capmatinib exposure may decrease Tabrecta anti-tumour activity. Co-administration of Tabrecta with strong CYP3A inducers, should be avoided
Capmatinib [1], posaconazole ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], pravastatine ---> SmPC of [1] of EMA
Caution should be exercised during co-administration of Tabrecta with BCRP (methotrexate, rosuvastatin, pravastatin, mitoxantrone and sulphasalazine) substrates.
Capmatinib [1], pregnancy ---> SmPC of [1] of EMA
Tabrecta should not be used during pregnancy unless the clinical condition of the woman requires treatment with capmatinib. The pregnancy status of women of childbearing potential should be verified prior to starting treatment with Tabrecta.
Capmatinib [1], rabeprazole ---> SmPC of [1] of EMA
Clinically relevant drug-drug interactions between capmatinib and gastric-acid-reducing agents are unlikely to occur as co-administration of rabeprazole had no clinically meaningful effect on exposure of capmatinib.
Capmatinib [1], rifampicin ---> SmPC of [1] of EMA
Decreases in capmatinib exposure may decrease Tabrecta anti-tumour activity. Co-administration of Tabrecta with strong CYP3A inducers, should be avoided
Capmatinib [1], ritonavir ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], rosuvastatin ---> SmPC of [1] of EMA
Caution should be exercised during co-administration of Tabrecta with BCRP (methotrexate, rosuvastatin, pravastatin, mitoxantrone and sulphasalazine) substrates.
Capmatinib [1], saquinavir ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], saxagliptin ---> SmPC of [1] of EMA
Caution should be exercised during co-administration of Tabrecta with P-gp (digoxin, dabigatran etexilate, colchicine, sitagliptin, saxagliptin and posaconazole)
Capmatinib [1], sitagliptin ---> SmPC of [1] of EMA
Caution should be exercised during co-administration of Tabrecta with P-gp (digoxin, dabigatran etexilate, colchicine, sitagliptin, saxagliptin and posaconazole)
Capmatinib [1], St. John's wort ---> SmPC of [1] of EMA
Decreases in capmatinib exposure may decrease Tabrecta anti-tumour activity. Co-administration of Tabrecta with strong CYP3A inducers, should be avoided
Capmatinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA
Decreases in capmatinib exposure may decrease Tabrecta anti-tumour activity. Co-administration of Tabrecta with strong CYP3A inducers, should be avoided
Capmatinib [1], strong CYP3A4 inhibitors ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], sulfasalazine ---> SmPC of [1] of EMA
Caution should be exercised during co-administration of Tabrecta with BCRP (methotrexate, rosuvastatin, pravastatin, mitoxantrone and sulphasalazine) substrates.
Capmatinib [1], telaprevir ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], telithromycin ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], theophylline ---> SmPC of [1] of EMA
If capmatinib is co-administered with narrow therapeutic index CYP1A2 substrates, such as theophylline and tizanidine, dose reduction of the co-administered medicinal product may be required.
Capmatinib [1], tizanidine ---> SmPC of [1] of EMA
If capmatinib is co-administered with narrow therapeutic index CYP1A2 substrates, such as theophylline and tizanidine, dose reduction of the co-administered medicinal product may be required.
Capmatinib [1], verapamil ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], voriconazole ---> SmPC of [1] of EMA
Patients should be closely monitored for adverse reactions during co-administration of Tabrecta with strong CYP3A inhibitors
Capmatinib [1], women of childbearing potential ---> SmPC of [1] of EMA
Sexually-active women of childbearing potential should use effective contraception (methods that result in less than 1% pregnancy rates) during treatment with Tabrecta and for at least 7 days after the last dose.
CONTRAINDICATIONS of Capmatinib (Tabrecta)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/tabrecta-epar-product-information_en.pdf 27/08/2025
Capsaicin (Qutenza)
Breast-feeding, capsaicin [2] ---> SmPC of [2] of EMA
A risk to the newborns/infants cannot be excluded. Breast-feeding should be discontinued during treatment with Qutenza.
Capsaicin [1], fertility ---> SmPC of [1] of EMA
There is no data in humans available on fertility. A reproductive toxicology study in rats showed a reduction in the number and percent of motile sperm and the number of pregnancies (see section 5.3).
Capsaicin [1], interactions ---> SmPC of [1] of EMA
No formal interaction studies with other medicinal products have been performed as only transient low levels of systemic absorption have been shown to occur with Qutenza.
Capsaicin [1], pregnancy ---> SmPC of [1] of EMA
The likelihood that Qutenza increases the risk of developmental abnormalities when given to pregnant women is very low.
CONTRAINDICATIONS of Capsaicin (Qutenza)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/qutenza-epar-product-information_en.pdf. 23/10/2023
Captopril
Ability to drive, captopril [2] ---> SPC of [2] of eMC
As with other antihypertensives, the ability to drive and use machines may be reduced
ACE inhibitors, AIIRA
The dual blockade of the RAA-system through the combined use of ACE-inhibitors, AIIRA or aliskiren is associated with a higher frequency of adverse events such as hypotension, hyperkalaemia and decreased renal function (including acute renal failure)
ACE inhibitors, aliskiren
The combination of ACE inhibitors with aliskiren is contraindicated in diabetes mellitus or renal impairment (GFR < 60 ml/min/1.73 m²) and is not recommended in other patients
ACE inhibitors, allopurinol ---> SPC of [captopril] of eMC
Concomitant administration of allopurinol with ACE inhibitors may lead to an increased risk for leucopenia especially when the latter are used at higher than currently recommended doses.
ACE inhibitors, cytostatics ---> SPC of [captopril] of eMC
Concomitant administration of cytostatics with ACE inhibitors may lead to an increased risk for leucopenia especially when the latter are used at higher than currently recommended doses.
ACE inhibitors, immunosuppressives ---> SPC of [captopril] of eMC
Concomitant administration of immunosuppressive agents with ACE inhibitors may lead to an increased risk for leucopenia especially when the latter are used at higher than currently recommended doses.
ACE inhibitors, procainamide ---> SPC of [captopril] of eMC
Concomitant administration of procainamide with ACE inhibitors may lead to an increased risk for leucopenia especially when the latter are used at higher than currently recommended doses.
ACE inhibitors, sympathomimetics ---> SPC of [captopril] of eMC
Sympathomimetics may reduce the antihypertensive effects of ACE inhibitors.
ACE inhibitors, tricyclic antidepressant ---> SPC of [captopril] of eMC
ACE inhibitors may enhance the hypotensive effects of certain tricyclic antidepressants and antipsychotics. Postural hypotension may occur.
Acetylsalicylic acid, captopril [2] ---> SPC of [2] of eMC
It has been described NSAIDs and ACE inhibitors exert an additive effect on the increase in serum potassium whereas renal function may decrease. Chronic administration of NSAIDs may reduce the antihypertensive effect of an ACE inhibitor.
Alcohol, captopril
Additive effect
Alfa-adrenergic receptor blockers, captopril [2] ---> SPC of [2] of eMC
Concomitant use of captopril and alpha blocking agents may increase the antihypertensive effects of captopril and increase the risk of orthostatic hypotension.
Algeldrate/magnesium hydroxide, captopril
The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 2 hours
Allopurinol, captopril [2] ---> SPC of [2] of eMC
Concomitant administration of allopurinol with ACE inhibitors may lead to an increased risk for leucopenia especially when the latter are used at higher than currently recommended doses.
Aluminium hydroxide, captopril
The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 2 hours
Aluminium oxide/magnesium hydroxide, captopril
The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 2 hours
Amiloride, captopril [2] ---> SPC of [2] of eMC
Potassium sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.
Amiloride/hydrochlorothiazide, captopril
In patients receiving amiloride/hydrochlorothiazide, there is the risk of significant hypotension and worsening of renal function at beginning of an additional treatment with ACE inhibitors. Increased risk of hypercaliemia
Anaesthetics, captopril
The co-administration may cause hypotension
Antihypertensives, captopril [2] ---> SPC of [2] of eMC
Concomitant use of other antihypertensive agents and captopril may increase the hypotensive effects of captopril.
Ataluren [1], captopril ---> SPC of [1] of EMA
Caution should be exercised when ataluren is co-administered with medicinal products that are substrates of UGT1A9, OAT1, OAT3, or OATP1B3 because of the risk of increase concentration of these medicinal products
Azathioprine [1], captopril ---> SPC of [1] of eMC
There have been case reports suggesting that haematological abnormalities may develop due to the concomitant administration of azathioprine and ACE Inhibitors.
Bendroflumethiazide, captopril [2] ---> SPC of [2] of eMC
Prior treatment with high dose diuretics may result in volume depletion and a risk of hypotension when initiating therapy with captopril
Betablockers, captopril [2] ---> SPC of [2] of eMC
Concomitant use of betablockers and captopril may increase the hypotensive effects of captopril.
Breast-feeding, captopril [2] ---> SPC of [2] of eMC
The use of captopril in breastfeeding is not recommended for preterm infants and for the first few weeks after delivery, because of the hypothetical risk of cardiovascular and renal effects and there is not enough clinical experience.
Calcium antagonists, captopril [2] ---> SPC of [2] of eMC
Concomitant use of long-acting calcium antagonists and captopril may increase the hypotensive effects of captopril.
Captopril [1], cytostatics ---> SPC of [1] of eMC
Concomitant administration of cytostatics with ACE inhibitors may lead to an increased risk for leucopenia especially when the latter are used at higher than currently recommended doses.
Captopril [1], hyperkalemia ---> SPC of [1] of eMC
Potassium sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.
Captopril [1], immunosuppressives ---> SPC of [1] of eMC
Concomitant administration of immunosuppressive agents with ACE inhibitors may lead to an increased risk for leucopenia especially when the latter are used at higher than currently recommended doses.
Captopril [1], indometacin ---> SPC of [1] of eMC
It has been described NSAIDs and ACE inhibitors exert an additive effect on the increase in serum potassium whereas renal function may decrease. Chronic administration of NSAIDs may reduce the antihypertensive effect of an ACE inhibitor.
Captopril [1], insulin ---> SPC of [1] of eMC
Pharmacological studies have shown that ACE inhibitors can potentiate the blood glucose-reducing effects of insulin and oral antidiabetics in diabetics.
Captopril [1], lithium ---> SPC of [1] of eMC
Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with ACE inhibitors. Use of captopril with lithium is not recommended
Captopril [1], loop diuretics ---> SPC of [1] of eMC
Prior treatment with high dose diuretics may result in volume depletion and a risk of hypotension when initiating therapy with captopril
Captopril [1], neuroleptics ---> SPC of [1] of eMC
ACE inhibitors may enhance the hypotensive effects of certain tricyclic antidepressants and antipsychotics. Postural hypotension may occur.
Captopril [1], nitroglycerine ---> SPC of [1] of eMC
Treatment of captopril with nitroglycerine and other nitrates, or other vasodilators, should be used with caution.
Captopril [1], NSAID ---> SPC of [1] of eMC
It has been described NSAIDs and ACE inhibitors exert an additive effect on the increase in serum potassium whereas renal function may decrease. Chronic administration of NSAIDs may reduce the antihypertensive effect of an ACE inhibitor.
Captopril [1], oral antidiabetics ---> SPC of [1] of eMC
Pharmacological studies have shown that ACE inhibitors can potentiate the blood glucose-reducing effects of insulin and oral antidiabetics in diabetics.
Captopril [1], organic nitrates ---> SPC of [1] of eMC
Treatment of captopril with nitroglycerine and other nitrates, or other vasodilators, should be used with caution.
Captopril [1], potassium ---> SPC of [1] of eMC
Potassium sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.
Captopril [1], potassium-sparing diuretics ---> SPC of [1] of eMC
Potassium sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.
Captopril [1], pregnancy ---> SPC of [1] of eMC
The use of ACE inhibitors is not recommended during the first trimester of pregnancy. The use of ACE inhibitors is contraindicated during the second and third trimesters of pregnancy
Captopril [1], procainamide ---> SPC of [1] of eMC
Concomitant administration of procainamide with ACE inhibitors may lead to an increased risk for leucopenia especially when the latter are used at higher than currently recommended doses.
Captopril [1], salt ---> SPC of [1] of eMC
The hypotensive effects can be reduced by increasing salt intake
Captopril [1], spironolactone ---> SPC of [1] of eMC
Since ACE inhibitors decrease aldosterone production they should not routinely be used with spironolactone, particularly in patients with marked renal impairment.
Captopril [1], sulfonylureas ---> SPC of [1] of eMC
Pharmacological studies have shown that ACE inhibitors can potentiate the blood glucose-reducing effects of insulin and oral antidiabetics in diabetics.
Captopril [1], sympathomimetics ---> SPC of [1] of eMC
Sympathomimetics may reduce the antihypertensive effects of ACE inhibitors; patients should be carefully monitored.
Captopril [1], thiazides ---> SPC of [1] of eMC
Prior treatment with high dose diuretics may result in volume depletion and a risk of hypotension when initiating therapy with captopril
Captopril [1], triamterene ---> SPC of [1] of eMC
Potassium sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.
Captopril [1], tricyclic antidepressant ---> SPC of [1] of eMC
ACE inhibitors may enhance the hypotensive effects of certain tricyclic antidepressants and antipsychotics. Postural hypotension may occur.
Captopril [1], vasodilators ---> SPC of [1] of eMC
Treatment of captopril with nitroglycerine and other nitrates, or other vasodilators, should be used with caution.
Captopril, carbaldrate
The aluminium salt decreases the absorption of captopril. Separate administration by at least 2 hours
Captopril, corticosteroids
The co-administration with systemic corticosteroids may cause decrease of leucocytes, neutropenia and agranulocytosis
Captopril, digital glycosides
Increased plasma level of digital glucoside
Captopril, digoxin
Serum levels of digoxin may be increased by concomitant administration of captopril
Captopril, doubutamine
Simultaneous administration of dobutamine and ACE inhibitors (e.g. captopril) may increase the cardiac output, accompanied by increased myocardial oxygen consumption.
Captopril, gliclazide [2] ---> SPC of [2] of eMC
Potentiation of the blood glucose lowering effect and thus, in some instances, hypoglycaemia may occur when angiotensin converting enzyme inhibitors are taken
Captopril, heparin
The co-administration may increase the potassium level
Captopril, insulin lispro [2] ---> SPC of [2] of EMA
Insulin requirements may be reduced in the presence of medicinal products with hypoglycaemic activity
Captopril, magnesium hydroxide
The magnesium hydroxide may decrease the absorption of captopril. Separate administration by 2-3 hours
Captopril, metildigoxin
Increased plasma levels of metildigoxin
Captopril, oxetacaine
Decreased absorption of captopril
Captopril, piretanide
At the beginning of treatment there is a risk of pronounced hypotension until shock and a risk of worsening of renal function
Captopril, probenecide
The co-administration may delay the elimination of captopril and increase its plasma levels, effects and adverse reactions
Captopril, pyrazolones
The co-administration may cause interactions
CONTRAINDICATIONS of Captopril
- History of hypersensitivity to captopril, to any of the excipients or any other ACE inhibitor.
- History of angioedema associated with previous ACE inhibitor therapy.
- Hereditary / idiopathic angioneurotic oedema.
- Second and third trimester of pregnancy
- Lactation
http://www.medicines.org.uk/emc/
Carbamazepine
Abemaciclib [1], carbamazepine ---> SPC of [1] of EMA
Concomitant use of strong CYP3A4 inducers should be avoided due to the risk of decreased efficacy of abemaciclib.
Ability to drive, carbamazepine [2] ---> SPC of [2] of eMC
The patient's ability to react may be impaired by the medical condition resulting in seizures and adverse reactions including dizziness, drowsiness, ataxia, diplopia, impaired accommodation and blurred vision
Abiraterone [1], carbamazepine ---> SPC of [1] of EMA
Strong inducers of CYP3A4 (decreased mean plasma AUCinf of abiraterone) during treatment are to be avoided, unless there is no therapeutic alternative.
Acenocoumarol [1], carbamazepine ---> SPC of [1] of eMC
Carbamazepine may lower the plasma level of oral anticoagulant
Acetazolamide, carbamazepine [2] ---> SPC of [2] of eMC
The plasma concentrations of carbamazepine may be increased
Afatinib [1], carbamazepine ---> SPC of [1] of EMA
Strong P-gp inducers may decrease exposure to afatinib
Ajmaline, carbamazepine
Co-administration of ajmaline with enzymatic inductors decreases significant the plasma concentrations of ajmaline
Albendazole, carbamazepine
The co-administration may decrease the plasma concentrations of active albendazole metabolite
Alcohol, carbamazepine [2] ---> SPC of [2] of eMC
Carbamazepine may reduce alcohol tolerance. It is therefore advisable for the patient to abstain from alcohol.
Alectinib [1], carbamazepine ---> SPC of [1] of EMA
Appropriate monitoring is recommended for patients taking concomitant strong CYP3A inducers (including, but not limited to, carbamazepine, phenobarbital, phenytoin, rifabutin, rifampicin and St. John's Wort (Hypericum perforatum)).
Allopurinol/lesinurad [1], carbamazepine ---> SPC of [1] of EMA
Lesinurad exposure is expected to decrease when it is co-administered with inducers of CYP2C9 (e.g. carbamazepine, a moderate CYP2C9 inducer).
Alprazolam, carbamazepine [2] ---> SPC of [2] of eMC
Carbamazepine may decrease the plasma levels of alprazolam
Amifampridine, carbamazepine
Potent inducers of enzymes that metabolize medicinal products may increase amifampridine elimination and give rise to subtherapeutic exposure of amifampridine.
Aminophylline, carbamazepine [2] ---> SPC of [2] of eMC
The carbamazepine plasma levels may be decreased.
Amitriptyline [1], carbamazepine ---> SPC of [1] of eMC
Carbamazepine may decrease the plasma levels of amitriptyline
Amlodipine, carbamazepine ---> SPC of [amlodipine/valsartan/hydrochlorothiazide] of EMA
The concomitant use of CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.
Amlodipine/valsartan [1], carbamazepine ---> SPC of [1] of EMA
The concomitant use of CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.
Amlodipine/valsartan/hydrochlorothiazide [1], carbamazepine ---> SPC of [1] of EMA
The concomitant use of CYP3A4 inducers may give a lower plasma concentration of amlodipine. Amlodipine should be used with caution together with CYP3A4 inducers.
Amprenavir [1], carbamazepine ---> SPC of [1] of EMA
Concomitant administration of anticonvulsant active substances known as enzymatic inductors with amprenavir may lead to a decrease in the plasma concentrations of amprenavir.
Analgesics, carbamazepine
The co-administration may promote the neurological adverse effects.
Antiarrhythmics, carbamazepine
The co-administration may increase the risk of cardiac conduction abnormalities
Antidepressants, carbamazepine
The co-administration may promote the neurological adverse effects.
Apixaban [1], carbamazepine ---> SPC of [1] of EMA
The concomitant use of apixaban with strong CYP3A4 and P-gp inducers may lead to reduced apixaban plasma concentrations. No dose adjustment for apixaban (almost always) is required during concomitant therapy with such agents
Apremilast [1], carbamazepine ---> SPC of [1] of EMA
Co-administration of strong CYP3A4 enzyme inducer rifampicin resulted in a reduction of systemic exposure of apremilast. Therefore, the use of strong CYP3A4 enzyme inducers with apremilast is not recommended.
Aprepitant [1], carbamazepine ---> SPC of [1] of EMA
Concomitant administration of aprepitant with active substances that strongly induce CYP3A4 activity should be avoided as the combination results in reductions of the plasma concentrations of aprepitant that may result in decreased efficacy of aprepitant
Aripiprazole [1], carbamazepine ---> SPC of [1] of EMA
Concomitant administration of aripiprazole and inducers of CYP3A4 may be expected to reduce the geometric means of Cmax and AUC for aripiprazole. The concomitant use of CYP3A4 inducers with aripiprazole should be avoided
Atazanavir [1], carbamazepine ---> SPC of [1] of EMA
REYATAZ may increase plasma levels of carbamazepine due to CYP3A4 inhibition. Due to carbamazepine inducing effect, a reduction on atazanavir/ritonavir exposure cannot be ruled out.
Atazanavir/cobicistat [1], carbamazepine ---> SPC of [1] of EMA
Coadministration (contraindicated) of EVOTAZ with strong inducers of CYP3A may result in decreased plasma concentrations of atazanavir and/or cobicistat, leading to loss of therapeutic effect and possible development of resistance to atazanavir.
Atenolol/nifedipine, carbamazepine
The CYP3A4 induction decreases the bioavailability and efficacy of nifedipine
Atorvastatin [1], carbamazepine ---> SPC of [1] of eMC
Carbamazepine may lower the plasma level of atorvastatin
Atracurium [1], carbamazepine ---> SPC of [1] of eMC
The onset of non-depolarising neuromuscular block is likely to be lengthened and the duration of block shortened in patients receiving chronic anticonvulsant therapy (phenytoin, carbamazepine).
Avanafil [1], carbamazepine ---> SPC of [1] of EMA
The potential effect of CYP inducers, especially inducers of CYP3A4 on the pharmacokinetics and efficacy of avanafil has not been evaluated. The concomitant use of avanafil and a CYP inducer is not recommended as it may decrease the efficacy of avanafil.
Axitinib [1], carbamazepine ---> SPC of [1] of EMA
Co-administration of axitinib with strong CYP3A4/5 inducers may decrease axitinib plasma concentrations. Selection of concomitant medicinal products with no or minimal CYP3A4/5 induction potential is recommended.
Azole antifungals, carbamazepine [2] ---> SPC of [2] of eMC
Co-administration of carbamazepine with inhibitors of CYP 3A4 may result in increased carbamazepine plasma concentrations which could induce adverse reactions.
Barnidipine, carbamazepine
The enzymatic inductor may decrease the plasma levels of barnidipine. Caution is recommended
Bazedoxifene [1], carbamazepine ---> SPC of [1] of EMA
The metabolism of bazedoxifene may be increased by concomitant use of substances known to induce UGTs potentially leading to decreased systemic concentrations of bazedoxifene.
Bedaquiline [1], carbamazepine ---> SPC of [1] of EMA
Bedaquiline exposure may be reduced during co-administration with inducers of CYP3A4. Co-administration of bedaquiline and moderate or strong CYP3A4 inducers used systemically should be avoided.
Bendroflumethiazide, carbamazepine
Concomitant use of carbamazepine and bendroflumethiazide may increase the risk of hyponatraemia.
Benperidol, carbamazepine
Carbamazepine may theoretically enhance the metabolic breakdown of neuroleptics, necessitating an increased dose.
Bictegravir/emtricitabine/tenofovir alafenamide [1], carbamazepine ---> SPC of [1] of EMA
Co-administration is not recommended.
Binimetinib [1], carbamazepine ---> SPC of [1] of EMA
Inducers of CYP1A2 enzymes (such as carbamazepine and rifampicin) may decrease binimetinib exposure, which could result in a decrease of efficacy.
Boceprevir [1], carbamazepine ---> SPC of [1] of EMA
The concomitant use of boceprevir with carbamazepine may significantly reduce the plasma exposure of boceprevir. No data are available, therefore, the combination of boceprevir with these medicines is not-recommended
Bortezomib [1], carbamazepine ---> SPC of [1] of EMA
The concomitant use of bortezomib with strong CYP3A4 inducers is not recommended, as efficacy may be reduced.
Bosentan [1], carbamazepine ---> SPC of [1] of EMA
Concomitant administration of bosentan and CYP3A4 inductors is expected to lead to reduced systemic exposure to bosentan. A clinically significant reduction of efficacy cannot be excluded.
Bosutinib [1], carbamazepine ---> SPC of [1] of EMA
The concomitant use of bosutinib with strong CYP3A inductors should be avoided, as a decrease in bosutinib plasma levels will occur.
Breast-feeding, carbamazepine [2] ---> SPC of [2] of eMC
Carbamazepine passes into the breast milk. The benefits of breastfeeding should be weighed against the remote possibility of adverse effects occurring in the infant.
Brivaracetam [1], carbamazepine ---> SPC of [1] of EMA
Brivaracetam plasma concentrations are decreased when coadministered with strong enzyme inducing AEDs (carbamazepine, phenobarbital, phenytoin) but no dose adjustment is required
Bromperidol, carbamazepine [2] ---> SPC of [2] of eMC
Carbamazepine may lower the plasma level of bromperidol
Brotizolam, carbamazepine
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma concentrations of brotizolam
Budesonide, carbamazepine
Concomitant treatment of budesonide with CYP3A4 inducers may reduce budesonide exposure, which may require a dose increase.
Buprenorphine [1], carbamazepine ---> SPC of [1] of eMC
The interaction between buprenorphine and CYP3A4 inducers has not been investigated. It is recommended that patients that are treated with buprenorphine are monitored closely if enzyme inducers are given concomitantly.
Buprenorphine/naloxone [1], carbamazepine ---> SPC of [1] of EMA
Concomitant use of CYP3A4 inducers with buprenorphine may decrease buprenorphine plasma concentrations, potentially resulting in sub-optimal treatment of opioid dependence with buprenorphine.
Bupropion [1], carbamazepine ---> SPC of [1] of eMC
Since bupropion is extensively metabolised, caution is advised when bupropion is co-administered with medicinal products known to induce metabolism, as these may affect its clinical efficacy and safety.
Buspirone, carbamazepine
When used buspirone in combination with a potent inducer of CYP3A4, an adjustment of the dosage of buspirone may be necessary to maintain buspirone's anxiolytic effect.
Cabazitaxel [1], carbamazepine ---> SPC of [1] of EMA
Repeated administration of rifampin, a strong CYP3A inducer, resulted in an increase in cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inducers should be avoided as a decrease of plasma concentrations of cabazitaxel may occur
Cabozantinib [1], carbamazepine ---> SPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inductors (decreased plasma cabozantinib exposure (AUC) should be approached with caution.
Canagliflozin [1], carbamazepine ---> SPC of [1] of EMA
Enzyme inducers may give rise to decreased exposure of canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Canagliflozin/metformin [1], carbamazepine ---> SPC of [1] of EMA
Enzyme inducers may give rise to decreased exposure of canagliflozin. These decreases in exposure to canagliflozin may decrease efficacy.
Carbamazepine [1], cimetidine ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], cisatracurium ---> SPC of [1] of eMC
Carbamazepine may antagonise the effects of non-depolarising muscle relaxants
Carbamazepine [1], cisplatin ---> SPC of [1] of eMC
The carbamazepine plasma levels may be decreased.
Carbamazepine [1], clomipramine ---> SPC of [1] of eMC
Carbamazepine may lower the plasma level of tricyclic antidepressant
Carbamazepine [1], clonazepam ---> SPC of [1] of eMC
Carbamazepine may decrease the plasma levels of clonazepam. Clonazepam may decrease the levels of carbamazepine
Carbamazepine [1], dantrolene ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], desipramine ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], dexamethasone ---> SPC of [1] of eMC
Carbamazepine may decrease the plasma levels of dexamethasone
Carbamazepine [1], dextropropoxyphene ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], dicoumarol ---> SPC of [1] of eMC
Carbamazepine may lower the plasma level of oral anticoagulant
Carbamazepine [1], digoxin ---> SPC of [1] of eMC
Carbamazepine may decrease the plasma levels of digoxine.
Carbamazepine [1], dihydropyridines ---> SPC of [1] of eMC
Carbamazepine may decrease the plasma levels of the dihydropyridine
Carbamazepine [1], doxycycline ---> SPC of [1] of eMC
Carbamazepine may lower the plasma level of doxycycline
Carbamazepine [1], erythromycin ---> SPC of [1] of eMC
Co-administration of carbamazepine with inhibitors of CYP 3A4 may result in increased carbamazepine plasma concentrations which could induce adverse reactions.
Carbamazepine [1], ethosuximide ---> SPC of [1] of eMC
Carbamazepine may decrease the plasma levels of ethosuximide
Carbamazepine [1], felbamate ---> SPC of [1] of eMC
Carbamazepine may decrease the plasma levels of felbamate. Felbamate may decrease the levels of carbamazepine
Carbamazepine [1], fosphenytoin ---> SPC of [1] of eMC
The carbamazepine plasma levels may be decreased. Carbamazepine may lower or increase the plasma level of phenytoin
Carbamazepine [1], furosemide ---> SPC of [1] of eMC
Concomitant medication with carbamazepine and furosemide may lead to symptomatic hyponatraemia.
Carbamazepine [1], grapefruit juice ---> SPC of [1] of eMC
The active metabolite carbamazepine-10,11-epoxide plasma levels may be increased.
Carbamazepine [1], ibuprofen ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], IMAOs ---> SPC of [1] of eMC
The use of carbamazepine is contraindicated in combination with monoamine-oxidase inhibitors (MAOIs); before administering carbamazepine MAOIs should be discontinued for a minimum of 2 weeks, or longer if the clinical situation permits
Carbamazepine [1], inhibitors of epoxide hydrolase ---> SPC of [1] of eMC
Co-administration of inhibitors of human microsomal epoxide hydrolase may result in increased carbamazepine-10,11 epoxide plasma concentrations.
Carbamazepine [1], isotretinoin ---> SPC of [1] of eMC
The carbamazepine plasma levels may be decreased.
Carbamazepine [1], josamycin ---> SPC of [1] of eMC
Co-administration of carbamazepine with inhibitors of CYP 3A4 may result in increased carbamazepine plasma concentrations which could induce adverse reactions.
Carbamazepine [1], levetiracetam ---> SPC of [1] of eMC
Concomitant use of carbamazepine and levetiracetam has been reported to increase carbamazepine-induced toxicity.
Carbamazepine [1], lithium ---> SPC of [1] of eMC
The combination of lithium and carbamazepine may cause enhanced neurotoxicity in spite of lithium plasma concentrations being within the therapeutic range.
Carbamazepine [1], loratadine ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], loxapine ---> SPC of [1] of eMC
The active metabolite carbamazepine-10,11-epoxide plasma levels may be increased.
Carbamazepine [1], macrolide antibiotics ---> SPC of [1] of eMC
Co-administration of carbamazepine with inhibitors of CYP 3A4 may result in increased carbamazepine plasma concentrations which could induce adverse reactions.
Carbamazepine [1], methadone ---> SPC of [1] of eMC
Carbamazepine, enzymatic inductor, may decrease the plasma levels of methadone
Carbamazepine [1], metoclopramide ---> SPC of [1] of eMC
Combined use of carbamazepine with metoclopramide may result in an increase in neurological side-effects.
Carbamazepine [1], midazolam ---> SPC of [1] of eMC
Carbamazepine may decrease the plasma concentrations of midazolam
Carbamazepine [1], midecamycin ---> SPC of [1] of eMC
Co-administration of carbamazepine with inhibitors of CYP 3A4 may result in increased carbamazepine plasma concentrations which could induce adverse reactions.
Carbamazepine [1], muscle relaxants (non-depolarizing) ---> SPC of [1] of eMC
Carbamazepine may antagonise the effects of non-depolarising muscle relaxants
Carbamazepine [1], nefazodone ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased. Carbamazepine may lower the plasma level of nefazodone
Carbamazepine [1], neuroleptics ---> SPC of [1] of eMC
Combined use of carbamazepine with major tranquillisers may result in an increase in neurological side-effects.
Carbamazepine [1], nicotinic acid ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], nortriptyline ---> SPC of [1] of eMC
Carbamazepine may lower the plasma level of tricyclic antidepressant
Carbamazepine [1], omeprazole ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], oral anticoagulants ---> SPC of [1] of eMC
Carbamazepine may lower the plasma level of oral anticoagulant
Carbamazepine [1], oral contraceptives ---> SPC of [1] of eMC
Carbamazepine may lower the plasma level of oral contraceptive
Carbamazepine [1], oxcarbazepine ---> SPC of [1] of eMC
Carbamazepine may decrease the plasma levels of active metabolite of oxcarbazepine (MHD). Oxcarbazepine may decrease the plasma levels of carbamazepine
Carbamazepine [1], oxybutynine ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], pancuronium ---> SPC of [1] of eMC
Carbamazepine may antagonise the effects of non-depolarising muscle relaxants
Carbamazepine [1], paracetamol ---> SPC of [1] of eMC
Carbamazepine may lower the plasma level of paracetamol
Carbamazepine [1], phenazone ---> SPC of [1] of eMC
Carbamazepine may decrease the plasma levels of phenazone
Carbamazepine [1], phenprocoumon ---> SPC of [1] of eMC
Carbamazepine may lower the plasma level of oral anticoagulant
Carbamazepine [1], phensuximide ---> SPC of [1] of eMC
The carbamazepine plasma levels may be decreased.
Carbamazepine [1], phenytoin ---> SPC of [1] of eMC
The carbamazepine plasma levels may be decreased. Carbamazepine may lower or increase the plasma level of phenytoin
Carbamazepine [1], praziquantel ---> SPC of [1] of eMC
Carbamazepine may decrease the plasma levels of praziquantel
Carbamazepine [1], pregnancy ---> SPC of [1] of eMC
Pregnant women with epilepsy should be treated with special care.
Carbamazepine [1], primidone ---> SPC of [1] of eMC
The active metabolite carbamazepine-10,11-epoxide plasma levels may be increased and carbamazepine levels may be decreased. Carbamazepine may lower the plasma level of primidone
Carbamazepine [1], progabide ---> SPC of [1] of eMC
The active metabolite carbamazepine-10,11-epoxide plasma levels may be increased.
Carbamazepine [1], protease inhibitors ---> SPC of [1] of eMC
Protease inhibitors may increase plasma levels of carbamazepine. Carbamazepine may lower the plasma level of protease inhibitors
Carbamazepine [1], quetiapine ---> SPC of [1] of eMC
The active metabolite carbamazepine-10,11-epoxide plasma levels may be increased. Carbamazepine may lower the plasma level of quetiapine
Carbamazepine [1], rifampicin ---> SPC of [1] of eMC
The carbamazepine plasma levels may be decreased.
Carbamazepine [1], strong CYP3A4 inductors ---> SPC of [1] of eMC
Co-administration of carbamazepine with CYP 3A4 inducers might increase the rate of carbamazepine metabolism, thus leading to potential decreases in the carbamazepine serum level and therapeutic effect.
Carbamazepine [1], strong CYP3A4 inhibitors ---> SPC of [1] of eMC
Co-administration of carbamazepine with inhibitors of CYP 3A4 may result in increased carbamazepine plasma concentrations which could induce adverse reactions.
Carbamazepine [1], terfenadine ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], thioridazine ---> SPC of [1] of eMC
Combined use of carbamazepine with major tranquillisers may result in an increase in neurological side-effects.
Carbamazepine [1], ticlopidine ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], topiramate ---> SPC of [1] of eMC
Carbamazepine decreases the plasma concentration of topiramate.
Carbamazepine [1], troleandomycin ---> SPC of [1] of eMC
Co-administration of carbamazepine with inhibitors of CYP 3A4 may result in increased carbamazepine plasma concentrations which could induce adverse reactions.
Carbamazepine [1], valnoctamide ---> SPC of [1] of eMC
The active metabolite carbamazepine-10,11-epoxide plasma levels may be increased.
Carbamazepine [1], valpromide ---> SPC of [1] of eMC
The active metabolite carbamazepine-10,11-epoxide plasma levels may be increased.
Carbamazepine [1], vigabatrin ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], viloxazine ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine [1], ziprasidone ---> SPC of [1] of eMC
Carbamazepine may lower the plasma level of ziprasidone
Carbamazepine, cariprazine [2] ---> SPC of [2] of EMA
Co-administration of cariprazine with strong and moderate inducers of CYP3A4 may result in a significant decrease in total cariprazine exposure, therefore the co-administration of cariprazine and strong or moderate CYP3A4 inducers is contraindicated
Carbamazepine, caspofungin [2] ---> SPC of [2] of EMA
Concomitant use of caspofungin with the enzym inducer may result in a decrease in caspofungin AUC.
Carbamazepine, celecoxib [2] ---> SPC of [2] of EMA
Concomitant use of inducers of celecoxib with CYP2C9 may reduce plasma concentrations of celecoxib.
Carbamazepine, ceritinib [2] ---> SPC of [2] of EMA
Co-administration of ceritinib with strong CYP3A inducers decreases ceritinib plasma concentrations. Concomitant use of strong CYP3A inducers should be avoided.
Carbamazepine, cerivastatin
Carbamazepine may lower the plasma level of cerivastatin
Carbamazepine, chlomethiazole
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma concentrations of clomethiazole
Carbamazepine, chlormadinone
The co-administration increases the metabolism and decreases the plasma levels of gestagen
Carbamazepine, chloroquine
The co-administration of chloroquine with hepatotoxic medicinal products is not recommended
Carbamazepine, chlorprothixene
Carbamazepine, enzymatic inductor, may decrease the plasma levels of co-administered chlorprothixene
Carbamazepine, cilostazol [2] ---> SPC of [2] of EMA
The effect of CYP3A4 and CYP2C19 inducers on cilostazol pharmacokinetics has not been evaluated. The antiplatelet effect may theoretically be altered
Carbamazepine, citalopram [2] ---> SPC of [2] of eMC
Thus no change or only very small changes of no clinical importance were observed when citalopram was given with CYP3A4 substrates
Carbamazepine, clarithromycin [2] ---> SPC of [2] of eMC
Drugs that are inducers of CYP3A may induce the metabolism of clarithromycin. This may result in sub-therapeutic levels of clarithromycin leading to reduced efficacy.
Carbamazepine, clobazam [2] ---> SPC of [2] of eMC
Carbamazepine may cause an increase in the metabolic conversion of clobazam to the active metabolite N-desmethyl clobazam
Carbamazepine, clopidogrel [2] ---> SPC of [2] of EMA
Since clopidogrel is metabolised to its active metabolite partly by CYP2C19, use of medicinal products that inhibit the activity of this enzyme would be expected to result in reduced drug levels of the active metabolite of clopidogrel.
Carbamazepine, clopidogrel/acetylsalicylic acid [2] ---> SPC of [2] of EMA
Since clopidogrel is metabolised to its active metabolite partly by CYP2C19, use of medicinal products that inhibit the activity of this enzyme would be expected to result in reduced drug levels of the active metabolite of clopidogrel.
Carbamazepine, cloprednol
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma concentrations of cloprednol
Carbamazepine, clozapine [2] ---> SPC of [2] of eMC
Carbamazepine should not to be used concomitantly with clozapine, due to its myelosuppressive potential
Carbamazepine, cobicistat [2] ---> SPC of [2] of EMA
Co-administration of cobicistat with medicinal products that are strong inducers of CYP3A may result in decreased plasma concentrations of cobicistat. Coadministration is contraindicated
Carbamazepine, cobimetinib [2] ---> SPC of [2] of EMA
Concomitant use of moderate and strong CYP3A inducers should be avoided. Given that cobimetinib concentrations are likely to be significantly reduced when co-administered with moderate to strong CYP3A inducers, patient's efficacy may be compromised.
Carbamazepine, conjugated oestrogens/bazedoxifene [2] ---> SPC of [2] of EMA
The metabolism of oestrogens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes
Carbamazepine, corticosteroids
Carbamazepine, enzymatic inductor, may decrease the plasma levels of corticosteroid
Carbamazepine, crizotinib [2] ---> SPC of [2] of EMA
Coadministration of crizotinib with strong CYP3A inducers may decrease crizotinib plasma concentrations. The concurrent use of strong CYP3A inducers should be avoided
Carbamazepine, cyclophosphamide
The co-administration may increase the concentration of cytotoxic metabolites
Carbamazepine, cyclosporine [2] ---> SPC of [2] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Carbamazepine, CYP3A4 inductors
The CYP3A4 induction may decrease the plasma concentrations of carbamazepine
Carbamazepine, cyproterone/ethinylestradiol [2] ---> SPC of [2] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Carbamazepine, dabigatran etexilate [2] ---> SPC of [2] of EMA
Dabigatran etexilate is a substrate for the efflux transporter P-gp. Concomitant administration of a P-gp inducer is expected to result in decreased dabigatran concentrations and should be avoided
Carbamazepine, dabigatran [2] ---> SPC of [2] of EMA
Dabigatran etexilate is a substrate for the efflux transporter P-gp. Concomitant administration of a P-gp inducer is expected to result in decreased dabigatran concentrations and should be avoided
Carbamazepine, dabrafenib [2] ---> SPC of [2] of EMA
Dabrafenib is a substrate for the metabolising enzymes CYP3A4. Medicines that are strong inductors of CYP3A4 are therefore likely to decrease dabrafenib concentrations. Avoid coadministration of dabrafenib with potent inducers of CYP3A4.
Carbamazepine, daclatasvir [2] ---> SPC of [2] of EMA
Daclatasvir is contraindicated in combination with medicinal products that strongly induce CYP3A4 and P-gp, and thus may lead to lower exposure and loss of efficacy of daclatasvir.
Carbamazepine, danazol [2] ---> SPC of [2] of eMC
The plasma concentrations of carbamazepine may be increased
Carbamazepine, darifenacin [2] ---> SPC of [2] of EMA
Substances that are inducers of CYP3A4 are likely to decrease the plasma concentrations of darifenacin.
Carbamazepine, darunavir/cobicistat ---> SPC of [darunavir] of EMA
Darunavir and cobicistat are metabolised by CYP3A, and co-administration with CYP3A inducers may result in subtherapeutic plasma exposure to darunavir. Co-administration of darunavir/cobicistat with strong inducers of CYP3A is contraindicated
Carbamazepine, darunavir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Co-administration is contraindicated due to the potential for loss of therapeutic effect
Carbamazepine, darunavir/ritonavir ---> SPC of [darunavir] of EMA
No dose adjustment for darunavir/ritonavir is recommended. If there is a need to combine darunavir/ritonavir and carbamazepine, patients should be monitored for potential carbamazepine-related adverse events.
Carbamazepine, dasabuvir with ombitasvir/paritaprevir/ritonavir ---> SPC of [dasabuvir] of EMA
CYP3A4 induction by carbamazepine may decrease the plasma concentrations of carbamazepine 10, 11-epoxide, dasabuvir, ombitasvir and paritaprevir. Concomitant use is contraindicated
Carbamazepine, dasabuvir [2] ---> SPC of [2] of EMA
Co-administration (contraindicated) of dasabuvir with medicinal products that are strong or moderate enzyme inducers is expected to decrease dasabuvir plasma concentrations and reduce its therapeutic effect
Carbamazepine, dasatinib [2] ---> SPC of [2] of EMA
The administration of dasatinib with a strong CYP3A4 inductor may increase metabolism and decrease dasatinib plasma concentrations. Therefore, concomitant use of potent CYP3A4 inducers with dasatinib is not recommended.
Carbamazepine, deferasirox [2] ---> SPC of [2] of EMA
The concomitant use of deferasirox with potent UGT inducers may result in a decrease in deferasirox efficacy.
Carbamazepine, deflazacort
Deflazacort is metabolised in the liver. It is recommended to increase the maintenance dose of deflazacort if drugs which are liver enzyme inducers are co-administered
Carbamazepine, delamanid [2] ---> SPC of [2] of EMA
Taking medicinal products that are strong inducers of CYP3A4 (e.g. carbamazepine) with delamanid is contraindicated
Carbamazepine, desmopressin [2] ---> SPC of [2] of eMC
Substances which are known to induce SIADH may cause an additive antidiuretic effect leading to an increased risk of water retention and/or hyponatraemia.
Carbamazepine, desogestrel [2] ---> SPC of [2] of eMC
Interactions can occur with medicinal products that induce microsomal enzymes, which can result in increased clearance of sex hormones
Carbamazepine, dextromethorphan/quinidine [2] ---> SPC of [2] of EMA
Potent CYP3A4 inducers may accelerate the metabolism of quinidine, resulting in lower plasma concentrations and hence decreased inhibition of CYP2D6. This may lead to decreased efficacy of dextromethorphan/quinidine.
Carbamazepine, diazepam
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma levels of diazepam. The co-administration is not recommended
Carbamazepine, diltiazem [2] ---> SPC of [2] of eMC
Increase in circulating carbamazepine levels. It is recommended that the plasma carbamazepine concentrations be assayed and that the dose should be adjusted if necessary.
Carbamazepine, diuretics
Increased risk of hyponatraemia when diuretics given with carbamazepine
Carbamazepine, dolutegravir [2] ---> SPC of [2] of EMA
The CYP3A4 and UGT1A1 induction may decrease plasma levels of dolutegravir. Co-administration with this enzyme inducer should be avoided.
Carbamazepine, dolutegravir/abacavir/lamivudine [2] ---> SPC of [2] of EMA
The CYP3A4 and UGT1A1 induction may decrease plasma levels of dolutegravir. Co-administration with this enzyme inducer should be avoided.
Carbamazepine, dolutegravir/rilpivirine [2] ---> SPC of [2] of EMA
Metabolic inducers may significantly decrease dolutegravir/rilpivirine plasma concentrations, resulting in loss of therapeutic effect. Co-administration of Juluca with these metabolic inducers is contraindicated
Carbamazepine, donepezil [2] ---> SPC of [2] of eMC
The enzymatic induction may decrease the plasma levels of donepezil
Carbamazepine, doxorubicine [2] ---> SPC of [2] of eMC
Concomitant administration of doxorubicin with inducers of CYP450 might decrease plasma concentrations of doxorubicin and reduce efficacy and decrease the absorption of carbamazepine
Carbamazepine, dronedarone [2] ---> SPC of [2] of EMA
Rifampicin decreased dronedarone exposure. Therefore, co-administration of rifampicin and other potent CYP3A4 inducers is not recommended as they decrease dronedarone exposure.
Carbamazepine, drugs primarily metabolised by CYP3A4
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma concentrations of the medicinal products mainly metabolized by CYP3A4
Carbamazepine, dydrogesterone/estradiol
The metabolism of oestrogens and progestagens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes
Carbamazepine, edoxaban [2] ---> SPC of [2] of EMA
The concomitant use of edoxaban with P-gp inducers may lead to reduced edoxaban plasma concentrations. Edoxaban should be used with caution when co-administered with P-gp inducers.
Carbamazepine, efavirenz [2] ---> SPC of [2] of EMA
The CYP3A4 induction decreases the plasma concentrations of carbamazepine and efavirenz
Carbamazepine, efavirenz/emtricitabine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
Decrease in carbamazepine concentrations: CYP3A4 induction; decrease in efavirenz concentrations: CYP3A4 and CYP2B6 induction
Carbamazepine, elbasvir/grazoprevir [2] ---> SPC of [2] of EMA
CYP3A or P-gp induction. Co-administration is contraindicated.
Carbamazepine, eliglustat [2] ---> SPC of [2] of EMA
Concomitant administration of a strong CYP3A4 inducer resulted in a decrease in eliglustat exposure. Use of a strong CYP3A inducer with eliglustat is not recommended in poor, intermediate and extensive metabolisers.
Carbamazepine, elvitegravir [2] ---> SPC of [2] of EMA
Co-administration of elvitegravir with medicines that are strong inducers of CYP3A is contraindicated as the expected decrease in elvitegravir plasma levels can lead to loss of therapeutic effect and possible development of resistance to elvitegravir
Carbamazepine, elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Co-administration of carbamazepine, a potent CYP3A inducer, may significantly decrease cobicistat plasma concentrations. Co-administration of Genvoya with carbamazepine is contraindicated
Carbamazepine, elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
The contraindicated coadministration of Stribild and carbamazepine (CYP3A inducer) may result in significantly decreased cobicistat and elvitegravir plasma concentrations, which may result in loss of therapeutic effect and development of resistance
Carbamazepine, emtricitabine/rilpivirine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Co-administration may cause significant decreases in the plasma concentrations of rilpivirine (induction of CYP3A) and tenofovir alafenamide (induction of P-gp). Co-administration is contraindicated.
Carbamazepine, emtricitabine/rilpivirine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
Co-administration of medicinal products that induce CYP3A has been observed to decrease the plasma concentrations of rilpivirine which could potentially lead to loss of therapeutic effect. Concomitant use contraindicated
Carbamazepine, emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Medicinal products that induce P-gp activity (e.g., rifampicin, rifabutin, carbamazepine, phenobarbital) are expected to decrease the absorption of tenofovir alafenamide, resulting in decreased plasma concentration of tenofovir alafenamide
Carbamazepine, encorafenib [2] ---> SPC of [2] of EMA
A reduction in encorafenib exposure is likely and may result in compromised efficacy. Alternative agents with no or minimal CYP3A induction potential should be considered.
Carbamazepine, enzalutamide [2] ---> SPC of [2] of EMA
Enzalutamide, enzymatic inductor, may increase the metabolism of carbamazepine and decrease its plasma levels and effect
Carbamazepine, enzyme inductors
The enzymatic induction may decrease the plasma concentrations of carbamazepine
Carbamazepine, eplerenone [2] ---> SPC of [2] of eMC
Due to the risk of decreased eplerenone efficacy, the concomitant use of strong CYP3A4 inducers with eplerenone is not recommended
Carbamazepine, erlotinib [2] ---> SPC of [2] of EMA
Erlotinib is metabolised in the liver by the hepatic cytochromes in humans, primarily CYP3A4 and to a lesser extent by CYP1A2. Potent inducers of CYP3A4 activity increase erlotinib metabolism and significantly decrease erlotinib plasma concentrations.
Carbamazepine, eslicarbazepine [2] ---> SPC of [2] of EMA
The co-administration increases the risk of adverse reactions and slightly the clearance of carbamazepine
Carbamazepine, estradiol valerate/norgestrel [2] ---> SPC of [2] of eMC
The metabolism of oestrogens and progestagens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes
Carbamazepine, estradiol [2] ---> SPC of [2] of eMC
The metabolism of estrogens and progestagens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes
Carbamazepine, estradiol/norethisterone [2] ---> SPC of [2] of eMC
The metabolism of oestrogens and progestogens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes
Carbamazepine, estriol [2] ---> SPC of [2] of eMC
The metabolism of estrogens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes
Carbamazepine, estrogens ---> SPC of [estradiol] of eMC
The metabolism of oestrogens and progestagens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes
Carbamazepine, ethinyl estradiol
The enzymatic induction may accelerate the metabolism of steroid hormones and decrease their plasma levels and effect.
Carbamazepine, ethinylestradiol/chlormadinone
Interactions can occur with drugs that induce hepatic enzymes which can result in increased clearance of sex hormones
Carbamazepine, ethinylestradiol/desogestrel [2] ---> SPC of [2] of eMC
Interactions can occur with drugs that induce microsomal enzymes, which can result in increased clearance of sex hormones
Carbamazepine, ethinylestradiol/drospirenone [2] ---> SPC of [2] of eMC
Interactions can occur with drugs that induce hepatic enzymes which can result in increased clearance of sex hormones
Carbamazepine, ethinylestradiol/etonogestrel [2] ---> SPC of [2] of eMC
Interactions can occur with drugs that induce hepatic enzymes which can result in increased clearance of sex hormones
Carbamazepine, ethinylestradiol/gestodene [2] ---> SPC of [2] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Carbamazepine, ethinylestradiol/norgestimate [2] ---> SPC of [2] of eMC
Drugs or herbal products that induce enzymes, especially CYP3A4, may decrease the plasma concentrations of contraceptive hormones, and may decrease their effectiveness and/or increase breakthrough bleeding.
Carbamazepine, etonogestrel [2] ---> SPC of [2] of eMC
Interactions can occur with medicinal products that induce microsomal enzymes, specifically cytochrome P450 enzymes, which can result in increased clearance of sex hormones
Carbamazepine, etravirine [2] ---> SPC of [2] of EMA
Carbamazepine is expected to decrease plasma concentrations of etravirine. Combination not recommended.
Carbamazepine, everolimus [2] ---> SPC of [2] of EMA
Decreased exposure of everolimus expected. Avoid the use of concomitant potent CYP3A4 inducers.
Carbamazepine, exemestane [2] ---> SPC of [2] of eMC
The co-administration of drugs known to induce CYP3A4 may reduce the efficacy of exemestane.
Carbamazepine, felodipine
Carbamazepine, enzymatic inductor, may decrease the plasma levels of felodipine
Carbamazepine, felodipine/metoprolol
It has been shown that inductors of cytochrome P450-3A4 system decrease the plasma concentrations of felodipine. The concomitant use with strong CYP3A4 inductors should be avoided
Carbamazepine, felodipine/ramipril [2] ---> SPC of [2] of eMC
The CYP3A4 induction may decrease the plasma levels of felodipine. The co-administration of felodipine with CYP3A4 inductors should be avoided
Carbamazepine, fesoterodine [2] ---> SPC of [2] of EMA
Induction of CYP3A4 may lead to subtherapeutic plasma levels. Concomitant use (of fesoterodine) with CYP3A4 inducers is not recommended
Carbamazepine, fingolimod [2] ---> SPC of [2] of EMA
Co-administration of fingolimod with strong CYP3A4 enzyme inducers may reduce the AUC of fingolimod and its metabolite. The co-administration should be used with caution.
Carbamazepine, flecainide [2] ---> SPC of [2] of eMC
Limited data in patients receiving known enzyme inducers of CYP2D6 (phenytoin, phenobarbital, carbamazepine) indicate only a 30% increase in the rate of flecainide elimination.
Carbamazepine, fluconazole [2] ---> SPC of [2] of eMC
Fluconazole inhibits the metabolism of carbamazepine and an increase in serum carbamazepine of 30% has been observed. There is a risk of developing carbamazepine toxicity. Dose adjustment of carbamazepine may be necessary
Carbamazepine, fludrocortisone
Increased metabolic clearance of fludrocortisone. Patients should be carefully observed for possible diminished effect of steroid, and the dosage should be adjusted accordingly.
Carbamazepine, fluocortolone
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma concentrations of fluocortolone
Carbamazepine, fluoxetine [2] ---> SPC of [2] of eMC
Concomitant therapy of flecainide with drugs predominantly metabolised by CYP2D6, and which have a narrow therapeutic index, should be initiated at or adjusted to the low end of their dose range.
Carbamazepine, flupentixol
The enzymatic induction may decrease the plasma levels of flupentixol
Carbamazepine, fluphenazine
The enzymatic induction may decrease the plasma levels of fluphenazine
Carbamazepine, flupirtine
The co-administration should be avoided
Carbamazepine, fluspirilene
The enzymatic induction may decrease the plasma levels of neuroleptic agent
Carbamazepine, fluvoxamine [2] ---> SPC of [2] of eMC
Patients co-administered fluvoxamine and CYP3A4 metabolised drugs with a narrow therapeutic index should be carefully monitored and, if necessary, dose adjustment of these drugs is recommended.
Carbamazepine, folic acid
Drugs that may adversely affect the absorption or metabolism of folic acid may cause statuses of folate deficiency
Carbamazepine, fosamprenavir/ritonavir ---> SPC of [fosamprenavir] of EMA
It is expected that the modest CYP3A4 induction by carbamazepine reduces amprenavir concentration. Use with caution
Carbamazepine, fosaprepitant [2] ---> SPC of [2] of EMA
Concomitant administration of fosaprepitant with active substances that strongly induce CYP3A4 activity should be avoided as the combination could result in reductions of the plasma concentrations of aprepitant
Carbamazepine, gabapentin [2] ---> SPC of [2] of eMC
There is no interaction between gabapentin and carbamazepine
Carbamazepine, gallopamil
Increased effect of carbamazepine and increased neurotoxic adverse effects
Carbamazepine, gefitinib [2] ---> SPC of [2] of EMA
Substances that are inducers of CYP3A4 activity may increase metabolism and decrease gefitinib plasma concentrations and thereby reduce the efficacy of gefitinib. Concomitant medicinal products that induce CYP3A4 should be avoided.
Carbamazepine, gestagens ---> SPC of [estradiol] of eMC
The metabolism of estrogens and progestagens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes
Carbamazepine, glecaprevir/pibrentasvir [2] ---> SPC of [2] of EMA
Medicinal products that are strong P-gp and CYP3A inducers could significantly decrease glecaprevir or pibrentasvir plasma levels and may lead to reduced therapeutic effect of Maviret or loss of virologic response. Co-administration is contraindicated
Carbamazepine, glucocorticoids
Carbamazepine enhances the corticosteroid metabolism and its therapeutic effects may be reduced. Therefore it may be necessary to adjust the dose of prednisolone accordingly
Carbamazepine, guanfacin [2] ---> SPC of [2] of EMA
There was a significant decrease in the rate and extent of guanfacine exposure when co-administered with rifampin, a CYP3A4 inducer. Other CYP3A4 inducers may have a comparable effect
Carbamazepine, haloperidol [2] ---> SPC of [2] of eMC
When prolonged treatment with enzyme-inducing drugs is added to haloperidol therapy, this results in a significant reduction of haloperidol plasma levels.
Carbamazepine, hemp extract
The co-administration may decrease the Cmax and THC and CBD.
Carbamazepine, hydrochlorothiazide ---> SPC of [irbesartan/hydrochlorothiazide] of EMA
Concomitant use of carbamazepine and hydrochlorothiazide has been associated with the risk of symptomatic hyponatraemia.
Carbamazepine, hydrocortisone [2] ---> SPC of [2] of EMA
Potent CYP 3A4 inducers can enhance the metabolic clearance of cortisol, decrease terminal half-life and thus reduce circulating levels and increase fluctuations of cortisol (due to shorter terminal half-life).
Carbamazepine, hydroquinidine
Concurrent administration of hydroquinidine with enzyme-inducing drugs may reduce the plasma concentrations of hydroquinidine.
Carbamazepine, hypnotics
The co-administration may promote the neurological adverse effects.
Carbamazepine, hyponatremia
The co-administration may increase the risk of hyponatraemia
Carbamazepine, ibrutinib [2] ---> SPC of [2] of EMA
Ibrutinib is primarily metabolised by cytochrome P450 enzyme 3A4. Administration with inducers of CYP3A4 can decrease ibrutinib plasma concentrations. Avoid concomitant use of strong CYP3A4 inducers
Carbamazepine, idelalisib [2] ---> SPC of [2] of EMA
The co-administration of idelalisib with carbamazepine may increase the serum concentrations of carbamazepine. Anticonvulsant drug levels should be monitored. Idelalisib exposure may be reduced when co-administered with CYP3A inducers
Carbamazepine, imatinib [2] ---> SPC of [2] of EMA
Substances that are inducers of CYP3A4 activity may significantly reduce exposure to imatinib, potentially increasing the risk of therapeutic failure. Concomitant use of strong CYP3A4 inducers and imatinib should be avoided.
Carbamazepine, imipramine [2] ---> SPC of [2] of eMC
Drugs which activate the hepatic mono-oxygenase enzyme system may lower plasma concentrations of imipramine, resulting in decreased efficacy. Plasma levels of carbamazepine may increase, with corresponding adverse effects.
Carbamazepine, indinavir [2] ---> SPC of [2] of EMA
Indinavir inhibits CYP3A4 and as a result is expected to increase the plasma concentrations of this anticonvulsant. Concomitant use of medicinal products that are inducers of CYP3A4 may reduce indinavir plasma concentrations.
Carbamazepine, indinavir/ritonavir ---> SPC of [indinavir] of EMA
Ritonavir/ritonavir, CYP3A4 inhibitors, may increase the concentrations of carbamazepine. Careful monitoring of therapeutic and adverse effects is recommended.
Carbamazepine, interferon
Caution should be used when administering interferon with medicines mainly metabolised by hepatic cytochrome P450 and have a narrow therapeutic window
Carbamazepine, irinotecan [2] ---> SPC of [2] of EMA
Co-administration of ONIVYDE with inducers of CYP3A4 may reduce systemic exposure of ONIVYDE.
Carbamazepine, isavuconazole [2] ---> SPC of [2] of EMA
Co-administration of CRESEMBA with potent/moderate CYP3A4/5 inducers is contraindicated, since these medicinal products can significantly decrease plasma concentrations of isavuconazole
Carbamazepine, isoniazid [2] ---> SPC of [2] of eMC
Concomitant use of carbamazepine and isoniazid has been reported to increase isoniazid-induced hepatotoxicity.
Carbamazepine, isradipine [2] ---> SPC of [2] of eMC
Concurrent administration of isradipine with enzyme-inducing drugs may reduce the plasma concentrations of isradipine. Concomitant administration of isradipine with enzyme-inducing drugs should be avoided.
Carbamazepine, itraconazol [2] ---> SPC of [2] of eMC
Coadministration of itraconazole with potent enzyme inducers of CYP3A4 may decrease the bioavailability of itraconazole and hydroxy-itraconazole to such an extent that efficacy may be largely reduced.
Carbamazepine, ivacaftor [2] ---> SPC of [2] of EMA
Co-administration of ivacaftor with rifampicin, a strong CYP3A inducer, decreased ivacaftor exposure (AUC) and M1 exposure. Co-administration with strong CYP3A inducers is not recommended
Carbamazepine, ixabepilone
Carbamazepine, strong CYP3A4 inductor, may reduce plasma concentrations of ixabepilone
Carbamazepine, ixazomib [2] ---> SPC of [2] of EMA
Co-administration of ixazomib with rifampicin decreased ixazomib Cmax by 54% and AUC by 74%. Therefore, co-administration of strong CYP3A inducers with ixazomib is not recommended
Carbamazepine, ketoconazole [2] ---> SPC of [2] of EMA
Ketoconazole HRA is mainly metabolised by cytochrome CYP3A4. Enzyme-inducing drugs may significantly reduce the bioavailability of ketoconazole. Use of Ketoconazole HRA with potent enzyme inducers is not recommended.
Carbamazepine, lacidipine
It has been shown that the plasma levels of other dihydropyridines are decreased with the co-administration of enzymatic inductors
Carbamazepine, lacosamide [2] ---> SPC of [2] of EMA
The enzymatic induction may decrease the exposition to lacosamide. Lacosamide should be used with caution in patients treated with medicinal products known to be associated with PR prolongation
Carbamazepine, lamotrigine [2] ---> SPC of [2] of eMC
Carbamazepine may lower the plasma level of lamotrigine
Carbamazepine, lapatinib [2] ---> SPC of [2] of EMA
Lapatinib is predominantly metabolised by CYP3A. The CYP3A4 induction decreases the exposition to lapatinib. Co-administration of lapatinib with known inducers of CYP3A4 should be avoided.
Carbamazepine, lasofoxifene
Lasofoxifene clearance may be increased in patients chronically treated with inducers of CYP3A4 and may result in reduced efficacy
Carbamazepine, ledipasvir/sofosbuvir [2] ---> SPC of [2] of EMA
Medicinal products that are potent P-gp inducers may significantly decrease ledipasvir and sofosbuvir plasma concentrations leading to reduced therapeutic effect of ledipasvir/sofosbuvir and thus are contraindicated with Harvoni
Carbamazepine, lercanidipine [2] ---> SPC of [2] of eMC
Co-administration of lercanidipine with CYP3A4 inducers should be approached with caution since the antihypertensive effect may be reduced and blood pressure should be monitored more frequently than usual.
Carbamazepine, lesinurad [2] ---> SPC of [2] of EMA
Lesinurad exposure is expected to decrease when it is co-administered with inducers of CYP2C9 (e.g. carbamazepine, a moderate CYP2C9 inducer). Monitor for decreased efficacy when Zurampic is co-administered with a CYP2C9 inducer.
Carbamazepine, letermovir [2] ---> SPC of [2] of EMA
Co-treatment with moderate and strong inducers may give rise to subtherapeutic letermovir exposure
Carbamazepine, levomepromazine
Carbamazepine, enzymatic inductor, may decrease the plasma levels of levomepromazine
Carbamazepine, levomethadone
The enzymatic induction may decrease the plasma levels of levomethadone and abstinence syndrome may occur
Carbamazepine, levonorgestrel [2] ---> SPC of [2] of eMC
The metabolism of levonorgestrel is enhanced by concomitant use of liver enzyme inducers.
Carbamazepine, levonorgestrel/ethinylestradiol [2] ---> SPC of [2] of eMC
Interactions of enzyme inducers with oral contraceptives may lead to breakthrough bleeding and/or contraceptive failure: Women should temporarily use a barrier method in addition to the COC or choose another method of contraception.
Carbamazepine, levothyroxine [2] ---> SPC of [2] of eMC
Carbamazepine enhances the metabolism of thyroid hormones and may displace them from plasma proteins.
Carbamazepine, lithium carbonate [2] ---> SPC of [2] of eMC
Carbamazepine may lead to dizziness, somnolence, confusion and cerebellar symptoms such as ataxia.
Carbamazepine, lomitapide [2] ---> SPC of [2] of EMA
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma concentrations of lomitapide
Carbamazepine, lopinavir/ritonavir [2] ---> SPC of [2] of EMA
The inhibition and induction of CYP3A4 (by lopinavir/ritonavir, by carbamazepine) may increase/decrease the levels of carbamazepine/lopinavir. Caution should be exercised
Carbamazepine, losartan/hydrochlorothiazide [2] ---> SPC of [2] of eMC
Risk of symptomatic hyponatraemia. Clinical and biological monitoring is required.
Carbamazepine, lovastatine
Carbamazepine may lower the plasma level of lovastatin
Carbamazepine, lumacaftor/ivacaftor [2] ---> SPC of [2] of EMA
Concomitant use of lumacaftor/ivacaftor with these anticonvulsants is not recommended. The exposures of ivacaftor and the anticonvulsant may be significantly decreased, which may reduce the efficacy of both active substances.
Carbamazepine, lurasidone [2] ---> SPC of [2] of EMA
Lurasidone and its active metabolite ID-14283 are primarily metabolised by CYP3A4. Lurasidone is contraindicated with strong CYP3A4 inductors
Carbamazepine, lymecycline
Concurrent use of carbamazepine may decrease plasma levels of tetracyclines.
Carbamazepine, macitentan [2] ---> SPC of [2] of EMA
In the presence of strong CYP3A4 inducers reduced efficacy of macitentan could occur. The combination of macitentan with strong CYP3A4 inducers should be avoided
Carbamazepine, manidipine
Manidipine should not be administered with CYP3A4 inductors
Carbamazepine, maprotiline
The enzymatic induction may increase the formation of desmethyl maprotiline and decrease the effect of maprotiline. Dose adjustment may be necessary
Carbamazepine, mebendazol
The enzymatic induction may decrease the plasma and tissue levels of mebendazole
Carbamazepine, medroxyprogesterone ---> SPC of [estradiol] of eMC
The metabolism of progestogens may be increased by concomitant administration of compounds known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes.
Carbamazepine, mefloquine
Inductors of the isoenzyme CYP3A4 may modify the pharmacokinetics/metabolism of mefloquine, leading to an decrease in mefloquine plasma concentration.
Carbamazepine, megestrol
Accelerated metabolism of carbamazepine
Carbamazepine, melatonin [2] ---> SPC of [2] of EMA
CYP1A2 inducers such as carbamazepine and rifampicin may give rise to reduced plasma concentrations of melatonin.
Carbamazepine, mephenytoin
Carbamazepine may lower (also increase) the plasma level of mephenytoin
Carbamazepine, methylphenidate
Carbamazepine, enzymatic inductor, may decrease the plasma levels of methylphenidate
Carbamazepine, methylprednisolone [2] ---> SPC of [2] of eMC
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma concentrations of glucocorticoid
Carbamazepine, mianserin [2]
Carbamazepine may decrease the plasma levels of mianserin
Carbamazepine, midostaurin [2] ---> SPC of [2] of EMA
Concomitant use of Rydapt with strong inducers of CYP3A4 (e.g. carbamazepine, rifampicin, enzalutamide, phenytoin, St. John's Wort [Hypericum perforatum]) is contraindicated
Carbamazepine, mifepristone [2] ---> SPC of [2] of eMC
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma concentrations of mifepristone
Carbamazepine, minocycline
The enzymatic inductor may increase the metabolism of minocycline and decrease its plasma levels
Carbamazepine, mirtazapine [2] ---> SPC of [2] of eMC
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma concentrations of mirtazapine
Carbamazepine, modafinil [2] ---> SPC of [2] of eMC
Co-administration of potent inducers of CYP activity could reduce the plasma levels of modafinil.
Carbamazepine, naloxegol [2] ---> SPC of [2] of EMA
Naloxegol is not recommended in patients who are taking strong CYP3A4 inducers (e.g. carbamazepine, rifampin, St. John's Wort)
Carbamazepine, naltrexone/bupropion [2] ---> SPC of [2] of EMA
Since bupropion is extensively metabolised, caution is advised when naltrexone/bupropion is co-administered with medicinal products known to induce CYP2B6 as these may affect the clinical efficacy of naltrexone/bupropion.
Carbamazepine, nelfinavir [2] ---> SPC of [2] of EMA
Potent inducers of CYP3A4 (e.g., rifampicin, phenobarbital and carbamazepine) may reduce nelfinavir plasma concentrations and their coadministration is contraindicated
Carbamazepine, neratinib [2] ---> SPC of [2] of EMA
Co-administration with this medical product that is strong inducer of the CYP3A4/Pgp isoform of cytochrome P450 is contraindicated
Carbamazepine, nicardipine [2] ---> SPC of [2] of eMC
Nicardipine is metabolized by cytochrome P450 3A4. Concomitant administration of nicardipine with inductors of cytochrome P450 3A4 may alter the plasma levels of nicardipine.
Carbamazepine, nifedipine [2] ---> SPC of [2] of eMC
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma concentrations of nifedipine
Carbamazepine, nilotinib [2] ---> SPC of [2] of EMA
The concomitant administration of other medicinal products that induce CYP3A4 is likely to reduce exposure to nilotinib to a clinically relevant extent.
Carbamazepine, nilvadipine
The enzymatic induction may decrease the plasma levels of nilvadipine
Carbamazepine, nimodipine [2] ---> SPC of [2] of eMC
The concomitant use of oral nimodipine and cytochrome P450 3A4 system-inducing carbamazepine is contraindicated. The efficacy of nimodipine could be reduced if this drug is administered concomitantly.
Carbamazepine, nintedanib [2] ---> SPC of [2] of EMA
Potent P-gp inducers may decrease exposure to nintedanib. Co-administration with nintedanib should be carefully considered.
Carbamazepine, niraparib [2] ---> SPC of [2] of EMA
No dose adjustment for Zejula is required when administered concomitantly with medicinal products known to inhibit (e.g. itraconazole, ritonavir, and clarithromycin) or induce CYP enzymes (e.g. rifampin, carbamazepine, and phenytoin)
Carbamazepine, nisoldipine
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma concentrations of nisoldipine. The co-administration is contraindicated
Carbamazepine, nitrendipine
Carbamazepine, strong CYP3A4 inductor, may decrease the bioavailability and effect of nitrendipine
Carbamazepine, nomegestrol
The enzymatic inductor may increase the metabolism of nomegestrol and decrease its plasma levels
Carbamazepine, nomegestrol/estradiol [2] ---> SPC of [2] of EMA
Interactions between oral contraceptives and enzyme-inducing medicinal products may lead to breakthrough bleeding and even contraceptive failure.
Carbamazepine, norelgestromin/ethinylestradiol [2] ---> SPC of [2] of EMA
Interactions can occur with medicinal products that induce hepatic enzymes which can result in increased clearance of sex hormones
Carbamazepine, norethisterone
The enzymatic induction may decrease the plasma levels and the effect of progestagen
Carbamazepine, norethisterone acetate
Reduced contraceptive efficacy with hepatic enzyme-inducing drugs
Carbamazepine, norethisterone enantate
Reduced contraceptive efficacy with hepatic enzyme-inducing drugs
Carbamazepine, norgestimate
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma levels and the effect of norgestimate. The induction lasts at least 4 weeks after dose interruption
Carbamazepine, norgestrel
The enzymatic induction may accelerate the metabolism of steroid hormones and decrease their plasma levels and effect.
Carbamazepine, octreotide
Drugs mainly metabolised by CYP3A4 and which have a low therapeutic index should be only used with octreotide with caution.
Carbamazepine, olanzapine [2] ---> SPC of [2] of EMA
The metabolism of olanzapine may be induced by carbamazepine, which may lead to reduced olanzapine concentrations.
Carbamazepine, olaparib [2] ---> SPC of [2] of EMA
Known strong inducers of CYP3A4/5 are not recommended with olaparib, as it is possible that the efficacy of olaparib could be substantially reduced
Carbamazepine, ombitasvir/paritaprevir/ritonavir [2] ---> SPC of [2] of EMA
Coadministration of Viekirax with/without dasabuvir with drugs that are strong or moderate enzyme inducers is expected to decrease ombitasvir, paritaprevir, and ritonavir plasma levels and reduce their therapeutic effect. Concomitant use contraindicated
Carbamazepine, ondansetron [2] ---> SPC of [2] of eMC
In patients treated with potent inducers of CYP3A4, the oral clearance of ondansetron was increased and ondansetron blood concentrations were decreased.
Carbamazepine, opipramol
The enzymatic inductor may increase the antidepressant metabolism and decrease its effect. Opipramol may potentiate the effects of other CNS depressants
Carbamazepine, ornidazole
The enzymatic inductor may increase the metabolism of ornidazole and decrease its plasma levels
Carbamazepine, osimertinib [2] ---> SPC of [2] of EMA
It is recommended that concomitant use of strong CYP3A inducers (e.g. Phenytoin, rifampicin and carbamazepine) with TAGRISSO should be avoided.
Carbamazepine, ospemifene [2] ---> SPC of [2] of EMA
Rifampicin, strong CYP3A/CYP2C9 enzyme inducer, decreased the ospemifene AUC by 58%. Therefore, co-administration of ospemifene with strong enzyme inducers would be expected to decrease the exposure of ospemifene, which may decrease the clinical effect.
Carbamazepine, paclitaxel [2] ---> SPC of [2] of EMA
The metabolism of paclitaxel is catalysed, in part, by cytochrome P450 isoenzymes CYP2C8 and CYP3A4. Therefore, caution should be exercised when administering paclitaxel concomitantly with medicines known to induce either CYP2C8 or CYP3A4.
Carbamazepine, palbociclib [2] ---> SPC of [2] of EMA
Coadministration of CYP3A inducers may lead to decreased palbociclib exposure and consequently a risk for lack of efficacy. Therefore, concomitant use of palbociclib with strong CYP3A4 inducers should be avoided.
Carbamazepine, paliperidone [2] ---> SPC of [2] of EMA
Carbamazepine, inducer of P-gp, may increase in renal clearance of paliperidone
Carbamazepine, panobinostat [2] ---> SPC of [2] of EMA
Strong inducers may reduce the efficacy of panobinostat, therefore the concomitant use of strong CYP3A4 inducers should be avoided.
Carbamazepine, pantoprazole [2] ---> SPC of [2] of EMA
No clinically significant interactions were observed
Carbamazepine, parecoxib [2] ---> SPC of [2] of EMA
The metabolism of valdecoxib may increase when co-administered with enzyme inducers
Carbamazepine, paroxetine [2] ---> SPC of [2] of eMC
No initial dosage adjustment is considered necessary when the drug is to be co-administered with known drug metabolising enzyme inducers
Carbamazepine, perampanel [2] ---> SPC of [2] of EMA
Carbamazepine, enzymatic inductor, may decrease the plasma levels of perampanel
Carbamazepine, perazine
The enzymatic inductor may increase the metabolism of perazine and decrease its plasma levels
Carbamazepine, perphenazine
The co-administration of perphenazine and carbamazepine may increase the metabolism of perphenazine
Carbamazepine, phenelzine
Phenelzine should not be administered at the same time as, or within 14 days of, treatment with carbamazepine
Carbamazepine, phenobarbital
The carbamazepine plasma levels may be decreased.
Carbamazepine, phenylalkylamines
Increased effect of carbamazepine and increased neurotoxic adverse effects
Carbamazepine, pipamperone
The enzymatic inductor may increase the metabolism of pipamperone and decrease its plasma levels and effect
Carbamazepine, piperaquine ---> SPC of [piperaquine/artenimol] of EMA
Enzyme inducing medicinal products are likely to lead to reduced piperaquine plasma concentrations. The concentration of DHA may also be reduced. Concomitant treatment with such medicinal products is not recommended.
Carbamazepine, piperaquine/artenimol [2] ---> SPC of [2] of EMA
Enzyme inducing medicinal products are likely to lead to reduced piperaquine plasma concentrations. The concentration of DHA may also be reduced. Concomitant treatment with such medicinal products is not recommended.
Carbamazepine, pitolisant [2] ---> SPC of [2] of EMA
Co-administration of pitolisant with potent CYP3A4 inducers (e.g. rifampicin, phenobarbital, carbamazepine, phenytoin) should be done with caution.
Carbamazepine, pixantrone [2] ---> SPC of [2] of EMA
Caution should be taken when pixantrone is continuously co-administered with efflux transport inducers, as pixantrone excretion might be increased with a consequent decrease of systemic exposure.
Carbamazepine, pomalidomide [2] ---> SPC of [2] of EMA
Co-administration of pomalidomide with the strong CYP3A4/5 inducer carbamazepine had no clinically relevant effect on exposure to pomalidomide.
Carbamazepine, ponatinib [2] ---> SPC of [2] of EMA
Coadministration of ponatinib with strong CYP3A4 inducers (decreases in ponatinib exposure are possible) should be avoided, and alternatives to the CYP3A4 inducer should be sought, unless the benefit outweighs the possible risk of ponatinib underexposure
Carbamazepine, posaconazole [2] ---> SPC of [2] of EMA
Posaconazole concentrations may be significantly lowered in combination; therefore, concomitant use with posaconazole should be avoided unless the benefit to the patient outweighs the risk
Carbamazepine, prajmalium
The enzymatic inductor decreases significant the plasma concentrations of prajmalium
Carbamazepine, prasugrel [2] ---> SPC of [2] of EMA
CYP3A inductors are not anticipated to have a significant effect on the pharmacokinetics of the prasugrel active metabolite.
Carbamazepine, prednisolone
Carbamazepine enhances the corticosteroid metabolism and its therapeutic effects may be reduced. Therefore it may be necessary to adjust the dose of prednisolone accordingly
Carbamazepine, prednisone [2] ---> SPC of [2] of eMC
The efficacy of glucocorticoids is reduced.
Carbamazepine, procarbazine
Use of procarbazine with enzyme-inducing antiepileptics is associated with an increased risk of hypersensitivity reactions to procarbazine.
Carbamazepine, progesterone
The strong CYP3A4 induction may decrease the levels of progesterone
Carbamazepine, promazine
The concomitant administration of promazine with myelosuppressive drugs increases the risk of toxicity
Carbamazepine, propafenone
Carbamazepine, strong CYP3A4 inductor, may decrease the plasma concentrations of propafenone and its antiarrhythmic effect
Carbamazepine, propoxyphene
The CYP3A4 inhibition may increase the plasma concentrations of carbamazepine
Carbamazepine, propranolol
Carbamazepine, enzymatic inductor, may decrease the plasma levels of propranolol
Carbamazepine, quinine
Suboptimal quinine serum levels may result from concomitant use of CYP3A4 inducers
Carbamazepine, ranolazine [2] ---> SPC of [2] of EMA
The CYP3A4 induction may decrease the plasma levels of ranolazine. During the treatment with CYP3A4 inductors should not be initiated a therapy with ranolazine
Carbamazepine, reboxetine [2] ---> SPC of [2] of eMC
Low reboxetine serum levels have been reported with the concurrent administration of CYP3A4 inducers
Carbamazepine, regorafenib [2] ---> SPC of [2] of EMA
The strong CYP3A4 inductor may increase metabolism of regorafenib. The combination of regorafenib with strong CYP3A4 inductors should be avoided
Carbamazepine, repaglinide [2] ---> SPC of [2] of EMA
Rifampicin, a potent inducer of CYP3A4, but also CYP2C8, acts both as an inducer and inhibitor of the metabolism of repaglinide. It cannot be excluded that other inducers may have a similar effect.
Carbamazepine, retigabine [2] ---> SPC of [2] of EMA
Carbamazepine may decrease the systemic exposition to retigabine
Carbamazepine, ribociclib [2] ---> SPC of [2] of EMA
The concomitant use of strong CYP3A4 inducers may therefore lead to decreased exposure and consequently a risk for lack of efficacy. The concomitant use of strong CYP3A4 inducers should be avoided
Carbamazepine, rilpivirine [2] ---> SPC of [2] of EMA
Significant decreases in rilpivirine plasma concentrations are expected (induction of CYP3A enzymes). The co-administration is contraindicated
Carbamazepine, rimonabant [2] ---> SPC of [2] of EMA
It is expected that concomitant administration of potent CYP3A4 inducers may reduce the plasma concentration of rimonabant and may result in loss of efficacy.
Carbamazepine, riociguat [2] ---> SPC of [2] of EMA
The concomitant use of riociguat with strong CYP3A4 inducers may lead to decreased riociguat plasma concentration.
Carbamazepine, risperidone [2] ---> SPC of [2] of eMC
The CYP3A4 and P-glycoprotein induction may decrease the plasma levels of the active antipsychotic fraction of risperidone
Carbamazepine, ritonavir [2] ---> SPC of [2] of EMA
Ritonavir dosed as a pharmacokinetic enhancer or as an antiretroviral agent inhibits CYP3A4 and as a result is expected to increase the plasma concentrations of carbamazepine. Careful monitoring of therapeutic and adverse effects is recommended
Carbamazepine, rivaroxaban [2] ---> SPC of [2] of EMA
The strong CYP3A4 induction may decrease the plasma concentrations of rivaroxaban. Concomitant administration of strong CYP3A4 inducers should be avoided unless the patient is closely observed for signs and symptoms of thrombosis.
Carbamazepine, rocuronium [2] ---> SPC of [2] of eMC
The prior chronic administration of carbamazepine decreases rocuronium effects
Carbamazepine, roflumilast [2] ---> SPC of [2] of EMA
The use of strong cytochrome P450 enzyme inducers may reduce the therapeutic efficacy of roflumilast. Thus, roflumilast treatment is not recommended in patients receiving strong cytochrome P450 enzyme inducers.
Carbamazepine, rolapitant [2] ---> SPC of [2] of EMA
Varuby in patients who require chronic administration of strong inducers (e.g. rifampicin, carbamazepine, enzalutamide, phenytoin) is not recommended
Carbamazepine, rosiglitazone [2] ---> SPC of [2] of EMA
Co-administration of rosiglitazone with rifampicin (an inducer of CYP2C8) resulted in a 66 % decrease in rosiglitazone plasma concentrations. It cannot be excluded that other inducers may also affect rosiglitazone exposure.
Carbamazepine, rufinamide [2] ---> SPC of [2] of EMA
Rufinamide appears not to have clinically relevant effect on carbamazepine steady state concentrations
Carbamazepine, ruxolitinib [2] ---> SPC of [2] of EMA
The strong CYP3A4 induction may reduce the AUC of ruxolitinib. It is possible that an increase of the ruxolitinib dose is needed with strong CYP3A4 inductors
Carbamazepine, saquinavir [2] ---> SPC of [2] of EMA
Carbamazepine, CYP3A4 inductor, may decrease the plasma levels of saquinavir
Carbamazepine, saquinavir/ritonavir ---> SPC of [saquinavir] of EMA
Carbamazepine, CYP3A4 inductor, may decrease the plasma levels of saquinavir
Carbamazepine, saxagliptin [2] ---> SPC of [2] of EMA
The co-administration of saxagliptin and CYP3A4/5 inducers may result in decreased plasma concentration of saxagliptin and increased concentration of its major metabolite. Glycaemic control should be carefully assessed
Carbamazepine, saxagliptin/dapagliflozin [2] ---> SPC of [2] of EMA
Using CYP3A4 inducers may reduce the glycaemic lowering effect of Qtern. Glycaemic control should be assessed when it is used concomitantly with a potent CYP3A4/5 inducer
Carbamazepine, saxagliptin/metformin [2] ---> SPC of [2] of EMA
The co-administration of saxagliptin and CYP3A4/5 inducers may result in decreased plasma concentration of saxagliptin and increased concentration of its major metabolite. Glycaemic control should be carefully assessed
Carbamazepine, sedating antihistamines
The co-administration may promote the neurological adverse effects.
Carbamazepine, sedatives
The co-administration may promote the neurological adverse effects.
Carbamazepine, selexipag [2] ---> SPC of [2] of EMA
In the presence of 600 mg rifampicin, once a day, an inducer of CYP2C8, the exposure to the active metabolite was reduced by half. Dose adjustment of selexipag may be required with concomitant administration of inducers of CYP2C8.
Carbamazepine, serrapeptase
Possible decrease of plasma levels of carbamazepine
Carbamazepine, sertindole
The metabolism of sertindole may be significantly enhanced by agents known to induce CYP isozymes, which can decrease the plasma concentrations of sertindole
Carbamazepine, sibutramine [2]
Rifampicin, phenytoin, carbamazepine, phenobarbital and dexamethasone are CYP3A4 enzyme inducers and may accelerate sibutramine metabolism, although this has not been studied experimentally.
Carbamazepine, silodosin [2] ---> SPC of [2] of EMA
Silodosin is metabolised extensively, mainly via CYP3A4, alcohol dehydrogenase and UGT2B7. Substances that induce these enzymes may affect the plasma concentrations of silodosin and its active metabolite.
Carbamazepine, simeprevir [2] ---> SPC of [2] of EMA
Co-administration of simeprevir with moderate or strong inductors of CYP3A4 may significantly reduce the plasma exposure of simeprevir and lead to loss of efficacy. Co-administration of simeprevir with these inductors is not recommended.
Carbamazepine, simvastatine
Carbamazepine may lower the plasma level of simvastatine
Carbamazepine, sirolimus [2] ---> SPC of [2] of EMA
Inducers of CYP3A4 may increase the metabolism of sirolimus and decrease sirolimus blood levels
Carbamazepine, sodium valproate [2] ---> SPC of [2] of eMC
Antiepileptics with enzyme inducing effect decrease valproic acid plasma concentrations. Valproic acid may potentiate toxic effects of carbamazepine.
Carbamazepine, sofosbuvir [2] ---> SPC of [2] of EMA
Medicinal products that are potent P-gp inducers in the intestine may significantly decrease sofosbuvir plasma concentration leading to reduced therapeutic effect of Sovaldi and thus are contraindicated with Sovaldi
Carbamazepine, sofosbuvir/velpatasvir [2] ---> SPC of [2] of EMA
Medicinal products that are potent P-glycoprotein or potent cytochrome P450 inducers are contraindicated with Epclusa. Co-administration will significantly decrease sofosbuvir or velpatasvir plasma levels and could result in loss of efficacy of Epclusa
Carbamazepine, sofosbuvir/velpatasvir/voxilaprevir [2] ---> SPC of [2] of EMA
Medicinal products that are strong inducers of P-gp or strong inducers of CYP2B6, CYP2C8, or CYP3A4 may decrease plasma levels of sofosbuvir, velpatasvir and/or voxilaprevir. The use of such medicinal products with Vosevi is contraindicated
Carbamazepine, solifenacin [2] ---> SPC of [2] of eMC
Since solifenacin is metabolised by CYP3A4, pharmacokinetic interactions are possible with CYP3A4 inducers
Carbamazepine, sonidegib [2] ---> SPC of [2] of EMA
Sonidegib undergoes metabolism primarily by CYP3A4, and concomitant administration of strong inducers of CYP3A4 can decrease sonidegib concentrations significantly. Concomitant use of strong CYP3A inducers should be avoided
Carbamazepine, sorafenib [2] ---> SPC of [2] of EMA
Inducers of CYP3A4 activity and/or glucuronidation may increase metabolism of sorafenib and thus decrease sorafenib concentrations.
Carbamazepine, spiramycin
Spiramycin may delay the elimination of carbamazepine
Carbamazepine, SSRI
The co-administration may cause a toxic serotoninergic syndrome
Carbamazepine, St. John's wort [2] ---> SPC of [2] of eMC
St. John's wort, enzymatic inductor, may decrease the plasma concentrations of carbamazepine (with risk of seizures). St. John's Wort should be avoided
Carbamazepine, stiripentol [2] ---> SPC of [2] of EMA
Inhibition of CYP450 isoenzyme CYP2C19 and CYP3A4 may provoke pharmacokinetic interactions. The consequences are increased plasma levels of the anticonvulsant with potential risk of overdose.
Carbamazepine, sultiame
The co-administration may decrease the plasma levels of sultiame
Carbamazepine, sunitinib [2] ---> SPC of [2] of EMA
Administration of sunitinib with potent CYP3A4 inducers may decrease sunitinib concentrations. Combination with CYP3A4 inducers should therefore be avoided
Carbamazepine, tacrolimus [2] ---> SPC of [2] of EMA
Carbamazepine has the potential to decrease tacrolimus concentrations.
Carbamazepine, tadalafil [2] ---> SPC of [2] of EMA
The CYP3A4 induction may decrease the plasma concentrations of tadalafil
Carbamazepine, talinolol
Concomitant use of a P-gp inductor decreases the bioavailability of talinolol
Carbamazepine, telaprevir [2] ---> SPC of [2] of EMA
Concomitant administration of telaprevir is contraindicated with active substances that strongly induce CYP3A and thus may lead to lower exposure and loss of efficacy of telaprevir
Carbamazepine, telithromycin [2] ---> SPC of [2] of EMA
Concomitant administration of CYP3A4 inducers is likely to result in subtherapeutic levels of telithromycin and loss of effect. Telithromycin should not be used during and 2 weeks after treatment with CYP3A4 inducers.
Carbamazepine, temsirolimus [2] ---> SPC of [2] of EMA
The strong CYP3A4 induction may decrease exposure of the active moieties, temsirolimus and its metabolite, sirolimus. Concomitant treatment of temsirolimus with agents that have CYP3A4/5 induction potential should be avoided
Carbamazepine, tenofovir alafenamide [2] ---> SPC of [2] of EMA
Co-administration of Vemlidy with inducers of P-glycoprotein (P-gp) may decrease tenofovir alafenamide plasma concentrations and is not recommended.
Carbamazepine, teriflunomide [2] ---> SPC of [2] of EMA
Rifampicin und andere bekannte starke CYP und Transporter-Induktoren, wie etwa Carbamazepin, Phenobarbital, Phenytoin und Johanniskraut, sollten während der Behandlung mit Teriflunomid mit Vorsicht angewendet werden.
Carbamazepine, testosterone undecanoate
Concurrent administration of liver enzyme inducing may decrease the effect of testosterone undecanoate.
Carbamazepine, tetracyclic antidepressant
The co-administration may increase the risk of cardiac conduction abnormalities
Carbamazepine, tetracyclines
Concurrent use of carbamazepine may decrease plasma levels of tetracyclines.
Carbamazepine, theophylline [2] ---> SPC of [2] of eMC
The carbamazepine increases clearance of theophylline and it may be necessary to increase dosage to ensure a therapeutic effect
Carbamazepine, thiazides
The co-administration may increase the risk of hyponatraemia
Carbamazepine, thiotepa [2] ---> SPC of [2] of EMA
Co-administration of inducers of Cytochrome P450 may increase the metabolism of thiotepa leading to increased plasma concentrations of the active metabolite.
Carbamazepine, thyroid hormones
Carbamazepine, enzymatic inductor, increases the metabolism of the thyroid hormone and may also displace the thyroid hormone from its plasma protein binding sites
Carbamazepine, tiagabine [2] ---> SPC of [2] of eMC
Anti-epileptic agents that induce hepatic enzymes enhance the metabolism of tiagabine.
Carbamazepine, tibolone
CYP3A4 inducing compounds such as barbiturates, carbamazepine, hydantoins and rifampicin may enhance the metabolism of tibolone and thus affect its therapeutic effect.
Carbamazepine, ticagrelor [2] ---> SPC of [2] of EMA
Co-administration of ticagrelor with strong CYP3A4 inducers is discouraged, as co-administration may lead to a decrease in exposure and efficacy of ticagrelor
Carbamazepine, tipranavir [2] ---> SPC of [2] of EMA
Carbamazepine, CYP3A4 inductor, may decrease the plasma concentrations of tipranavir. Caution should be used when prescribing
Carbamazepine, tipranavir/ritonavir ---> SPC of [tipranavir] of EMA
Carbamazepine, CYP3A4 inductor, may decrease the plasma concentrations of tipranavir. Caution should be used when prescribing
Carbamazepine, toremifene [2] ---> SPC of [2] of EMA
Enzyme inducers may increase the rate of toremifene metabolism thus lowering the steady-state concentration in serum. In such cases doubling of the daily dose may be necessary.
Carbamazepine, tramadol [2] ---> SPC of [2] of eMC
Simultaneous administration of carbamazepine markedly decreases serum concentrations of tramadol to an extent that a decrease in analgesic effectiveness and shorter duration of action may occur.
Carbamazepine, trandolapril/verapamil [2] ---> SPC of [2] of eMC
Verapamil may increase the plasma concentrations of carbamazepine thus increasing risk of toxicity
Carbamazepine, trazodone [2] ---> SPC of [2] of eMC
Carbamazepine reduced plasma concentrations of trazodone when coadministered.
Carbamazepine, triamcinolone acetonide [2] ---> SPC of [2] of eMC
Hepatic enzyme inducers may increase the metabolic clearance of triamcinolone
Carbamazepine, triamcinolone [2]
Hepatic enzyme inducers may increase the metabolic clearance of triamcinolone
Carbamazepine, triamterene
Increased risk of hyponatraemia when diuretics given with carbamazepine
Carbamazepine, triazolam
Carbamazepine causes induction of CYP3A4. The effect of triazolam coadministered with carbamazepine is significantly reduced
Carbamazepine, tricyclic antidepressant
The co-administration may increase the risk of cardiac conduction abnormalities
Carbamazepine, trimipramine
Risk of generalized convulsive seizures
Carbamazepine, trofosfamide
It has to be taken into account a prior or actual treatment with drugs that are enzyme inducers
Carbamazepine, tropisetron
The enzymatic inductor may increase the metabolism of tropisetron and decrease its plasma levels
Carbamazepine, tryptophan
Carbamazepine may enhance the effect of tryptophane
Carbamazepine, ulipristal [2] ---> SPC of [2] of EMA
Administration of the potent CYP3A4 inducers markedly decreased Cmax and AUC of ulipristal acetate and its active metabolite. Concomitant use of ulipristal acetate and potent CYP3A4 inducers is not recommended
Carbamazepine, valproic acid [2] ---> SPC of [2] of eMC
Antiepileptics with enzyme inducing effect decrease valproic acid plasma concentrations. Valproic acid may potentiate toxic effects of carbamazepine.
Carbamazepine, vandetanib [2] ---> SPC of [2] of EMA
In healthy male subjects, the exposure to vandetanib was reduced by 40% when given together with the potent CYP3A4 inducer, rifampicin. Administration of vandetanib with potent CYP3A4 inducers should be avoided.
Carbamazepine, vecuronium [2] ---> SPC of [2] of eMC
The prior chronic administration of carbamazepine decreases vecuronium effects
Carbamazepine, vemurafenib [2] ---> SPC of [2] of EMA
Concomitant administration of vemurafenib and potent inducers of CYP3A4 may lead to suboptimal exposure to vemurafenib and should be avoided.
Carbamazepine, venetoclax [2] ---> SPC of [2] of EMA
Concomitant use of Venclyxto with strong CYP3A inducers or moderate CYP3A inducers should be avoided. Alternative treatments with less CYP3A induction should be considered.
Carbamazepine, verapamil [2] ---> SPC of [2] of eMC
Verapamil may increase the plasma concentrations of carbamazepine. This may produce side effects such as diplopia, headache, ataxia or dizziness.
Carbamazepine, vinorelbine [2] ---> SPC of [2] of eMC
CYP3A4 is the main enzyme involved in the metabolism of vinorelbine, and the combination with a drug that induces this iso-enzyme can affect the concentration of vinorelbine
Carbamazepine, vismodegib [2] ---> SPC of [2] of EMA
Concomitant treatment with strong CYP inducers (e.g. rifampicin, carbamazepine or phenytoin) should be avoided, as a risk for decreased plasma concentrations and decreased efficacy of vismodegib cannot be excluded.
Carbamazepine, vorapaxar [2] ---> SPC of [2] of EMA
Co-administration of rifampin with vorapaxar substantially decreased the vorapaxar mean Cmax and AUC. Concomitant use of vorapaxar with strong (potent) inducers of CYP3A should be avoided.
Carbamazepine, voriconazole [2] ---> SPC of [2] of EMA
The coadministration is contra-indicated since the CYP3A4 induction may decrease significantly the plasma concentrations of voriconazole
Carbamazepine, vortioxetine [2] ---> SPC of [2] of EMA
The strong induction may decrease the AUC of vortioxetine. The co-administration may require an adjustment of the dose of vortioxetine
Carbamazepine, warfarin [2] ---> SPC of [2] of eMC
Carbamazepine antagonises the effect of warfarin
Carbamazepine, xipamide
Risk of symptomatic hyponatremia
Carbamazepine, zaleplon [2] ---> SPC of [2] of EMA
Co-administration of zaleplon together with inducers of CYP3A4 may result in a reduction of zaleplon efficacy.
Carbamazepine, zolpidem
The strong CYP3A4 induction may reduce plasma concentrations and de hypnotic effects of zolpidem
Carbamazepine, zonisamide [2] ---> SPC of [2] of EMA
The strong CYP3A4 induction decreases the zonisamide exposition. This effect is unlikely to be of clinical significance when zonisamide is added to existing therapy
Carbamazepine, zopiclone [2] ---> SPC of [2] of eMC
Plasma levels of zopiclone may be decreased when co-administered with CYP3A4 inducers
Carbamazepine, zotepine
The enzymatic induction may decrease the plasma levels of zotepine
CONTRAINDICATIONS of Carbamazepine
- Known hypersensitivity to carbamazepine or structurally related drugs (e.g. tricyclic antidepressants) or any other component of the formulation.
- Patients with atrioventricular block, a history of bone marrow depression or a history of hepatic porphyrias (e.g. acute intermittent porphyria,
variegate porphyria, porphyria cutanea tarda).
- The use of Tegretol is contraindicated in combination with monoamine oxidase inhibitors (MAOIs)
http://www.medicines.org.uk/emc/
Carbenoxolone
Aliskiren/hydrochlorothiazide [1], carbenoxolone ---> SPC of [1] of EMA
The potassium-depleting effect of hydrochlorothiazide on serum potassium would be expected to be potentiated by other medicinal products associated with potassium loss and hypokalaemia
Aluminium hydroxide, carbenoxolone
The aluminium hydroxide may decrease the absorption of carbenoxolone. Separate administration by at least 2 hours
Amlodipine/valsartan/hydrochlorothiazide [1], carbenoxolone ---> SPC of [1] of EMA
The hypokalaemic effect of hydrochlorothiazide may be increased by concomitant administration of carbenoxolone. If these medicines are to be prescribed with amlodipine/valsartan/hydrochlorothiazide, monitoring of potassium plasma levels is advised.
Atenolol/chlortalidone, carbenoxolone
Increased loss of potassium and/or magnesium.
Bendroflumethiazide, carbenoxolone
Carbenoxolone may exacerbate the hypokalaemia associated with thiazide use.
Breast-feeding, carbenoxolone
This medicinal product should not be used during breastfeeding
Carbenoxolone [1], corticosteroids
Hypokalaemic effects of carbenoxolone are enhanced by corticosteroids.
Carbenoxolone, chlortalidone
The hypokalaemic effect of diuretics may be potentiated by carbenoxolone
Carbenoxolone, deflazacort
Hypokalaemic effects of carbenoxolone are enhanced by corticosteroids.
Carbenoxolone, digital glycosides
Electrolyte imbalance may increase the toxicity of cardiac glycosides
Carbenoxolone, digitoxin
Increased effect of digitoxin and risk of digitoxin intoxication due to drug-induced hypokaliemia and hypomagnesemia
Carbenoxolone, digoxin [2] ---> SPC of [2] of eMC
Agents causing hypokalaemia or intracellular potassium deficiency may cause increased sensitivity to digoxin
Carbenoxolone, enalapril/hydrochlorothiazide [2] ---> SPC of [2] of eMC
Hydrochlorothiazide may increase the loss of potassium and/or magnesium.
Carbenoxolone, furosemide [2] ---> SPC of [2] of eMC
The co-administration may increase the risk of hypokalaemia.
Carbenoxolone, hydrochlorothiazide
Concomitant use of hydrochlorothiazide und amphotericin B (parenteral), carbenoxolone, corticosteroids, corticotropin (ACTH) or stimulant laxatives may intensify the electrolyte disorder, specially hypokaliemia
Carbenoxolone, hydrotalcite
The co-administration of hydrotalcite with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 1-2 hours
Carbenoxolone, hypokalemia
Increased risk of hypokalemia.
Carbenoxolone, irbesartan/hydrochlorothiazide [2] ---> SPC of [2] of EMA
The co-administration may increase the risk of hypokalaemia. Monitoring of potassium plasma levels is advised.
Carbenoxolone, lactitol
The co-administration of hypokaliemia-inducer drugs may enhance the potassium loss
Carbenoxolone, lactulose
Lactulose may enhance other drug-induced hypokalemia
Carbenoxolone, loop diuretics
The hypokalaemic effect of diuretics may be potentiated by carbenoxolone
Carbenoxolone, methyldopa
Carbenoxolone antagonises the hypotensive effect.
Carbenoxolone, metildigoxin
Electrolyte imbalance may increase the toxicity of cardiac glycosides
Carbenoxolone, piretanide
The co-administration of piretanide with glucocorticoids may cause a great loss of potassium with the risk of hypokaliemia
Carbenoxolone, potassium canrenoate
Potassium canreonate and carbenoxolone may mutually decrease their effects. Great quantities of sweet root act in this regard like carbenoxolone
Carbenoxolone, pregnancy
This medicinal product should not be used during pregnancy
Carbenoxolone, spironolactone
As carbenoxolone may cause sodium retention and thus decrease the effectiveness of spironolactone, concurrent use should be avoided.
Carbenoxolone, telmisartan/hydrochlorothiazide [2] ---> SPC of [2] of EMA
Medicinal products associated with potassium loss and hypokalaemia: These medicinal products may potentiate the effect of hydrochlorothiazide on serum potassium
Carbenoxolone, thiazides
Carbenoxolone may exacerbate the hypokalaemia associated with thiazide use.
Carbenoxolone, xipamide [2] ---> SPC of [2] of eMC
Concomitant use with xipamide may provoke hypokalaemia.
Carbetocin
Antihypertensives, carbetocin
Increased hypotensive effect
Breast-feeding, carbetocin [2] ---> SPC of [2] of eMC
Small amounts of carbetocin pass from plasma into breast milk of nursing women. The small amounts transferred into colostrum or breast milk after a single injection of carbetocin, are assumed to be degraded by enzymes in the gut.
Carbetocin [1], ergot derivatives ---> SPC of [1] of eMC
During combination with ergot-alkaloids, such as methylergometrine, oxytocin and carbetocin may enhance the blood pressure enhancing effect of these agents.
Carbetocin [1], halogenated anaesthetics ---> SPC of [1] of eMC
Some inhalation-anesthetics, such as halothane and cyclopropane may enhance the hypotensive effect and weaken the effect of carbetocin on the uterus. Arrhythmias have been reported for oxytocin during concomitant use.
Carbetocin [1], pregnancy ---> SPC of [1] of eMC
Carbetocin is contraindicated during pregnancy and must not be used for the induction of labour
Carbetocin [1], prostaglandins ---> SPC of [1] of eMC
Since it has been found that prostaglandins potentiate the effect of oxytocin, it is expected that this can also occur with carbetocin. Therefore, it is not recommended that prostaglandins and carbetocin be used together.
Carbetocin [1], vasoconstrictors ---> SPC of [1] of eMC
Severe hypertension has been reported when oxytocin was given 3 to 4 hours following prophylactic administration of a vasoconstrictor in conjunction with caudal-block anaesthesia.
Carbetocin, sympathomimetics
Prolonged arterial hypertension
Ergot derivatives, oxytocin ---> SPC of [carbetocin] of eMC
During combination with ergot-alkaloids, such as methylergometrine, oxytocin and carbetocin may enhance the blood pressure enhancing effect of these agents.
CONTRAINDICATIONS of Carbetocin
- During pregnancy and labour before delivery of the infant.
- Carbetocin must not be used for the induction of labour.
- Hypersensitivity to carbetocin, oxytocin or to any of the excipients.
- Hepatic or renal disease.
- Cases of pre-eclampsia and eclampsia.
- Serious cardiovascular disorders.
- Epilepsy.
http://www.medicines.org.uk/emc/
Carbocisteine
Anticholinergics, carbocisteine
The concomitant use of carbocisteine and drugs that inhibit the bronchial secretions is not recommended
Antitussives, carbocisteine
The concomitant use of carbocisteine and drugs that inhibit the cough reflex is not recommended
Breast-feeding, carbocisteine [2] ---> SPC of [2] of eMC
Effects not known.
Carbocisteine [1], pregnancy ---> SPC of [1] of eMC
Carbocisteine is not recommended during the first trimester of pregnancy.
CONTRAINDICATIONS of Carbocisteine
- Hypersensitivity to the active substance(s) or to any of the excipients.
- Use in patients with active peptic ulceration.
http://www.medicines.org.uk/emc/
Carbomer
Breast-feeding, carbomer [2] ---> SPC of [2] of eMC
Caution should be exercised when prescribing to pregnant or breast-feeding women.
Carbomer [1], pregnancy ---> SPC of [1] of eMC
Caution should be exercised when prescribing to pregnant or breast-feeding women.
CONTRAINDICATIONS of Carbomer
- Hypersensitivity to any of the components of the product.
http://www.medicines.org.uk/emc/
Carboplatin
Ability to drive, carboplatin [2] ---> SPC of [2] of eMC
Carboplatin may cause nausea and vomiting, indirectly impairing the ability to drive and use machines.
Aluminium containing equipment, carboplatin [2] ---> SPC of [2] of eMC
Needles, syringes, catheters or intravenous sets containing aluminum parts that may come into contact with carboplatin should not be used for preparation or administration of carboplatin.
Aluminium, carboplatin
Carboplatin may interact with aluminium to form a black precipitate
Aminoglycoside antibiotics, carboplatin [2] ---> SPC of [2] of eMC
Concurrent therapy of carboplatin with nephrotoxic/ototoxic drugs such as aminoglycoside is not recommended, since this may lead to increased/exacerbated toxicity due to carboplatin induced changes in renal clearance of these substances
Antihistamines, carboplatin
Antihistaminics may mask the ototoxic effects of other drugs
Breast-feeding, carboplatin [2] ---> SPC of [2] of eMC
It is not known whether carboplatin is excreted in human milk. Because of the possibility of harmful effects in suckling infants, breast-feeding must be discontinued if the mother is treated with carboplatin
Capreomycin, carboplatin
Concurrent therapy with nephrotoxic drugs or ototoxic drugs is not recommended, since this may lead to increased or exacerbated toxicity due to carboplatin induced changes in renal clearance of these substances.
Carboplatin [1], myelosuppressive agents ---> SPC of [1] of eMC
When combining carboplatin with other myelosuppressive compounds, the myelosuppressive effect of carboplatin and/or the other compounds may be more pronounced.
Carboplatin [1], nephrotoxic substances ---> SPC of [1] of eMC
Concurrent therapy with nephrotoxic drugs or ototoxic drugs is not recommended, since this may lead to increased or exacerbated toxicity due to carboplatin induced changes in renal clearance of these substances.
Carboplatin [1], ototoxic agents ---> SPC of [1] of eMC
Concurrent therapy with nephrotoxic drugs or ototoxic drugs is not recommended, since this may lead to increased or exacerbated toxicity due to carboplatin induced changes in renal clearance of these substances.
Carboplatin [1], pregnancy ---> SPC of [1] of eMC
Carboplatin has been shown to be an embryo toxin and teratogen in rats and mutagenic in vivo and in vitro. Carboplatin should not be used during pregnancy unless clearly indicated.
Carboplatin, chelating agents
The concurrent administration of carboplatin and chelating agents should be avoided as it can therapeutically lead to a decrease of the antineoplastic effect of carboplatin.
Carboplatin, cyclosporine
The co-administration of carboplatin with ciclosporin may cause an excessive immunosuppression with risk of lymphoproliferation
Carboplatin, diuretics
May increase or exacerbate toxicity due to carboplatin induced changes in renal clearance
Carboplatin, docetaxel [2] ---> SPC of [2] of EMA
Limited data from a single uncontrolled study were suggestive of an interaction between docetaxel and carboplatin. When combined to docetaxel, the clearance of carboplatin was about 50% higher than values previously reported for carboplatin monotherapy.
Carboplatin, erlotinib [2] ---> SPC of [2] of EMA
Erlotinib increases carboplatin concentrations
Carboplatin, loop diuretics
Concurrent therapy of carboplatin with diuretics is not recommended, since this may lead to increased or exacerbated toxicity due to carboplatin induced changes in renal clearance of these substances.
Carboplatin, oral anticoagulants
The possible interaction between oral anticoagulants and antineoplastic agents requires more frequent monitoring of INR, if patients should be treated with oral anticoagulants
Carboplatin, phenytoin
A decrease in phenytoin serum levels has been observed in case of concurrent administration of carboplatin and phenytoin. This may lead to reappearance of seizure and may require an increase of phenytoin dosages.
Carboplatin, sirolimus
The co-administration of carboplatin with sirolimus may cause an excessive immunosuppression with risk of lymphoproliferation
Carboplatin, tacrolimus
The co-administration of carboplatin with tacrolimus may cause an excessive immunosuppression with risk of lymphoproliferation
Carboplatin, trastuzumab [2] ---> SPC of [2] of EMA
Pharmacokinetic data from Study H4613g/GO01305 in patients with metastatic or locally advanced inoperable HER2-positive cancer suggested that trastuzumab had no impact on the PK of carboplatin
Carboplatin, vaccinations with live organism vaccines
The co-administration of carboplatin with a live attenuated vaccine (except yellow fever vaccine) is not recommended because of the risk of fatal systemic vaccinal disease
Carboplatin, vancomycin [2] ---> SPC of [2] of eMC
Concurrent or sequential systemic or topical use of other potentially neurotoxic or nephrotoxic drugs may potentiate the nephrotoxicity and/or ototoxicity of vancomycin and consequently requires careful monitoring.
Carboplatin, yellow fever vaccine
The co-administration of carboplatin with the yellow fever vaccine is contra-indicated because of the risk of fatal systemic vaccinal disease
CONTRAINDICATIONS of Carboplatin
Carboplatin is contra-indicated in patients with:
- hypersensitivity to the active substance or to any of the excipients listed in section 6.1 or to other platinum containing compounds
- breast-feeding
- severe myelosuppression
- bleeding tumours
- pre-existing severe renal impairment (with creatinine clearance of ≤ 20 ml per minute).
http://www.medicines.org.uk/emc/
Carfilzomib (Kyprolis)
Ability to drive, carfilzomib [2] ---> SmPC of [2] of EMA
Fatigue, dizziness, fainting, blurred vision, somnolence and/or a drop in blood pressure have been observed in clinical trials.
Breast-feeding, carfilzomib [2] ---> SmPC of [2] of EMA
As a precautionary measure, breast-feeding is contra-indicated during and for at least 2 days after treatment with Kyprolis.
Carfilzomib [1], colchicine ---> SmPC of [1] of EMA
Carfilzomib is a P-glycoprotein (P-gp) but not a BCRP substrate. Caution should be observed when carfilzomib is combined with substrates of P-gp (e.g. digoxin, colchicine).
Carfilzomib [1], cytochrome P450 ---> SmPC of [1] of EMA
Carfilzomib is primarily metabolised via peptidase and epoxide hydrolase activities, and as a result, the pharmacokinetic profile of carfilzomib is unlikely to be affected by concomitant administration of cytochrome P450 inhibitors and inducers.
Carfilzomib [1], digoxin ---> SmPC of [1] of EMA
Carfilzomib is a P-glycoprotein (P-gp) but not a BCRP substrate. Caution should be observed when carfilzomib is combined with substrates of P-gp (e.g. digoxin, colchicine).
Carfilzomib [1], fertility ---> SmPC of [1] of EMA
No fertility studies have been performed in animals (see section 5.3).
Carfilzomib [1], men ---> SmPC of [1] of EMA
Male patients must use effective contraception measures during and for 3 months following treatment if their partner is pregnant or of child bearing potential not using effective contraception.
Carfilzomib [1], midazolam ---> SmPC of [1] of EMA
The pharmacokinetics of midazolam were unaffected by concomitant carfilzomib administration, indicating that carfilzomib is not expected to inhibit the metabolism of CYP3A4/5 substrates and is not a CYP3A4 inducer in human subjects.
Carfilzomib [1], oral contraceptives ---> SmPC of [1] of EMA
If a patient is currently using oral contraceptives or a hormonal method of contraception that is associated with a risk of thrombosis, the patient should switch to an alternative method of effective contraception.
Carfilzomib [1], P-glycoprotein substrates ---> SmPC of [1] of EMA
Carfilzomib is a P-glycoprotein (P-gp) but not a BCRP substrate. Caution should be observed when carfilzomib is combined with substrates of P-gp (e.g. digoxin, colchicine).
Carfilzomib [1], pregnancy ---> SmPC of [1] of EMA
Studies in animals have shown reproductive toxicity (see section 5.3). Kyprolis should not be used during pregnancy unless the potential benefit outweighs the potential risk to the foetus.
Carfilzomib [1], pregnancy ---> SmPC of [1] of EMA
If Kyprolis is used during pregnancy, or if the patient becomes pregnant while taking this medicinal product, the patient should be apprised of the potential hazard to the foetus.
Carfilzomib [1], pregnancy ---> SmPC of [1] of EMA
If lenalidomide is taken during pregnancy, a teratogenic effect of lenalidomide in humans is expected.
Carfilzomib [1], QT interval prolonging drugs ---> SmPC of [1] of EMA
There have been cases of QT interval prolongation reported in clinical studies and post-marketing. Cases of ventricular tachycardia have been reported in patients receiving Kyprolis.
Carfilzomib [1], thrombosis risk ---> SmPC of [1] of EMA
Caution should be used in the concomitant administration of other agents that may increase the risk of thrombosis (e.g. erythropoietic agents or hormone replacement therapy).
Carfilzomib [1], UGT1A1 substrates ---> SmPC of [1] of EMA
Carfilzomib does not inhibit human UGT2B7 but inhibits human UGT1A1 with an IC50 of 5.5 ?M. Nonetheless, the risk of clinically relevant interactions with substrates of OATP1B1 and UGT1A1 is probably low.
Carfilzomib [1], women of childbearing potential ---> SmPC of [1] of EMA
Female patients of child bearing potential treated with Kyprolis (and/or their partners) must use effective contraception measures during and for one month following treatment.
CONTRAINDICATIONS of Carfilzomib (Kyprolis)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Women who are breast-feeding (see section 4.6)
As Kyprolis is administered in combination with other medicinal products, refer to their summaries of product characteristics for additional contraindications.
https://www.ema.europa.eu/en/documents/product-information/kyprolis-epar-product-information_en.pdf 10/04/2024
Carglumic acid (Carbaglu)
Ability to drive, carglumic acid [2] ---> SmPC of [2] of EMA
No studies on the effects on the ability to drive and use machines have been performed.
Breast-feeding, carglumic acid [2] ---> SmPC of [2] of EMA
Breast-feeding during the use of carglumic acid is contraindicated
Carglumic acid [1], pregnancy ---> SmPC of [1] of EMA
Caution should be exercised when prescribing to pregnant women
Carglumic acid [1], systematic surveillance ---> SmPC of [1] of EMA
As very few data on the safety of carglumic acid are available, systematic surveillance of liver, renal, cardiac functions and haematological parameters is recommended.
CONTRAINDICATIONS of Carglumic acid (Carbaglu)
- Hypersensitivity to the active substance or to any of the excipients.
- Breast-feeding during the use of carglumic acid is contraindicated
https://www.ema.europa.eu/en/documents/product-information/carbaglu-epar-product-information_en.pdf 09/12/2025
Other trade names: Ucedane,
Cariprazine (Reagila)
Ability to drive, cariprazine [2] ---> SmPC of [2] of EMA
Patients should be cautioned about operating hazardous machinery, including motor vehicles, until they are reasonably certain that therapy with Reagila does not affect them adversely.
Alcohol, cariprazine [2] ---> SmPC of [2] of EMA
Given the primary central nervous system effects of cariprazine, Reagila should be used with caution in combination with other centrally acting medicinal products and alcohol.
Boceprevir, cariprazine [2] ---> SmPC of [2] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazol
Bosentan, cariprazine [2] ---> SmPC of [2] of EMA
The co-administration of cariprazine and strong or moderate CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, St. John's wort (Hypericum perforatum), bosentan, efavirenz, etravirine, modafinil, nafcillin) is contraindicated
Breast-feeding, cariprazine [2] ---> SmPC of [2] of EMA
Breast-feeding should be discontinued during treatment with cariprazine.
Carbamazepine, cariprazine [2] ---> SmPC of [2] of EMA
The co-administration of cariprazine and strong or moderate CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, St. John's wort (Hypericum perforatum), bosentan, efavirenz, etravirine, modafinil, nafcillin) is contraindicated
Cariprazine [1], clarithromycin ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], CNS depressants ---> SmPC of [1] of EMA
Given the primary central nervous system effects of cariprazine, Reagila should be used with caution in combination with other centrally acting medicinal products and alcohol.
Cariprazine [1], cobicistat ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], CYP2D6 inhibitors ---> SmPC of [1] of EMA
Therefore CYP2D6 inhibitors are unlikely to have a clinically relevant effect on cariprazine metabolism.
Cariprazine [1], dabigatran ---> SmPC of [1] of EMA
Cariprazine is a P-gp inhibitor in vitro at its theoretical maximum intestinal concentration. The use of P-gp substrates with narrow therapeutic index such as dabigatran and digoxin could require extra monitoring and dose adjustment.
Cariprazine [1], digoxin ---> SmPC of [1] of EMA
Cariprazine is a P-gp inhibitor in vitro at its theoretical maximum intestinal concentration. The use of P-gp substrates with narrow therapeutic index such as dabigatran and digoxin could require extra monitoring and dose adjustment.
Cariprazine [1], diltiazem ---> SmPC of [1] of EMA
Therefore, during a period of co-administration of cariprazine with a moderate CYP3A4 inhibitor (e.g., erythromycin, fluconazole, diltiazem, verapamil), monitoring of the individual response and tolerability is recommended
Cariprazine [1], efavirenz ---> SmPC of [1] of EMA
The co-administration of cariprazine and strong or moderate CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, St. John's wort (Hypericum perforatum), bosentan, efavirenz, etravirine, modafinil, nafcillin) is contraindicated
Cariprazine [1], erythromycin ---> SmPC of [1] of EMA
Therefore, during a period of co-administration of cariprazine with a moderate CYP3A4 inhibitor (e.g., erythromycin, fluconazole, diltiazem, verapamil), monitoring of the individual response and tolerability is recommended
Cariprazine [1], etravirine ---> SmPC of [1] of EMA
The co-administration of cariprazine and strong or moderate CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, St. John's wort (Hypericum perforatum), bosentan, efavirenz, etravirine, modafinil, nafcillin) is contraindicated
Cariprazine [1], fertility ---> SmPC of [1] of EMA
The effect of cariprazine on human fertility has not been evaluated. In rat studies lower female fertility and conception indices were observed (see section 5.3).
Cariprazine [1], fluconazole ---> SmPC of [1] of EMA
Therefore, during a period of co-administration of cariprazine with a moderate CYP3A4 inhibitor (e.g., erythromycin, fluconazole, diltiazem, verapamil), monitoring of the individual response and tolerability is recommended
Cariprazine [1], grapefruit juice ---> SmPC of [1] of EMA
Consumption of grapefruit juice should be avoided.
Cariprazine [1], hormonal contraceptives ---> SmPC of [1] of EMA
In a drug interaction study, 28 days of treatment with cariprazine at 6 mg daily had no clinically relevant effect on the pharmacokinetics of oral contraceptives (ethinylestradiol and levonorgestrel).
Cariprazine [1], indinavir ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], itraconazol ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], ketoconazole ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], modafinil ---> SmPC of [1] of EMA
The co-administration of cariprazine and strong or moderate CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, St. John's wort (Hypericum perforatum), bosentan, efavirenz, etravirine, modafinil, nafcillin) is contraindicated
Cariprazine [1], moderate CYP3A4 inductors ---> SmPC of [1] of EMA
The co-administration of cariprazine and strong or moderate CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, St. John's wort (Hypericum perforatum), bosentan, efavirenz, etravirine, modafinil, nafcillin) is contraindicated
Cariprazine [1], moderate CYP3A4 inhibitors ---> SmPC of [1] of EMA
Therefore, during a period of co-administration of cariprazine with a moderate CYP3A4 inhibitor (e.g., erythromycin, fluconazole, diltiazem, verapamil), monitoring of the individual response and tolerability is recommended
Cariprazine [1], nafcillin ---> SmPC of [1] of EMA
The co-administration of cariprazine and strong or moderate CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, St. John's wort (Hypericum perforatum), bosentan, efavirenz, etravirine, modafinil, nafcillin) is contraindicated
Cariprazine [1], nefazodone ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], nelfinavir ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], new-born child ---> SmPC of [1] of EMA
Neonates exposed to antipsychotics (including cariprazine) during the third trimester of pregnancy are at risk of adverse reactions including extrapyramidal and/or withdrawal symptoms that may vary in severity and duration following delivery.
Cariprazine [1], P-glycoprotein substrates with small therapeutic index ---> SmPC of [1] of EMA
Cariprazine is a P-gp inhibitor in vitro at its theoretical maximum intestinal concentration. The use of P-gp substrates with narrow therapeutic index such as dabigatran and digoxin could require extra monitoring and dose adjustment.
Cariprazine [1], phenobarbital ---> SmPC of [1] of EMA
The co-administration of cariprazine and strong or moderate CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, St. John's wort (Hypericum perforatum), bosentan, efavirenz, etravirine, modafinil, nafcillin) is contraindicated
Cariprazine [1], phenytoin ---> SmPC of [1] of EMA
The co-administration of cariprazine and strong or moderate CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, St. John's wort (Hypericum perforatum), bosentan, efavirenz, etravirine, modafinil, nafcillin) is contraindicated
Cariprazine [1], posaconazole ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], pregnancy ---> SmPC of [1] of EMA
Reagila is not recommended during pregnancy and in women of childbearing potential not using effective contraception.
Cariprazine [1], pregnancy ---> SmPC of [1] of EMA
After discontinuation of cariprazine treatment contraception should be used for at least 10 weeks due to the slow elimination of active moieties.
Cariprazine [1], QT interval prolonging drugs ---> SmPC of [1] of EMA
Cariprazine should be used cautiously in patients with known cardiovascular disease or in patients with a family history of QT prolongation and in patients treated with medicinal products that might cause QT prolongation
Cariprazine [1], rifampicin ---> SmPC of [1] of EMA
The co-administration of cariprazine and strong or moderate CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, St. John's wort (Hypericum perforatum), bosentan, efavirenz, etravirine, modafinil, nafcillin) is contraindicated
Cariprazine [1], ritonavir ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], saquinavir ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], St. John's wort ---> SmPC of [1] of EMA
The co-administration of cariprazine and strong or moderate CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, St. John's wort (Hypericum perforatum), bosentan, efavirenz, etravirine, modafinil, nafcillin) is contraindicated
Cariprazine [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA
The co-administration of cariprazine and strong or moderate CYP3A4 inducers (e.g. carbamazepine, phenobarbital, phenytoin, rifampicin, St. John's wort (Hypericum perforatum), bosentan, efavirenz, etravirine, modafinil, nafcillin) is contraindicated
Cariprazine [1], strong CYP3A4 inhibitors ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], telaprevir ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], telithromycin ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], verapamil ---> SmPC of [1] of EMA
Therefore, during a period of co-administration of cariprazine with a moderate CYP3A4 inhibitor (e.g., erythromycin, fluconazole, diltiazem, verapamil), monitoring of the individual response and tolerability is recommended
Cariprazine [1], voriconazole ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cariprazine [1], women of childbearing potential ---> SmPC of [1] of EMA
Women of childbearing potential must be advised to avoid pregnancy while on Reagila. Female patients of child-bearing potential must use highly effective contraceptive methods during treatment and for at least 10 weeks following the last dose of Reagila.
CONTRAINDICATIONS of Cariprazine (Reagila)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Concomitant administration of strong CYP3A4 inhibitors (see section 4.5).
- Concomitant administration of strong or moderate CYP3A4 inducers (see section 4.5).
https://www.ema.europa.eu/en/documents/product-information/reagila-epar-product-information_en.pdf 28/05/2024
Carisoprodol
Ability to drive, carisoprodol
Carisoprodol may cause somnolence
Barbiturates, carisoprodol
The co-administration may enhance the depressive effect on the central nervous system.
Benzodiazepines, carisoprodol
The co-administration may enhance the depressive effect on the central nervous system.
Breast-feeding, carisoprodol
Carisoprodol is excreted into the breast milk in significant quantities and it should not be administered during breastfeeding
Carisoprodol, CNS depressants
The co-administration may enhance the depressive effect on the central nervous system.
Carisoprodol, CYP2C19 inhibitors
The CYP2C19 inhibition may increase the plasma concentrations of carisoprodol
Carisoprodol, dasabuvir with ombitasvir/paritaprevir/ritonavir ---> SPC of [dasabuvir] of EMA
CYP2C19 induction by ritonavir. No dose adjustment required for carisoprodol; increase dose if clinically indicated.
Carisoprodol, hypnotics
The co-administration may enhance the depressive effect on the central nervous system.
Carisoprodol, narcotics
The co-administration may enhance the depressive effect on the central nervous system.
Carisoprodol, ombitasvir/paritaprevir/ritonavir [2] ---> SPC of [2] of EMA
CYP2C19 induction by ritonavir. No dose adjustment required for carisoprodol; increase dose if clinically indicated
Carisoprodol, pregnancy
The use of carisoprodol in pregnancy is not recommended.
Carisoprodol, sedatives
The co-administration may enhance the depressive effect on the central nervous system.
Carisoprodol, strong CYP2C19 inhibitors
The strong CYP2C19 inhibition may increase the plasma concentrations of carisoprodol
Carmellose
Ability to drive, carmellose
Transitory blurred vision may occur
Breast-feeding, carmellose
Carmellose can be used in breast-feeding
Carmellose, pregnancy
Carmellose can be used in pregnancy
CONTRAINDICATIONS of Carmellose
Hypersensitivity to carmellose sodium or to any of the excipients.
http://www.medicines.org.uk/emc/
Carmustine (Carmustine medac)
Ability to drive, carmustine [2] ---> SmPC of [2] of EMA
The possibility will have to be taken into consideration, that the alcohol quantity in these pharmaceutical medicines can impair the ability to drive and use machines.
Actinomycin, carmustine
The co-administration of carmustine with other myelosuppressive agents may increase the myelotoxicity (thrombopenia and leucopenia)
Alkylator, carmustine
Possible cross resistance with other alkylator agents
Antiepileptics, carmustine [2] ---> SmPC of [2] of EMA
In combination with chemotherapeutic medicinal products reduced activity of antiepileptic medicinal products must be anticipated.
Antiepileptics, chemotherapeutic agents ---> SmPC of [carmustine] of EMA
In combination with chemotherapeutic medicinal products reduced activity of antiepileptic medicinal products must be anticipated.
Bleomycin, carmustine
Increased risk of pulmonary toxicity with pulmotoxic substances
Breast-feeding, carmustine [2] ---> SmPC of [2] of EMA
Carmustine medac is contraindicated during breast-feeding and up to seven days post-treatment (see section 4.3).
Carmustine [1], cimetidine ---> SmPC of [1] of EMA
Concomitant use with cimetidine leads to delayed, major, suspected, increased carmustine toxic effect (due to the inhibition of carmustine metabolism).
Carmustine [1], dexamethasone ---> SmPC of [1] of EMA
In combination with chemotherapeutic medicinal products reduced activity of antiepileptic medicinal products must be anticipated.
Carmustine [1], digoxin ---> SmPC of [1] of EMA
Concomitant use with digoxin leads to delayed, moderate, suspected, decreased effect of digoxin (due to the decreased digoxin absorption).
Carmustine [1], fertility ---> SmPC of [1] of EMA
Carmustine may impair male fertility. Males should be advised of potential risk of infertility and to seek fertility/family planning counselling prior to therapy with carmustine
Carmustine [1], melphalan ---> SmPC of [1] of EMA
Concomitant use with melphalan leads to increased risk of pulmonary toxicity.
Carmustine [1], men ---> SmPC of [1] of EMA
Male patients should be advised to use adequate contraceptive measures while on treatment with carmustine and for at least 6 months after treatment.
Carmustine [1], phenytoin ---> SmPC of [1] of EMA
In combination with chemotherapeutic medicinal products reduced activity of antiepileptic medicinal products must be anticipated.
Carmustine [1], pregnancy ---> SmPC of [1] of EMA
Carmustine should not be administered to patients who are pregnant. The patient should be apprised of the potential hazard to the foetus.
Carmustine [1], women of childbearing potential ---> SmPC of [1] of EMA
Women should use effective contraception to avoid becoming pregnant while on treatment and for at least 6 months after treatment.
Carmustine, chlormethine
The co-administration of carmustine with other myelosuppressive agents may increase the myelotoxicity (thrombopenia and leucopenia)
Carmustine, cimetidine [2] ---> SmPC of [2] of eMC
Cimetidine may potentiate the myelosuppressive effects
Carmustine, cyclophosphamide
The co-administration of carmustine with other myelosuppressive agents may increase the myelotoxicity (thrombopenia and leucopenia)
Carmustine, dactinomycin
The co-administration of carmustine with other myelosuppressive agents may increase the myelotoxicity (thrombopenia and leucopenia)
Carmustine, doxorubicine
The co-administration of carmustine with other myelosuppressive agents may increase the myelotoxicity (thrombopenia and leucopenia)
Carmustine, fluorouracil
The co-administration of carmustine with other myelosuppressive agents may increase the myelotoxicity (thrombopenia and leucopenia)
Carmustine, hydantoins
Carmustine decreases the effect of hydantoin
Carmustine, lomustine
Possible cross resistance with other alkylator agents
Carmustine, myelosuppressive agents
The co-administration of carmustine with other myelosuppressive agents may increase the myelotoxicity (thrombopenia and leucopenia)
Carmustine, pentostatine [2] ---> SmPC of [2] of eMC
Acute pulmonary oedema and hypotension leading to death, have been reported in the literature in patients treated with pentostatin in combination with carmustine, etoposide and high dose cyclophosphamide
Carmustine, procarbazine
The co-administration of carmustine with other myelosuppressive agents may increase the myelotoxicity (thrombopenia and leucopenia)
Carmustine, trastuzumab
Trastuzumab may increase the risk of neutropenia and anemia.
Carmustine, vinblastine
The co-administration of carmustine with other myelosuppressive agents may increase the myelotoxicity (thrombopenia and leucopenia)
CONTRAINDICATIONS of Carmustine (Carmustine medac)
Hypersensitivity to the active substance, to other nitrosoureas or to any of the excipients listed in section 6.1.
Severe bone marrow depression.
Severe (end-stage) renal impairment.
Children and adolescents
Breast-feeding.
Carteolol
Ability to drive, carteolol [2] ---> SPC of [2] of eMC
As with any other eye medication, should a patient experience any disturbance of vision, dizziness or syncope following instillation of carteolol eye drops, driving and the operation of machinery must be avoided
Adrenaline, carteolol [2] ---> SPC of [2] of eMC
Mydriasis resulting from concomitant use of ophthalmic beta-blockers and adrenaline (epinephrine) has been reported occasionally.
Alfa-adrenergic receptor blockers, carteolol
Increased antihypertensive effect, increased risk of orthostatic hypotension
Alfuzosin, carteolol
Increased antihypertensive effect, increased risk of orthostatic hypotension
Alpha-methyldopa, carteolol
Sudden withdrawal of central antihypertensive should be avoided if possible.
Ambenonium, carteolol
Risk of excessive bradycardia (addition of bradycardic effects)
Amifostine, carteolol
Increased antihypertensive effect
Amiodarone, carteolol [2] ---> SPC of [2] of eMC
There is a potential for additive effects resulting in hypotension and/or marked bradycardia when ophthalmic beta-blockers solution is administered concomitantly with antiarrhythmics (including amiodarone)
Amisulpride, carteolol
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Antiarrhythmics, carteolol [2] ---> SPC of [2] of eMC
There is a potential for additive effects resulting in hypotension and/or marked bradycardia when ophthalmic beta-blockers solution is administered concomitantly with antiarrhythmics (including amiodarone)
Anticholinesterase, carteolol
Risk of excessive bradycardia (addition of bradycardic effects)
Antidiabetics, carteolol ---> SPC of [brinzolamide/timolol] of EMA
The beta-blocker may increase the hypoglycaemic effect of insulin. Blockade of beta-adrenoreceptors may mask the symptoms of hypoglycaemia
Antihypertensives, carteolol
Enhanced hypotensive effect
Baclofen, carteolol
Increased antihypertensive effect
Benzamides, carteolol
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Bepridil, carteolol
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Betablockers, carteolol [2] ---> SPC of [2] of eMC
There is a potential for additive effects resulting in hypotension and/or marked bradycardia when ophthalmic beta-blockers solution is administered concomitantly with beta-adrenergic blocking agents
Breast-feeding, carteolol [2] ---> SPC of [2] of eMC
Beta-blockers are excreted in breast milk. However, at therapeutic doses of carteolol in eye drops it is not likely that sufficient amounts would be present in breast milk to produce clinical symptoms of beta-blockade in the infant.
Butyrophenones, carteolol
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Calcium antagonists, carteolol [2] ---> SPC of [2] of eMC
There is a potential for additive effects resulting in hypotension and/or marked bradycardia when ophthalmic beta-blockers solution is administered concomitantly with oral calcium channel blockers
Carteolol [1], class IA antiarrhythmic agents ---> SPC of [1] of eMC
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol [1], digital glycosides ---> SPC of [1] of eMC
There is a potential for additive effects resulting in hypotension and/or marked bradycardia when ophthalmic beta-blockers solution is administered concomitantly with digitalis glycosides
Carteolol [1], diltiazem ---> SPC of [1] of eMC
There is a potential for additive effects resulting in hypotension and/or marked bradycardia when ophthalmic beta-blockers solution is administered concomitantly with oral calcium channel blockers
Carteolol [1], disopyramide ---> SPC of [1] of eMC
There is a potential for additive effects resulting in hypotension and/or marked bradycardia when ophthalmic beta-blockers solution is administered concomitantly with antiarrhythmics (including amiodarone)
Carteolol [1], guanethidine ---> SPC of [1] of eMC
There is a potential for additive effects resulting in hypotension and/or marked bradycardia when ophthalmic beta-blockers solution is administered concomitantly with guanethidine
Carteolol [1], parasympathomimetics ---> SPC of [1] of eMC
There is a potential for additive effects resulting in hypotension and/or marked bradycardia when ophthalmic beta-blockers solution is administered concomitantly with parasympathomimetics
Carteolol [1], pregnancy ---> SPC of [1] of eMC
Carteolol should not be used during pregnancy unless clearly necessary.
Carteolol [1], quinidine ---> SPC of [1] of eMC
There is a potential for additive effects resulting in hypotension and/or marked bradycardia when ophthalmic beta-blockers solution is administered concomitantly with antiarrhythmics (including amiodarone)
Carteolol [1], verapamil ---> SPC of [1] of eMC
There is a potential for additive effects resulting in hypotension and/or marked bradycardia when ophthalmic beta-blockers solution is administered concomitantly with oral calcium channel blockers
Carteolol, catecholamine depleting drugs
The co-administration may cause an additive beta-adrenergic blockade und bradycardia und hypotension mit dizziness, syncope or postural hypotension
Carteolol, centrally-acting antihypertensives
Sudden withdrawal of central antihypertensive should be avoided if possible.
Carteolol, chlorpromazine
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, cisapride
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, class III antiarrhythmic agents
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, coxibs
Reduction of the antihypertensive effect
Carteolol, cyamemazine
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, dihydropyridines
The co-administration may increase the risk of hypotension, and cardiac failure may occur in patients with latent cardiac insufficiency
Carteolol, diphemanil
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, dipyridamole
Increased hypotensive effect of IV dipyridamole
Carteolol, dofetilide
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, donepezil
Risk of excessive bradycardia (addition of bradycardic effects)
Carteolol, doxazosin
Increased antihypertensive effect, increased risk of orthostatic hypotension
Carteolol, droperidol
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, erythromycin
The co-administration of carteolol and I.V. erythromycin increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, fingolimod
Enhancement of bradycardia, which can have serious outcomes
Carteolol, galantamine
Risk of excessive bradycardia (addition of bradycardic effects)
Carteolol, glinides
All betablocker may mask certain symptoms of hypoglycaemia (palpitations, tachycardia).
Carteolol, guanfacin
Sudden withdrawal of central antihypertensive should be avoided if possible.
Carteolol, halofantrine
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, halogenated anaesthetics
Betablockers reduce the compensatory cardiovascular reactions
Carteolol, haloperidol
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, hydroquinidine
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, ibutilide
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, imipramine
Antihypertensive effect and increased risk of orthostatic hypotension (additive effect)
Carteolol, insulin
All betablocker may mask certain symptoms of hypoglycaemia (palpitations, tachycardia).
Carteolol, levomepromazine
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, lidocaine
When used IV, plasma concentrations of lidocaine may be increased due to decreasing of its hepatic clearance
Carteolol, mefloquine
Risk of excessive bradycardia (addition of bradycardic effects)
Carteolol, mizolastine
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, moxifloxacin
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, moxonidine
Sudden withdrawal of central antihypertensive should be avoided if possible.
Carteolol, neostigmine
Risk of excessive bradycardia (addition of bradycardic effects)
Carteolol, NSAID
Reduction of the antihypertensive effect
Carteolol, oral antidiabetics
All betablocker may mask certain symptoms of hypoglycaemia (palpitations, tachycardia).
Carteolol, pasireotide [2] ---> SPC of [2] of EMA
Clinical monitoring of heart rate, notably at the beginning of treatment, is recommended in patients receiving pasireotide concomitantly with bradycardic medicinal products
Carteolol, pentamidine
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, phenothiazines
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, pilocarpine
Risk of excessive bradycardia (addition of bradycardic effects)
Carteolol, pimozide
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, prazosin
Increased antihypertensive effect, increased risk of orthostatic hypotension
Carteolol, propafenone
Conduction, automatism and contractibility disorders (suppression of sympathetic compensatory mechanisms)
Carteolol, pyridostigmine
Risk of excessive bradycardia (addition of bradycardic effects)
Carteolol, rauwolfia
The co-administration may cause an additive beta-adrenergic blockade und bradycardia und hypotension mit dizziness, syncope or postural hypotension
Carteolol, reserpine
The co-administration may cause an additive beta-adrenergic blockade und bradycardia und hypotension mit dizziness, syncope or postural hypotension
Carteolol, rilmenidine
Sudden withdrawal of central antihypertensive should be avoided if possible.
Carteolol, rivastigmine
Risk of excessive bradycardia (addition of bradycardic effects)
Carteolol, sotalol
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, sparfloxacin
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, sulfonylureas
All betablocker may mask certain symptoms of hypoglycaemia (palpitations, tachycardia).
Carteolol, sulpiride
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, sultopride
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, tacrine
Risk of excessive bradycardia (addition of bradycardic effects)
Carteolol, tamsulosin
Increased antihypertensive effect, increased risk of orthostatic hypotension
Carteolol, terazosine
Increased antihypertensive effect, increased risk of orthostatic hypotension
Carteolol, thioridazine
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, tiapride
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, torsades de pointes inducing drugs
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, tricyclic antidepressant
Antihypertensive effect and increased risk of orthostatic hypotension (additive effect)
Carteolol, trifluoperazine
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Carteolol, vincamine
The co-administration of carteolol and I.V. vincamine increases the risk of heart rhythm disorders, particularly torsades de pointes
CONTRAINDICATIONS of Carteolol
The carteolol eye drops are contraindicated in patients with:
- Hypersensitivity to the active substance or to any of the excipients
- Reactive airway disease including bronchial asthma, bronchospasms, or a history of bronchial asthma, severe chronic obstructive pulmonary disease.
- Sinus bradycardia, sick sinus syndrome, sino-atrial block, second or third degree atrioventricular block not controlled
http://www.medicines.org.uk/emc/
Carvedilol
Ability to drive, carvedilol [2] ---> SPC of [2] of eMC
Some individuals may have reduced alertness especially on initiation and adjustment of medication.
Acetylsalicylic acid, carvedilol
Decreased hypotensive effect of carvedilol due to water and sodium retention
Alcohol, carvedilol [2] ---> SPC of [2] of eMC
Carvedilol may potentiate the effects of medicines with antihypertensive adverse reactions such as alcohol
Alfa and beta-adrenergic agonists, carvedilol [2] ---> SPC of [2] of eMC
Risk of hypertension and excessive bradycardia.
Alfa-adrenergic agonists, carvedilol
Increased risk of hypertension and excessive bradycardia
Alfa1-adrenergic receptor blockers, carvedilol [2] ---> SPC of [2] of eMC
Carvedilol may potentiate the effects of other concomitantly administered antihypertensives
Amiodarone, carvedilol [2] ---> SPC of [2] of eMC
Isolated cases of conduction disturbance (rarely compromised haemodynamics) have been reported, if oral carvedilol and amiodarone are given concomitantly.
Antihypertensives, carvedilol [2] ---> SPC of [2] of eMC
Carvedilol may potentiate the effects of other concomitantly administered antihypertensives
Barbiturates, carvedilol [2] ---> SPC of [2] of eMC
The co-administration may increase the hypotensive effect and the enzymatic induction may decrease the plasma levels of carvedilol
Benzothiazepines, carvedilol [2] ---> SPC of [2] of eMC
As with other beta-blockers, ECG and blood pressure should be monitored closely when concomitantly administering calcium-channel-blockers of the diltiazem type due to the risk of AV conduction disorder or risk of cardiac failure (synergetic effect)
Beta-adrenergic agonists, carvedilol
Increased risk of hypertension and excessive bradycardia
Betablockers, digoxin ---> SPC of [carvedilol] of eMC
Digoxin, in association with beta-adrenoceptor blocking drugs, may increase atrio-ventricular conduction time.
Betablockers, phenylalkylamines ---> SPC of [carvedilol] of eMC
As with other beta-blockers, ECG and blood pressure should be monitored closely when concomitantly administering calcium-channel-blockers of the verapamil type due to the risk of AV conduction disorder or risk of cardiac failure (synergetic effect)
Breast-feeding, carvedilol [2] ---> SPC of [2] of eMC
Carvedilol and its metabolites are excreted in breast milk and, therefore, mothers receiving carvedilol should not breast-feed.
Carvedilol [1], cimetidine ---> SPC of [1] of eMC
The enzymatic inhibition may increase the plasma levels of carvedilol
Carvedilol [1], class IA antiarrhythmic agents ---> SPC of [1] of eMC
Close monitoring should be done in case of co-administration of carvedilol and class I antiarrhythmics. There is a risk of cardiac failure in case of class Ia antiarrhythmics concomitant intravenous therapy.
Carvedilol [1], class IB antiarrhythmic agents ---> SPC of [1] of eMC
Close monitoring should be done in case of co-administration of carvedilol and class I antiarrhythmics.
Carvedilol [1], class IC antiarrhythmic agents ---> SPC of [1] of eMC
Close monitoring should be done in case of co-administration of carvedilol and class I antiarrhythmics. There is a risk of cardiac failure in case of class Ic antiarrhythmics concomitant intravenous therapy.
Carvedilol [1], clonidine ---> SPC of [1] of eMC
In case of withdrawal of both carvedilol and clonidine, carvedilol should be withdrawn several days before the stepwise withdrawal of clonidine.
Carvedilol [1], corticosteroids ---> SPC of [1] of eMC
The antihypertensive effect of carvedilol is decreased due to water and sodium retention.
Carvedilol [1], cyclosporine ---> SPC of [1] of eMC
Modest increases in mean trough cyclosporine concentrations were observed following the initiation of carvedilol treatment in 21 renal transplant patients suffering from chronic vascular rejection.
Carvedilol [1], digital glycosides ---> SPC of [1] of eMC
In patients with chronic heart failure treated with digitalis, carvedilol should be given with caution, as digitalis and carvedilol both lengthen the AV conduction time
Carvedilol [1], digoxin ---> SPC of [1] of eMC
An increase of steady state digoxin levels by approximately 16% and of digitoxin by approximately 13% has been seen in hypertensive patients in connection with the concomitant use of carvedilol and digoxin.
Carvedilol [1], dihydropyridines ---> SPC of [1] of eMC
The administration of dihydropyridines and carvedilol should be done under close supervision as heart failure and severe hypotension have been reported.
Carvedilol [1], diltiazem ---> SPC of [1] of eMC
Isolated cases of conduction disturbance (rarely compromised haemodynamics) have been reported, if oral carvedilol and oral diltiazem are given concomitantly. The intravenous co-administration is contraindicated
Carvedilol [1], enzyme inhibitors ---> SPC of [1] of eMC
The enzymatic inhibition may increase the plasma levels of carvedilol
Carvedilol [1], ergotamine ---> SPC of [1] of eMC
Vasoconstriction increased.
Carvedilol [1], erythromycin ---> SPC of [1] of eMC
The enzymatic inhibition may increase the plasma levels of carvedilol
Carvedilol [1], estrogens ---> SPC of [1] of eMC
The antihypertensive effect of carvedilol is decreased due to water and sodium retention.
Carvedilol [1], fluoxetine ---> SPC of [1] of eMC
The enzymatic inhibition may increase the plasma levels of carvedilol
Carvedilol [1], guanethidine ---> SPC of [1] of eMC
Concomitant treatment of carvedilol with guanethidine can lead to additional decrease in heart rate. A monitoring of vital signs is recommended.
Carvedilol [1], guanfacin ---> SPC of [1] of eMC
Concomitant treatment of carvedilol with guanfacine can lead to additional decrease in heart rate. A monitoring of vital signs is recommended.
Carvedilol [1], halogenated anaesthetics ---> SPC of [1] of eMC
Caution is advised in case of anaesthesia due to synergistic, negative inotrope and hypotensive effect of carvedilol and certain anaesthetics.
Carvedilol [1], haloperidol ---> SPC of [1] of eMC
The enzymatic inhibition may increase the plasma levels of carvedilol
Carvedilol [1], IMAOs ---> SPC of [1] of eMC
Concomitant treatment of carvedilol with monoamine oxidase inhibitors (exception MAO-B inhibitors) can lead to additional decrease in heart rate. A monitoring of vital signs is recommended.
Carvedilol [1], insulin ---> SPC of [1] of eMC
The blood sugar-lowering effect of insulin may be intensified. Symptoms of hypoglycaemia may be masked.
Carvedilol [1], ketoconazole ---> SPC of [1] of eMC
The enzymatic inhibition may increase the plasma levels of carvedilol
Carvedilol [1], methyldopa ---> SPC of [1] of eMC
Concomitant treatment of carvedilol with methyldopa can lead to additional decrease in heart rate. A monitoring of vital signs is recommended.
Carvedilol [1], muscle relaxants ---> SPC of [1] of eMC
Increased neuromuscular block.
Carvedilol [1], NSAID ---> SPC of [1] of eMC
The antihypertensive effect of carvedilol is decreased due to water and sodium retention.
Carvedilol [1], oral antidiabetics ---> SPC of [1] of eMC
The blood sugar-lowering effect of oral diabetic medicines may be intensified. Symptoms of hypoglycaemia may be masked.
Carvedilol [1], organic nitrates ---> SPC of [1] of eMC
Increased hypotensive effects.
Carvedilol [1], phenothiazines ---> SPC of [1] of eMC
Carvedilol may potentiate the effects of medicines with antihypertensive adverse reactions such as phenothiazines
Carvedilol [1], phenylalkylamines ---> SPC of [1] of eMC
As with other beta-blockers, ECG and blood pressure should be monitored closely when concomitantly administering calcium-channel-blockers of the verapamil type due to the risk of AV conduction disorder or risk of cardiac failure (synergetic effect)
Carvedilol [1], pregnancy ---> SPC of [1] of eMC
Carvedilol should not be used during pregnancy unless clearly necessary (that is if the potential benefit for the mother outweighs the potential risk for the fetus/neonate).
Carvedilol [1], reserpine ---> SPC of [1] of eMC
Concomitant treatment of carvedilol with reserpine can lead to additional decrease in heart rate. A monitoring of vital signs is recommended.
Carvedilol [1], rifampicin ---> SPC of [1] of eMC
Rifampicin, enzymatic inductor, may increase the metabolism of carvedilol and decrease its plasma levels and effect
Carvedilol [1], tricyclic antidepressant ---> SPC of [1] of eMC
Carvedilol may potentiate the effects of medicines with antihypertensive adverse reactions such as tricyclic antidepressants
Carvedilol [1], vasodilators ---> SPC of [1] of eMC
Carvedilol may potentiate the effects of medicines with antihypertensive adverse reactions such as vasodilating agents
Carvedilol [1], verapamil ---> SPC of [1] of eMC
Isolated cases of conduction disturbance (rarely compromised haemodynamics) have been reported, if oral carvedilol and verapamil are given concomitantly. The intravenous co-administration is contraindicated
Carvedilol, catecholamine depleting drugs
Concomitant treatment of carvedilol with catecholamine-depleting medicinal products can lead to additional decrease in heart rate. A monitoring of vital signs is recommended.
Carvedilol, cyclooxygenase inhibitors
Decreased hypotensive effect of carvedilol due to water and sodium retention
Carvedilol, darunavir/cobicistat ---> SPC of [darunavir] of EMA
Boosted darunavir is expected to increase betablocker plasma concentrations. (CYP2D6 inhibition)
Carvedilol, darunavir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Based on theoretical considerations DRV/COBI is expected to increase this beta-blocker plasma concentrations. CYP2D6 inhibition
Carvedilol, darunavir/ritonavir ---> SPC of [darunavir] of EMA
Boosted darunavir is expected to increase betablocker plasma concentrations. (CYP2D6 inhibition)
Carvedilol, enzyme inductors
The enzymatic induction may decrease the plasma levels of carvedilol
Carvedilol, fampridine [2] ---> SPC of [2] of EMA
OCT2 is the transporter responsible for the active secretion of fampridine. Thus, concomitant use of fampridine with medicinal products that are substrates of OCT2 is cautioned
Carvedilol, hydralazine
Increased systemic availability of carvedilol
Carvedilol, hydroquinidine
Negative inotropic effect with risk of decompensated cardiac failure (synergistic effects). The co-administration is contraindicated
Carvedilol, narcotics
Synergistic negative inotropic and hypertensive effects. Careful monitoring of vital signs is recommended
Carvedilol, P-glycoprotein substrates
The concomitant use of carvedilol with medicinal products that are transported by P-glycoprotein may increase the bioavailability from these drugs
Carvedilol, stiripentol [2] ---> SPC of [2] of EMA
Stiripentol is an inhibitor of the enzymes CYP2D6 and may markedly increase the plasma concentrations of substances metabolised by these enzymes and increase the risk of adverse reactions
Carvedilol, strong CYP2C9 inductors
Strong CYP2C9 inductors may decrease plasma concentrations of carvedilol
Carvedilol, strong CYP2C9 inhibitors
The strong CYP2C9 inhibition may increase plasma levels of carvedilol
Carvedilol, strong CYP2D6 inductors
Strong CYP2D6 inductors may decrease plasma concentrations of carvedilol
Carvedilol, strong CYP2D6 inhibitors
The strong CYP2D6 inhibition may increase plasma levels of carvedilol
Carvedilol, strong P-gp inductors
Induction of P-glycoprotein may lead to decreased bioavailability of oral carvedilol
Carvedilol, strong P-gp inhibitors
Inhibition of P-glycoprotein may lead to increased bioavailability of oral carvedilol
Carvedilol, tedisamil
Tedisamil, strong CYP2D6 inhibitor, may increase the plasma concentrations of carvedilol
Carvedilol, tiapride
Tiapride with betablockers given in heart failure increases the risk of ventricular arrhythmias, particularly torsades de pointes. Clinical and electrocardiographic monitoring is necessary
CONTRAINDICATIONS of Carvedilol
- Hypersensitivity to the carvedilol or to any of the excipients of Carvedilol
- Heart failure belonging to NYHA Class IV of the heart failure classification with marked fluid retention or overload requiring intravenous inotropic treatment.
- Chronic obstructive pulmonary disease with bronchial obstruction
- Clinically significant hepatic dysfunction.
- Bronchial asthma.
- AV block, degree II or III (unless a permanent pacemaker is in place).
- Severe bradycardia (<50 bpm).
- Sick sinus syndrome (incl. sino-atrial block).
- Cardiogenic shock.
- Severe hypotension (systolic blood pressure below 85 mmHg).
- Prinzmetal's angina.
- Untreated phaeochromocytoma.
- Metabolic acidosis.
- Severe peripheral arterial circulatory disturbances.
- Concomitant intravenous treatment with verapamil or diltiazem
http://www.medicines.org.uk/emc/
Casirivimab/imdevimab (Ronapreve)
Breast-feeding, casirivimab/imdevimab [2] ---> SmPC of [2] of EMA
Breast-feeding can be considered when clinically indicated.
Casirivimab/imdevimab [1], cytochrome P450 ---> SmPC of [1] of EMA
Therefore, interactions with concomitant medicinal products that are renally excreted or that are substrates, inducers, or inhibitors of cytochrome P450 enzymes are unlikely.
Casirivimab/imdevimab [1], fertility ---> SmPC of [1] of EMA
No fertility studies have been performed.
Casirivimab/imdevimab [1], pregnancy ---> SmPC of [1] of EMA
Ronapreve should be used during pregnancy only if the potential benefit justifies the potential risk for the mother and the foetus considering all associated health factors.
CONTRAINDICATIONS of Casirivimab/imdevimab (Ronapreve)
- Hypersensitivity to the active substances or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/ronapreve-epar-product-information_en.pdf 27/05/2024
Caspofungin (Cancidas)
Breast-feeding, caspofungin [2] ---> SmPC of [2] of EMA
Women receiving caspofungin should not breast-feed.
Carbamazepine, caspofungin [2] ---> SmPC of [2] of EMA
When co-administering inducers of metabolic enzymes, an increase in the daily dose of caspofungin to 70 mg, following the 70 mg loading dose, should be considered in adult patients (see section 4.2).
Caspofungin [1], cyclosporine ---> SmPC of [1] of EMA
Close monitoring of liver enzymes should be considered if the two medicinal products are used concomitantly.
Caspofungin [1], dexamethasone ---> SmPC of [1] of EMA
When co-administering inducers of metabolic enzymes, an increase in the daily dose of caspofungin to 70 mg, following the 70 mg loading dose, should be considered in adult patients (see section 4.2).
Caspofungin [1], efavirenz ---> SmPC of [1] of EMA
When co-administering inducers of metabolic enzymes, an increase in the daily dose of caspofungin to 70 mg, following the 70 mg loading dose, should be considered in adult patients (see section 4.2).
Caspofungin [1], enzyme inductors ---> SmPC of [1] of EMA
Limited data suggest that an increase in the daily dose of caspofungin to 70 mg, following the 70 mg loading dose, should be considered when co-administering caspofungin in adult patients with certain inducers of metabolic enzymes
Caspofungin [1], fertility ---> SmPC of [1] of EMA
For caspofungin, there were no effects on fertility in studies conducted in male and female rats (see section 5.3). There are no clinical data for caspofungin to assess its impact on fertility.
Caspofungin [1], nevirapine ---> SmPC of [1] of EMA
When co-administering inducers of metabolic enzymes, an increase in the daily dose of caspofungin to 70 mg, following the 70 mg loading dose, should be considered in adult patients (see section 4.2).
Caspofungin [1], pharmacokinetics ---> SmPC of [1] of EMA
Clinical studies in healthy adult volunteers show that the pharmacokinetics of caspofungin are not altered to a clinically relevant extent by itraconazole, amphotericin B, mycophenolate, nelfinavir, or tacrolimus.
Caspofungin [1], pharmacokinetics ---> SmPC of [1] of EMA
Caspofungin did not influence the pharmacokinetics of amphotericin B, itraconazole, rifampicin or mycophenolate mofetil.
Caspofungin [1], phenytoin ---> SmPC of [1] of EMA
When co-administering inducers of metabolic enzymes, an increase in the daily dose of caspofungin to 70 mg, following the 70 mg loading dose, should be considered in adult patients (see section 4.2).
Caspofungin [1], pregnancy ---> SmPC of [1] of EMA
Caspofungin should not be used during pregnancy unless clearly needed
Caspofungin [1], rifampicin ---> SmPC of [1] of EMA
When co-administering inducers of metabolic enzymes, an increase in the daily dose of caspofungin to 70 mg, following the 70 mg loading dose, should be considered in adult patients (see section 4.2).
Caspofungin [1], tacrolimus ---> SmPC of [1] of EMA
Caspofungin reduced the trough concentration of tacrolimus by 26 % in healthy adult volunteers. For patients receiving both therapies, standard monitoring of tacrolimus blood concentrations and appropriate tacrolimus dosage adjustments are mandatory.
CONTRAINDICATIONS of Caspofungin (Cancidas)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/cancidas-epar-product-information_en.pdf 08/01/2026
Catridecacog (NovoThirteen)
Breast-feeding, catridecacog [2] ---> SmPC of [2] of EMA
A decision on whether to continue/discontinue breast-feeding or to continue/discontinue therapy
Catridecacog [1], fertility ---> SmPC of [1] of EMA
No effects on reproductive organs have been seen in non-clinical studies. There are no human data on potential effects on fertility.
Catridecacog [1], medicinal products ---> SmPC of [1] of EMA
There are no clinical data available on interaction between NovoThirteen and other medicinal products.
Catridecacog [1], pregnancy ---> SmPC of [1] of EMA
The use of NovoThirteen may be considered during pregnancy only if clearly indicated.
Catridecacog [1], recombinant activated FVII ---> SmPC of [1] of EMA
Based on the non-clinical study (see section 5.3) it is not recommended to combine NovoThirteen and recombinant activated FVII (rFVIIa).
CONTRAINDICATIONS of Catridecacog (NovoThirteen)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
Catumaxomab (Korjuny)
Ability to drive, catumaxomab [2] ---> SmPC of [2] of EMA
Patients experiencing infusion-related symptoms should be advised not to drive and use machines until symptoms abate.
Breast-feeding, catumaxomab [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breast-feeding or to discontinue / abstain from Korjuny therapy taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.
Catumaxomab [1], fertility ---> SmPC of [1] of EMA
No data on the effect of catumaxomab on fertility are available.
Catumaxomab [1], pregnancy ---> SmPC of [1] of EMA
Korjuny is not recommended during pregnancy and in women of childbearing potential not using contraception.
CONTRAINDICATIONS of Catumaxomab (Korjuny)
- Hypersensitivity to the active substance or to any of the excipients
- Hypersensitivity to murine (rat and / or mouse) proteins.
https://www.ema.europa.eu/en/documents/product-information/korjuny-epar-product-information_en.pdf 20/05/2025
Cefepime (Exblifep)
Ability to drive, cefepime [2] ---> SmPC of [2] of EMA
EXBLIFEP has moderate influence on the ability to drive and use machines. Possible adverse reactions such as altered state of consciousness, dizziness, confusion or hallucinations may alter the ability to drive and use machines
Bacteriostatic antibiotic, beta-lactam antibiotic ---> SmPC of [cefepime] of EMA
Concomitant treatment with bacteriostatic antibiotics may interfere with the action of beta-lactam antibiotics.
Breast-feeding, cefepime [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from cefepime-enmetazobactam therapy taking into account the benefit of breast feeding for the child and the benefit of therapy for the woman.
Cefepime [1], coumarin anticoagulants ---> SmPC of [1] of EMA
Cephalosporin antibiotics can potentiate the action of coumarin anticoagulants as seen with cefepime.
Cefepime [1], fertility ---> SmPC of [1] of EMA
The effects of cefepime and enmetazobactam on fertility in humans have not been studied. No impairment of fertility has been seen in male and female rats treated with cefepime or enmetazobactam (see section 5.3).
Cefepime [1], pregnancy ---> SmPC of [1] of EMA
Enmetazobactam should only be used during pregnancy when clearly indicated and only if the benefit for the mother outweighs the risk for the child.
Cefepime, oral anticoagulants [2] ---> SmPC of [2] of eMC
There have been many reports of increases in the anti-coagulant effects of orally administered anti-coagulant agents, including warfarin in patients who are concomitantly receiving antibacterial agents.
Enmetazobactam, pharmacokinetics ---> SmPC of [cefepime] of EMA
No clinical interaction studies have been performed with enmetazobactam. However, based on in vitro studies and considering routes of elimination, the pharmacokinetic interaction potential for enmetazobactam is low.
CONTRAINDICATIONS of Cefepime (Exblifep)
- Hypersensitivity to the active substances or to any of the excipients listed in section 6.1.
- Hypersensitivity to any cephalosporin antibacterial agent.
- Severe hypersensitivity (e.g., anaphylactic reaction, severe skin reaction) to any other type of beta-lactam antibacterial agent (e.g., penicillins, carbapenems or monobactams).
https://www.ema.europa.eu/en/documents/product-information/exblifep-epar-product-information_en.pdf 22/03/2024
Cefiderocol (Fetcroja)
Breast-feeding, cefiderocol [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from Fetcroja therapy taking into account the benefit of breast feeding for the child and the benefit of therapy for the woman.
Cefiderocol [1], cytochrome P450 ---> SmPC of [1] of EMA
Based on in vitro studies and two phase 1 clinical studies no significant drug-drug interactions are anticipated between cefiderocol and substrates, inhibitors or inducers of cytochrome P450 enzymes (CYPs) or transporters (see section 5.2).
Cefiderocol [1], fertility ---> SmPC of [1] of EMA
The effect of cefiderocol on fertility in humans has not been studied. Based on preclinical data, from a study with sub-clinical exposure, there is no evidence that Fetcroja has an effect on male or female fertility (see section 5.3).
Cefiderocol [1], midazolam ---> SmPC of [1] of EMA
Co-administration with 2 g doses of cefiderocol given every 8 hours did not affect the pharmacokinetics of midazolam (a CYP3A substrate), furosemide (a OAT1 and OAT3 substrate) or metformin (a OCT1, OCT2, and MATE2-K substrate).
Cefiderocol [1], pregnancy ---> SmPC of [1] of EMA
As a precautionary measure, it is preferable to avoid the use of Fetcroja during pregnancy.
Cefiderocol [1], rosuvastatin ---> SmPC of [1] of EMA
Co-administration with 2 g doses of cefiderocol given every 8 hours increased rosuvastatin (a OATP1B3 substrate) AUC by 21%, which was considered not to be clinically meaningful.
CONTRAINDICATIONS of Cefiderocol (Fetcroja)
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
Hypersensitivity to any cephalosporin antibacterial medicinal product.
Severe hypersensitivity (e.g. anaphylactic reaction, severe skin reaction) to any other type of betalactam antibacterial agent (e.g. penicillins, monobactams or carbapenems).
https://www.ema.europa.eu/en/documents/product-information/fetcroja-epar-product-information_en.pdf 19/07/2024
Ceftarolin fosamil (Zinforo)
Ability to drive, ceftarolin fosamil [2] ---> SmPC of [2] of EMA
Undesirable effects e.g. dizziness may occur and this may have an effect on the ability to drive and use of machines (see section 4.8).
Breast-feeding, ceftarolin fosamil [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from Zinforo therapy taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.
Ceftarolin fosamil [1], CYP450 ---> SmPC of [1] of EMA
The interaction potential of ceftaroline or ceftaroline fosamil on medicinal products metabolised by CYP450 enzymes is expected to be low since they are not inhibitors nor inducers of CYP450 enzymes in vitro.
Ceftarolin fosamil [1], CYP450 ---> SmPC of [1] of EMA
Ceftaroline or ceftaroline fosamil are not metabolised by CYP450 enzymes in vitro, therefore co-administered CYP450 inducers or inhibitors are unlikely to influence the pharmacokinetics of ceftaroline.
Ceftarolin fosamil [1], fertility ---> SmPC of [1] of EMA
The effects of ceftaroline fosamil on fertility on humans have not been studied. Animal studies with ceftaroline fosamil do not indicate harmful effects with respect to fertility (see section 5.3).
Ceftarolin fosamil [1], pregnancy ---> SmPC of [1] of EMA
As a precautionary measure, it is preferable to avoid the use of Zinforo during pregnancy unless the clinical condition of the woman requires treatment with an antibiotic with Zinforo's antibacterial profile.
Ceftarolin fosamil [1], probenecide ---> SmPC of [1] of EMA
Ceftaroline is neither a substrate, nor an inhibitor of renal uptake transporters (OCT2, OAT1, and OAT3) in vitro. Therefore, interactions of ceftaroline with drugs that are substrates or inhibitors of these transporters would not be expected.
Ceftarolin fosamil [1], renal uptake transporters ---> SmPC of [1] of EMA
Ceftaroline is neither a substrate, nor an inhibitor of renal uptake transporters (OCT2, OAT1, and OAT3) in vitro. Therefore, interactions of ceftaroline with drugs that are substrates or inhibitors of these transporters would not be expected.
CONTRAINDICATIONS of Ceftarolin fosamil (Zinforo)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Hypersensitivity to the cephalosporin class of antibacterials.
- Immediate and severe hypersensitivity (e.g. anaphylactic reaction) to any other type of beta-lactam antibacterial agent (e.g. penicillins or carbapenems).
https://www.ema.europa.eu/en/documents/product-information/zinforo-epar-product-information_en.pdf 21/02/2024
Ceftazidime/avibactam (Zavicefta)
Ability to drive, ceftazidime/avibactam [2] ---> SPC of [2] of EMA
Undesirable effects may occur (e.g. dizziness), which may influence the ability to drive and use machines following administration of Zavicefta
Aminoglycoside antibiotics, cephalosporins ---> SPC of [ceftazidime/avibactam] of EMA
Concurrent treatment with high doses of cephalosporins and nephrotoxic medicinal products such as aminoglycosides or potent diuretics (e.g. furosemide) may adversely affect renal function
Breast-feeding, ceftazidime/avibactam [2] ---> SPC of [2] of EMA
A decision must be made whether to discontinue breast feeding or to discontinue/abstain from ceftazidime/avibactam therapy taking into account the benefit of breast feeding for the child and the benefit of therapy for the woman.
Ceftazidime, chloramphenicol ---> SPC of [ceftazidime/avibactam] of EMA
Chloramphenicol is antagonistic in vitro with ceftazidime and other cephalosporins. The clinical relevance of this finding is unknown, but due to the possibility of antagonism in vivo this drug combination should be avoided.
Ceftazidime/avibactam [1], cytochrome P450 ---> SPC of [1] of EMA
Avibactam showed no significant inhibition of cytochrome P450 enzymes in vitro. Avibactam and ceftazidime showed no in vitro cytochrome P450 induction at clinically relevant concentrations.
Ceftazidime/avibactam [1], cytochrome P450 ---> SPC of [1] of EMA
Avibactam and ceftazidime do not inhibit the major renal or hepatic transporters in the clinically relevant exposure range, therefore the interaction potential via these mechanisms is considered to be low.
Ceftazidime/avibactam [1], metronidazole ---> SPC of [1] of EMA
Clinical data have demonstrated that there is no interaction between ceftazidime and avibactam, and between ceftazidime/avibactam and metronidazole.
Ceftazidime/avibactam [1], pregnancy ---> SPC of [1] of EMA
Ceftazidime/avibactam should only be used during pregnancy if the potential benefit outweighs the possible risk.
Ceftazidime/avibactam [1], probenecide ---> SPC of [1] of EMA
In vitro, avibactam is a substrate of OAT1 and OAT3 transporters. Probenecid (a potent OAT inhibitor) inhibits the active uptake of avibactam by 56% to 70% in vitro and, therefore, has the potential to alter the elimination of avibactam.
Cephalosporins, chloramphenicol ---> SPC of [ceftazidime/avibactam] of EMA
Chloramphenicol is antagonistic in vitro with ceftazidime and other cephalosporins. The clinical relevance of this finding is unknown, but due to the possibility of antagonism in vivo this drug combination should be avoided.
Cephalosporins, furosemide ---> SPC of [ceftazidime/avibactam] of EMA
Concurrent treatment with high doses of cephalosporins and nephrotoxic medicinal products such as aminoglycosides or potent diuretics (e.g. furosemide) may adversely affect renal function
Cephalosporins, nephrotoxic substances ---> SPC of [ceftazidime/avibactam] of EMA
Concurrent treatment with high doses of cephalosporins and nephrotoxic medicinal products such as aminoglycosides or potent diuretics (e.g. furosemide) may adversely affect renal function
Cephalosporins, strong diuretic agents ---> SPC of [ceftazidime/avibactam] of EMA
Concurrent treatment with high doses of cephalosporins and nephrotoxic medicinal products such as aminoglycosides or potent diuretics (e.g. furosemide) may adversely affect renal function
CONTRAINDICATIONS of Ceftazidime/avibactam (Zavicefta)
- Hypersensitivity to the active substances or to any of the excipients listed in section 6.1.
- Hypersensitivity to any cephalosporin antibacterial agent.
- Severe hypersensitivity (e.g. anaphylactic reaction, severe skin reaction) to any other type of beta-lactam antibacterial agent (e.g. penicillins, monobactams or carbapenems).
https://www.ema.europa.eu/en/documents/product-information/zavicefta-epar-product-information_en.pdf 27/02/2025
Ceftolozane/tazobactam (Zerbaxa)
Ability to drive, ceftolozane/tazobactam [2] ---> SmPC of [2] of EMA
Zerbaxa may have a minor influence on the ability to drive and use machines. Dizziness may occur following administration of Zerbaxa (see section 4.8).
Breast-feeding, ceftolozane/tazobactam [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from Zerbaxa therapy taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.
Ceftolozane/tazobactam [1], cytochrome P450 ---> SmPC of [1] of EMA
No significant medicinal product interactions are anticipated between ceftolozane/tazobactam and substrates, inhibitors, and inducers of cytochrome P450 enzymes (CYPs) based on in vitro and in vivo studies.
Ceftolozane/tazobactam [1], fertility ---> SmPC of [1] of EMA
Fertility studies in rats showed no effect on fertility and mating after intraperitoneal administration of tazobactam or intravenous administration of ceftolozane (see section 5.3).
Ceftolozane/tazobactam [1], furosemide ---> SmPC of [1] of EMA
Co-administration of ceftolozane/tazobactam with OAT1 and OAT3 substrate furosemide in a clinical study did not significantly increase furosemide plasma exposures
Ceftolozane/tazobactam [1], OAT1 inhibitors ---> SmPC of [1] of EMA
Tazobactam is a substrate for OAT1 and OAT3. Active substances that inhibit OAT1 or OAT3 (e.g., probenecid) may increase tazobactam plasma concentrations.
Ceftolozane/tazobactam [1], OAT3 inhibitors ---> SmPC of [1] of EMA
Tazobactam is a substrate for OAT1 and OAT3. Active substances that inhibit OAT1 or OAT3 (e.g., probenecid) may increase tazobactam plasma concentrations.
Ceftolozane/tazobactam [1], pregnancy ---> SmPC of [1] of EMA
Zerbaxa should only be used during pregnancy if the expected benefit outweighs the possible risks to the pregnant woman and foetus.
Ceftolozane/tazobactam [1], probenecide ---> SmPC of [1] of EMA
Tazobactam is a substrate for OAT1 and OAT3. Active substances that inhibit OAT1 or OAT3 (e.g., probenecid) may increase tazobactam plasma concentrations.
CONTRAINDICATIONS of Ceftolozane/tazobactam (Zerbaxa)
- Hypersensitivity to the active substances or to any of the excipients listed in section 6.1;
- Hypersensitivity to any cephalosporin antibacterial agent;
- Severe hypersensitivity (e.g., anaphylactic reaction, severe skin reaction) to any other type of beta-lactam antibacterial agent (e.g., penicillins or carbapenems).
https://www.ema.europa.eu/en/documents/product-information/zerbaxa-epar-product-information_en.pdf 16/04/2025
Ceftriaxone
Ability to drive, ceftriaxone [2] ---> SPC of [2] of eMC
Since ceftriaxone sometimes induces dizziness the ability to drive and use machines can be impaired.
Alcohol, ceftriaxone
No effect similar to that of disulfiram has been demonstrated after ingestion of alcohol subsequent to the administration of ceftriaxone.
Aminoglycoside antibiotics, ceftriaxone [2] ---> SPC of [2] of eMC
No interference with the action or increase in nephrotoxicity of aminoglycosides has been observed during simultaneous administration with ceftriaxone.
Amsacrine, ceftriaxone [2] ---> SPC of [2] of eMC
Based on literature reports ceftriaxone is incompatible with amsacrine
Bacteriostatic antibiotics, ceftriaxone
The co-administration of a bactericide antibiotic with a bacteriostatic should be avoided due to possible antagonist effects
Breast-feeding, ceftriaxone [2] ---> SPC of [2] of eMC
Low concentrations of ceftriaxone are excreted in human milk. Caution should be exercised when ceftriaxone is administered to a nursing woman.
Calcium, ceftriaxone
The parenteral co-administration of ceftriaxone with calcium-containing solutions is contraindicated in newborns
Ceftriaxone [1], chloramphenicol ---> SPC of [1] of eMC
In an in-vitro study antagonistic effects have been observed with the combination of chloramphenicol and ceftriaxone. Caution is advised if concurrent administration of ceftriaxone with chloramphenicol is proposed.
Ceftriaxone [1], fluconazole ---> SPC of [1] of eMC
Based on literature reports ceftriaxone is incompatible with fluconazole
Ceftriaxone [1], oral contraceptives ---> SPC of [1] of eMC
Ceftriaxone may adversely affect the efficacy of oral hormonal contraceptives. Consequently, it is advisable to use supplementary (non-hormonal) contraceptive measures during treatment and in the month following treatment.
Ceftriaxone [1], pregnancy ---> SPC of [1] of eMC
Since safety in human pregnancy is not established ceftriaxone should not be used unless absolutely indicated.
Ceftriaxone [1], probenecide ---> SPC of [1] of eMC
The elimination of ceftriaxone is not altered by probenecid.
Ceftriaxone [1], sulphamides ---> SPC of [1] of eMC
The co-administration of a bactericide antibiotic with a bacteriostatic should be avoided due to possible antagonist effects
Ceftriaxone [1], sulphonamides ---> SPC of [1] of eMC
The co-administration of a bactericide antibiotic with a bacteriostatic should be avoided due to possible antagonist effects
Ceftriaxone, diclofenac
Diclofenac may increase the elimination of ceftriaxone
Ceftriaxone, erythromycin
The co-administration of a bactericide antibiotic with a bacteriostatic should be avoided due to possible antagonist effects
Ceftriaxone, gadoxetate
Block of hepatic uptake of gadoxetic acid and decreased hepatic contrast
Ceftriaxone, gadoxetic acid
Block of hepatic uptake of gadoxetic acid and decreased hepatic contrast
Ceftriaxone, lidocaine
Contraindicated: during pregnancy and lactation and the intramuscular administration in newborns with cardiac disturbances in conduction or acute decompensated cardiac failure
Ceftriaxone, oral anticoagulants
There have been many reports of increases in the anti-coagulant effects of orally administered anti-coagulant agents, including warfarin in patients who are concomitantly receiving antibacterial agents.
Ceftriaxone, strong diuretic agents
No impairment of renal function has so far been observed after concurrent administration of large doses of ceftriaxone and potent diuretics
Ceftriaxone, tetracyclines
The co-administration of a bactericide antibiotic with a bacteriostatic should be avoided due to possible antagonist effects
Ceftriaxone, vancomycin [2] ---> SPC of [2] of eMC
Based on literature reports ceftriaxone is incompatible with vancomycin
Ceftriaxone, warfarin
Ceftriaxone may enhance the anticoagulant effect
CONTRAINDICATIONS of Ceftriaxone
- Ceftriaxone is contraindicated in patients with known hypersensitivity to beta-lactam antibiotics.
- In patients hypersensitive to penicillin, the possibility of allergic cross-reactions should be borne in mind.
- Hyperbilirubinaemic newborns and preterm newborns should not be treated with ceftriaxone. In vitro studies have shown that ceftriaxone can displace bilirubin from its binding to serum albumin and bilirubin encephalopathy can possibly develop in these patients.
- Premature newborns up to a corrected age of 41 weeks (weeks of gestation + weeks of life).
- Full-term newborns (up to 28 days of age)
- with jaundice, or who are hypoalbuminaemic or acidotic because these are conditions in which bilirubin binding is likely to be impaired
- if they require (or are expected to require) IV calcium treatment, or calcium-containing infusions because of the risk of precipitation of ceftriaxone-calcium
Contraindications of lidocaine must be excluded before intramuscular injection of ceftriaxone when lidocaine is used as a solvent.
http://www.medicines.org.uk/emc/
Cefuroxime axetil
Alkalinizing agents [1], cefuroxime axetil
Drugs which reduce gastric acidity may result in a lower bioavailability of cefuroxime axetil compared with that of the fasting state and tend to cancel the effect of enhanced absorption after food.
Breast-feeding, cefuroxime axetil [2] ---> SPC of [2] of eMC
Cefuroxime should only be used during breastfeeding after benefit/risk assessment by the physician in charge.
Cefuroxime axetil [1], estrogens ---> SPC of [1] of eMC
Cefuroxime axetil may affect the gut flora, leading to lower oestrogen reabsorption and reduced efficacy of combined oral contraceptives.
Cefuroxime axetil [1], gastric pH increasing medication ---> SPC of [1] of eMC
Drugs which reduce gastric acidity may result in a lower bioavailability of cefuroxime axetil compared with that of the fasting state and tend to cancel the effect of enhanced absorption after food.
Cefuroxime axetil [1], pregnancy ---> SPC of [1] of eMC
Cefuroxime axetil should be prescribed to pregnant women only if the benefit outweighs the risk.
Cefuroxime axetil [1], probenecide ---> SPC of [1] of eMC
Concurrent administration of probenecid significantly increases the peak concentration, area under the serum concentration time curve and elimination half-life of cefuroxime.
CONTRAINDICATIONS of Cefuroxime axetil
- Hypersensitivity to cefuroxime or to any of the excipients
- Patients with known hypersensitivity to cephalosporin antibiotics.
- History of severe hypersensitivity (e.g. anaphylactic reaction) to any other type of betalactam antibacterial agent (penicillins, monobactams and carbapenems).
http://www.medicines.org.uk/emc/
Celecoxib
Ability to drive, celecoxib [2] ---> SPC of [2] of EMA
Dizziness, vertigo or somnolence may occur
ACE inhibitors, celecoxib [2] ---> SPC of [2] of EMA
The co-administration may decrease the antihypertensive effect and increase the risk of renal failure
Acenocoumarol, celecoxib
The co-administration may enhance the anticoagulant effect and increase the bleeding risk.
Acetylsalicylic acid, celecoxib [2] ---> SPC of [2] of EMA
Increased risk of gastrointestinal ulcus/complications
AIIRA, celecoxib [2] ---> SPC of [2] of EMA
The co-administration may decrease the antihypertensive effect and increase the risk of renal failure
Antihypertensives, celecoxib [2] ---> SPC of [2] of EMA
NSAIDs may reduce the effect of antihypertensive medicinal products.
Antihypertensives, tenoxicam ---> SPC of [celecoxib] of EMA
Tenoxicam and other NSAIDs can reduce the effects of anti-hypertensive drugs.
Barbiturates, celecoxib [2] ---> SPC of [2] of EMA
Concomitant use of inducers of celecoxib with CYP2C9 may reduce plasma concentrations of celecoxib.
Breast-feeding, celecoxib [2] ---> SPC of [2] of EMA
Women who take celecoxib should not breastfeed.
Calcium antagonists, celecoxib
Increased risk of acute renal insufficiency in patients with renal insufficiency
Carbamazepine, celecoxib [2] ---> SPC of [2] of EMA
Concomitant use of inducers of celecoxib with CYP2C9 may reduce plasma concentrations of celecoxib.
Celecoxib [1], cyclosporine ---> SPC of [1] of EMA
The combination may increase the risk of nephrotoxicity. Renal function must be closely monitored.
Celecoxib [1], CYP2C9 inductors ---> SPC of [1] of EMA
Concomitant use of inducers of celecoxib with CYP2C9 may reduce plasma concentrations of celecoxib.
Celecoxib [1], CYP2C9 inhibitors ---> SPC of [1] of EMA
Concomitant treatment of celecoxib with CYP2C9 inhibitors could result in further increases in celecoxib exposure.
Celecoxib [1], diuretics ---> SPC of [1] of EMA
Reduced diuretic and antihypertensive effect of diuretic. Diuretic can increase the risk of nephrotoxicity of the NSAID
Celecoxib [1], drugs metabolised by CYP2D6 ---> SPC of [1] of EMA
The plasma concentrations of medicinal products that are substrates of CYP2D6 may be increased when celecoxib is used concomitantly.
Celecoxib [1], drugs primarily metabolised by CYP2D6 ---> SPC of [1] of EMA
The plasma concentrations of medicinal products that are substrates of CYP2D6 may be increased when celecoxib is used concomitantly.
Celecoxib [1], lisinopril ---> SPC of [1] of EMA
Administration of celecoxib 200 mg BID resulted in no clinically significant increases, when compared to placebo treatment, in mean daily systolic or diastolic blood pressure
Celecoxib [1], lithium ---> SPC of [1] of EMA
Increased plasma levels of lithium
Celecoxib [1], oral anticoagulants ---> SPC of [1] of EMA
Anticoagulant activity should be monitored in patients taking warfarin or other anticoagulants
Celecoxib [1], pregnancy ---> SPC of [1] of EMA
Celecoxib is contraindicated in pregnancy and in women who can become pregnant unless using an effective method of contraception
Celecoxib [1], rifampicin ---> SPC of [1] of EMA
Concomitant use of inducers of celecoxib with CYP2C9 may reduce plasma concentrations of celecoxib.
Celecoxib [1], strong CYP2C9 inhibitors ---> SPC of [1] of EMA
Concomitant treatment of celecoxib with CYP2C9 inhibitors could result in further increases in celecoxib exposure.
Celecoxib [1], tacrolimus ---> SPC of [1] of EMA
The combination may increase the risk of nephrotoxicity. Renal function must be closely monitored.
Celecoxib [1], warfarin ---> SPC of [1] of EMA
Anticoagulant activity should be monitored in patients taking warfarin or other anticoagulants
Celecoxib, dextromethorphan
Treatment with celecoxib produced an increase in plasma concentrations of dextromethorphan (CYP2D6 substrate)
Celecoxib, felodipine/metoprolol
CYP2D6 inhibitors may increase the plasma levels of metoprolol
Celecoxib, fluconazole [2] ---> SPC of [2] of eMC
During concomitant treatment with fluconazole and celecoxib the celecoxib Cmax and AUC increased by 68% and 134%, respectively. Half of the celecoxib dose may be necessary when combined with fluconazole.
Celecoxib, glycerol phenylbutyrate [2] ---> SPC of [2] of EMA
The effects of glycerol phenylbutyrate on cytochrome P450 (CYP) 2C9 isoenzyme and potential for interaction with celecoxib has been studied in humans with no evidence of an interaction observed.
Celecoxib, primidone
Primidone, enzymatic inductor, may accelerate the metabolism of celecoxib and decrease its plasma levels and effect
Celecoxib, proteolytic enzymes enriched in bromelain [2] ---> SPC of [2] of EMA
NexoBrid, when absorbed, is an inhibitor of CYP2C8 and CYP2C9. This should be taken into account if it is used in patients receiving CYP2C9 substrates
CONTRAINDICATIONS of Celecoxib
- Hypersensitivity to the active substance or to any of the excipients
- Known hypersensitivity to sulphonamides.
- Active peptic ulceration or gastrointestinal (GI) bleeding.
- Patients who have experienced asthma, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria or other allergic-type reactions after taking acetylsalicylic acid or non steroidal antiinflammatory drugs (NSAIDs) including COX-2 (cyclooxigenase-2) selective inhibitors.
- In pregnancy and in women who can become pregnant unless using an effective method of contraception
- Breast feeding
- Severe hepatic dysfunction (serum albumin < 25 g/l or Child-Pugh score >10) (Class C).
- Patients with renal insufficiency with estimated creatinine clearance <30 ml/ min.
- Inflammatory bowel disease.
- Congestive heart failure (NYHA II-IV).
- Established ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease longer authorised
Celiprolol
Ability to drive, celiprolol [2] ---> SPC of [2] of eMC
It should be taken into account that occasional dizziness or fatigue may occur as well as the potential for tremor, headaches or impaired vision.
Adrenaline, celiprolol
Sympathomimetic agents, such as adrenaline, may counteract the effects of beta blockers.
Alcohol, celiprolol
Increased hypotensive effect
Amiodarone, celiprolol [2] ---> SPC of [2] of eMC
Care should be taken in prescribing beta-adrenoceptor blockers with Class I antiarrhythmic agents, since these agents may potentiate the negative effects on A-V conduction and myocardial contractility.
Anaesthetics, celiprolol [2] ---> SPC of [2] of eMC
Therapy with beta-adrenoceptor blockers must be reported to the anaesthetist prior to general anaesthesia as they may attenuate the reflex tachycardia and increase the risk of hypotension
Analgesics, celiprolol
Additive effect
Antidepressants, celiprolol
Additive effect
Antiepileptics, celiprolol
Additive effect
Antihypertensives, celiprolol
Concomitant use may potentiate the orthostatic hypotensive effects of beta blockers.
Barbiturates, celiprolol
Concomitant use may potentiate the orthostatic hypotensive effects of beta blockers.
Beta2-adrenergic agonists, celiprolol
Celiprolol may weaken or antagonise the effect of the beta2-adrenergic agonist
Breast-feeding, celiprolol [2] ---> SPC of [2] of eMC
The use of celiprolol is not recommended in breast-feeding mothers.
Cardiodepressants, celiprolol
The co-administration with anaesthetic agents causing myocardial depression should be avoided
Catecholamine depleting drugs, celiprolol
The co-administration may increase the hypotensive effect and the negative chronotropic and dromotropic effect
Celiprolol [1], class IA antiarrhythmic agents ---> SPC of [1] of eMC
Care should be taken in prescribing beta-adrenoceptor blockers with Class I antiarrhythmic agents, since these agents may potentiate the negative effects on A-V conduction and myocardial contractility.
Celiprolol [1], class IB antiarrhythmic agents ---> SPC of [1] of eMC
Care should be taken in prescribing beta-adrenoceptor blockers with Class I antiarrhythmic agents, since these agents may potentiate the negative effects on A-V conduction and myocardial contractility.
Celiprolol [1], class IC antiarrhythmic agents ---> SPC of [1] of eMC
Care should be taken in prescribing beta-adrenoceptor blockers with Class I antiarrhythmic agents, since these agents may potentiate the negative effects on A-V conduction and myocardial contractility.
Celiprolol [1], dihydropyridines ---> SPC of [1] of eMC
Concomitant therapy of celiprolol with dihydropyridine calcium channel antagonists may increase the risk of hypotension, and cardiac failure may occur in patients with latent or uncontrolled cardiac insufficiency.
Celiprolol [1], diltiazem ---> SPC of [1] of eMC
Calcium channel antagonists such as verapamil (and to a lesser extent diltiazem) and beta blockers both slow A-V conduction and depress myocardial contractility through different mechanisms.
Celiprolol [1], disopyramide ---> SPC of [1] of eMC
Care should be taken in prescribing beta-adrenoceptor blockers with Class I antiarrhythmic agents, since these agents may potentiate the negative effects on A-V conduction and myocardial contractility.
Celiprolol [1], floctafenine ---> SPC of [1] of eMC
In case of shock or hypotension due to floctafenine, beta-blockers may reduce the effectiveness of drugs used to compensate these symptoms.
Celiprolol [1], foods ---> SPC of [1] of eMC
It has been shown that the bioavailability of celiprolol is impaired when it is given with food.
Celiprolol [1], ibuprofen ---> SPC of [1] of eMC
Drugs inhibiting prostaglandin synthetase may decrease the hypotensive effects of beta-adrenoceptor blocking drugs.
Celiprolol [1], IMAOs ---> SPC of [1] of eMC
There is a theoretical risk that concurrent administration of monoamine oxidase inhibitors and high doses of beta-adrenoceptor blockers, even if they are cardio selective, can produce hypotension and is therefore not recommended.
Celiprolol [1], indometacin ---> SPC of [1] of eMC
Drugs inhibiting prostaglandin synthetase may decrease the hypotensive effects of beta-adrenoceptor blocking drugs.
Celiprolol [1], insulin ---> SPC of [1] of eMC
Beta blockers may intensify the blood sugar lowering effects of insulin. In addition, beta-adrenoceptor blockers may mask the symptoms of thyrotoxicosis or hypoglycaemia (in particular, tachycardia).
Celiprolol [1], mefloquine ---> SPC of [1] of eMC
Concomitant therapy with mefloquine may cause bradycardia.
Celiprolol [1], nifedipine ---> SPC of [1] of eMC
Concomitant therapy of celiprolol with dihydropyridine calcium channel antagonists may increase the risk of hypotension, and cardiac failure may occur in patients with latent or uncontrolled cardiac insufficiency.
Celiprolol [1], NSAID ---> SPC of [1] of eMC
Drugs inhibiting prostaglandin synthetase may decrease the hypotensive effects of beta-adrenoceptor blocking drugs.
Celiprolol [1], oral antidiabetics ---> SPC of [1] of eMC
Beta blockers may intensify the blood sugar lowering effects of oral antidiabetic drugs. In addition, beta-adrenoceptor blockers may mask the symptoms of thyrotoxicosis or hypoglycaemia (in particular, tachycardia).
Celiprolol [1], phenothiazines ---> SPC of [1] of eMC
Concomitant use may potentiate the orthostatic hypotensive effects of beta blockers.
Celiprolol [1], phenylalkylamines ---> SPC of [1] of eMC
Calcium channel antagonists such as verapamil (and to a lesser extent diltiazem) and beta blockers both slow A-V conduction and depress myocardial contractility through different mechanisms.
Celiprolol [1], pregnancy ---> SPC of [1] of eMC
Celiprolol should not be used during pregnancy unless there is no safer alternative.
Celiprolol [1], quinidine ---> SPC of [1] of eMC
Care should be taken in prescribing beta-adrenoceptor blockers with Class I antiarrhythmic agents, since these agents may potentiate the negative effects on A-V conduction and myocardial contractility.
Celiprolol [1], tricyclic antidepressant ---> SPC of [1] of eMC
Concomitant use may potentiate the orthostatic hypotensive effects of beta blockers.
Celiprolol [1], verapamil ---> SPC of [1] of eMC
Calcium channel antagonists such as verapamil (and to a lesser extent diltiazem) and beta blockers both slow A-V conduction and depress myocardial contractility through different mechanisms.
Celiprolol, centrally-acting antihypertensives
The co-administration may increase the hypotensive effect and the negative chronotropic and dromotropic effect
Celiprolol, chloroform
The co-administration with anaesthetic agents causing myocardial depression should be avoided
Celiprolol, chlortalidone
The co-administration may decrease the bioavailibility of celiprolol
Celiprolol, cimetidine
Enhanced celiprolol effect
Celiprolol, clenbuterol
Celiprolol may weaken or antagonise the effect of clenbuterol
Celiprolol, clonidine
The co-administration may increase the hypotensive effect and the negative chronotropic and dromotropic effect
Celiprolol, CNS depressants
Additive effect
Celiprolol, cyclopropane
The co-administration with anaesthetic agents causing myocardial depression should be avoided
Celiprolol, digital glycosides
Digitalis glycosides, in association with beta-adrenoceptor blocking drugs, may increase A-V conduction time.
Celiprolol, ether
The co-administration with anaesthetic agents causing myocardial depression should be avoided
Celiprolol, grapefruit juice
The intake of grapefruit/grapefruit juice should be avoided
Celiprolol, guanfacin
The co-administration may increase the hypotensive effect and the negative chronotropic and dromotropic effect
Celiprolol, hydrochlorothiazide
The co-administration may decrease the bioavailibility of celiprolol
Celiprolol, hypnotics
Additive effect
Celiprolol, methyldopa
The co-administration may increase the hypotensive effect and the negative chronotropic and dromotropic effect
Celiprolol, neuroleptics
Additive effect
Celiprolol, noradrenaline
Noradrenaline may counteract the effects of celiprolol
Celiprolol, norepinephrine
Noradrenaline may counteract the effects of celiprolol
Celiprolol, opiate agonists
Additive effect
Celiprolol, orange juice
The intake of orange juice should be avoided
Celiprolol, parasympathomimetics
The co-administration may prolong the atrioventricular conduction time and cause additive effects (e. g. hypotension, bradycardia and AV blockade)
Celiprolol, peripheral muscle relaxants
Increased neuromuscular blockade
Celiprolol, prolongation of the AV conduction time
The co-administration may prolong the atrioventricular conduction time and cause additive effects (e. g. hypotension, bradycardia and AV blockade)
Celiprolol, reserpine
The co-administration may increase the hypotensive effect and the negative chronotropic and dromotropic effect
Celiprolol, rifampicin
Rifampicin, enzymatic inductor, may increase the metabolism of celiprolol and decrease its plasma levels and effect
Celiprolol, salbutamol
Celiprolol may weaken or antagonise the effect of salbutamol
Celiprolol, succinylcholine
The co-administration may enhance or prolong the neuromuscular blocking effects of suxamethonium
Celiprolol, suxamethonium
The co-administration may enhance or prolong the neuromuscular blocking effects of suxamethonium
Celiprolol, sympathomimetics
Sympathomimetic agents, such as adrenaline, may counteract the effects of beta blockers.
Celiprolol, trichloroethylene
The co-administration with anaesthetic agents causing myocardial depression should be avoided
Celiprolol, tubocuranine
Increased neuromuscular blockade
Celiprolol, vasodilators
Concomitant use may potentiate the orthostatic hypotensive effects of beta blockers.
CONTRAINDICATIONS of Celiprolol
As with other beta-adrenoceptor antagonists, celiprolol should not be used in cases of
- cardiogenic shock,
- uncontrolled heart failure,
- sick-sinus syndrome, (including sino-atrial block),
- second or third degree heart block,
- severe bradycardia (< 45-50 beats per minute),
- severe renal impairment with creatinine clearance less than 15 ml per minute,
- acute episodes of asthma,
- untreated phaeochromocytoma,
- metabolic acidosis,
- hypotension,
- hypersensitivity to the active substance or any of the excipients, or
- severe peripheral arterial circulatory disturbances.
The tablets should not be prescribed for patients being treated with theophylline.
http://www.medicines.org.uk/emc/
Cemiplimab (Libtayo)
Ability to drive, cemiplimab [2] ---> SmPC of [2] of EMA
Cemiplimab has no or negligible influence on the ability to drive and use machines. Fatigue has been reported following treatment with cemiplimab
Breast-feeding, cemiplimab [2] ---> SmPC of [2] of EMA
If a woman chooses to be treated with cemiplimab, she should be instructed not to breast-feed while being treated with cemiplimab and for at least 4 months after the last dose.
Cemiplimab [1], corticosteroids ---> SmPC of [1] of EMA
The use of systemic corticosteroids or immunosuppressants before starting cemiplimab, except for physiological doses of systemic corticosteroid (≤ 10 mg/day prednisone or equivalent), should be avoided
Cemiplimab [1], corticosteroids ---> SmPC of [1] of EMA
However, systemic corticosteroids or other immunosuppressants can be used after starting cemiplimab to treat immune-mediated adverse reactions (see section 4.2).
Cemiplimab [1], fertility ---> SmPC of [1] of EMA
No effects on fertility assessment parameters or in the male and female reproductive organs were observed in a 3-month repeat dose fertility assessment study with sexually mature cynomolgus monkeys.
Cemiplimab [1], immunosuppressives ---> SmPC of [1] of EMA
The use of systemic corticosteroids or immunosuppressants before starting cemiplimab, except for physiological doses of systemic corticosteroid (≤ 10 mg/day prednisone or equivalent), should be avoided
Cemiplimab [1], interactions ---> SmPC of [1] of EMA
No pharmacokinetic (PK) drug-drug interaction studies have been conducted with cemiplimab.
Cemiplimab [1], pregnancy ---> SmPC of [1] of EMA
Cemiplimab is not recommended during pregnancy and in women of childbearing potential not using effective contraception unless the clinical benefit outweighs the potential risk.
Cemiplimab [1], women of childbearing potential ---> SmPC of [1] of EMA
Women of childbearing potential should use effective contraception during treatment with cemiplimab and for at least 4 months after the last dose of cemiplimab.
CONTRAINDICATIONS of Cemiplimab (Libtayo)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/libtayo-epar-product-information_en.pdf 12/01/2024
Cenegermin (Oxervate)
Ability to drive, cenegermin [2] ---> SmPC of [2] of EMA
If blurred vision occurs at instillation, the patient must wait until the vision clears before driving or using machines.
Absorption, cenegermin [2] ---> SmPC of [2] of EMA
As systemic absorption of cenegermin after use of the medicinal product is negligible or not detectable, no drug interactions are anticipated.
Benzalkonium chloride, cenegermin [2] ---> SmPC of [2] of EMA
Other topical ophthalmic products may be used during treatment with OXERVATE when used 15 minutes apart, with the exception of agents known to inhibit epithelial healing (e.g. corticosteroids or eye drops containing preservatives
Breast-feeding, cenegermin [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from this therapy
Cenegermin [1], cetrimide ---> SmPC of [1] of EMA
Other topical ophthalmic products may be used during treatment with OXERVATE when used 15 minutes apart, with the exception of agents known to inhibit epithelial healing (e.g. corticosteroids or eye drops containing preservatives
Cenegermin [1], corticosteroids ---> SmPC of [1] of EMA
Other topical ophthalmic products may be used during treatment with OXERVATE when used 15 minutes apart, with the exception of agents known to inhibit epithelial healing (e.g. corticosteroids or eye drops containing preservatives
Cenegermin [1], epithelial healing ---> SmPC of [1] of EMA
Other topical ophthalmic products may be used during treatment with OXERVATE when used 15 minutes apart, with the exception of agents known to inhibit epithelial healing (e.g. corticosteroids or eye drops containing preservatives
Cenegermin [1], fertility ---> SmPC of [1] of EMA
There are no data on the effects of cenegermin on human fertility.
Cenegermin [1], pregnancy ---> SmPC of [1] of EMA
As a precautionary measure, it is preferable to avoid the use of OXERVATE during pregnancy.
Cenegermin [1], preservative ---> SmPC of [1] of EMA
Other topical ophthalmic products may be used during treatment with OXERVATE when used 15 minutes apart, with the exception of agents known to inhibit epithelial healing (e.g. corticosteroids or eye drops containing preservatives
CONTRAINDICATIONS of Cenegermin (Oxervate)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/oxervate-epar-product-information_en.pdf 25/10/2024
cenobamate (Ontozry)
Ability to drive, cenobamate [2] ---> SmPC of [2] of EMA
Cenobamate may cause somnolence, dizziness, fatigue, impaired vision and other CNS-related symptoms, which may influence the ability to drive or use machines.
Alcohol, cenobamate [2] ---> SmPC of [2] of EMA
Concomitant use of cenobamate with other CNS depressants, including alcohol, barbiturates, and benzodiazepines may increase the risk of neurological adverse reactions.
Antiepileptic therapy, cenobamate [2] ---> SmPC of [2] of EMA
Discontinuation of anti-epileptic treatments may result in exacerbation of the disease which could be harmful to the mother and the foetus.
Barbiturates, cenobamate [2] ---> SmPC of [2] of EMA
Concomitant use of cenobamate with other CNS depressants, including alcohol, barbiturates, and benzodiazepines may increase the risk of neurological adverse reactions.
Baricitinib, cenobamate [2] ---> SmPC of [2] of EMA
In vitro studies have shown that cenobamate inhibits OAT3. Therefore, concomitant administration of cenobamate and medicinal products transported by OAT3 may result in higher exposure of these medicinal products.
Benzodiazepines, cenobamate [2] ---> SmPC of [2] of EMA
Concomitant use of cenobamate with other CNS depressants, including alcohol, barbiturates, and benzodiazepines may increase the risk of neurological adverse reactions.
Benzylpenicillin, cenobamate [2] ---> SmPC of [2] of EMA
In vitro studies have shown that cenobamate inhibits OAT3. Therefore, concomitant administration of cenobamate and medicinal products transported by OAT3 may result in higher exposure of these medicinal products.
Breast-feeding, cenobamate [2] ---> SmPC of [2] of EMA
A risk to the suckling child cannot be excluded. As a precautionary measure, breast-feeding should be discontinued during treatment with Ontozry.
Bupropion, cenobamate [2] ---> SmPC of [2] of EMA
An increase in the dose of medicines metabolized by CYP2B6 may be required when used concomitantly with cenobamate.
Capivasertib [1], cenobamate ---> SmPC of [1] of EMA
Co-administration of capivasertib with moderate CYP3A4 inducer has the potential to decrease the concentration of capivasertib. This may reduce the efficacy of TRUQAP. Co-administration of moderate CYP3A4 inducers should be avoided
Carbamazepine, cenobamate [2] ---> SmPC of [2] of EMA
No clinically meaningful decreases in efficacy were observed in subpopulation analyses of patients taking concomitant carbamazepine. Therefore, no dose adjustments are required.
Cefaclor, cenobamate [2] ---> SmPC of [2] of EMA
In vitro studies have shown that cenobamate inhibits OAT3. Therefore, concomitant administration of cenobamate and medicinal products transported by OAT3 may result in higher exposure of these medicinal products.
Cenobamate [1], clobazam ---> SmPC of [1] of EMA
Due to a possible increase in exposure of the active metabolite of clobazam (N-desmethylclobazam), related to the induction of CYP3A4 (formation) and the inhibition of CYP2C19 (elimination), the dose of clobazam may need to be reduced.
Cenobamate [1], CNS depressants ---> SmPC of [1] of EMA
Concomitant use of cenobamate with other CNS depressants, including alcohol, barbiturates, and benzodiazepines may increase the risk of neurological adverse reactions.
Cenobamate [1], drugs primarily metabolised by CYP2B6 ---> SmPC of [1] of EMA
An increase in the dose of medicines metabolized by CYP2B6 may be required when used concomitantly with cenobamate.
Cenobamate [1], drugs primarily metabolised by CYP2C19 ---> SmPC of [1] of EMA
A dose reduction of medicines metabolized by CYP2C19 may be required when used concomitantly with cenobamate.
Cenobamate [1], drugs primarily metabolised by CYP3A4 ---> SmPC of [1] of EMA
An increase in the dose of medicines metabolized by CYP3A4 may be required when used concomitantly with cenobamate
Cenobamate [1], empagliflozin ---> SmPC of [1] of EMA
In vitro studies have shown that cenobamate inhibits OAT3. Therefore, concomitant administration of cenobamate and medicinal products transported by OAT3 may result in higher exposure of these medicinal products.
Cenobamate [1], fertility ---> SmPC of [1] of EMA
The effects of cenobamate on human fertility are unknown. Animal data are insufficient due to exposure below clinical levels (see section 5.3).
Cenobamate [1], hormonal contraceptives ---> SmPC of [1] of EMA
Since hormonal contraceptives may also be metabolized by CYP3A4, their efficacy may be reduced by concomitant use with cenobamate.
Cenobamate [1], lacosamide ---> SmPC of [1] of EMA
No dose adjustments are required.
Cenobamate [1], lamotrigine ---> SmPC of [1] of EMA
Depending on individual response, the dose of cenobamate may need to be increased.
Cenobamate [1], levetiracetam ---> SmPC of [1] of EMA
No dose adjustments are required.
Cenobamate [1], midazolam ---> SmPC of [1] of EMA
An increase in the dose of medicines metabolized by CYP3A4 may be required when used concomitantly with cenobamate.
Cenobamate [1], OAT3 substrates ---> SmPC of [1] of EMA
In vitro studies have shown that cenobamate inhibits OAT3. Therefore, concomitant administration of cenobamate and medicinal products transported by OAT3 may result in higher exposure of these medicinal products.
Cenobamate [1], omeprazole ---> SmPC of [1] of EMA
A dose reduction of medicines metabolized by CYP2C19 may be required when used concomitantly with cenobamate.
Cenobamate [1], oxcarbazepine ---> SmPC of [1] of EMA
No dose adjustments are required.
Cenobamate [1], phenobarbital ---> SmPC of [1] of EMA
No dose adjustment of cenobamate is required. Concentrations of phenobarbital should be monitored during cenobamate titration, and based on individual response, the dose of phenobarbital may need to be reduced.
Cenobamate [1], phenytoin ---> SmPC of [1] of EMA
No dose adjustment of cenobamate is required. Phenytoin concentrations should be monitored during titration of cenobamate, and based on individual response, the dose of phenytoin may need to be reduced.
Cenobamate [1], pregnancy ---> SmPC of [1] of EMA
Ontozry should not be used during pregnancy unless the clinical condition of the woman requires treatment with cenobamate.
Cenobamate [1], sitagliptin ---> SmPC of [1] of EMA
In vitro studies have shown that cenobamate inhibits OAT3. Therefore, concomitant administration of cenobamate and medicinal products transported by OAT3 may result in higher exposure of these medicinal products.
Cenobamate [1], valproic acid ---> SmPC of [1] of EMA
No dose adjustments are required.
Cenobamate [1], women of childbearing potential ---> SmPC of [1] of EMA
Cenobamate is not recommended in women of childbearing potential not using contraception.
Cenobamate [1], women of childbearing potential ---> SmPC of [1] of EMA
Women of childbearing potential must use effective contraception during use of cenobamate and until 4 weeks after treatment discontinuation (see section 4.5).
Cenobamate, elacestrant [2] ---> SmPC of [2] of EMA
Concomitant administration of ORSERDU with moderate CYP3A4 inductors should be avoided, which may decrease elacestrant activity
CONTRAINDICATIONS of Cenobamate (Ontozry)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Familial Short-QT syndrome
https://www.ema.europa.eu/en/documents/product-information/ontozry-epar-product-information_en.pdf 18/01/2024
Cephalexin
Aminoglycoside antibiotics, cephalexin
Increased nephrotoxicity has been reported following concomitant parenteral administration of aminoglycoside antibiotics and cephalosporins.
Breast-feeding, cephalexin [2] ---> SPC of [2] of eMC
Caution should be exercised when cefalexin is administered to a nursing woman, possible effects to the infant include modification of bowel flora.
Cephalexin [1], pregnancy ---> SPC of [1] of eMC
Caution should be exercised when prescribing for the pregnant patient.
Cephalexin [1], probenecide ---> SPC of [1] of eMC
Probenecid causes reduced excretion of cefalexin leading to increased plasma concentration.
Cephalexin, colistin
Increased risk of nephrotoxicity
Cephalexin, estrogens
Cefalexin decreases the contraceptive effect of oral oestrogens.
Cephalexin, indometacin
Delayed renal elimination of cefalexin and increase of its plasma and biliary concentrations
Cephalexin, loop diuretics
Cephalosporins may have an increased risk of nephrotoxicity in the presence of loop diuretics
Cephalexin, metformin
The co-administration may increase the serum levels of either one and/or both principle actives due to competition for the active tubular secretion.
Cephalexin, methoxyflurane
Increased risk of nephrotoxicity
Cephalexin, nephrotoxic substances
Increased risk of nephrotoxicity
Cephalexin, oral anticoagulants
There have been many reports of increases in the anti-coagulant effects of orally administered anti-coagulant agents, including warfarin in patients who are concomitantly receiving antibacterial agents.
Cephalexin, organic acids
Delayed renal elimination of cefalexin and increase of its plasma and biliary concentrations
Cephalexin, phenylbutazone
Delayed renal elimination of cefalexin and increase of its plasma and biliary concentrations
Cephalexin, polymyxin
Increased risk of nephrotoxicity
Cephalexin, salicylates
Delayed renal elimination of cefalexin and increase of its plasma and biliary concentrations
Cephalexin, sucroferric oxyhydroxide [2] ---> SPC of [2] of EMA
In vitro studies did not show any relevant interaction
CONTRAINDICATIONS of Cephalexin
- Cefalexin is contra-indicated in patients with known allergy to the cephalosporin group of antibiotics.
- Cefalexin should be given cautiously to patients who have shown hypersensitivity to other drugs. Cephalosporins should be given with caution to penicillin-sensitive
patients, as there is some evidence of partial cross-allergenicity between the penicillins and the cephalosporins. Patients have had severe reactions
(including anaphylaxis) to both drugs.
- Cefalexin is contraindicated in patients with acute porphyria.
http://www.medicines.org.uk/emc/
Ceritinib (Zykadia)
Ability to drive, ceritinib [2] ---> SmPC of [2] of EMA
Caution should be exercised when driving or using machines during treatment as patients may experience fatigue or vision disorders.
Alfentanyl, ceritinib [2] ---> SmPC of [2] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Alfuzosin, ceritinib [2] ---> SmPC of [2] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Amiodarone, ceritinib [2] ---> SmPC of [2] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Antacids, ceritinib [2] ---> SmPC of [2] of EMA
Ceritinib demonstrates pH-dependent solubility and becomes poorly soluble as pH increases in vitro. Acid reducing agents can alter the solubility of ceritinib and reduce its bioavailability.
Astemizole, ceritinib [2] ---> SmPC of [2] of EMA
Co-administration of ceritinib with CYP3A substrates known to have narrow therapeutic indices should be avoided.
BCRP substrates, ceritinib [2] ---> SmPC of [2] of EMA
Therefore, ceritinib may have the potential to increase plasma concentrations of co-administered medicinal products transported by these proteins.
Breast-feeding, ceritinib [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from ceritinib therapy taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman (see section 5.3).
Capivasertib [1], ceritinib ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Carbamazepine, ceritinib [2] ---> SmPC of [2] of EMA
Co-administration of ceritinib with strong CYP3A inducers decreases ceritinib plasma concentrations. Concomitant use of strong CYP3A inducers should be avoided.
Ceritinib [1], chloroquine ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], cisapride ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], clarithromycin ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], class I antiarrhythmic agents ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], class III antiarrhythmic agents ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], colchicine ---> SmPC of [1] of EMA
Caution should be exercised with concomitant use of BCRP substrates (e.g. rosuvastatin, topotecan, sulfasalazine) and P-gp substrates (digoxin, dabigatran, colchicine, pravastatin) and ADRs carefully monitored.
Ceritinib [1], cyclosporine ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], CYP2C9 substrates with narrow therapeutic index ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP2C9 or CYP2C9 substrates known to have narrow therapeutic indices (e.g. phenytoin and warfarin) should be avoided.
Ceritinib [1], dabigatran ---> SmPC of [1] of EMA
Caution should be exercised with concomitant use of BCRP substrates (e.g. rosuvastatin, topotecan, sulfasalazine) and P-gp substrates (digoxin, dabigatran, colchicine, pravastatin) and ADRs carefully monitored.
Ceritinib [1], digoxin ---> SmPC of [1] of EMA
Caution should be exercised with concomitant use of BCRP substrates (e.g. rosuvastatin, topotecan, sulfasalazine) and P-gp substrates (digoxin, dabigatran, colchicine, pravastatin) and ADRs carefully monitored.
Ceritinib [1], dihydroergotamine ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], disopyramide ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], dofetilide ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], domperidone ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], droperidol ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], drugs inducing bradycardia ---> SmPC of [1] of EMA
Use of Zykadia in combination with other agents known to cause bradycardia (e.g. beta blockers, non-dihydropyridine calcium channel blockers, clonidine and digoxin) should be avoided as far as possible.
Ceritinib [1], drugs primarily metabolised by CYP2A6 ---> SmPC of [1] of EMA
Therefore, ceritinib may have the potential to increase plasma concentrations of co-administered medicinal products that are predominantly metabolised by these enzymes.
Ceritinib [1], drugs primarily metabolised by CYP2C9 ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP2C9 or CYP2C9 substrates known to have narrow therapeutic indices (e.g. phenytoin and warfarin) should be avoided.
Ceritinib [1], drugs primarily metabolised by CYP2E1 ---> SmPC of [1] of EMA
Therefore, ceritinib may have the potential to increase plasma concentrations of co-administered medicinal products that are predominantly metabolised by these enzymes.
Ceritinib [1], drugs primarily metabolised by CYP3A4 ---> SmPC of [1] of EMA
Ceritinib could inhibit the clearance of other medicinal products metabolised by CYP3A at clinically relevant concentrations. Dose reduction may be needed for co-administered medicinal products that are predominantly metabolised by CYP3A.
Ceritinib [1], drugs primarily metabolised by CYP3A4 with narrow therapeutic index ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], ergotamine ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], fentanyl ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], fertility ---> SmPC of [1] of EMA
The potential for ceritinib to cause infertility in male and female patients is unknown (see section 5.3).
Ceritinib [1], foods ---> SmPC of [1] of EMA
For patients who are unable to take ceritinib with food, ceritinib can be taken on an empty stomach as the alternate continued treatment regimen, in which no food should be eaten for at least two hours before and one hour after the dose.
Ceritinib [1], foods ---> SmPC of [1] of EMA
Ceritinib is for oral use. The capsules should be administered orally once daily with food at the same time every day. It is important that ceritinib is taken with food to reach the appropriate exposure.
Ceritinib [1], gastric pH increasing medication ---> SmPC of [1] of EMA
However, the risk for a clinically relevant decrease in bioavailability of ceritinib is possibly lower with concomitant use of H2 blockers if they are administered 10 hours before or 2 hours after the ceritinib dose, and with antacids if they are administered 2 hours before or 2 hours after the ceritinib dose.
Ceritinib [1], grapefruit ---> SmPC of [1] of EMA
Patients should be instructed to avoid grapefruit and grapefruit juice as they may inhibit CYP3A in the gut wall and may increase the bioavailability of ceritinib.
Ceritinib [1], grapefruit juice ---> SmPC of [1] of EMA
Patients should be instructed to avoid grapefruit and grapefruit juice as they may inhibit CYP3A in the gut wall and may increase the bioavailability of ceritinib.
Ceritinib [1], H2 antagonists ---> SmPC of [1] of EMA
Ceritinib demonstrates pH-dependent solubility and becomes poorly soluble as pH increases in vitro. Acid reducing agents can alter the solubility of ceritinib and reduce its bioavailability.
Ceritinib [1], halofantrine ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], haloperidol ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], ibutilide ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], itraconazol ---> SmPC of [1] of EMA
If it is not possible to avoid concomitant use with strong CYP3A inhibitors, reduce the ceritinib dose by approximately one third, rounded to the nearest multiple of the 150 mg dosage strength.
Ceritinib [1], ketoconazole ---> SmPC of [1] of EMA
If it is not possible to avoid concomitant use with strong CYP3A inhibitors, reduce the ceritinib dose by approximately one third, rounded to the nearest multiple of the 150 mg dosage strength.
Ceritinib [1], lovastatine ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], metabolized by CYP2C9 and CYP3A4 ---> SmPC of [1] of EMA
Dose reduction may be needed for co-administered medicinal products that are predominantly metabolised by CYP3A and CYP2C9.
Ceritinib [1], methadone ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], midazolam ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], moxifloxacin ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], nefazodone ---> SmPC of [1] of EMA
If it is not possible to avoid concomitant use with strong CYP3A inhibitors, reduce the ceritinib dose by approximately one third, rounded to the nearest multiple of the 150 mg dosage strength.
Ceritinib [1], oral contraceptives ---> SmPC of [1] of EMA
The effectiveness of concomitant administration of oral contraceptives may be reduced.
Ceritinib [1], P-glycoprotein substrates ---> SmPC of [1] of EMA
Therefore, ceritinib may have the potential to increase plasma concentrations of co-administered medicinal products transported by these proteins.
Ceritinib [1], phenobarbital ---> SmPC of [1] of EMA
Co-administration of ceritinib with strong CYP3A inducers decreases ceritinib plasma concentrations. Concomitant use of strong CYP3A inducers should be avoided.
Ceritinib [1], phenytoin ---> SmPC of [1] of EMA
Co-administration of ceritinib with strong CYP3A inducers decreases ceritinib plasma concentrations. Concomitant use of strong CYP3A inducers should be avoided.
Ceritinib [1], pimozide ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], posaconazole ---> SmPC of [1] of EMA
If it is not possible to avoid concomitant use with strong CYP3A inhibitors, reduce the ceritinib dose by approximately one third, rounded to the nearest multiple of the 150 mg dosage strength.
Ceritinib [1], pravastatine ---> SmPC of [1] of EMA
Caution should be exercised with concomitant use of BCRP substrates (e.g. rosuvastatin, topotecan, sulfasalazine) and P-gp substrates (digoxin, dabigatran, colchicine, pravastatin) and ADRs carefully monitored.
Ceritinib [1], pregnancy ---> SmPC of [1] of EMA
Ceritinib should not be used during pregnancy unless the clinical condition of the woman requires treatment with ceritinib.
Ceritinib [1], procainamide ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], proton pump inhibitors ---> SmPC of [1] of EMA
Ceritinib demonstrates pH-dependent solubility and becomes poorly soluble as pH increases in vitro. Acid reducing agents can alter the solubility of ceritinib and reduce its bioavailability.
Ceritinib [1], QT interval prolonging drugs ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], quetiapine ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], quinidine ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], rifabutin ---> SmPC of [1] of EMA
Co-administration of ceritinib with strong CYP3A inducers decreases ceritinib plasma concentrations. Concomitant use of strong CYP3A inducers should be avoided.
Ceritinib [1], rifampicin ---> SmPC of [1] of EMA
Co-administration of ceritinib with strong CYP3A inducers decreases ceritinib plasma concentrations. Concomitant use of strong CYP3A inducers should be avoided.
Ceritinib [1], rosuvastatin ---> SmPC of [1] of EMA
Caution should be exercised with concomitant use of BCRP substrates (e.g. rosuvastatin, topotecan, sulfasalazine) and P-gp substrates (digoxin, dabigatran, colchicine, pravastatin) and ADRs carefully monitored.
Ceritinib [1], saquinavir ---> SmPC of [1] of EMA
If it is not possible to avoid concomitant use with strong CYP3A inhibitors, reduce the ceritinib dose by approximately one third, rounded to the nearest multiple of the 150 mg dosage strength.
Ceritinib [1], sildenafil ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], simvastatine ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], sirolimus ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], sotalol ---> SmPC of [1] of EMA
In clinical studies, QT prolongation was observed with ceritinib. Therefore, ceritinib should be used with caution in patients who have or may develop prolongation of the QT interval. Monitoring of the QT interval is indicated
Ceritinib [1], St. John's wort ---> SmPC of [1] of EMA
Co-administration of ceritinib with strong CYP3A inducers decreases ceritinib plasma concentrations. Concomitant use of strong CYP3A inducers should be avoided.
Ceritinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA
Co-administration of ceritinib with strong CYP3A inducers decreases ceritinib plasma concentrations. Concomitant use of strong CYP3A inducers should be avoided.
Ceritinib [1], strong CYP3A4 inhibitors ---> SmPC of [1] of EMA
If it is not possible to avoid concomitant use with strong CYP3A inhibitors, reduce the ceritinib dose by approximately one third, rounded to the nearest multiple of the 150 mg dosage strength.
Ceritinib [1], strong P-gp inductors ---> SmPC of [1] of EMA
Co-administration of ceritinib with strong P-gp inducers decreases ceritinib plasma concentrations. Caution should be exercised with concomitant use of P-gp inducers.
Ceritinib [1], strong P-gp inhibitors ---> SmPC of [1] of EMA
Based on in vitro data, ceritinib is a substrate of the efflux transporter P-glycoprotein (P-gp). If ceritinib is administered with medicinal products that inhibit P-gp, an increase in ceritinib concentration is likely.
Ceritinib [1], sulfasalazine ---> SmPC of [1] of EMA
Caution should be exercised with concomitant use of BCRP substrates (e.g. rosuvastatin, topotecan, sulfasalazine) and P-gp substrates (digoxin, dabigatran, colchicine, pravastatin) and ADRs carefully monitored.
Ceritinib [1], tacrolimus ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], telithromycin ---> SmPC of [1] of EMA
If it is not possible to avoid concomitant use with strong CYP3A inhibitors, reduce the ceritinib dose by approximately one third, rounded to the nearest multiple of the 150 mg dosage strength.
Ceritinib [1], topotecan ---> SmPC of [1] of EMA
Caution should be exercised with concomitant use of BCRP substrates (e.g. rosuvastatin, topotecan, sulfasalazine) and P-gp substrates (digoxin, dabigatran, colchicine, pravastatin) and ADRs carefully monitored.
Ceritinib [1], transporters ---> SmPC of [1] of EMA
Therefore, clinical drug-drug interactions as a result of ceritinib-mediated inhibition of substrates for these transporters are unlikely to occur.
Ceritinib [1], triazolam ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP3A or CYP3A substrates known to have narrow therapeutic indices should be avoided
Ceritinib [1], voriconazole ---> SmPC of [1] of EMA
If it is not possible to avoid concomitant use with strong CYP3A inhibitors, reduce the ceritinib dose by approximately one third, rounded to the nearest multiple of the 150 mg dosage strength.
Ceritinib [1], warfarin ---> SmPC of [1] of EMA
Co-administration of ceritinib with substrates primarily metabolised by CYP2C9 or CYP2C9 substrates known to have narrow therapeutic indices (e.g. phenytoin and warfarin) should be avoided.
Ceritinib [1], women of childbearing potential ---> SmPC of [1] of EMA
Women of childbearing potential should be advised to use a highly effective method of contraception while taking ceritinib and for up to 3 months after discontinuing treatment (see section 4.5).
Ceritinib, erdafitinib [2] ---> SmPC of [2] of EMA
Co-administration with a moderate CYP2C9 or strong CYP3A4 inhibitor increased erdafitinib exposure and may lead to increased drug-related toxicity.
Ceritinib, lopinavir/ritonavir [2] ---> SmPC of [2] of EMA
Serum concentrations may be increased due to CYP3A and P-gp inhibition by lopinavir/ritonavir. Caution should be exercised in administering ceritinib with Kaletra.
Ceritinib, mirvetuximab soravtansine [2] ---> SmPC of [2] of EMA
Concomitant use of ELAHERE with strong CYP3A4 inhibitors may increase unconjugated DM4 exposure (see section 5.2), which may increase the risk of ELAHERE adverse reactions (see section 4.8).
Ceritinib, nirmatrelvir/ritonavir [2] ---> SmPC of [2] of EMA
Serum concentrations of ceritinib may be increased due to CYP3A and P-gp inhibition by ritonavir. Caution should be exercised in administering ceritinib with Paxlovid.
Ceritinib, pralsetinib [2] ---> SmPC of [2] of EMA
Co-administration of pralsetinib with P-gp and/or strong or moderate CYP3A4 inhibitors may increase pralsetinib plasma concentrations, which may increase the risk of adverse reactions of pralsetinib. The coadministration should be avoided
Ceritinib, ritonavir [2] ---> SmPC of [2] of EMA
Serum concentrations may be increased due to CYP3A and P-gp inhibition by ritonavir. Caution should be exercised in administering ceritinib with Norvir.
CONTRAINDICATIONS of Ceritinib (Zykadia)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/zykadia-epar-product-information_en.pdf 29/01/2026
Cerliponase alfa (Brineura)
Ability to drive, cerliponase alfa [2] ---> SmPC of [2] of EMA
No studies on the effect of cerliponase alfa on the ability to drive or use machines have been performed.
Breast-feeding, cerliponase alfa [2] ---> SmPC of [2] of EMA
Breastfeeding should be discontinued during treatment with Brineura.
Cerliponase alfa [1], cytochrome P450 ---> SmPC of [1] of EMA
Interactions between cerliponase alfa and medicinal products metabolised by cytochrome P450 enzymes are unlikely to occur.
Cerliponase alfa [1], fertility ---> SmPC of [1] of EMA
No fertility studies with cerliponase alfa have been conducted in animals or humans.
Cerliponase alfa [1], pregnancy ---> SmPC of [1] of EMA
Brineura should be given to a pregnant woman only if clearly needed.
CONTRAINDICATIONS of Cerliponase alfa (Brineura)
- Life-threatening anaphylactic reaction to the active substance or to any of the excipients listed in section 6.1, if re-challenge is unsuccessful
- CLN2 patients with ventriculo-peritoneal shunts
- Brineura must not be administered as long as there are signs of acute intracerebroventricular access device leakage, device failure, or device-related infection
https://www.ema.europa.eu/en/documents/product-information/brineura-epar-product-information_en.pdf. 12/12/2023
Certolizumab pegol (Cimzia)
Abatacept, certolizumab pegol [2] ---> SmPC of [2] of EMA
Severe infections and neutropaenia may result with concurrent use. The combination of certolizumab pegol and abatacept is not recommended
Ability to drive, certolizumab pegol [2] ---> SmPC of [2] of EMA
Cimzia may have a minor influence on the ability to drive and use machines. Dizziness (including vertigo, vision disorder and fatigue) may occur following administration of Cimzia (see section 4.8).
Anakinra, certolizumab pegol [2] ---> SmPC of [2] of EMA
Severe infections and neutropaenia may result with concurrent use. The combination of certolizumab pegol and anakinra is not recommended
Analgesics, certolizumab pegol [2] ---> SmPC of [2] of EMA
Concomitant treatment with methotrexate, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics showed no effect on the pharmacokinetics of certolizumab pegol based on a population pharmacokinetics analysis.
Breast-feeding, certolizumab pegol [2] ---> SmPC of [2] of EMA
Consequently, Cimzia can be used during breastfeeding.
Certolizumab pegol [1], corticosteroids ---> SmPC of [1] of EMA
Concomitant treatment with methotrexate, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics showed no effect on the pharmacokinetics of certolizumab pegol based on a population pharmacokinetics analysis.
Certolizumab pegol [1], etanercept ---> SmPC of [1] of EMA
Severe infections and neutropaenia were reported in clinical trials with concurrent use of anakinra (an interleukin-1 antagonist) or abatacept (a CD28 modulator) and another TNF-antagonist, etanercept,
Certolizumab pegol [1], fertility ---> SmPC of [1] of EMA
Effects on sperm motility measures and a trend of reduced sperm count in male rodents have been observed with no apparent effect on fertility (see section 5.3).
Certolizumab pegol [1], methotrexate ---> SmPC of [1] of EMA
Co-administration of Cimzia with methotrexate had no significant effect on the pharmacokinetics of methotrexate.
Certolizumab pegol [1], NSAID ---> SmPC of [1] of EMA
Concomitant treatment with methotrexate, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesics showed no effect on the pharmacokinetics of certolizumab pegol based on a population pharmacokinetics analysis.
Certolizumab pegol [1], pregnancy ---> SmPC of [1] of EMA
Cimzia should only be used during pregnancy if clinically needed. For women planning pregnancy, continued contraception may be considered for 5 months after the last Cimzia dose due to its elimination rate
Certolizumab pegol [1], semen quality ---> SmPC of [1] of EMA
During the 14-week follow-up, no treatment effects of certolizumab pegol were seen on semen quality parameters compared to placebo.
Certolizumab pegol [1], vaccinations ---> SmPC of [1] of EMA
Patients treated with Cimzia may receive vaccinations, except for live vaccines. Live vaccines should not be administered concurrently with Cimzia.
Certolizumab pegol [1], vaccinations with live organism vaccines ---> SmPC of [1] of EMA
It is recommended to wait a minimum of 5 months following the mother's last Cimzia administration during pregnancy before administration of live or live-attenuated vaccines (e.g. BCG vaccine)
Certolizumab pegol [1], women of childbearing potential ---> SmPC of [1] of EMA
The use of adequate contraception should be considered for women of childbearing potential.
CONTRAINDICATIONS of Certolizumab pegol (Cimzia)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Active tuberculosis or other severe infections such as sepsis or opportunistic infections
- Moderate to severe heart failure (NYHA classes III/IV)
https://www.ema.europa.eu/en/documents/product-information/cimzia-epar-product-information_en.pdf 27/01/2026
Cetirizine
Alcohol, cetirizine
Increased CNS depressant effect
Breast-feeding, cetirizine [2] ---> SPC of [2] of eMC
Cetirizine is contraindicated in lactating women as it is excreted in breast milk.
Cetirizine [1], pregnancy ---> SPC of [1] of eMC
Cetirizine hydrochloride should not be used during pregnancy unless clearly necessary.
Cetirizine, CNS depressants
Increased CNS depressant effect
Cetirizine, efavirenz [2] ---> SPC of [2] of EMA
The changes in plasma levels of cetirizine are not considered clinically significant. No dose adjustment is necessary for either medicinal product.
CONTRAINDICATIONS of Cetirizine
- Hypersensitivity to the active substance, to any of the excipients, to hydroxyzine or to any piperazine derivatives.
- Patients with severe renal impairment at less than 10 ml/min creatinine clearance.
- Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency of glucose-galactose malabsorption should not take cetirizine film-coated tablets.
http://www.medicines.org.uk/emc/
Cetrorelix (Cetrotide)
Breast-feeding, cetrorelix [2] ---> SmPC of [2] of EMA
Cetrotide is not intended to be used during pregnancy and lactation (see section 4.3).
Cetrorelix [1], cytochrome P450 ---> SmPC of [1] of EMA
In vitro investigations have shown that interactions are unlikely with medicinal products that are metabolised by cytochrome P450 or glucuronised or conjugated in some other way.
Cetrorelix [1], fertility ---> SmPC of [1] of EMA
Studies in animals have indicated that cetrorelix exerts a dose related influence on fertility, reproductive performance and pregnancy.
Cetrorelix [1], fertility ---> SmPC of [1] of EMA
No teratogenic effects occurred when the medicinal product was administered during the sensitive phase of gestation.
Cetrorelix [1], gonadotropins ---> SmPC of [1] of EMA
The possibility of interactions with gonadotropins or products that may induce histamine release in susceptible individuals, cannot be totally excluded.
Cetrorelix [1], pregnancy ---> SmPC of [1] of EMA
Cetrotide is not intended to be used during pregnancy and lactation (see section 4.3).
CONTRAINDICATIONS of Cetrorelix (Cetrotide)
Cetrorelix is not to be used in the presence of any of the conditions listed below:
- Hypersensitivity to the active substance or any structural analogues of gonadotropin-releasing hormone (GnRH), extrinsic peptide hormones or to any of the excipients listed in section 6.1.
- During pregnancy and lactation.
- Patients with severe renal impairment.
https://www.ema.europa.eu/en/documents/product-information/cetrotide-epar-product-information_en.pdf 12/04/2023
Cetuximab (Erbitux)
Ability to drive, cetuximab [2] ---> SmPC of [2] of EMA
If patients experience treatment-related symptoms affecting their ability to concentrate and react, it is recommended that they do not drive or use machines until the effect subsides.
Breast-feeding, cetuximab [2] ---> SmPC of [2] of EMA
It is recommended that women do not breast-feed during treatment with Erbitux and for 2 months after the last dose, because it is not known whether cetuximab is excreted in breast milk.
Capecitabine, cetuximab [2] ---> SmPC of [2] of EMA
In combination with capecitabine and oxaliplatin (XELOX) the frequency of severe diarrhoea may be increased.
Cetuximab [1], fertility ---> SmPC of [1] of EMA
There are no data on the effect of cetuximab on human fertility. Effects on male and female fertility have not been evaluated within formal animal studies (see section 5.3).
Cetuximab [1], fluoropyrimidines ---> SmPC of [1] of EMA
In combination with fluoropyrimidines, the frequency of cardiac ischaemia as well as the frequency of hand-foot syndrome (palmar-plantar erythrodysaesthesia) were increased compared to that with fluoropyrimidines.
Cetuximab [1], irinotecan ---> SmPC of [1] of EMA
The pharmacokinetic characteristics of cetuximab remain unaltered after co-administration of a single dose of irinotecan (350 mg/m2 body surface area). Similarly, the pharmacokinetics of irinotecan were unchanged when cetuximab was co-administered.
Cetuximab [1], oxaliplatin ---> SmPC of [1] of EMA
In combination with capecitabine and oxaliplatin (XELOX) the frequency of severe diarrhoea may be increased.
Cetuximab [1], platinum-based chemotherapy ---> SmPC of [1] of EMA
In combination with platinum-based chemotherapy, the frequency of severe leukopenia or severe neutropenia may be increased, and thus may lead to a higher rate of infectious complications such as febrile neutropenia, pneumonia
Cetuximab [1], pregnancy ---> SmPC of [1] of EMA
It is strongly recommended that be given only during pregnancy if the potential benefit justifies a potential risk to the foetus
CONTRAINDICATIONS of Cetuximab (Erbitux)
- Cetuximab is contraindicated in patients with known severe (grade 3 or 4) hypersensitivity reactions to cetuximab.
- The combination of cetuximab with oxaliplatin-containing chemotherapy is contraindicated for patients with mutant RAS metastatic colorectal cancer (mCRC) or for whom RAS mCRC status is unknown
- Before initiation of combination treatment, contraindications for concomitantly used chemotherapeutic agents or radiation therapy must be considered.
https://www.ema.europa.eu/en/documents/product-information/erbitux-epar-product-information_en.pdf 16/08/2024
Activated charcoal
Acetylcysteine, activated charcoal
Decreased effect of acetylcysteine
Activated charcoal [1], breast-feeding ---> SPC of [1] of eMC
There is no evidence to suggest that activated charcoal should not be used during lactation. The product is not systemically absorbed.
Activated charcoal [1], pregnancy ---> SPC of [1] of eMC
There is no evidence to suggest that activated charcoal should not be used during pregnancy. The product is not systemically absorbed.
Activated charcoal, albumin tannate
The co-administration should be avoided due to tannin decreases the resorptive capacity of charcoal
Activated charcoal, antidotes
Activated charcoal may adsorb simultaneously used antidotes. Concomitant use is not recommended
Activated charcoal, apixaban [2] ---> SPC of [2] of EMA
Administration of activated charcoal reduces apixaban exposure
Activated charcoal, desogestrel [2] ---> SPC of [2] of eMC
During treatment with medical charcoal, the absorption of the steroid may be reduced and thereby the contraceptive efficacy.
Activated charcoal, digital glycosides
Decreased intestinal absorption of digitalis.
Activated charcoal, digoxin
Decreased digoxin absorption or increased elimination due to enterohepatic circulation interruption. Digoxin should be administered 2 hours before.
Activated charcoal, doxycycline
Decreased absorption of doxycycline. It is recommended to administer the two substances at least 2 to 3 hours apart.
Activated charcoal, ethinyl estradiol
Treatment with activated charcoal will compromise absorption of steroid hormones.
Activated charcoal, ethinylestradiol/chlormadinone
Treatment with activated charcoal will compromise absorption of steroid hormones.
Activated charcoal, ethinylestradiol/norgestimate [2] ---> SPC of [2] of eMC
Treatment with activated charcoal will compromise absorption of steroid hormones.
Activated charcoal, leflunomide [2] ---> SPC of [2] of EMA
It is recommended that patients receiving leflunomide are not treated with colestyramine or activated powdered charcoal because this leads to a rapid and significant decrease in plasma A771726 (the active metabolite of leflunomide)
Activated charcoal, metildigoxin
Decreased intestinal absorption of digitalis. Metildigoxin should be taken 2 hours before
Activated charcoal, miglitol
Possible decrease of miglitol effect. It is recommended to avoid the concomitant use
Activated charcoal, minocycline
Absorption of minocycline is impaired by the concomitant administration. Dosages should be maximally separated.
Activated charcoal, moxifloxacin [2] ---> SPC of [2] of eMC
Concomitant administration of charcoal with an oral dose of 400 mg moxifloxacin led to a pronounced prevention of drug absorption and a reduced systemic availability of the drug by more than 80%. Concomitant use is not recommended
Activated charcoal, mycophenolic acid [2] ---> SPC of [2] of eMC
Caution should be used when co-administering drugs or therapies that may bind bile acids because of the potential to decrease MPA exposure and thus reduce the efficacy of mycophenolic acid.
Activated charcoal, olanzapine [2] ---> SPC of [2] of EMA
Activated charcoal reduces the bioavailability of oral olanzapine and should be taken at least 2 hours before or after olanzapine.
Activated charcoal, rifaximin
Rifaximin should be taken at least 2 hours after the administration of activated charcoal
Activated charcoal, teriflunomide [2] ---> SPC of [2] of EMA
It is recommended that patients receiving teriflunomide are not treated with cholestyramine or activated charcoal because this leads to a rapid and significant decrease in plasma concentration unless an accelerated elimination is desired.
CONTRAINDICATIONS of Activated charcoal
There are no contraindications to the use of Carbomix but see under (4.4).
http://www.medicines.org.uk/emc/
Chenodeoxycholic acid (Leadiant)
Alginate, chenodeoxycholic acid
Decreased absorption of chenodeoxycholic acid.
Aluminium hydroxide, chenodeoxycholic acid [2] ---> SmPC of [2] of EMA
If it is necessary to take a medicinal product containing one of these active substances it should be taken either 2 hours before or after taking chenodeoxycholic acid.
Aluminium oxide, chenodeoxycholic acid [2] ---> SmPC of [2] of EMA
If it is necessary to take a medicinal product containing one of these active substances it should be taken either 2 hours before or after taking chenodeoxycholic acid.
Aluminium, chenodeoxycholic acid
Decreased absorption of chenodeoxycholic acid. Administer chenodeoxycholic acid 1 hour before or 2 hours after
Breast-feeding, chenodeoxycholic acid [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from chenodeoxycholic acid therapy taking into account the benefit of breast feeding for the child and the benefit of therapy for the woman
Calcium acetate [1], chenodeoxycholic acid ---> SmPC of [1] of eMC
Decreased absorption of chenodeoxycholic acid
Calcium, chenodeoxycholic acid
Decreased absorption of chenodeoxycholic acid
Carbaldrate, chenodeoxycholic acid
The aluminium salt decreases the absorption of the co-administered active principle. Separate administration by at least 2 hours
Chenodeoxycholic acid [1], cholestyramine ---> SmPC of [1] of EMA
If it is necessary to take colestyramine then chenodeoxycholic acid should be taken either one hour before colestyramine or 4-6 hours after.
Chenodeoxycholic acid [1], colestipol ---> SmPC of [1] of EMA
If it is necessary to take a medicinal product containing one of these active substances it should be taken either 2 hours before or after taking chenodeoxycholic acid.
Chenodeoxycholic acid [1], cyclosporine ---> SmPC of [1] of EMA
If administration of ciclosporin or sirolimus is considered necessary, serum and urine bile alcohol levels should be closely monitored and the chenodeoxycholic acid dose adjusted accordingly.
Chenodeoxycholic acid [1], fertility ---> SmPC of [1] of EMA
Chenodeoxycholic acid is an endogenous bile acid used for replacement therapy and it is anticipated to have no effects on fertility at therapeutic doses.
Chenodeoxycholic acid [1], oral contraceptives ---> SmPC of [1] of EMA
The administration of oral contraceptives reduces the pool size of chenodeoxycholic acid. Co-administration with oral contraceptives is not recommended.
Chenodeoxycholic acid [1], phenobarbital ---> SmPC of [1] of EMA
Concomitant administration of chenodeoxycholic acid with phenobarbital increases HMG CoA reductase and thus counteracts one of the pharmacodynamics effects of chenodeoxycholic acid in CTX.
Chenodeoxycholic acid [1], pregnancy ---> SmPC of [1] of EMA
Chenodeoxycholic acid is not recommended during pregnancy and in women of childbearing potential not using contraception.
Chenodeoxycholic acid [1], sirolimus ---> SmPC of [1] of EMA
If administration of ciclosporin or sirolimus is considered necessary, serum and urine bile alcohol levels should be closely monitored and the chenodeoxycholic acid dose adjusted accordingly.
Chenodeoxycholic acid [1], smectite ---> SmPC of [1] of EMA
If it is necessary to take a medicinal product containing one of these active substances it should be taken either 2 hours before or after taking chenodeoxycholic acid.
Chenodeoxycholic acid, clay
Chenodeoxycholic acid absorption alteration. Separate administration by at least 2 hours
Chenodeoxycholic acid, estrogens
The co-administration may increase the cholesterol concentration in the bile and prevent the dissolution of cholesterol gallstones by chenodeoxycholic acid
Chenodeoxycholic acid, fibrates
The co-administration may increase the cholesterol concentration in the bile and prevent the dissolution of cholesterol gallstones by chenodeoxycholic acid
Chenodeoxycholic acid, hydrotalcite
The co-administration of hydrotalcite with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 1-2 hours
Chenodeoxycholic acid, isoniazid
Increased elimination of isoniazid due to acetylation acceleration
Chenodeoxycholic acid, magaldrate
Decreased absorption of chenodeoxycholic acid. It is recommended to administer the two substances at least 2-3 hours apart.
Chenodeoxycholic acid, magnesium
Decreased absorption of chenodeoxycholic acid. Administer chenodeoxycholic acid 1 hour before or 2 hours after
Chenodeoxycholic acid, sucralfate
Concomitant administration of sucralfate may reduce the bioavailability of chenodeoxycholic acid. The bioavailability may be restored by separating the administration from sucralfate by 2 hours.
CONTRAINDICATIONS of Chenodeoxycholic acid (Leadiant)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
Chikungunya vaccine (live) (Ixchiq)
Ability to drive, Chikungunya vaccine (live) [2] ---> SmPC of [2] of EMA
IXCHIQ has no or negligible influence on the ability to drive and use machines. However, some of the effects mentioned under section 4.8 may temporarily affect the ability to drive or use machines.
Breast-feeding, Chikungunya vaccine (live) [2] ---> SmPC of [2] of EMA
Animal studies did not indicate any direct or indirect harmful effects with respect to lactation (see section 5.3).
Chikungunya vaccine (live) [1], fertility ---> SmPC of [1] of EMA
No specific studies have been performed on fertility. Animal studies did not indicate any harmful effects with respect to female fertility (see section 5.3).
Chikungunya vaccine (live) [1], immunoglobulins ---> SmPC of [1] of EMA
Administration of immune globulins, blood or plasma transfusions 3 months before or up to 1 month after IXCHIQ administration may interfere with the expected immune response.
Chikungunya vaccine (live) [1], pregnancy ---> SmPC of [1] of EMA
Decisions to administer IXCHIQ during pregnancy should take into consideration the individual's risk of exposure to wild-type CHIKV, gestational age, and risks to the foetus or neonate from vertical transmission of wild-type CHIKV.
Chikungunya vaccine (live) [1], vaccinations ---> SmPC of [1] of EMA
IXCHIQ is not recommended to be co-administered with other vaccines because there are no data on the safety and immunogenicity following concomitant administration of IXCHIQ with other vaccines.
CONTRAINDICATIONS of Chikungunya vaccine (live) (Ixchiq)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Immunodeficient or immunosuppressed individuals due to disease or medical therapy (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised).
https://www.ema.europa.eu/en/documents/product-information/ixchiq-epar-product-information_en.pdf 18/07/2024
Chloral hydrate
Ability to drive, chloral hydrate [2] ---> SmPC of [2] of eMC
Patients receiving chloral hydrate oral solution should be warned that their ability to drive or use machinery may be impaired by drowsiness.
Alcohol, chloral hydrate [2] ---> SmPC of [2] of eMC
Alcohol potentiates the sedative effect.
Amitriptyline, chloral hydrate
Chloral hydrate accelerates the metabolism of amitriptyline
Anticholinergics, chloral hydrate
Delirium may occur, especially in the elderly, particularly when used in conjunction with anticholinergics.
Breast-feeding, chloral hydrate [2] ---> SmPC of [2] of eMC
Chloral hydrate should not be used in lactation.
Chloral hydrate [1], pregnancy ---> SmPC of [1] of eMC
Chloral hydrate should not be used in pregnancy
Chloral hydrate, class IA antiarrhythmic agents
Concomitant use of chloral hydrate with drugs known to also prolong the QT interval should be avoided
Chloral hydrate, class III antiarrhythmic agents
Concomitant use of chloral hydrate with drugs known to also prolong the QT interval should be avoided
Chloral hydrate, coumarin anticoagulants
In patients taking anticoagulants, when chloral hydrate is added to or withdrawn from the drug regimen, or its dosage changed, careful monitoring of the prothrombin time is required.
Chloral hydrate, cyclophosphamide
The previous or concomitant treatment of chloral hydrate may increase the metabolism and thus enhance the effect of cyclophosphamide due to increasing formation of active alkylating metabolites of cyclophosphamide
Chloral hydrate, fluoxetine
The co-administration prolongs the effect of chloral hydrate
Chloral hydrate, furosemide [2] ---> SmPC of [2] of eMC
Chloral hydrate followed by intravenous furosemide may result in sweating, hot flushes and variable blood pressure including hypertension due to a hypermetabolic state caused by displacement of thyroid hormone from its bound state.
Chloral hydrate, hypnotics
Increased hypnotic effect
Chloral hydrate, hypokalemia
Concomitant use of chloral hydrate with drugs that can cause hypokaliemia should be avoided
Chloral hydrate, ifosfamide
The prior treatment with chloral hydrate (enzymatic inductor) may increase the metabolism of ifosfamide
Chloral hydrate, IMAOs
The co-administration may enhance the effect of chloral hydrate
Chloral hydrate, non-potassium-sparing diuretics
Concomitant use of chloral hydrate with drugs that can cause hypokaliemia should be avoided
Chloral hydrate, phenytoin
Chloral hydrate decreases the plasma levels of phenytoin
Chloral hydrate, QT interval prolonging drugs
Concomitant use of chloral hydrate with drugs known to also prolong the QT interval should be avoided
Chloral hydrate, sedatives
The co-administration prolongs the effect of chloral hydrate
CONTRAINDICATIONS of Chloral hydrate
Chloral Hydrate Oral Solution should not be used in patients
- with a marked hepatic or renal impairment, or
- with severe cardiac disease.
- Should not be used in patients susceptible to acute attacks of porphyria.
http://www.medicines.org.uk/emc/medicine/24800. Stand of information: 19/05/2014. Access date: 16/08/2014
Chlordiazepoxide
Ability to drive, chlordiazepoxide [2] ---> SPC of [2] of eMC
Patients should be advised that sedation, amnesia, impaired concentration, dizziness, blurred vision and impaired muscular function may occur
Alcohol, chlordiazepoxide [2] ---> SPC of [2] of eMC
Chlordiazepoxide should not be used together with alcohol (enhanced sedative effects)
Anaesthetics, chlordiazepoxide [2] ---> SPC of [2] of eMC
Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs.
Antidepressants, chlordiazepoxide [2] ---> SPC of [2] of eMC
Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs.
Antiepileptics, chlordiazepoxide [2] ---> SPC of [2] of eMC
Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs.
Anxiolytics, chlordiazepoxide [2] ---> SPC of [2] of eMC
Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs.
Barbiturates, chlordiazepoxide ---> SPC of [2] of eMC
When used concurrently chlordiazepoxide and anti-epileptic drugs, side effects and toxicity may be more evident, particularly with hydantoins (e.g. phenytoin) and/or barbiturates.
Breast-feeding, chlordiazepoxide [2] ---> SPC of [2] of eMC
Use during lactation should be avoided as chlordiazepoxide is found in breast milk.
Chlordiazepoxide [1], CNS depressants ---> SPC of [1] of eMC
Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs.
Chlordiazepoxide [1], enzyme inhibitors ---> SPC of [1] of eMC
Known inhibitors of hepatic enzymes, eg cimetidine, have been shown to reduce the clearance of benzodiazepines and may potentiate their action
Chlordiazepoxide [1], erythromycin ---> SPC of [1] of eMC
Enzymatic inhibitors reduce clearance and may potentiate the action of benzodiazepines.
Chlordiazepoxide [1], hypnotics ---> SPC of [1] of eMC
Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs.
Chlordiazepoxide [1], neuroleptics ---> SPC of [1] of eMC
Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs.
Chlordiazepoxide [1], omeprazole ---> SPC of [1] of eMC
Enzymatic inhibitors reduce clearance and may potentiate the action of benzodiazepines.
Chlordiazepoxide [1], opioid analgesics ---> SPC of [1] of eMC
Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs. Enhancement of the euphoria may lead to increased psychological dependence.
Chlordiazepoxide [1], pregnancy ---> SPC of [1] of eMC
Chlordiazepoxide should only be used during pregnancy if there are compelling reasons (e.g. no alternative: benefit outweighs risk).
Chlordiazepoxide [1], sedating antihistamines ---> SPC of [1] of eMC
Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs.
Chlordiazepoxide [1], sedatives ---> SPC of [1] of eMC
Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs.
Chlordiazepoxide [1], tranquilizers ---> SPC of [1] of eMC
Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs.
Chlordiazepoxide, cimetidine ---> SPC of [2] of eMC
Known inhibitors of hepatic enzymes, eg cimetidine, have been shown to reduce the clearance of benzodiazepines and may potentiate their action
Chlordiazepoxide, disulfiram
Enzymatic inhibitors reduce clearance and may potentiate the action of benzodiazepines.
Chlordiazepoxide, enzyme inductors ---> SPC of [1] of eMC
Inducers (e.g. rifampicin) may increase clearance of benzodiazepines
Chlordiazepoxide, fluorouracil
The co-administration may enhance the effect of fluorouracil
Chlordiazepoxide, fosphenytoin [2] ---> SPC of [2] of eMC
Chlordiazepoxide may increase or decrease phenytoin serum levels
Chlordiazepoxide, hydantoins ---> SPC of [1] of eMC
When used concurrently chlordiazepoxide and anti-epileptic drugs, side effects and toxicity may be more evident, particularly with hydantoins (e.g. phenytoin) and/or barbiturates.
Chlordiazepoxide, IMAOs
Additive effect
Chlordiazepoxide, magnesium hydroxide
The magnesium hydroxide may decrease the absorption of chlordiazepoxide. Separate administration by 2-3 hours
Chlordiazepoxide, muscle relaxants
Increased effect of muscle relaxant
Chlordiazepoxide, nilutamide
Nilutamide may inhibit the hepatic metabolism of chlordiazepoxide and increase its plasma levels
Chlordiazepoxide, oral contraceptives
Decreased chlordiazepoxide elimination rate
Chlordiazepoxide, phenytoin
Chlordiazepoxide may increase phenytoin serum levels
Chlordiazepoxide, rifampicin ---> SPC of [1] of eMC
Inducers (e.g. rifampicin) may increase clearance of benzodiazepines
Chlordiazepoxide, warfarin
The co-administration may decrease the anticoagulant effect
CONTRAINDICATIONS of Chlordiazepoxide
- Hypersensitivity to benzodiazepines or to any of the other ingredients
- Acute pulmonary insufficiency: respiratory depression: sleep apnoea (risk of further respiratory depression)
- Phobic and obsessional states (inadequate evidence of safety and efficacy).
- Chronic psychosis
- Severe hepatic insufficiency (may precipitate encephalopathy)
- Planning a pregnancy
- Pregnancy (unless there are compelling reasons)
http://www.medicines.org.uk/emc/
Chlorhexidine
Antiseptics, chlorhexidine
Chlorhexidine should not be used concomitantly with other antiseptics
Breast-feeding, chlorhexidine [2] ---> SPC of [2] of eMC
Like all medicines, care should be exercised during lactation
Chlorhexidine [1], pregnancy ---> SPC of [1] of eMC
Like all medicines, care should be exercised during pregnancy
CONTRAINDICATIONS of Chlorhexidine
- Hypersensitivity to any of the ingredients.
http://www.medicines.org.uk/emc/
Chlormethine (Ledaga)
Breast-feeding, chlormethine [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breast-feeding or to discontinue Ledaga therapy, taking into account the benefit of breast-feeding for the child and the benefit of therapy for the breastfeeding mother.
Chlormethine [1], fertility ---> SmPC of [1] of EMA
In animals, adverse effects of chlormethine on male fertility after systemic administration have been documented (see section 5.3). The relevance to humans receiving topical chlormethine is unknown.
Chlormethine [1], pregnancy ---> SmPC of [1] of EMA
There are limited data from the use of chlormethine in pregnant women. Studies in animals have shown reproductive toxicity after systemic administration (see section 5.3). Ledaga is not recommended during pregnancy.
Chlormethine [1], women of childbearing potential ---> SmPC of [1] of EMA
Ledaga is not recommended in women of childbearing potential not using contraception.
Chlormethine, cladribine [2] ---> SmPC of [2] of EMA
An in vitro study revealed cross-resistance between cladribine and chlormethine
CONTRAINDICATIONS of Chlormethine (Ledaga)
- Hypersensitivity to chlormethine or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/ledaga-epar-product-information_en.pdf 12/12/2024
Chloroquine
Ability to drive, chloroquine [2] ---> SPC of [2] of eMC
Defects in visual accommodation may occur on first taking chloroquine and patients should be warned regarding driving or operating machinery.
Agalsidase alfa [1], chloroquine ---> SPC of [1] of EMA
Agalsidase alfa should not be co-administered with chloroquine since this substance has the potential to inhibit intra-cellular alfa-galactosidase activity.
Agalsidase beta [1], chloroquine ---> SPC of [1] of EMA
Agalsidase beta should not be administered with chloroquine due to a theoretical risk of inhibition of intra-cellular alfa-galactosidase activity.
Algeldrate/magnesium hydroxide, chloroquine
The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 2 hours
Aluminium hydroxide, chloroquine
The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 2 hours
Aluminium oxide/magnesium hydroxide, chloroquine
The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 2 hours
Amiodarone, chloroquine [2] ---> SPC of [2] of eMC
If the patient is taking amiodarone then chloroquine may increase the risk of cardiac arrhythmias including ventricular arrhythmias, bradycardias and cardiac conduction defect. Concurrent use is contraindicated.
Ammonium chloride, chloroquine
Possible decrease of chloroquine effect
Ampicillin, chloroquine [2] ---> SPC of [2] of eMC
The absorption of ampicillin is reduced when taken concomitantly with chloroquine.
Antacids, chloroquine [2] ---> SPC of [2] of eMC
Antacids may reduce the absorption of chloroquine, so should be taken well separated from chloroquine (at least four hours apart).
Antihistamines, chloroquine
Antihistaminics may mask the ototoxic effects of other drugs
Antirabic vaccine, chloroquine [2] ---> SPC of [2] of eMC
Pre-exposure intradermal human diploid-cell rabies vaccine should not be administered to patients taking chloroquine as this may suppress the antibody response.
Arrhytmogenic agents, chloroquine
Co-administration of chloroquine and other drugs that have arrhythmogenic potential may increase the risk of cardiac arrhythmias.
Atomoxetine, chloroquine
Seizures are a potential risk with atomoxetine. Caution is advised with concomitant use of medicinal drugs which are known to lower the seizure threshold
Atracurium [1], chloroquine ---> SPC of [1] of eMC
Chloroquine may increase the sensitivity to atracurium and aggravate or unmask latent myasthenia gravis or induce a myasthenic syndrome
Aurothiomalate, chloroquine
The co-administration of aurothiomalate with photosensitizing agents should be avoided
Azithromycin, chloroquine
The concomitant use with azithromycin may increase the risk of cardiac arrhythmia.
Bosutinib [1], chloroquine ---> SPC of [1] of EMA
Bosutinib should be used with caution in patients who have or may develop prolongation of QT, including those patients taking anti-arrhythmic medicinal products or other medicinal products that may lead to QT prolongation
Breast-feeding, chloroquine [2] ---> SPC of [2] of eMC
When long-term high doses are used for rheumatoid disease, breast feeding is not recommended.
Bupropion, chloroquine
Bupropion may increase the risk of convulsions
Carbaldrate, chloroquine
The aluminium salt decreases the absorption of the co-administered active principle. Separate administration by at least 2 hours
Carbamazepine, chloroquine
The co-administration of chloroquine with hepatotoxic medicinal products is not recommended
Ceritinib [1], chloroquine ---> SPC of [1] of EMA
Ceritinib should be used with caution in patients taking other medicinal products that may lead to QT prolongation. Monitoring of the QT interval is indicated in the event of combinations of such medicinal products
Chloroquine [1], cimetidine ---> SPC of [1] of eMC
Cimetidine inhibits metabolism of chloroquine (increased plasma concentration)
Chloroquine [1], cyclosporine ---> SPC of [1] of eMC
If the patient is taking ciclosporin then chloroquine may cause an increase in ciclosporin levels.
Chloroquine [1], digoxin ---> SPC of [1] of eMC
Hydroxychloroquine and possibly chloroquine increase plasma concentration of digoxin.
Chloroquine [1], kaolin ---> SPC of [1] of eMC
Adsorbents (e.g. kaolin) may reduce the absorption of chloroquine, so should be taken well separated from chloroquine (at least four hours apart).
Chloroquine [1], mefloquine ---> SPC of [1] of eMC
Increased risk of convulsion with mefloquine.
Chloroquine [1], neostigmine ---> SPC of [1] of eMC
Chloroquine has potential to increase symptoms of myasthenia gravis and thus diminish effect of neostigmine
Chloroquine [1], praziquantel ---> SPC of [1] of eMC
Chloroquine significantly reduces levels of praziquantel.
Chloroquine [1], pregnancy ---> SPC of [1] of eMC
Chloroquine should not be used during pregnancy unless, in the judgement of the physician, potential benefit outweighs the risk.
Chloroquine [1], pyridostigmine ---> SPC of [1] of eMC
Chloroquine has potential to increase symptoms of myasthenia gravis and thus diminish effect of pyridostigmine
Chloroquine, cholestyramine
Cholestyramine may decrease the absorption of chloroquine. Patients should take other drugs at least 1 hour before or 4-6 hours after colestyramine to minimize possible interference with their absorption.
Chloroquine, cloprednol
Increased risk of myopathies and cardiomyopathies
Chloroquine, corticosteroids
The co-administration of chloroquine and corticoids may increase the risk of myopathies and cardiomyopathies
Chloroquine, deflazacort
The co-administration of chloroquine and corticoids may increase the risk of myopathies and cardiomyopathies
Chloroquine, droperidol [2] ---> SPC of [2] of eMC
Medicinal products known to prolong the QTc interval should not be concomitantly administered with droperidol.
Chloroquine, ethosuximide
Concomitant use of antiepileptic and antimalarial agents may increase the risk of seizures
Chloroquine, folic acid antagonists
The effect of folic acid antagonists (methotrexate) is enhanced by chloroquine
Chloroquine, glucocorticoids
Increased risk of myopathies and cardiomyopathies
Chloroquine, hepatotoxic drugs
The co-administration of chloroquine with hepatotoxic medicinal products is not recommended
Chloroquine, hydrocortisone
Increased risk of myopathies and cardiomyopathies
Chloroquine, IMAOs
The co-administration of chloroquine with MAOI is not recommended
Chloroquine, isoniazid
The co-administration of chloroquine with hepatotoxic medicinal products is not recommended
Chloroquine, ketoconazole
The co-administration of chloroquine with hepatotoxic medicinal products is not recommended
Chloroquine, lanthanum carbonate [2] ---> SPC of [2] of eMC
The lanthanum carbonate decreases the absorption of chloroquine. Separate administration by at least 2 hours
Chloroquine, laronidase [2] ---> SPC of [2] of EMA
Laronidase should not be administered simultaneously with chloroquine due to a potential risk of interference with the intracellular uptake of laronidase
Chloroquine, levacetylmethadol [2] ---> SPC of [2] of EMA
The co-administration of levacetylmethadol with medicinal products that prolong the interval QT is contraindicated
Chloroquine, levothyroxine
Decreased effect of levothyroxine and increased plasma levels of TSH
Chloroquine, lidocaine/prilocaine [2] ---> SPC of [2] of EMA
Methaemoglobinaemia may be accentuated in patients already taking medicinal products known to induce the condition
Chloroquine, liothyronine
Decreased effect of liothyronine and increased plasma levels of TSH
Chloroquine, methotrexate
The effect of folic acid antagonists (methotrexate) is enhanced by chloroquine
Chloroquine, metronidazole
Acute dystonic reaction has been reported after coadministration of chloroquine and metronidazole
Chloroquine, mivacurium
The co-administration may enhance and/or prolong the neuromuscular block, aggravate/unmask/induce a myasthenia or increase the sensitivity to non-depolarising blocker
Chloroquine, muscle relaxants (non-depolarizing)
The co-administration may aggravate/unmask/induce a myasthenia or may increase the sensitivity to non-depolarising blocker
Chloroquine, nebivolol [2] ---> SPC of [2] of eMC
The CYP2D6 inhibition may lead to increased plasma levels of nebivolol (metabolized by CYP2D6) that is associated with an increased risk of excessive bradycardia and adverse events.
Chloroquine, nilotinib [2] ---> SPC of [2] of EMA
Significant prolongation of the QT interval may occur when nilotinib is inappropriately taken with medicinal products with a known potential to prolong QT. Prolongation of the QT interval may expose patients to the risk of fatal outcome.
Chloroquine, panobinostat [2] ---> SPC of [2] of EMA
Based on preclinical and clinical data, panobinostat has the potential to prolong the QT interval. Concomitant use of panobinostat and other substances that are known to prolong the QT interval is not recommended.
Chloroquine, pasireotide [2] ---> SPC of [2] of EMA
Pasireotide should be used with caution in patients who are concomitantly receiving medicinal products that prolong the QT interval
Chloroquine, penicillamine
Penicillamine may increase the risk of severe haematological and/or renal adverse effects
Chloroquine, phenothiazines
The co-administration of chloroquine with hepatotoxic medicinal products is not recommended
Chloroquine, phenylbutazone
Increased risk of exfoliative dermatitis
Chloroquine, phenytoin
The co-administration of chloroquine with hepatotoxic medicinal products is not recommended
Chloroquine, piperaquine ---> SPC of [piperaquine/artenimol] of EMA
The combination of piperaquine with drugs that are known to prolong the QTc interval is contraindicated: additive effect on the QTc interval
Chloroquine, piperaquine/artenimol [2] ---> SPC of [2] of EMA
The combination of piperaquine/dihydroartemisinin with drugs that are known to prolong the QTc interval is contraindicated: additive effect on the QTc interval
Chloroquine, probenecide
Probenecid increases the risk of sensibilization
Chloroquine, proteolytic enzymes enriched in bromelain [2] ---> SPC of [2] of EMA
NexoBrid, when absorbed, is an inhibitor of CYP2C8 and CYP2C9. This should be taken into account if it is used in patients receiving CYP2C8 substrates
Chloroquine, pyrimethamine
The combination of chloroquine and pyrimethamine significantly increases the risk of skin reactions
Chloroquine, ribociclib [2] ---> SPC of [2] of EMA
Co-administration of Kisqali with medicinal products with a known potential to prolong the QT interval such as anti-arrhythmic medicinal products should be avoided
Chloroquine, sodium valproate
The co-administration may decrease the seizure threshold. Caution is recommended
Chloroquine, sonidegib [2] ---> SPC of [2] of EMA
Patients should be closely monitored for muscle-related symptoms if Odomzo is used in combination with certain medicinal products that may increase the potential risk of developing muscle toxicity
Chloroquine, succinylcholine
The co-administration may enhance or prolong the neuromuscular blocking effects of suxamethonium
Chloroquine, sulfadoxine
The combination of chloroquine and sulfadoxine significantly increases the risk of skin reactions
Chloroquine, suxamethonium
The co-administration may enhance or prolong the neuromuscular blocking effects of suxamethonium
Chloroquine, treosulfan ---> SPC of [2] of eMC
In one patient the effect of ibuprofen/chloroquine was reduced with concomitant administration of treosulfan.
Chloroquine, triamcinolone
Increased risk of myopathies and cardiomyopathies
Chloroquine, triamcinolone acetonide
Increased risk of myopathies and cardiomyopathies
Chloroquine, triiodthyronine
Decreased effect of liothyronine and increased plasma levels of TSH
Chloroquine, urinary alkalinizing agents ---> SPC of [2] of eMC
Care should be taken when alkalinization of urine occurs as this may reduce chloroquine renal excretion.
Chloroquine, valproic acid
The co-administration may decrease the seizure threshold. Caution is recommended
CONTRAINDICATIONS of Chloroquine
- Known hypersensitivity to chloroquine or any other ingredients of the formulation.
- Concomitant use with amiodarone.
http://www.medicines.org.uk/emc/
Chlorpromazine
Ability to drive, chlorpromazine [2] ---> SPC of [2] of eMC
Patients should be warned about drowsiness during the early days of treatment and advised not to drive or operate machinery.
Alcohol, chlorpromazine [2] ---> SPC of [2] of eMC
Alcohol enhances the sedative effect of neuroleptics. Association not recommended
Alcohol, neuroleptics ---> SPC of [chlorpromazine] of eMC
Alcohol enhances the sedative effect of neuroleptics. Association not recommended
Algeldrate/magnesium hydroxide, chlorpromazine
The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 2 hours
Almasilate, chlorpromazine
There are studies which describe an absorption reduction of the active principle co-administered with almasilate
Aluminium hydroxide, chlorpromazine [2] ---> SPC of [2] of eMC
The aluminium hydroxide may decrease the absorption of chlorpromazine. Separate administration by at least 2-3 hours
Aluminium oxide/magnesium hydroxide, chlorpromazine
The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 2 hours
Aluminium, chlorpromazine [2] ---> SPC of [2] of eMC
The aluminium salt decreases the absorption of chlorpromazine. Separate administration by at least 2 hours
Amantadine, chlorpromazine
The co-administration of amantadine with drugs that prolong the QT interval is contraindicated
Amiodarone [1], chlorpromazine ---> SPC of [1] of eMC
The combined therapy of amiodarone with drugs that may induce torsades de pointes is contraindicated
Amisulpride, chlorpromazine
Co-administration is not recommended
Amphetamine, chlorpromazine ---> SPC of [lisdexamfetamine] of eMC
Chlorpromazine blocks dopamine and norepinephrine receptors, thus inhibiting the central stimulant effects of amfetamines.
Antacids, chlorpromazine
The antacid can decrease the gastrointestinal absorption of phenothiazine
Anticholinergics, chlorpromazine [2] ---> SPC of [2] of eMC
The co-administration causes addition of atropinic adverse effects e. g. retention of urine, dry mouth, obstipation
Antidiabetics, chlorpromazine [2] ---> SPC of [2] of eMC
Possible increase of glycemia (decreased insulin release). The concomitant use should be done with caution
Antihistamines, chlorpromazine [2] ---> SPC of [2] of eMC
The co-administration may increase the CNS depressant effect
Antihypertensives, chlorpromazine [2] ---> SPC of [2] of eMC
Potentiation of the antihypertensive effect and risk of orthostatic hypotension (additive effects).
Anxiolytics, chlorpromazine [2] ---> SPC of [2] of eMC
The co-administration may increase the CNS depressant effect
Atracurium [1], chlorpromazine ---> SPC of [1] of eMC
Chlorpromazine may increase the sensitivity to atracurium and aggravate or unmask latent myasthenia gravis or induce a myasthenic syndrome
Atropine, chlorpromazine [2] ---> SPC of [2] of eMC
The co-administration causes addition of atropinic adverse effects e. g. retention of urine, dry mouth, obstipation
Aurothiomalate, chlorpromazine
The co-administration of aurothiomalate with photosensitizing agents should be avoided
Azithromycin, chlorpromazine [2] ---> SPC of [2] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Barbiturates, chlorpromazine [2] ---> SPC of [2] of eMC
The co-administration may increase the CNS depressant effect
Benzodiazepines, chlorpromazine [2] ---> SPC of [2] of eMC
The co-administration may increase the CNS depressant effect
Benzylpenicillin, chlorpromazine
Incompatible with benzylpenicillin in solution
Breast-feeding, chlorpromazine [2] ---> SPC of [2] of eMC
Chlorpromazine may be excreted in milk, therefore breastfeeding should be suspended during treatment.
Brimonidine [1], chlorpromazine ---> SPC of [1] of EMA
Caution is advised in patients taking substances which can affect the metabolism and uptake of circulating amines
Brinzolamide/brimonidine [1], chlorpromazine ---> SPC of [1] of EMA
Caution is advised in patients taking substances which can affect the metabolism and uptake of circulating amines
Bromocriptine, chlorpromazine [2] ---> SPC of [2] of eMC
Reciprocal antagonism of dopaminergic antiparkinsonian agent and chlorpromazine. The combination is not recommended
Budipine, chlorpromazine
The co-administration of budipine with drugs known to prolong QT interval is contraindicated
Cabergoline, chlorpromazine [2] ---> SPC of [2] of eMC
Reciprocal antagonism of dopaminergic agent and neuroleptic. Association contraindicated except with dopaminergic antiparkinsonian agents
Calcium hydroxide, chlorpromazine [2] ---> SPC of [2] of eMC
The calcium hydroxide may decrease the absorption of chlorpromazine. Separate administration by at least 2-3 hours
Carbaldrate, chlorpromazine [2] ---> SPC of [2] of eMC
The aluminium salt decreases the absorption of the co-administered active principle. Separate administration by at least 2 hours
Carteolol, chlorpromazine
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Centrally-acting antihypertensives, chlorpromazine [2] ---> SPC of [2] of eMC
The co-administration may increase the CNS depressant effect
Chlorpromazine [1], cisapride ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], citalopram ---> SPC of [1] of eMC
The combination of citalopram and chlorpromazine is contraindicated
Chlorpromazine [1], class IA antiarrhythmic agents ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], class III antiarrhythmic agents ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], clonidine ---> SPC of [1] of eMC
The co-administration may increase the CNS depressant effect
Chlorpromazine [1], CNS depressants ---> SPC of [1] of eMC
The co-administration may increase the CNS depressant effect
Chlorpromazine [1], cotrimoxazole ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], dopamine agonists ---> SPC of [1] of eMC
Reciprocal antagonism of dopaminergic agent and neuroleptic. Association contraindicated except with dopaminergic antiparkinsonian agents
Chlorpromazine [1], dopaminergic antiparkinsonian agents ---> SPC of [1] of eMC
Reciprocal antagonism of dopaminergic antiparkinsonian agent and chlorpromazine. The combination is not recommended
Chlorpromazine [1], drugs inducing bradycardia ---> SPC of [1] of eMC
QT prolongation is exacerbated, in particular, in the presence of bradycardia
Chlorpromazine [1], electrolyte imbalance ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with drugs causing electrolyte imbalance. The combination is not recommended
Chlorpromazine [1], erythromycin ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], escitalopram ---> SPC of [1] of eMC
The combination of escitalopram and chlorpromazine is contraindicated
Chlorpromazine [1], guanethidine ---> SPC of [1] of eMC
The anti-hypertensive action of guanethidine may be reduced by chlorpromazine
Chlorpromazine [1], hypnotics ---> SPC of [1] of eMC
The co-administration may increase the CNS depressant effect
Chlorpromazine [1], hypokalemia ---> SPC of [1] of eMC
QT prolongation is exacerbated, in particular, in the presence of hypokalaemia
Chlorpromazine [1], ketoconazole ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], levodopa ---> SPC of [1] of eMC
Reciprocal antagonism of dopaminergic antiparkinsonian agent and chlorpromazine. The combination is not recommended
Chlorpromazine [1], lisuride ---> SPC of [1] of eMC
Reciprocal antagonism of dopaminergic antiparkinsonian agent and chlorpromazine. The combination is not recommended
Chlorpromazine [1], magnesium hydroxide ---> SPC of [1] of eMC
The magnesium hydroxide may decrease the absorption of chlorpromazine. Separate administration by at least 2-3 hours
Chlorpromazine [1], methadone ---> SPC of [1] of eMC
The co-administration may increase the CNS depressant effect
Chlorpromazine [1], mibefradil ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], pentamidine ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], pergolide ---> SPC of [1] of eMC
Reciprocal antagonism of dopaminergic antiparkinsonian agent and chlorpromazine. The combination is not recommended
Chlorpromazine [1], piribedil ---> SPC of [1] of eMC
Reciprocal antagonism of dopaminergic antiparkinsonian agent and chlorpromazine. The combination is not recommended
Chlorpromazine [1], pregnancy ---> SPC of [1] of eMC
Like other drugs it should be avoided in pregnancy unless the physician considers it essential.
Chlorpromazine [1], probucol ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], procainamide ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], QT interval prolonging drugs ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], quinagolide ---> SPC of [1] of eMC
Reciprocal antagonism of dopaminergic agent and neuroleptic. Association contraindicated except with dopaminergic antiparkinsonian agents
Chlorpromazine [1], quinidine ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], ropinirole ---> SPC of [1] of eMC
Reciprocal antagonism of dopaminergic antiparkinsonian agent and chlorpromazine. The combination is not recommended
Chlorpromazine [1], sedative antidepressants ---> SPC of [1] of eMC
The co-administration may increase the CNS depressant effect
Chlorpromazine [1], sedatives ---> SPC of [1] of eMC
The co-administration may increase the CNS depressant effect
Chlorpromazine [1], tetracyclic antidepressant ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], tricyclic antidepressant ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], trimethoprim/sulfamethoxazol ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine [1], vasopressin ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine, ciprofloxacin
The strong CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, clinafloxacin
The strong CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, codeine
The co-administration may enhance the sedative and respiratory depressor effect
Chlorpromazine, delamanid [2] ---> SPC of [2] of EMA
Treatment with delamanid should not be initiated in patients with risk factors like taking medicinal products that are known to prolong the QTc interval, unless the possible benefit is considered to outweigh the potential risks.
Chlorpromazine, desmopressin [2] ---> SPC of [2] of eMC
Substances which are known to induce SIADH may cause an additive antidiuretic effect leading to an increased risk of water retention and/or hyponatraemia.
Chlorpromazine, dextromethorphan/quinidine [2] ---> SPC of [2] of EMA
Concomitant use of dextromethorphan/quinidine and chlorpromazine, CYP2D6 substrate that also prolongs QT interval, requires caution
Chlorpromazine, diazoxide
The co-administration of diazoxide and chlorpromazine may potentiate the effect of diazoxide
Chlorpromazine, disopyramide
The co-administration causes addition of atropinic adverse effects e. g. retention of urine, dry mouth, obstipation
Chlorpromazine, droperidol [2] ---> SPC of [2] of eMC
Medicinal products known to prolong the QTc interval should not be concomitantly administered with droperidol.
Chlorpromazine, enoxacin
The strong CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, esmolol [2] ---> SPC of [2] of eMC
Concomitant administration of esmolol and phenothiazines may increase the blood pressure lowering effect.
Chlorpromazine, etintidine
The strong CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, glibenclamide
The co-administration may weaken the hypoglycemic effect
Chlorpromazine, gliclazide [2] ---> SPC of [2] of eMC
High doses (>100 mg per day of chlorpromazine) increase blood glucose levels (reduced insulin release).
Chlorpromazine, glimepiride [2] ---> SPC of [2] of eMC
Weakening of the blood-glucose-lowering effect and possible hyperglycaemia
Chlorpromazine, haloperidol [2] ---> SPC of [2] of eMC
Inhibition of the CYP2D6 by another drug may result in increased haloperidol concentrations and an increased risk of adverse events, including QT-prolongation.
Chlorpromazine, hydrochlorothiazide ---> SPC of [losartan/hydrochlorothiazide] of eMC
Periodic monitoring of serum potassium and ECG is recommended, when hydrochlorothiazide is administered with drugs which may induce torsades de pointes
Chlorpromazine, hydroquinidine
Concomitant use is not recommended due to increased risk of heart rhythm disorders (torsades de pointes)
Chlorpromazine, ibutilide
Possible increase of proarrhythmic risk if ibutilide is used with drugs that prolong the QT interval. Contraindicated within 4 hours after completing infusion
Chlorpromazine, idrocilamide
The strong CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, ifosfamide
The co-administration may increase the antineoplasic effect and the toxicity
Chlorpromazine, indapamide [2] ---> SPC of [2] of eMC
The co-administration may increase the risk of ventricular arrhythmias, particularly torsades de pointes (hypokalemia is a risk factor)
Chlorpromazine, interferon
Caution should be used when administering interferon with medicines mainly metabolised by hepatic cytochrome P450 and have a narrow therapeutic window
Chlorpromazine, isoniazid
Metabolism inhibition of isoniazid and increase of its plasma levels
Chlorpromazine, levacetylmethadol [2] ---> SPC of [2] of EMA
The co-administration of levacetylmethadol with medicinal products that prolong the interval QT is contraindicated
Chlorpromazine, levobunolol
Caution is advised because of possible additive effects and the production of hypotension and/or marked bradycardia
Chlorpromazine, lisdexamfetamine [2] ---> SPC of [2] of eMC
Chlorpromazine blocks dopamine and norepinephrine receptors, thus inhibiting the central stimulant effects of amfetamines.
Chlorpromazine, lithium ---> SPC of [zuclopenthixol] of eMC
Combined use of antipsychotics and lithium has been associated with an increased risk of neurotoxicity.
Chlorpromazine, losartan/hydrochlorothiazide [2] ---> SPC of [2] of eMC
Periodic monitoring of serum potassium and ECG is recommended when losartan/hydrochlorothiazide is administered with torsades de pointes-inducing medicinal products
Chlorpromazine, lymecycline
The co-administration of tetracyclines with other potentially hepatotoxic medicinal products should be avoided
Chlorpromazine, metamizole
The co-administration may cause a severe hypothermia
Chlorpromazine, metformin
Decreased hypoglycemic effect
Chlorpromazine, metoprolol
The CYP2D6 inhibition may increase the plasma levels of metoprolol.
Chlorpromazine, mexiletine
The moderate CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, mivacurium
The co-administration may enhance and/or prolong the neuromuscular block, aggravate/unmask/induce a myasthenia or increase the sensitivity to non-depolarising blocker
Chlorpromazine, moderate CYP1A2 inhibitors
The moderate CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, muscle relaxants (non-depolarizing)
The co-administration may aggravate/unmask/induce a myasthenia or may increase the sensitivity to non-depolarising blocker
Chlorpromazine, oltipraz
The strong CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, oral contraceptives
The moderate CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, organophosphorous insecticides
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Chlorpromazine, orphenadrine
Due to the increased risk of hypothermia, the concomitant use of chlorpromazine and orphenadrine is not recommended
Chlorpromazine, pasireotide [2] ---> SPC of [2] of EMA
Pasireotide should be used with caution in patients who are concomitantly receiving medicinal products that prolong the QT interval
Chlorpromazine, pethidine
Risk of toxicity with chlorpromazine due to increased concentration of norpethidine
Chlorpromazine, phenylpropanolamine
The moderate CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, pimozide
The co-administration may predispose to the cardiotoxic effects of pimozide. The combination should be avoided
Chlorpromazine, pioglitazone/glimepiride [2] ---> SPC of [2] of EMA
Weakening of the blood-glucose-lowering effect and, thus raised blood glucose levels may occur
Chlorpromazine, pipemidic acid
The strong CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, piperaquine ---> SPC of [piperaquine/artenimol] of EMA
The combination of piperaquine with drugs that are known to prolong the QTc interval is contraindicated: additive effect on the QTc interval
Chlorpromazine, piperaquine/artenimol [2] ---> SPC of [2] of EMA
The combination of piperaquine/dihydroartemisinin with drugs that are known to prolong the QTc interval is contraindicated: additive effect on the QTc interval
Chlorpromazine, propranolol [2] ---> SPC of [2] of eMC
Concomitant administration may result in an increase in plasma levels of both drugs. This may lead to an enhanced antipsychotic effect for chlorpromazine and an increased antihypertensive effect for propranolol.
Chlorpromazine, protirelin
Enhancement of TSH-increase
Chlorpromazine, rivastigmine [2] ---> SPC of [2] of EMA
Since bradycardia constitutes a risk factor in the occurrence of torsades de pointes, the combination of rivastigmine with torsades de pointes-inducing medicinal products should be observed with caution and clinical monitoring (ECG) may also be required.
Chlorpromazine, rofecoxib
The strong CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, saquinavir/ritonavir ---> SPC of [saquinavir] of EMA
The combination is contraindicated due to the potential for life threatening cardiac arrhythmia
Chlorpromazine, sotalol [2] ---> SPC of [2] of eMC
Sotalol should be given with extreme caution in conjunction with other drugs known to prolong the QT-interval. Drugs that prolong the QT-interval may cause torsades de pointes. The co-administration with sotalol is contraindicated
Chlorpromazine, stiripentol [2] ---> SPC of [2] of EMA
Stiripentol enhances the central depressant effect of chlorpromazine.
Chlorpromazine, strong CYP1A2 inhibitors
The strong CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, succinylcholine [2] ---> SPC of [2] of eMC
The decrease in the normal plasma cholinesterase activity may prolong the neuromuscular blocking effects of suxamethonium
Chlorpromazine, sulfonylureas
Weakening of the blood-glucose-lowering effect and, thus raised blood glucose levels may occur
Chlorpromazine, sultopride
The addition of electrophysiological effects may increase the risk of ventricular rhythm disorders, particularly torsades de pointes. Concomitant use is not recommended
Chlorpromazine, suxamethonium [2] ---> SPC of [2] of eMC
The decrease in the normal plasma cholinesterase activity may prolong the neuromuscular blocking effects of suxamethonium
Chlorpromazine, tamsulosin
Chlorpromazine, strong CYP2D6 inhibitor, may increase the plasma levels of tamsulosin
Chlorpromazine, telmisartan/hydrochlorothiazide [2] ---> SPC of [2] of EMA
Periodic monitoring of serum potassium and ECG is recommended when MicardisPlus is administered with drugs affected by serum potassium disturbances (e.g. digitalis glycosides, antiarrhythmics) and torsades de pointes inducing medicinal products
Chlorpromazine, tetrabenazine
The co-administration may cause significant dopamine depletion. Tetrabenazine should be used with caution with other medicinal products with the potential to prolong QT interval
Chlorpromazine, thiobendazole
The moderate CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, tiapride
Tiapride should not be combined with drugs that prolong the QT interval. These drugs (with the exception of anti-infectious) should be discontinued, if possible, if they induce torsades de pointes
Chlorpromazine, tolterodine
The co-administration may increase the plasma concentrations of tolterodine
Chlorpromazine, trazodone [2] ---> SPC of [2] of eMC
Severe orthostatic hypotension has been observed in case of concomitant use of trazodone und phenothiazines
Chlorpromazine, vandetanib [2] ---> SPC of [2] of EMA
The concomitant use of vandetanib with medicinal products known to also prolong the QTc interval and/or induce Torsades de pointes is either contraindicated or not recommended
Chlorpromazine, venlafaxine
Chlorpromazine, strong CYP2D6 inhibitor, may increase the plasma levels of venlafaxine
Chlorpromazine, xipamide
The combination increases the risk of ventricular arrhythmias, particularly torsades de pointes (favored by hypokaliemia). It is recommended a special caution
Chlorpromazine, zafirlukast
The strong CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, zileuton
The moderate CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Chlorpromazine, zuclopenthixol [2] ---> SPC of [2] of eMC
Since zuclopenthixol is partly metabolised by CYP2D6 concomitant use of drugs known to inhibit this enzyme may lead to higher than expected plasma concentrations of zuclopenthixol, increasing the risk of adverse effects and cardiotoxicity.
Dopaminergic antiparkinsonian agents, neuroleptics ---> SPC of [chlorpromazine] of eMC
Reciprocal antagonism of dopaminergic antiparkinsonian agent and neuroleptic. The combination is not recommended
Levodopa, neuroleptics
Levodopa and neuroleptics have reciprocal antagonism. In patients with Parkinson disease it is recommended to use the lesser dose of both active principles
CONTRAINDICATIONS of Chlorpromazine
- Hypersensitivity to chlorpromazine or to any of the excipients
- Bone marrow depression
- Risk of angle-closure glaucoma
- Risk of urinary retention related to urethroprostatic disorders
- History of agranulocytosis
- Dopaminergic antiparkinsonism agents
- Nursing mothers
- Citalopram, escitalopram
http://www.medicines.org.uk/emc/
Chlortetracycline
Ability to drive, chlortetracycline
Transitory blurred sight or vision disorders may occur
Almasilate, chlortetracycline
Absorption reduction of the active principle co-administered with almasilate due to formation of non-soluble complexes. It is recommended to administer the two substances at least 2 to 3 hours apart.
Aminoglycoside antibiotics, chlortetracycline
The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects
Anaesthetics, chlortetracycline
Chlortetracycline increases the neuromuscular blockade
Anticoagulants, chlortetracycline
Chlortetracycline increases the anticoagulant effect
Breast-feeding, chlortetracycline
It should not be used during breastfeeding
Calcium, chlortetracycline
Administer tetracycline 1 hour before or 2 hours after the other medicinal product to minimize the decrease of the absorption.
Cheese, chlortetracycline
Administer tetracycline 1 hour before or 2 hours after dairy foods to minimize the decrease of the absorption.
Chlortetracycline, citric acid
The citric acid promotes the absorption of the tetracycline
Chlortetracycline, divalent cations ---> SPC of [strontium ranelate] of EMA
As divalent cations can form complexes with oral tetracycline at the gastro-intestinal level and thereby reduce their absorption, simultaneous administration is not recommended.
Chlortetracycline, iron
Administer tetracycline 1 hour before or 2 hours after the other medicinal product to minimize the decrease of the absorption.
Chlortetracycline, magnesium
Administer tetracycline 1 hour before or 2 hours after the other medicinal product to minimize the decrease of the absorption.
Chlortetracycline, magnesium hydroxide
The magnesium hydroxide may decrease the absorption of tetracycline. Separate administration by 2-3 hours
Chlortetracycline, milk
Administer tetracycline 1 hour before or 2 hours after dairy foods to minimize the decrease of the absorption.
Chlortetracycline, muscle relaxants
Chlortetracycline increases the neuromuscular blockade
Chlortetracycline, oral contraceptives
The effect of hormonal contraceptives may be decreased
Chlortetracycline, penicillins
The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects
Chlortetracycline, pregnancy
It should not be used during pregnancy
Chlortetracycline, trivalent cations
Decreased absorption of tetracycline. It is recommended to administer the two substances at least 2 to 3 hours apart.
Cholecalciferol
Antiepileptics, cholecalciferol ---> SPC of [alendronic acid/colecalciferol] of EMA
Anticonvulsants, cimetidine and thiazides may increase the catabolism of vitamin D.
Barbiturates, calcium carbonate/cholecalciferol ---> SPC of [cholecalciferol] of eMC
The co-administration may increase the metabolism and decrease the effect of vitamin D3
Barbiturates, cholecalciferol [2] ---> SPC of [2] of eMC
The co-administration may increase the metabolism and decrease the effect of vitamin D3
Barbiturates, vitamin D ---> SPC of [cholecalciferol] of eMC
The co-administration may increase the metabolism and decrease the effect of vitamin D3
Bile-acid sequestrants, cholecalciferol [2] ---> SPC of [2] of eMC
Simultaneous treatment of colecalciferol with ion exchange resins such may reduce the gastrointestinal absorption of vitamin D.
Breast-feeding, cholecalciferol [2] ---> SPC of [2] of eMC
Vitamin D and its metabolites are excreted in breast milk. Overdose in infants induced by nursing mothers has not observed
Calcium carbonate/cholecalciferol, phenytoin ---> SPC of [cholecalciferol] of eMC
The co-administration may increase the metabolism and decrease the effect of vitamin D3
Calcium, cholecalciferol
High doses of calcium-containing preparations may increase the risk of hypercalcaemia.
Cardiac glycosides, cholecalciferol [2] ---> SPC of [2] of eMC
The effects of digitalis and other cardiac glycosides may be accentuated with the oral administration of calcium combined with Vitamin D.
Cholecalciferol [1], cholestyramine ---> SPC of [1] of eMC
Simultaneous treatment of colecalciferol with ion exchange resins such may reduce the gastrointestinal absorption of vitamin D.
Cholecalciferol [1], glucocorticoids ---> SPC of [1] of eMC
Concomitant use of glucocorticoids can decrease the effect of vitamin D.
Cholecalciferol [1], laxatives ---> SPC of [1] of eMC
Simultaneous treatment of colecalciferol with laxatives may reduce the gastrointestinal absorption of vitamin D.
Cholecalciferol [1], mineral oil ---> SPC of [1] of eMC
Simultaneous treatment of colecalciferol with paraffin oil such may reduce the gastrointestinal absorption of vitamin D.
Cholecalciferol [1], paraffinic oil ---> SPC of [1] of eMC
Simultaneous treatment of colecalciferol with paraffin oil such may reduce the gastrointestinal absorption of vitamin D.
Cholecalciferol [1], phenytoin ---> SPC of [1] of eMC
The co-administration may increase the metabolism and decrease the effect of vitamin D3
Cholecalciferol [1], pregnancy ---> SPC of [1] of eMC
During pregnancy women should follow the advice of their physician as their requirements may vary depending on the severity of their disease and their response to treatment
Cholecalciferol [1], thiazides ---> SPC of [1] of eMC
Thiazides decrease the urinary excretion of calcium: Increased risk of hypercalcemia
Cholecalciferol, cimetidine ---> SPC of [alendronic acid/colecalciferol] of EMA
Anticonvulsants, cimetidine and thiazides may increase the catabolism of vitamin D.
Cholecalciferol, colestipol ---> SPC of [alendronic acid/colecalciferol] of EMA
Olestra, mineral oils, orlistat, and bile acid sequestrants (e.g. cholestyramine, colestipol) may impair the absorption of vitamin D.
Cholecalciferol, corticosteroids
There is a functional antagonism between vitamin D analogues (promotion of absorption) and the corticosteroids (inhibition of absorption).
Cholecalciferol, glutethimide
The co-administration may increase the metabolism and decrease the effect of vitamin D3
Cholecalciferol, olestra ---> SPC of [alendronic acid/colecalciferol] of EMA
Olestra, mineral oils, orlistat, and bile acid sequestrants (e.g. cholestyramine, colestipol) may impair the absorption of vitamin D.
Cholecalciferol, orlistat ---> SPC of [alendronic acid/colecalciferol] of EMA
Olestra, mineral oils, orlistat, and bile acid sequestrants (e.g. cholestyramine, colestipol) may impair the absorption of vitamin D.
Cholecalciferol, phosphates ---> SPC of [1] of EMA
The co-administration may increase the risk of hypercalcaemia
CONTRAINDICATIONS of Cholecalciferol
- Hypersensitivity to vitamin D or any of the excipients in the product
- Peanut or soya allergy
- Hypervitaminosis D
- Nephrolithiasis
- Diseases or conditions resulting in hypercalcaemia and/or hypercalciuria
- Severe renal impairment
http://www.medicines.org.uk/emc/
Cholera vaccine (Vaxchora)
Ability to drive, cholera vaccine [2] ---> SmPC of [2] of EMA
However, some of the effects mentioned under Section 4.8 (e.g., fatigue, dizziness) may temporarily affect the ability to drive or use machines.
Antibiotics, cholera vaccine [2] ---> SmPC of [2] of EMA
Vaxchora should not be administered to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.
Antibiotics, cholera vaccine [2] ---> SmPC of [2] of EMA
Concomitant administration of Vaxchora with systemic antibiotics active against V. cholerae should be avoided since these agents may prevent a sufficient degree of replication to occur in order to induce a protective immune response.
Breast-feeding, cholera vaccine [2] ---> SmPC of [2] of EMA
A risk to the breastfed child cannot be excluded. A decision must be made whether to discontinue breast-feeding or to abstain from using Vaxchora taking into account the benefit of breast feeding for the child and the benefit of Vaxchora for the woman.
Chloroquine, cholera vaccine [2] ---> SmPC of [2] of EMA
Immune responses to Vaxchora and protection against cholera may be diminished when Vaxchora is administered concomitantly with chloroquine.
Cholera vaccine [1], fertility ---> SmPC of [1] of EMA
No human or animal data on the effect of Vaxchora on fertility are available.
Cholera vaccine [1], foods ---> SmPC of [1] of EMA
Eating and drinking should be avoided for 60 minutes before and after taking Vaxchora as this may interfere with the protective effect of the buffer.
Cholera vaccine [1], pregnancy ---> SmPC of [1] of EMA
Vaxchora should be used during pregnancy only if the potential benefits to the mother outweigh the potential risks, including those to the foetus.
Cholera vaccine [1], typhoid vaccine ---> SmPC of [1] of EMA
There should be an interval of 2 hours between the administration of this vaccine and of typhoid vaccine Ty21a (gastro-resistant capsules)
CONTRAINDICATIONS of Cholera vaccine (Vaxchora)
- Hypersensitivity to the active substance(s) or to any of the excipients listed in section 6.1.
- Individuals with congenital immune deficiency or receiving immunosuppressive drugs or treatments.
https://www.ema.europa.eu/en/documents/product-information/vaxchora-epar-product-information_en.pdf 31/01/2025
Cholera vaccine (inactivated, oral) (Dukoral)
Ability to drive, cholera vaccine (inactivated, oral) [2] ---> SmPC of [2] of EMA
There is no evidence of an effect on the ability to drive and use machines.
Breast-feeding, cholera vaccine (inactivated, oral) [2] ---> SmPC of [2] of EMA
Following careful benefit/risk assessment the vaccine may be administered during pregnancy and to breast-feeding women although no specific clinical studies have been performed to address this issue.
Cholera vaccine (inactivated [1], oral), foods ---> SmPC of [1] of EMA
Food and/or drink will increase acid production in the stomach and the effect of the vaccine may be impaired. Consequently, food and drink should be avoided 1 hour before and 1 hour after vaccination.
Cholera vaccine (inactivated [1], oral), medicinal products ---> SmPC of [1] of EMA
No other vaccines/ medicinal products, including oral polio vaccine and antimalarials, have been given simultaneously with Dukoral in clinical studies.
Cholera vaccine (inactivated [1], oral), pregnancy ---> SmPC of [1] of EMA
Following careful benefit/risk assessment the vaccine may be administered during pregnancy and to breast-feeding women although no specific clinical studies have been performed to address this issue.
Cholera vaccine (inactivated [1], oral), pregnancy ---> SmPC of [1] of EMA
During a mass-vaccination campaign conducted in Zanzibar, 196 pregnant women had received at least one dose of Dukoral. There was no statistically significant evidence of a harmful effect of Dukoral exposure during pregnancy.
Cholera vaccine (inactivated [1], oral), vaccinations ---> SmPC of [1] of EMA
Oral administration of other vaccines and medicinal products should be avoided 1 hour before and 1 hour after vaccination
Cholera vaccine (inactivated [1], oral), yellow fever vaccine ---> SmPC of [1] of EMA
Similarly, a yellow fever vaccine was given concomitantly with Dukoral, and there was no interaction observed with the immune response to the yellow fever vaccine.
CONTRAINDICATIONS of Cholera vaccine (inactivated, oral) (Dukoral)
- Hypersensitivity to the active substances, to any of the excipients listed in section 6.1 or to formaldehyde.
- Administration of Dukoral should be postponed for subjects suffering from acute gastrointestinal illness or acute febrile illness.
https://www.ema.europa.eu/en/documents/product-information/dukoral-epar-product-information_en.pdf 06/04/2022
Cholestyramine
Acarbose, cholestyramine
The co-administration may reduce the effect of acarbose and should not therefore be taken concomitantly
Acenocoumarol [1], cholestyramine ---> SPC of [1] of eMC
The co-administration may decrease the anticoagulant effect of acenocoumarol
Acipimox, cholestyramine
The dosing should be separated by a time interval
Alendronate/colecalciferol [1], cholestyramine ---> SPC of [1] of EMA
Olestra, mineral oils, orlistat, and bile acid sequestrants (e.g. cholestyramine, colestipol) may impair the absorption of vitamin D.
Alendronic acid/colecalciferol [1], cholestyramine ---> SPC of [1] of EMA
Olestra, mineral oils, orlistat, and bile acid sequestrants (e.g. cholestyramine, colestipol) may impair the absorption of vitamin D.
Alfacalcidol [1], cholestyramine ---> SPC of [1] of eMC
Concomitant administration of colestyramine may interfere with the intestinal absorption of alfacalcidol.
Aliskiren/amlodipine/hydrochlorothiazide [1], cholestyramine ---> SPC of [1] of EMA
Absorption of thiazide is impaired in the presence of anionic exchange resins. The thiazide should be taken at least 4 hours before or 4-6 hours after of the other drug
Aliskiren/hydrochlorothiazide [1], cholestyramine ---> SPC of [1] of EMA
Absorption of thiazide diuretics is decreased by cholestyramine. This could result in sub-therapeutic effects of thiazide diuretics. The thiazide should be administered at least 4 hours before or 4-6 hours after the administration of resin
Amiodarone, cholestyramine
Cholestyramine may decrease plasma levels of amiodarone. Patients should take other drugs at least 1 hour before or 4-6 hours after colestyramine to minimize possible interference with their absorption.
Amlodipine/valsartan/hydrochlorothiazide [1], cholestyramine ---> SPC of [1] of EMA
Absorption of thiazide diuretics is decreased by cholestyramine. This could result in sub-therapeutic effects of thiazide diuretics. The thiazide should be administered at least 4 hours before or 4-6 hours after the administration of resin
Atenolol/chlortalidone, cholestyramine
Decreased absorption of atenolol/chlortalidone
Barbiturates, cholestyramine
Decreased absorption. Patients should take other drugs at least 1 hour before or 4-6 hours after colestyramine to minimize possible interference with their absorption.
Bendroflumethiazide, cholestyramine ---> SPC of [amlodipine/valsartan/hydrochlorothiazide] of EMA
Absorption of thiazide diuretics is decreased by cholestyramine and other anionic exchange resins. The thiazide should be taken at least 4 hours before or 4-6 hours after of the other medicinal product
Bezafibrate [1], cholestyramine ---> SPC of [1] of eMC
Should combined therapy with an ion-exchange resin be considered necessary, there should be an interval of 2 hours between the intake of the resin and bezafibrate as the absorption of bezafibrate otherwise may be impaired.
Breast-feeding, cholestyramine [2] ---> SPC of [2] of eMC
The safety of colestyramine in lactation has not been established
Budesonide, cholestyramine ---> SPC of [1] of eMC
Concomitant administration of colestyramine may reduce budesonide uptake, in common with other drugs.
Cabozantinib [1], cholestyramine ---> SPC of [1] of EMA
Bile salt-sequestering agents such as cholestyramine and cholestagel may interact with cabozantinib and may impact absorption (or reabsorption) resulting in potentially decreased exposure
Calcifediol, cholestyramine
Medicinal products that reduce calcifediol absorption may reduce its effects. It is recommended to separate the times of administration by at least 2 hours
Calcitriol [1], cholestyramine ---> SPC of [1] of eMC
Bile acid sequestrants including cholestyramine and sevelamer can reduce intestinal absorption of fat-soluble vitamins and therefore may impair intestinal absorption of calcitriol.
Canagliflozin [1], cholestyramine ---> SPC of [1] of EMA
Cholestyramine may potentially reduce canagliflozin exposure. Canagliflozin should be taken at least 1 hour prior to or 4-6 hours after taking the bile-acid sequestrant
Canagliflozin/metformin [1], cholestyramine ---> SPC of [1] of EMA
Cholestyramine may potentially reduce canagliflozin exposure. Canagliflozin should be taken at least 1 hour prior to or 4-6 hours after taking the bile-acid sequestrant
Cardiac glycosides, cholestyramine
Decreased intestinal absorption of digitalis.
Cefadroxil, cholestyramine
Cefadroxil binds to cholestyramine which may lead to reduced bioavailability of cefadroxil.
Chenodeoxycholic acid [1], cholestyramine ---> SPC of [1] of EMA
If it is necessary to take colestyramine then chenodeoxycholic acid should be taken either one hour before colestyramine or 4-6 hours after.
Chloroquine, cholestyramine
Cholestyramine may decrease the absorption of chloroquine. Patients should take other drugs at least 1 hour before or 4-6 hours after colestyramine to minimize possible interference with their absorption.
Chlortalidone, cholestyramine ---> SPC of [amlodipine/valsartan/hydrochlorothiazide] of EMA
Absorption of thiazide diuretics is decreased by cholestyramine and other anionic exchange resins. The thiazide should be taken at least 4 hours before or 4-6 hours after of the other medicinal product
Cholecalciferol [1], cholestyramine ---> SPC of [1] of eMC
Simultaneous treatment of colecalciferol with ion exchange resins such may reduce the gastrointestinal absorption of vitamin D.
Cholestyramine [1], doxycycline ---> SPC of [1] of eMC
Cholestyramine may delay or reduce the absorption of tetracycline. Patients should take other drugs at least 1 hour before or 4-6 hours after colestyramine to minimize possible interference with their absorption.
Cholestyramine [1], enterohepatic circulation ---> SPC of [1] of eMC
Colestyramine may interfere with the pharmacokinetics of drugs that undergo enterohepatic recirculation.
Cholestyramine [1], fat-soluble vitamins ---> SPC of [1] of eMC
Cholestyramine may delay/decrease the absorption of the fat-soluble vitamin. The vitamin should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine [1], paracetamol ---> SPC of [1] of eMC
The speed of absorption of paracetamol is reduced by cholestyramine. Therefore, the cholestyramine should not be taken within 1 hour if maximal analgesia is required.
Cholestyramine [1], pregnancy ---> SPC of [1] of eMC
The safety of colestyramine in pregnancy has not been established
Cholestyramine [1], tetracyclines ---> SPC of [1] of eMC
Cholestyramine may delay or reduce the absorption of tetracycline. Patients should take other drugs at least 1 hour before or 4-6 hours after colestyramine to minimize possible interference with their absorption.
Cholestyramine [1], warfarin ---> SPC of [1] of eMC
Cholestyramine may delay or reduce the absorption of warfarin. Patients should take other drugs at least 1 hour before or 4-6 hours after colestyramine to minimize possible interference with their absorption.
Cholestyramine, cholic acid [2] ---> SPC of [2] of EMA
The co-administration may decrease or prevent the absorption of cholic acid. Separate administration by at least 5 hours
Cholestyramine, clomipramine ---> SPC of [1] of eMC
Co-administration of ion exchange resins may reduce the plasma levels of clomipramine. It is recommended to administer clomipramine at least 2 h before or 4-6 h after the administration of resins
Cholestyramine, coumarin anticoagulants
Cholestyramine may delay/decrease the absorption of the co-administered medicament. This medicine should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, cyanocobalamin ---> SPC of [1] of eMC
Reduced absorption of vitamin B12
Cholestyramine, deferasirox [2] ---> SPC of [2] of EMA
Cholestyramine significantly reduced the deferasirox exposure in a mechanistic study to determine the degree of enterohepatic recycling
Cholestyramine, diclofenac
Decreased absorption of diclofenac.
Cholestyramine, digoxin
Decreased digoxin absorption or increased elimination due to enterohepatic circulation interruption. Digoxin should be administered 2 hours before.
Cholestyramine, dutasteride [2] ---> SPC of [2] of eMC
Administration of 12 g colestyramine one hour after a 5 mg single dose of dutasteride did not affect the pharmacokinetics of dutasteride.
Cholestyramine, estrogens
Cholestyramine may partially abolish the absorption of the co-administered medicament
Cholestyramine, ezetimibe [2] ---> SPC of [2] of eMC
Concomitant ezetimibe and cholestyramine administration decreased the mean area under the curve (AUC) of total ezetimibe (ezetimibe + ezetimibe glucuronide) approximately 55%.
Cholestyramine, ezetimibe/atorvastatin [2] ---> SPC of [2] of eMC
Concomitant cholestyramine administration decreased the mean area under the curve (AUC) of total ezetimibe (ezetimibe + ezetimibe glucuronide) approximately 55%.
Cholestyramine, ezetimibe/atorvastatin [2] ---> SPC of [2] of eMC
The incremental low-density lipoprotein cholesterol (LDL-C) reduction due to adding ATOZET to cholestyramine may be lessened by this interaction
Cholestyramine, ezetimibe/simvastatine [2] ---> SPC of [2] of eMC
Concomitant ezetimibe and cholestyramine administration decreased the mean area under the curve (AUC) of total ezetimibe (ezetimibe + ezetimibe glucuronide) approximately 55%.
Cholestyramine, fenofibrate/pravastatine [2] ---> SPC of [2] of EMA
Concomitant administration decreased the bioavailability of statine. The statine should be taken 1 h before or 4 h after colestyramine
Cholestyramine, fluvastatin [2] ---> SPC of [2] of eMC
Fluvastatin should be administered at least 4 hours after the cholestyramine to avoid a significant interaction due to drug binding of the resin.
Cholestyramine, folic acid
Drugs that may adversely affect the absorption or metabolism of folic acid may cause statuses of folate deficiency
Cholestyramine, furosemide
Decreased absorption of furosemide. Administer 2 to 3 hours apart
Cholestyramine, gestagens
Cholestyramine may partially abolish the absorption of the co-administered medicament
Cholestyramine, glipizide
Cholestyramine may decrease plasma levels of sulfonylurea. Patients should take other drugs at least 1 hour before or 4-6 hours after colestyramine to minimize possible interference with their absorption.
Cholestyramine, hydrochlorothiazide ---> SPC of [amlodipine/valsartan/hydrochlorothiazide] of EMA
The co-administration may decrease the absorption of hydrochlorothiazide. Hydrochlorothiazide should be administered 1 hour before or 4-6 hours after colestipol
Cholestyramine, hydrocortisone
Cholestyramine decreases the effect of hydrocortisone
Cholestyramine, ibuprofen
Possible decreased absorption of ibuprofen. Patients should take other drugs at least 1 hour before or 4-6 hours after colestyramine to minimize possible interference with their absorption.
Cholestyramine, imipramine
Cholestyramine may decrease plasma levels of imipramine. Patients should take other drugs at least 1 hour before or 4-6 hours after colestyramine to minimize possible interference with their absorption.
Cholestyramine, iron
Cholestyramine may delay/decrease the absorption of the co-administered medicament. This medicine should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, leflunomide [2] ---> SPC of [2] of EMA
It is recommended that patients receiving leflunomide are not treated with colestyramine or activated powdered charcoal because this leads to a rapid and significant decrease in plasma A771726 (the active metabolite of leflunomide)
Cholestyramine, levothyroxine
The ion-exchange resin inhibits the absorption of levothyroxine. Levothyroxine should be taken 4-5 hours before administration of resin
Cholestyramine, liothyronine
Cholestyramine may delay/decrease the absorption of the co-administered medicament. This medicine should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, lomitapide [2] ---> SPC of [2] of EMA
Because bile acid sequestrants can interfere with the absorption of oral medicines, bile acid sequestrants should be taken at least 4 hours before or at least 4 hours after lomitapide.
Cholestyramine, loperamide
Inhibition of loperamide effect
Cholestyramine, losartan/hydrochlorothiazide [2] ---> SPC of [2] of eMC
Absorption of hydrochlorothiazide is impaired in the presence of anionic exchange resins.
Cholestyramine, lovastatine
Concomitant administration decreased the bioavailability of statine. The statine should be taken 1 h before or 4 h after colestyramine
Cholestyramine, lymecycline
Cholestyramine may delay/decrease the absorption of the co-administered medicament. This medicine should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, mefruside
Absorption of mefruside is reduced.
Cholestyramine, meloxicam
Cholestyramine accelerates the elimination of meloxicam by interrupting the enterohepatic circulation
Cholestyramine, mepartricin
Mepartricin may enhance the lipid-lowering effect of cholestyramine
Cholestyramine, methionine
Medicinal product which increase homocysteine levels must not be co-administered with methionine
Cholestyramine, methotrexate [2] ---> SPC of [2] of EMA
Colestyramine can increase the non-renal elimination of methotrexate by interrupting the enterohepatic circulation.
Cholestyramine, methylprednisolone
Possible decrease of oral absorption of methylprednisolone
Cholestyramine, metildigoxin
Decreased intestinal absorption of digitalis. Metildigoxin should be taken 2 hours before
Cholestyramine, metronidazole
Colestyramine may delay or decrease the absorption of metronidazole
Cholestyramine, minocycline ---> SPC of [2] of eMC
Absorption of minocycline is impaired by the concomitant administration. Dosages should be maximally separated.
Cholestyramine, mycophenolate mofetil [2] ---> SPC of [2] of EMA
Drugs of other classes which interfere with MPA's enterohepatic cycle e.g. cholestyramine should be used with caution due to their potential to reduce the plasma levels and efficacy of mycophenolate mofetil
Cholestyramine, mycophenolate [2] ---> SPC of [2] of EMA
In view of the significant reduction in the AUC (area under the curve) of MPA by cholestyramine, caution should be used in the concomitant administration of mycophenolate with medicinal products that interfere with enterohepatic recirculation
Cholestyramine, mycophenolic acid
Caution should be used when co-administering drugs or therapies that may bind bile acids because of the potential to decrease MPA exposure and thus reduce the efficacy of mycophenolic acid.
Cholestyramine, naproxen ---> SPC of [naproxen/esomeprazole] of eMC
As with other NSAIDs, concomitant administration of cholestyramine can delay the absorption of naproxen.
Cholestyramine, naproxen/esomeprazole [2] ---> SPC of [2] of eMC
As with other NSAIDs, concomitant administration of cholestyramine can delay the absorption of naproxen.
Cholestyramine, nicotinic acid
The co-administration may increase the lowering effect of colestyramine on LDL-cholesterol. Statine should be taken 1 hour before or 4 hours after colestyramine
Cholestyramine, obeticholic acid [2] ---> SPC of [2] of EMA
Bile acid binding resins such as cholestyramine reduce bile acid absorption and may reduce efficacy of obeticholic acid. When co-administered, obeticholic acid should be taken at least 4-6 hours before or 4-6 hours after taking a bile acid binding resin
Cholestyramine, oral anticoagulants
Cholestyramine may partially abolish the absorption of the co-administered medicament
Cholestyramine, oxicams
Decreased elimination half-life of oxicame. Therefore, the cholestyramine should not be taken within 1 hour if maximal analgesia is required.
Cholestyramine, paricalcitol [2] ---> SPC of [2] of eMC
Cholestyramine may delay/decrease the absorption of the fat-soluble vitamin. The vitamin should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, penicillin G
Cholestyramine may delay/decrease the absorption of the co-administered medicament. This medicine should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, phenindione ---> SPC of [2] of eMC
Colestyramine antagonises the effect of phenindione
Cholestyramine, phenobarbital
Cholestyramine may delay/decrease the absorption of the co-administered medicament. This medicine should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, phenprocoumon
Weakening of phenprocoumon effect with the use concomitant or prior of colestyramine
Cholestyramine, phenylbutazone
Cholestyramine may delay/decrease the absorption of the co-administered medicament. This medicine should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, pindolol/clopamide
Colestyramine may decrease the absorption of pindolol/clopamide
Cholestyramine, piroxicam
Decreased elimination half-life of oxicame. Therefore, the cholestyramine should not be taken within 1 hour if maximal analgesia is required.
Cholestyramine, pravastatine [2] ---> SPC of [2] of eMC
Concomitant administration decreased the bioavailability of statine. The statine should be taken 1 h before or 4 h after colestyramine
Cholestyramine, prednisone
Possibly decreased oral absorption of corticosteroid
Cholestyramine, propranolol [2] ---> SPC of [2] of EMA
Co-administration of cholestyramine with propranolol resulted in up to 50% decrease in propranolol concentrations.
Cholestyramine, raloxifene [2] ---> SPC of [2] of EMA
Raloxifene should not be co-administered with cholestyramine (or other anion exchange resins), which significantly reduces the absorption and enterohepatic cycling of raloxifene.
Cholestyramine, regorafenib [2] ---> SPC of [2] of EMA
Bile salt-sequestering agents may interact with regorafenib by forming insoluble complexes which may impact absorption (or reabsorption), thus resulting in potentially decreased exposure.
Cholestyramine, retinol
Cholestyramine may delay/decrease the absorption of the fat-soluble vitamin. The vitamin should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, simvastatine
Concomitant administration decreased the bioavailability of statine. The statine should be taken 1 h before or 4 h after colestyramine
Cholestyramine, spironolactone
The co-administration may cause a hyperkaliemic metabolic acidosis
Cholestyramine, statins
Concomitant administration decreased the bioavailability of statine. The statine should be taken 1 h before or 4 h after colestyramine
Cholestyramine, sulfasalazine
Anion exchange resins bind sulfasalazine and its metabolites in the intestine
Cholestyramine, sulindac
Cholestyramine decreases the absolut bioavailability of sulindac and its metabolite
Cholestyramine, telmisartan/hydrochlorothiazide [2] ---> SPC of [2] of EMA
Absorption of hydrochlorothiazide is impaired in the presence of anionic exchange resins.
Cholestyramine, tenoxicam
Decreased elimination half-life of oxicame. Therefore, the cholestyramine should not be taken within 1 hour if maximal analgesia is required.
Cholestyramine, teriflunomide [2] ---> SPC of [2] of EMA
It is recommended that patients receiving teriflunomide are not treated with cholestyramine or activated charcoal because this leads to a rapid and significant decrease in plasma concentration unless an accelerated elimination is desired.
Cholestyramine, thiazides ---> SPC of [aliskiren/hydrochlorothiazide] of EMA
Absorption of thiazide diuretics is decreased by cholestyramine. This could result in sub-therapeutic effects of thiazide diuretics. The thiazide should be administered at least 4 hours before or 4-6 hours after the administration of resin
Cholestyramine, thyroid hormones
Cholestyramine may delay/decrease the absorption of the co-administered medicament. This medicine should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, torasemid [2] ---> SPC of [2] of eMC
Decreased oral absorption of torasemide
Cholestyramine, triamterene/hydrochlorothiazide ---> SPC of [2] of eMC
Colestyramine reduces the absorption of thiazides and if administered should be taken at least two hours apart.
Cholestyramine, trospium [2] ---> SPC of [2] of eMC
An inhibition of the absorption of trospium chloride cannot be excluded. Therefore the simultaneous administration of these drugs with trospium chloride is not recommended.
Cholestyramine, ursodeoxycholic acid [2] ---> SPC of [2] of eMC
Ursodeoxycholic acid should not be coadministered with colestyramine, because it binds ursodeoxycholic acid in the gut and thereby inhibits its absorption and efficacy. It must be taken at least 2 hours before or after ursodeoxycholic acid
Cholestyramine, valproic acid
Colestyramine may decrease the absorption of valproic acid
Cholestyramine, vitamin A
Cholestyramine may delay/decrease the absorption of the fat-soluble vitamin. The vitamin should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, vitamin D
Cholestyramine may delay/decrease the absorption of the fat-soluble vitamin. The vitamin should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, vitamin E
Cholestyramine may delay/decrease the absorption of the fat-soluble vitamin. The vitamin should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, vitamin K
Cholestyramine may delay/decrease the absorption of the fat-soluble vitamin. The vitamin should be administered 1 hour before or 4-6 hours after colestyramine
Cholestyramine, xipamide
Decreased absorption of xipamide
CONTRAINDICATIONS of Cholestyramine
- Questran is contraindicated in patients who have shown hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- In patients with complete biliary obstruction, since Questran cannot be effective where bile is not secreted into the intestine.
http://www.medicines.org.uk/emc/
Cholic acid (Orphacol)
Aluminium hydroxide, cholic acid [2] ---> SmPC of [2] of EMA
The dose of bile acid sequestrants or antacids must be separated from the dose of cholic acid by an interval of 5 hours, regardless of which medicinal product is administered first.
Antacids, cholic acid [2] ---> SmPC of [2] of EMA
The dose of bile acid sequestrants or antacids must be separated from the dose of cholic acid by an interval of 5 hours, regardless of which medicinal product is administered first.
Bile-acid sequestrants, cholic acid [2] ---> SmPC of [2] of EMA
The dose of bile acid sequestrants or antacids must be separated from the dose of cholic acid by an interval of 5 hours, regardless of which medicinal product is administered first.
Breast-feeding, cholic acid [2] ---> SmPC of [2] of EMA
Cholic acid and its metabolites are excreted in human milk, but at therapeutic doses of Orphacol, no effects on the breastfed newborns/infants are anticipated. Orphacol can be used during breast-feeding.
Cholestyramine, cholic acid [2] ---> SmPC of [2] of EMA
The dose of bile acid sequestrants or antacids must be separated from the dose of cholic acid by an interval of 5 hours, regardless of which medicinal product is administered first.
Cholic acid [1], colesevelam ---> SmPC of [1] of EMA
The dose of bile acid sequestrants or antacids must be separated from the dose of cholic acid by an interval of 5 hours, regardless of which medicinal product is administered first.
Cholic acid [1], colestipol ---> SmPC of [1] of EMA
The dose of bile acid sequestrants or antacids must be separated from the dose of cholic acid by an interval of 5 hours, regardless of which medicinal product is administered first.
Cholic acid [1], cyclosporine ---> SmPC of [1] of EMA
Ciclosporin alters the pharmacokinetics of cholic acid by inhibition of the hepatic uptake and hepatobiliary secretion of bile acids, as well as its pharmacodynamics by inhibition of cholesterol 7?-hydroxylase. Co-administration should be avoided.
Cholic acid [1], fertility ---> SmPC of [1] of EMA
No data on the effects of cholic acid on fertility are available. At therapeutic doses, no effect on fertility is anticipated.
Cholic acid [1], foods ---> SmPC of [1] of EMA
The effect of food on the bioavailability of cholic acid has not been studied. There is a theoretical possibility that administration with food may increase cholic acid bioavailability and improve tolerability.
Cholic acid [1], phenobarbital ---> SmPC of [1] of EMA
Use of phenobarbital or primidone in patients with 3?-Hydroxy-?5-C27-steroid oxidoreductase deficiency or ?4-3-Oxosteroid-5?-reductase deficiency treated with cholic acid is contraindicated
Cholic acid [1], pregnancy ---> SmPC of [1] of EMA
It is extremely important that pregnant women continue their therapy during pregnancy. As a precautionary measure, pregnant women and their unborn children should be closely monitored.
Cholic acid [1], primidone ---> SmPC of [1] of EMA
Use of phenobarbital or primidone in patients with 3?-Hydroxy-?5-C27-steroid oxidoreductase deficiency or ?4-3-Oxosteroid-5?-reductase deficiency treated with cholic acid is contraindicated
Cholic acid [1], women of childbearing potential ---> SmPC of [1] of EMA
There is no need for contraceptive measures in women of childbearing potential treated with cholic acid or their partners. Women of childbearing potential should conduct a pregnancy test as soon as a pregnancy is suspected.
Cholic acid, hyaluronidase
Inhibition of hyaluronidase
CONTRAINDICATIONS of Cholic acid (Orphacol)
- Hypersensitivity to cholic acid or to any of the excipients.
- Concomitant use of phenobarbital with cholic acid
https://www.ema.europa.eu/en/documents/product-information/orphacol-epar-product-information_en.pdf 11/04/2025
Other trade names: Kolbam,
Concizumab (Alhemo)
Breast-feeding, concizumab [2] ---> SmPC of [2] of EMA
A risk to the breast-fed infant cannot be excluded during this short period. Afterwards, concizumab could be used during breast-feeding if clinically needed.
Concizumab [1], contraceptives ---> SmPC of [1] of EMA
The benefits and thromboembolic risks of the type of contraceptives used should be evaluated by the treating physician.
Concizumab [1], fertility ---> SmPC of [1] of EMA
Animal studies do not indicate direct or indirect harmful effects with respect to fertility, see section 5.3. No fertility data are available in humans.
Concizumab [1], pregnancy ---> SmPC of [1] of EMA
Concizumab should only be used during pregnancy if the potential benefit for the mother outweighs the potential risk to the foetus.
Concizumab [1], recombinant activated factor VIIa ---> SmPC of [1] of EMA
No sign of thrombosis or other adverse findings were observed in normo-coagulant monkeys when adding three consecutive doses of up to 1 mg/kg rFVIIa on top of concizumab at steady state, see section 5.3.
Concizumab [1], women of childbearing potential ---> SmPC of [1] of EMA
Women of childbearing potential receiving concizumab should use highly effective contraception during treatment with concizumab and until 7 weeks after end of treatment.
CONTRAINDICATIONS of Concizumab (Alhemo)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/alhemo-epar-product-information_en.pdf 17/01/2025
Autologous chondrocyte (ChondroCelect)
Ability to drive, autologous chondrocyte [2] ---> SmPC of [2] of EMA
Driving cars and using machines may be limited during the rehabilitation period.
ACI procedures, autologous chondrocyte [2] ---> SmPC of [2] of EMA
Fibrin glues are routinely used in ACI procedures to seal the outside margins and to improve the water-tightness of the compartment of the biological membrane used to cover the defect.
Analgesics, autologous chondrocyte [2] ---> SmPC of [2] of EMA
Pain relief medicinal products should be used according to the recommendations of the responsible surgeon.
Autologous chondrocyte [1], breast-feeding ---> SmPC of [1] of EMA
A decision should be made whether to discontinue breast-feeding taking into account the potential benefits of the treatment for the woman and the potential risk to the infant.
Autologous chondrocyte [1], fertility ---> SmPC of [1] of EMA
There are no data on possible effects of ChondroCelect treatment on fertility.
Autologous chondrocyte [1], fibrin glue ---> SmPC of [1] of EMA
The use of fibrin glue inside the cartilage defect bed is not recommended as this may result in a significantly poorer outcome (see section 5.3).
Autologous chondrocyte [1], fibrin sealant ---> SmPC of [1] of EMA
The use of fibrin glue inside the cartilage defect bed is not recommended as this may result in a significantly poorer outcome
Autologous chondrocyte [1], pregnancy ---> SmPC of [1] of EMA
As ChondroCelect is used to repair a cartilage defect of the knee and is implanted with the ACI procedure using open-knee surgery, it is not recommended during pregnancy.
CONTRAINDICATIONS of Autologous chondrocyte (ChondroCelect)
- Hypersensitivity to any of the excipients listed in section 6.1, or to bovine serum.
- ChondroCelect must not be used in case of advanced osteoarthritis of the knee.
- Patients with femoral epiphyseal growth plate that is not fully closed
https://www.ema.europa.eu/en/documents/product-information/chondrocelect-epar-product-information_en.pdf 12/01/2017 (withdrawn)
Choriogonadotropin alfa (Ovitrelle)
Breast-feeding, choriogonadotropin alfa [2] ---> SmPC of [2] of EMA
Ovitrelle is not indicated during breastfeeding. There are no data on the excretion of choriogonadotropin alfa in milk.
Choriogonadotropin alfa [1], fertility ---> SmPC of [1] of EMA
Ovitrelle is indicated for use in infertility (see section 4.1).
Choriogonadotropin alfa [1], medicinal products ---> SmPC of [1] of EMA
No specific interaction studies with Ovitrelle and other medicinal products have been performed; however, no clinically significant medicinal product interactions have been reported during hCG therapy.
Choriogonadotropin alfa [1], pregnancy ---> SmPC of [1] of EMA
There is no indication for the use of Ovitrelle during pregnancy. Data on a limited number of exposed pregnancies indicate no increased risks of malformation or foeto/neonatal toxicity.
CONTRAINDICATIONS of Choriogonadotropin alfa (Ovitrelle)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Tumours of the hypothalamus or pituitary gland
- Ovarian enlargement or cyst due to reasons other than polycystic ovarian disease
- Gynaecological haemorrhages of unknown aetiology
- Ovarian, uterine or mammary carcinoma
- Extrauterine pregnancy in the previous 3 months
- Active thromboembolic disorders
- Primary ovarian failure
- Malformations of sexual organs incompatible with pregnancy
- Fibroid tumours of the uterus incompatible with pregnancy
- Postmenopausal women
https://www.ema.europa.eu/en/documents/product-information/ovitrelle-epar-product-information_en.pdf 23/05/2025
Ciclesonide
Breast-feeding, ciclesonide [2] ---> SPC of [2] of eMC
Administration of ciclesonide to women who are breast-feeding should only be considered if the expected benefit to the mother is greater than any possible risk to the child.
Ciclesonide [1], itraconazol ---> SPC of [1] of eMC
The concomitant administration of ciclesonide with potent inhibitors of CYP 3A4 should be avoided unless the benefit outweighs the increased risk of systemic side effects of corticosteroids.
Ciclesonide [1], nelfinavir ---> SPC of [1] of eMC
The concomitant administration of ciclesonide with potent inhibitors of CYP 3A4 should be avoided unless the benefit outweighs the increased risk of systemic side effects of corticosteroids.
Ciclesonide [1], pregnancy ---> SPC of [1] of eMC
As with other glucocorticoids, ciclesonide should only be used during pregnancy if the potential benefit to the mother justifies the potential risk to the fetus.
Ciclesonide [1], ritonavir ---> SPC of [1] of eMC
The concomitant administration of ciclesonide with potent inhibitors of CYP 3A4 should be avoided unless the benefit outweighs the increased risk of systemic side effects of corticosteroids.
Ciclesonide [1], strong CYP3A4 inhibitors ---> SPC of [1] of eMC
The concomitant administration of ciclesonide with potent inhibitors of CYP 3A4 should be avoided unless the benefit outweighs the increased risk of systemic side effects of corticosteroids.
Ciclesonide, ketoconazole [2] ---> SPC of [2] of EMA
Increased in plasma concentrations of Ciclesonide have been observed. Not recommended unless necessary. Careful monitoring and dose adjustment of this drug may be required
CONTRAINDICATIONS of Ciclesonide
Hypersensitivity to ciclesonide or any of the excipients.
http://www.medicines.org.uk/emc/
Ciclopirox
Breast-feeding, ciclopirox
Ciclopirox is not indicated in the breast-feeding due to the lack of clinical experience
Ciclopirox, pregnancy
Ciclopirox is not indicated during pregnancy due to the lack of clinical experience
Cidofovir (Vistide)
Ability to drive, cidofovir [2] ---> SPC of [2] of EMA
Adverse reactions such as asthenia may occur during cidofovir therapy.
Breast-feeding, cidofovir [2] ---> SPC of [2] of EMA
Breast-feeding should be discontinued during treatment with cidofovir.
Cidofovir [1], nephrotoxic substances ---> SPC of [1] of EMA
The co-administration of cidofovir and other potentially nephrotoxic agents is contraindicated
Cidofovir [1], pregnancy ---> SPC of [1] of EMA
Cidofovir is not recommended during pregnancy and in women of childbearing potential not using contraception.
Cidofovir [1], probenecide ---> SPC of [1] of EMA
Concomitant use of probenecid is essential for reducing the pronounced nephrotoxicity of cidofovir to an extent that results in an acceptable benefit/risk balance of cidofovir therapy.
Cidofovir, cytidine analogues
Cidofovir should not be co-administered with other cytidine analogues
Cidofovir, efavirenz/emtricitabine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
Due to similarities with emtricitabine, the fixed combination should not be administered concomitantly with other cytidine analogues
Cidofovir, elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
Use of emtricitabine/rilpivirine/tenofovir should be avoided with concurrent or recent use of a nephrotoxic medicinal product
Cidofovir, emtricitabine/rilpivirine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
Co-administration of medicinal products that reduce renal function or compete for active tubular secretion (e.g. cidofovir) may increase serum concentrations of emtricitabine, tenofovir and/or the co-administered medicinal products.
Cidofovir, emtricitabine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
Co-administration of medicinal products that reduce renal function or compete for active tubular secretion (e.g. cidofovir) may increase serum concentrations of emtricitabine, tenofovir and/or the co-administered medicinal products.
Cidofovir, ganciclovir [2] ---> SPC of [2] of eMC
Since ganciclovir is renal excreted, toxicity may be enhanced during coadministration of valganciclovir with drugs that might reduce the renal clearance of ganciclovir: nephrotoxicity and competitive inhibition of active tubular secretion
Cidofovir, gentamicin
Increased risk of nephrotoxicity. Caution should be exercised.
Cidofovir, meglumine and sodium ioxitalamate
The co-administration with other medicinal products with nephrotoxic potential may decrease the renal function and cause a permanent damage
Cidofovir, sacubitril/valsartan [2] ---> SPC of [2] of EMA
Co-administration of Entresto with inhibitors of OATP1B1, OATP1B3, OAT3 (e.g. rifampicin, ciclosporin), OAT1 (e.g. tenofovir, cidofovir) or MRP2 (e.g. ritonavir) may increase the systemic exposure of LBQ657 or valsartan.
Cidofovir, tafamidis [2] ---> SPC of [2] of EMA
Tafamidis inhibits the uptake transporters OAT1 and OAT3 (organic anion transporters) and may cause drug-drug interactions at clinically relevant concentrations with substrates of these transporters
Cidofovir, tenofovir disoproxil [2] ---> SPC of [2] of EMA
Use of tenofovir should be avoided with concurrent or recent use of a nephrotoxic medicinal product
Cidofovir, tiopronin
Increased risk of nephrotoxicity. Caution should be exercised
Cidofovir, valganciclovir [2] ---> SPC of [2] of eMC
The renal clearance of ganciclovir may be inhibited due to nephrotoxicity caused by drugs. Concomitant use of valganciclovir with these drugs should be considered only if the potential benefits outweigh the potential risks
CONTRAINDICATIONS of Cidofovir (Vistide)
- Hypersensitivity to the active substance or to any of the excipients.
- Cidofovir administration is contraindicated in patients unable to receive probenecid or other sulfa-containing medication
- Cidofovir is contraindicated in patients with renal insufficiency
- Concomitant administration of cidofovir and other potentially nephrotoxic agents is contraindicated
- Direct intraocular injection of cidofovir is contraindicated; direct injection may be associated with significant decreases in intraocular pressure and impairment of vision.
https://www.ema.europa.eu/en/documents/product-information/vistide-epar-product-information_en.pdf 19/01/2015 (withdrawn)
Cilazapril
Ability to drive, cilazapril [2] ---> SPC of [2] of eMC
When driving and operating machines, it should be taken into account that occasionally dizziness and fatigue may occur, especially when starting therapy
Acetylsalicylic acid, cilazapril [2] ---> SPC of [2] of eMC
When ACE inhibitors are administered simultaneously with NSAIDs attenuation of the antihypertensive effect may occur. Concomitant use may also lead to an increased risk of worsening of renal function, and an increase in serum potassium
Alcohol, cilazapril
Increased effect of alcohol
Aliskiren [1], cilazapril ---> SPC of [1] of EMA
The combination of ACE inhibitors with aliskiren is contraindicated in diabetes mellitus or renal impairment (GFR < 60 ml/min/1.73 m²) and is not recommended in other patients
Allopurinol, cilazapril
Increased blood count alterations
Amiloride, cilazapril [2] ---> SPC of [2] of eMC
Potassium sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.
Anaesthetics, cilazapril [2] ---> SPC of [2] of eMC
Concomitant use of certain anesthetic medicinal products with ACE inhibitors may result in further reduction of blood pressure
Antihypertensives, cilazapril [2] ---> SPC of [2] of eMC
An additive effect may be observed when cilazapril is administered in combination with other antihypertensive agents.
Breast-feeding, cilazapril [2] ---> SPC of [2] of eMC
Because no information is available regarding the safety of cilazapril during breast-feeding, cilazapril is not recommended, and alternative treatments with better established safety profiles during breast-feeding are preferable
Cilazapril [1], coxibs ---> SPC of [1] of eMC
When ACE inhibitors are administered simultaneously with NSAIDs attenuation of the antihypertensive effect may occur. Concomitant use may also lead to an increased risk of worsening of renal function, and an increase in serum potassium
Cilazapril [1], dihydropyrimidine dehydrogenase inhibitors 4 ---> SPC of [1] of eMC
Concomitant use of ACE inhibitors with DPP-IV inhibitor (e.g. vildagliptin) therapy may lead to an increased risk for angioedema
Cilazapril [1], gold ---> SPC of [1] of eMC
Nitritoid reactions following injectable gold have been reported more frequently in patients receiving ACE inhibitor therapy.
Cilazapril [1], heparin ---> SPC of [1] of eMC
Potassium sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.
Cilazapril [1], hyperkalemia ---> SPC of [1] of eMC
Potassium sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.
Cilazapril [1], insulin ---> SPC of [1] of eMC
Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.
Cilazapril [1], lithium ---> SPC of [1] of eMC
Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with ACE inhibitors.
Cilazapril [1], loop diuretics ---> SPC of [1] of eMC
Prior treatment with high dose diuretics may result in volume depletion and a risk of hypotension when initiating therapy with cilazapril
Cilazapril [1], neuroleptics ---> SPC of [1] of eMC
Concomitant use of antipsychotics with ACE inhibitors may result in further reduction of blood pressure
Cilazapril [1], NSAID ---> SPC of [1] of eMC
When ACE inhibitors are administered simultaneously with NSAIDs attenuation of the antihypertensive effect may occur. Concomitant use may also lead to an increased risk of worsening of renal function, and an increase in serum potassium
Cilazapril [1], oral antidiabetics ---> SPC of [1] of eMC
Concomitant treatment with ACE inhibitors and antidiabetic agents may cause a pronounced hypoglycaemic effect with the risk of hypoglycaemia.
Cilazapril [1], potassium ---> SPC of [1] of eMC
Potassium sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.
Cilazapril [1], potassium-sparing diuretics ---> SPC of [1] of eMC
Potassium sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.
Cilazapril [1], pregnancy ---> SPC of [1] of eMC
The use of ACE inhibitors such as cilazapril is not recommended during the first trimester of pregnancy. The use of ACE inhibitors such as cilazapril is contraindicated during the second and third trimester of pregnancy
Cilazapril [1], spironolactone ---> SPC of [1] of eMC
Potassium sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.
Cilazapril [1], sympathomimetics ---> SPC of [1] of eMC
Sympathomimetics may reduce the antihypertensive effects of ACE inhibitors.
Cilazapril [1], thiazides ---> SPC of [1] of eMC
Prior treatment with high dose diuretics may result in volume depletion and a risk of hypotension when initiating therapy with cilazapril
Cilazapril [1], triamterene ---> SPC of [1] of eMC
Potassium sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium.
Cilazapril [1], tricyclic antidepressant ---> SPC of [1] of eMC
Concomitant use of tricyclic antidepressants with ACE inhibitors may result in further reduction of blood pressure
Cilazapril, corticosteroids
Increased blood count alterations
Cilazapril, cytostatics
Increased blood count alterations
Cilazapril, dextran sulphate
Anaphylactoid reactions have also been reported in patients undergoing low-density lipoprotein apheresis with dextran sulfate absorption.
Cilazapril, hypnotics
Increased hypotensive effect.
Cilazapril, immunosuppressives
Increased risk of blood count alterations
Cilazapril, narcotics
Increased hypotensive effect.
Cilazapril, procainamide
Increased blood count alterations
Cilazapril, sodium
Decreased hypotensive effect
Cilazapril, table salt
Decreased hypotensive effect
Cilazapril, temsirolimus ---> SPC of [quinapril] of eMC
Concomitant use of ACE inhibitors with mTOR inhibitor therapy may lead to an increased risk for angioedema
CONTRAINDICATIONS of Cilazapril
- Hypersensitivity to cilazapril or any components of the product, or to other ACE inhibitors
- History of angioedema associated with previous ACE inhibitor therapy
- Hereditary or idiopathic angioedema
- Second and third trimesters of pregnancy
- Concomitant use with aliskiren in patients with diabetes mellitus or renal impairment (GFR < 60 ml/min/1.73 m²).
http://www.medicines.org.uk/emc/
Cilostazol
Ability to drive, cilostazol [2] ---> SPC of [2] of EMA
Cilostazol may cause dizziness
Anagrelide [1], cilostazol ---> SPC of [1] of EMA
Anagrelide is an inhibitor of PDE III. The effects of medicinal products with similar properties such as the inotropes milrinone, enoximone, amrinone, olprinone and cilostazol may be exacerbated by anagrelide.
Anticoagulants, cilostazol [2] ---> SPC of [2] of EMA
Caution is advised in patients receiving both cilostazol and any anticoagulant agent and is contraindicated with 2 or more additional antiplatelet/anticoagulant agents
Antihypertensives, cilostazol [2] ---> SPC of [2] of EMA
Caution is needed when co-administering cilostazol with any other agent which has the potential to reduce blood pressure due to the possibility that there may be an additive hypotensive effect with a reflex tachycardia.
Atorvastatin, cilostazol [2] ---> SPC of [2] of EMA
Caution is advised in case of co-administration of cilostazol (CYP3A4 inhibitor) with statins metabolised by CYP3A4
Azole antifungals, cilostazol [2] ---> SPC of [2] of EMA
Cilostazol is extensively metabolised by CYP3A4 and CYP2C19 and to a lesser extent CYP1A2. Drugs inhibiting CYP3A4 increase the total pharmacological activity and could have the potential to enhance the undesirable effects of cilostazol.
Breast-feeding, cilostazol [2] ---> SPC of [2] of EMA
The use of cilostazol is not recommended during breast feeding.
Carbamazepine, cilostazol [2] ---> SPC of [2] of EMA
The effect of CYP3A4 and CYP2C19 inducers on cilostazol pharmacokinetics has not been evaluated. The antiplatelet effect may theoretically be altered
Cilostazol [1], cisapride ---> SPC of [1] of EMA
Caution is advised when cilostazol is co-administered with CYP3A4 substrates with a narrow therapeutic index
Cilostazol [1], clopidogrel ---> SPC of [1] of EMA
Caution is advised when co-administering cilostazol with any drug that inhibits platelet aggregation and is contraindicated with 2 or more additional antiplatelet/anticoagulant agents
Cilostazol [1], CYP2C19 inhibitors ---> SPC of [1] of EMA
Cilostazol is extensively metabolised by CYP3A4 and CYP2C19 and to a lesser extent CYP1A2. Drugs inhibiting CYP2C19 increase the total pharmacological activity and could have the potential to enhance the undesirable effects of cilostazol.
Cilostazol [1], CYP3A4 inhibitors ---> SPC of [1] of EMA
Cilostazol is extensively metabolised by CYP3A4 and CYP2C19 and to a lesser extent CYP1A2. Drugs inhibiting CYP3A4 increase the total pharmacological activity and could have the potential to enhance the undesirable effects of cilostazol.
Cilostazol [1], diltiazem ---> SPC of [1] of EMA
The overall pharmacological activity of cilostazol increases 19% when co-administered with diltiazem. No dose adjustment is necessary.
Cilostazol [1], drugs primarily metabolised by CYP3A4 with narrow therapeutic index ---> SPC of [1] of EMA
Caution is advised when cilostazol is co-administered with CYP3A4 substrates with a narrow therapeutic index
Cilostazol [1], ergot derivatives ---> SPC of [1] of EMA
Caution is advised when cilostazol is co-administered with CYP3A4 substrates with a narrow therapeutic index
Cilostazol [1], erythromycin ---> SPC of [1] of EMA
The overall pharmacological activity of cilostazol increases 34% when co-administered with erythromycin.
Cilostazol [1], grapefruit juice ---> SPC of [1] of EMA
Administration of a single dose of 100 mg cilostazol with 240 ml grapefruit juice (an inhibitor of intestinal CYP3A4) did not have a notable effect on the pharmacokinetics of cilostazol.
Cilostazol [1], halofantrine ---> SPC of [1] of EMA
Caution is advised when cilostazol is co-administered with CYP3A4 substrates with a narrow therapeutic index
Cilostazol [1], itraconazol ---> SPC of [1] of EMA
Cilostazol is extensively metabolised by CYP3A4 and CYP2C19 and to a lesser extent CYP1A2. Drugs inhibiting CYP3A4 increase the total pharmacological activity and could have the potential to enhance the undesirable effects of cilostazol.
Cilostazol [1], lovastatine ---> SPC of [1] of EMA
Caution is advised in case of co-administration of cilostazol (CYP3A4 inhibitor) with statins metabolised by CYP3A4
Cilostazol [1], nicotine ---> SPC of [1] of EMA
In clinical trials, smoking (which induces CYP1A2) decreased cilostazol plasma concentrations by 18%.
Cilostazol [1], omeprazole ---> SPC of [1] of EMA
The overall pharmacological activity of cilostazol increases by 47% when co-administered with omeprazole.
Cilostazol [1], phenytoin ---> SPC of [1] of EMA
The effect of CYP3A4 and CYP2C19 inducers on cilostazol pharmacokinetics has not been evaluated. The antiplatelet effect may theoretically be altered
Cilostazol [1], pimozide ---> SPC of [1] of EMA
Caution is advised when cilostazol is co-administered with CYP3A4 substrates with a narrow therapeutic index
Cilostazol [1], platelet aggregation inhibitors ---> SPC of [1] of EMA
Caution is advised when co-administering cilostazol with any drug that inhibits platelet aggregation and is contraindicated with 2 or more additional antiplatelet/anticoagulant agents
Cilostazol [1], pregnancy ---> SPC of [1] of EMA
Cilostazol must not be used during pregnancy
Cilostazol [1], protease inhibitors ---> SPC of [1] of EMA
Cilostazol is extensively metabolised by CYP3A4 and CYP2C19 and to a lesser extent CYP1A2. Drugs inhibiting CYP3A4 increase the total pharmacological activity and could have the potential to enhance the undesirable effects of cilostazol.
Cilostazol [1], proton pump inhibitors ---> SPC of [1] of EMA
Cilostazol is extensively metabolised by CYP3A4 and CYP2C19 and to a lesser extent CYP1A2. Drugs inhibiting CYP2C19 increase the total pharmacological activity and could have the potential to enhance the undesirable effects of cilostazol.
Cilostazol [1], rifampicin ---> SPC of [1] of EMA
The effect of CYP3A4 and CYP2C19 inducers on cilostazol pharmacokinetics has not been evaluated. The antiplatelet effect may theoretically be altered
Cilostazol [1], simvastatine ---> SPC of [1] of EMA
Caution is advised in case of co-administration of cilostazol (CYP3A4 inhibitor) with statins metabolised by CYP3A4
Cilostazol [1], St. John's wort ---> SPC of [1] of EMA
The effect of CYP3A4 and CYP2C19 inducers on cilostazol pharmacokinetics has not been evaluated. The antiplatelet effect may theoretically be altered
Cilostazol [1], strong CYP2C19 inductors ---> SPC of [1] of EMA
The effect of CYP3A4 and CYP2C19 inducers on cilostazol pharmacokinetics has not been evaluated. The antiplatelet effect may theoretically be altered
Cilostazol [1], strong CYP2C19 inhibitors ---> SPC of [1] of EMA
Cilostazol is extensively metabolised by CYP3A4 and CYP2C19 and to a lesser extent CYP1A2. Drugs inhibiting CYP2C19 increase the total pharmacological activity and could have the potential to enhance the undesirable effects of cilostazol.
Cilostazol [1], strong CYP3A4 inductors ---> SPC of [1] of EMA
The effect of CYP3A4 and CYP2C19 inducers on cilostazol pharmacokinetics has not been evaluated. The antiplatelet effect may theoretically be altered
Cilostazol [1], strong CYP3A4 inhibitors ---> SPC of [1] of EMA
Cilostazol is extensively metabolised by CYP3A4 and CYP2C19 and to a lesser extent CYP1A2. Drugs inhibiting CYP3A4 increase the total pharmacological activity and could have the potential to enhance the undesirable effects of cilostazol.
Cilostazol [1], warfarin ---> SPC of [1] of EMA
Caution is advised in patients receiving both cilostazol and any anticoagulant agent and is contraindicated with 2 or more additional antiplatelet/anticoagulant agents
Cilostazol, clarithromycin
The co-administration may influence the therapeutic effect of both active principles. It may also increase the probability of experiencing side effects.
Cilostazol, eliglustat [2] ---> SPC of [2] of EMA
Caution should be used with weak CYP3A inhibitors in poor metabolisers.
Cilostazol, esomeprazole [2] ---> SPC of [2] of EMA
Esomeprazole, CYP2C19 inhibitor, may increase the plasma concentrations of cilostazol.
Cilostazol, ketoconazole [2] ---> SPC of [2] of EMA
The overall pharmacological activity of cilostazol increases 35% when co-administered with ketoconazole. Careful monitoring.
Cilostazol, lomitapide [2] ---> SPC of [2] of EMA
Weak CYP3A4 inhibitors are expected to increase the exposure of lomitapide when taken simultaneously. Separate the dose of the medications by 12 hours OR decrease the dose of Lojuxta by half.
CONTRAINDICATIONS of Cilostazol
- Known hypersensitivity to cilostazol or to any of the excipients
- Severe renal impairment: creatinine clearance of ≤ 25 ml/min
- Moderate or severe hepatic impairment
- Congestive heart failure
- Pregnancy
- Patients with any known predisposition to bleeding (e.g. active peptic ulceration, recent [within 6 months] haemorrhagic stroke, proliferative diabetic retinopathy, poorly controlled hypertension)
- Patients with any history of ventricular tachycardia, ventricular fibrillation or multifocal ventricular ectopics, whether or not adequately treated, and in patients with prolongation of the QTc interval
- Patients with a history of severe tachyarrhythmia
- Patients treated concomitantly with two or more additional antiplatelet or anticoagulant agents (e.g. acetylsalicylic acid, clopidogrel, heparin, warfarin, acenocoumarol, dabigatran, rivaroxaban or apixaban)
- Patients with unstable angina pectoris, myocardial infarction within the last 6 months, or a coronary intervention in the last 6 months.
Ciltacabtagene autoleucel (Carvykti)
Ability to drive, ciltacabtagene autoleucel [2] ---> SmPC of [2] of EMA
Due to the potential for neurologic events, patients receiving CARVYKTI are at risk for altered or decreased consciousness or coordination in the 8 weeks following CARVYKTI infusion (see section 4.4).
Breast-feeding, ciltacabtagene autoleucel [2] ---> SmPC of [2] of EMA
Women who are breast-feeding should be advised of the potential risk to the breast-fed infant.
Ciltacabtagene autoleucel [1], fertility ---> SmPC of [1] of EMA
There are no data on the effect of CARVYKTI on fertility. Effects of CARVYKTI on male and female fertility have not been evaluated in animal studies (see section 5.3).
Ciltacabtagene autoleucel [1], men ---> SmPC of [1] of EMA
Male patients with partners of childbearing potential or whose partners were pregnant were instructed to use a barrier method of contraception, until one year after the patient has received CARVYKTI.
Ciltacabtagene autoleucel [1], pregnancy ---> SmPC of [1] of EMA
CARVYKTI is not recommended for women who are pregnant, or for women of childbearing potential not using contraception. Pregnant women should be advised there may be risks to the foetus.
Ciltacabtagene autoleucel [1], pregnant women ---> SmPC of [1] of EMA
Pregnant women who have received CARVYKTI may have hypogammaglobulinaemia. Assessment of immunoglobulin levels in newborns of mothers treated with CARVYKTI should be considered.
Ciltacabtagene autoleucel [1], vaccinations with live organism vaccines ---> SmPC of [1] of EMA
As a precautionary measure, vaccination with live virus vaccines is not recommended for at least 6 weeks prior to the start of lymphodepleting chemotherapy, during CARVYKTI treatment, and until immune recovery following treatment with CARVYKTI.
Ciltacabtagene autoleucel [1], women of childbearing potential ---> SmPC of [1] of EMA
In clinical trials, female patients of childbearing potential were advised to practice a highly effective method of contraception
CONTRAINDICATIONS of Ciltacabtagene autoleucel (Carvykti)
- Hypersensitivity to the active substance(s) or to any of the excipients listed in section 6.1.
- Contraindications of the lymphodepleting chemotherapy and supportive therapy should be considered.
https://www.ema.europa.eu/en/documents/product-information/carvykti-epar-product-information_en.pdf 10/02/2026
Cimetidine
Abacavir/lamivudine [1], cimetidine ---> SPC of [1] of EMA
No dosage adjustment necessary.
Abacavir/lamivudine/zidovudine [1], cimetidine ---> SPC of [1] of EMA
No dosage adjustment necessary.
Acenocoumarol [1], cimetidine ---> SPC of [1] of eMC
The co-administration may enhance the anticoagulant effect of acenocoumarol and increase the bleeding risk
Aciclovir [1], cimetidine ---> SPC of [1] of eMC
The medicinal products eliminated by active tubular secretion can increase the plasma concentrations of aciclovir
Albendazole, cimetidine
The co-administration may increase the plasma concentrations of active albendazole metabolite
Alcohol, cimetidine
Cimetidine increases the alcohol effect
Alendronic acid/colecalciferol [1], cimetidine ---> SPC of [1] of EMA
Anticonvulsants, cimetidine and thiazides may increase the catabolism of vitamin D.
Alfentanyl [1], cimetidine ---> SPC of [1] of eMC
Available human pharmacokinetic data indicate that the metabolism of alfentanil is inhibited by known cytochrome P450 3A4 enzyme inhibitors. This could increase the risk of prolonged or delayed respiratory depression.
Aliskiren [1], cimetidine ---> SPC of [1] of EMA
Co-administration of aliskiren with either metformin (< 28%), amlodipine (> 29%) or cimetidine (> 19%) resulted in between 20% and 30% change in Cmax or AUC of Rasilez.
Almasilate, cimetidine
There are studies which describe an absorption reduction of the active principle co-administered with almasilate
Alogliptin/metformin [1], cimetidine ---> SPC of [1] of EMA
Cimetidine delays the elimination of metformin. Close monitoring of glycaemic control
Alprazolam [1], cimetidine ---> SPC of [1] of eMC
Caution and consideration of dose reduction is recommended when alprazolam is co-administered with cimetidine
Alprenolol, cimetidine
Cimetidine delays the elimination of betablocker and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)
Aluminium hydroxide, cimetidine
The aluminium hydroxide decreases the absorption of the co-administered active principle. Separate administration by at least 2 hours
Amifampridine [1], cimetidine ---> SPC of [1] of EMA
Potent cytochrome P450 (CYP450) enzyme inhibitors are not likely to inhibit the metabolism of amifampridine by human N-acetyltransferases (NATs) giving rise to increased amifampridine exposure.
Aminophylline, cimetidine ---> SPC of [1] of eMC
Cimetidine may decrease aminophylline clearance resulting in increased plasma theophylline concentrations and the potential for increased toxicity
Amitriptyline [1], cimetidine ---> SPC of [1] of eMC
Plasma concentrations of amitriptyline are increased by cimetidine (inhibition of metabolism).
Amitriptylinoxide, cimetidine
The combination may increase the plasma levels of amitriptylinoxide or of the metabolites amitriptyline and nortriptyline
Amprenavir [1], cimetidine ---> SPC of [1] of EMA
Amprenavir may increase the plasma concentrations of cimetidine
Antiepileptics, cimetidine
Cimetidine delays the elimination of antiepileptic agent and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)
Antineoplastics, cimetidine
Cimetidine may potentiate the myelosuppressive effects (e.g. neutropenia, agranulocytosis) of chemotherapeutic agent
Atazanavir, cimetidine [2] ---> SPC of [2] of eMC
Cimetidine increases the pH und the absorption of atazanavir.
Atenolol/nifedipine, cimetidine ---> SPC of [1] of eMC
Cimetidine may potentiate the antihypertensive effect of nifedipine if it is administered simultaneously.
Azapropazone, cimetidine
The co-administration may cause an increase in azapropazone and decrease in cimetidine plasma levels respectively
Azathioprine [1], cimetidine ---> SPC of [1] of eMC
It has been suggested that cimetidine may have myelosuppressive effects which may be enhanced by concomitant administration of azathioprine.
Azelastine, cimetidine
The CYP2D6 inhibition by cimetidine may increase the plasma concentrations and the adverse effects of azelastine. Concomitant use should be avoided
Barnidipine, cimetidine
The moderate CYP3A4 inhibition may increase the plasma concentrations of barnidipine. Caution is recommend with the concomitant use of barnidipine with weak CYP3A4 inhibitors
Beclometasone/formoterol/glycopyrronium, cimetidine ---> SPC of [glycopyrronium] of EMA
No clinically relevant drug interaction is expected when glycopyrronium is co-administered with cimetidine or other inhibitors of organic cation transport.
Bendamustine [1], cimetidine ---> SPC of [1] of eMC
Bendamustine metabolism involves cytochrome P450 (CYP) 1A2 isoenzyme. Therefore, the potential for interaction with CYP1A2 inhibitors
Benzodiazepines, cimetidine [2] ---> SPC of [2] of eMC
Known inhibitors of hepatic enzymes, e.g. cimetidine, have been shown to reduce the clearance of benzodiazepines and may potentiate their action
Benzylpenicillin, cimetidine
Incompatible with benzylpenicillin in solution
Betablockers, cimetidine
Cimetidine may reduce the hepatic metabolism of beta-blockers, resulting in increased plasma levels of beta-blocker and prolonged serum half-life. Marked bradycardia may occur.
Bicalutamide [1], cimetidine ---> SPC of [1] of eMC
Caution should be exercised when administering bicalutamide to patients taking medicinal products that inhibit the oxidation processes in the liver
Bisoprolol, cimetidine
The effect of bisoprolol can be potentiated by cimetidine
Breast-feeding, cimetidine [2] ---> SPC of [2] of eMC
Cimetidine should be avoided during lactation unless essential.
Bromazepam, cimetidine
Concomitant use with cimetidine can lengthen the elimination half-life of bromazepam
Bromopride, cimetidine
Decreased effect of cimetidine by acceleration of intestinal passage
Brotizolam, cimetidine
The CYP3A4 inhibition may increase the plasma concentrations of brotizolam
Buspirone [1], cimetidine ---> SPC of [1] of eMC
The concomitant use of buspirone and cimetidine has shown a slight increase in the 1-(2-pyrimidinyl)-piperazine metabolite of buspirone.
Caffeine [1], cimetidine ---> SPC of [1] of EMA
Lower doses of caffeine citrate may be needed following co-administration of active substances which are reported to decrease caffeine elimination in adults (e.g., cimetidine and ketoconazole)
Calcium antagonists, cimetidine
Cimetidine delays the elimination of calcium antagonist and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)
Canagliflozin/metformin [1], cimetidine ---> SPC of [1] of EMA
Cationic substances that are eliminated by renal tubular secretion may interact with metformin by competing for common renal tubular transport systems.
Carbaldrate, cimetidine
The aluminium salt decreases the absorption of the co-administered active principle. Separate administration by at least 2 hours
Carbamazepine [1], cimetidine ---> SPC of [1] of eMC
The plasma concentrations of carbamazepine may be increased
Carmustine [1], cimetidine ---> SPC of [1] of EMA
Concomitant use with cimetidine leads to delayed, major, suspected, increased carmustine toxic effect (due to the inhibition of carmustine metabolism).
Carmustine, cimetidine [2] ---> SPC of [2] of eMC
Cimetidine may potentiate the myelosuppressive effects
Carvedilol [1], cimetidine ---> SPC of [1] of eMC
The enzymatic inhibition may increase the plasma levels of carvedilol
Celiprolol, cimetidine
Enhanced celiprolol effect
Chlomethiazole, cimetidine
There is evidence to indicate that the metabolism of clomethiazole is inhibited by cimetidine, thus the co-administration of these drugs may lead to increased blood/plasma levels of clomethiazole.
Chlordiazepoxide, cimetidine ---> SPC of [2] of eMC
Known inhibitors of hepatic enzymes, eg cimetidine, have been shown to reduce the clearance of benzodiazepines and may potentiate their action
Chloroquine [1], cimetidine ---> SPC of [1] of eMC
Cimetidine inhibits metabolism of chloroquine (increased plasma concentration)
Cholecalciferol, cimetidine ---> SPC of [alendronic acid/colecalciferol] of EMA
Anticonvulsants, cimetidine and thiazides may increase the catabolism of vitamin D.
Cimetidine [1], class I antiarrhythmic agents ---> SPC of [1] of eMC
Cimetidine, enzyme inhibitor, may increase the plasma levels of antiarrhythmic agent
Cimetidine [1], clomipramine ---> SPC of [1] of eMC
Cimetidine, enzymatic inhibitor (CYP2D6 and CYP3A4), increases the plasma levels of antidepressant and enhances or prolongs its effects and adverse effects
Cimetidine [1], coumarin anticoagulants ---> SPC of [1] of eMC
Cimetidine, enzyme inhibitor, may increase the plasma levels of coumarine and prolong the prothrombin time
Cimetidine [1], diazepam ---> SPC of [1] of eMC
Cimetidine can prolong the elimination of drugs metabolised by oxidation in the liver.
Cimetidine [1], drugs primarily metabolised by CYP1A2 ---> SPC of [1] of eMC
Cimetidine, CYP1A2 inhibitor, may increase the plasma concentrations of the medicinal products mainly metabolized by CYP1A2
Cimetidine [1], drugs primarily metabolised by CYP2C19 ---> SPC of [1] of eMC
Cimetidine, CYP2C19 inhibitor, may increase the plasma concentrations of the medicinal products mainly metabolized by CYP2C19
Cimetidine [1], drugs primarily metabolised by CYP2C9 ---> SPC of [1] of eMC
Cimetidine, CYP2C9 inhibitor, may increase the plasma concentrations of the medicinal products mainly metabolized by CYP2C9
Cimetidine [1], drugs primarily metabolised by CYP2D6 ---> SPC of [1] of eMC
Cimetidine, CYP2D6 inhibitor, may increase the plasma concentrations of the medicinal products mainly metabolized by CYP2D6
Cimetidine [1], drugs primarily metabolised by CYP3A4 ---> SPC of [1] of eMC
Cimetidine, CYP3A4 inhibitor, may increase the plasma concentrations of the medicinal products mainly metabolized by CYP3A4
Cimetidine [1], glipizide ---> SPC of [1] of eMC
Cimetidine, enzyme inhibitor, may increase the plasma levels of sulfonylurea
Cimetidine [1], itraconazol ---> SPC of [1] of eMC
Cimetidine increases the pH und decreases the absorption of itraconazol.
Cimetidine [1], ketoconazole ---> SPC of [1] of eMC
Cimetidine increases the pH und decreases the absorption of ketoconazole.
Cimetidine [1], metoprolol ---> SPC of [1] of eMC
Cimetidine can prolong the elimination of drugs metabolised by oxidation in the liver.
Cimetidine [1], pregnancy ---> SPC of [1] of eMC
Cimetidine should be avoided during pregnancy unless essential.
Cimetidine [1], sulfonylureas ---> SPC of [1] of eMC
Cimetidine, enzyme inhibitor, may increase the plasma levels of sulfonylurea
Cimetidine [1], tricyclic antidepressant ---> SPC of [1] of eMC
Cimetidine, enzymatic inhibitor (CYP2D6 and CYP3A4), increases the plasma levels of antidepressant and enhances or prolongs its effects and adverse effects
Cimetidine, citalopram [2] ---> SPC of [2] of eMC
Cimetidine, a known enzyme-inhibitor, caused a slight rise in the average steady-state citalopram levels. Dose adjustment may be warranted.
Cimetidine, clebopride
Clebopride decreases the effects of cimetidine and digoxine
Cimetidine, clobazam
The enzymatic inhibition may potentiate and prolong the effect of clobazam
Cimetidine, clonazepam
Known inhibitors of hepatic enzymes, e. g. cimetidine, have been shown to reduce the clearance of benzodiazepines and may potentiate their action
Cimetidine, codeine ---> SPC of [2] of eMC
Cimetidine inhibits the metabolism of opioid analgesics causing increased plasma concentration of codeine.
Cimetidine, codergocrin
The CYP3A4 inhibition may increase the exposition to codergocrin, which may cause a dopaminergic effect. Concomitant use should be avoided
Cimetidine, cyanocobalamin ---> SPC of [1] of eMC
Reduced absorption of vitamin B12
Cimetidine, cyclophosphamide
The co-administration may increase the concentration of cytotoxic metabolites
Cimetidine, cyclosporine [2] ---> SPC of [2] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cimetidine, dapagliflozin/metformin [2] ---> SPC of [2] of EMA
Cationic active substances that are eliminated by renal tubular secretion may interact with metformin by competing for common renal tubular transport systems and hence delay the elimination of metformin
Cimetidine, darifenacin [2] ---> SPC of [2] of EMA
Concomitant treatment with potent CYP2D6 inhibitors results in an increase in darifenacin exposure
Cimetidine, darunavir/cobicistat [2] ---> SPC of [2] of EMA
Based on theoretical considerations, no mechanistic interaction is expected. Darunavir/cobicistat can be co-administered with H2-receptor antagonists without dose adjustments.
Cimetidine, darunavir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Based on theoretical considerations, no mechanistic interaction is expected. Symtuza can be co-administered with H2-receptor antagonists without dose adjustments.
Cimetidine, dextromethorphan
The CYP2D6 inhibition may increase the plasma concentrations of dextromethorphan
Cimetidine, diamorphine
Cimetidine inhibits metabolism of opioid analgesics.
Cimetidine, dihydrocodeine [2] ---> SPC of [2] of eMC
Cimetidine may inhibit the metabolism of dihydrocodeine resulting in increased plasma concentrations.
Cimetidine, dihydroergotamine
The co-administration may enhance the effects and adverse effects of dihydroergotamine. The concomitant use should be done with caution
Cimetidine, dihydroergotoxine
The CYP3A4 inhibition may increase the exposition to dihydroergotoxine, which may cause a dopaminergic effect. Concomitant use should be avoided
Cimetidine, diltiazem [2] ---> SPC of [2] of eMC
Increase in plasma diltiazem concentrations. Patients currently receiving diltiazem therapy should be carefully monitored when initiating or discontinuing therapy with H2 antagonists. An adjustment in diltiazem daily dose may be necessary.
Cimetidine, dipotassium clorazepate
The co-administration may enhance and prolong the clorazepate effect
Cimetidine, dofetilide [2] ---> SPC of [2] of EMA
The co-administration may increase the plasma levels of dofetilide. The combination is contraindicated
Cimetidine, dolutegravir/abacavir/lamivudine [2] ---> SPC of [2] of EMA
No dosage adjustment necessary.
Cimetidine, dolutegravir/rilpivirine [2] ---> SPC of [2] of EMA
Only H2-receptor antagonists that can be dosed once daily should be used. H2-receptor antagonists should be taken well separated in time from the administration of Juluca (minimum 4 hours after or 12 hours before)
Cimetidine, doubutamine ---> SPC of [2] of eMC
It is possible that cimetidine may inhibit the uptake and/or the metabolism of dobutamine by the liver with a subsequent increase in the degree and duration of its action.
Cimetidine, doxepin ---> SPC of [2] of eMC
Cimetidine has been reported to produce clinically significant fluctuations in steady-state serum concentrations of doxepin
Cimetidine, doxofylline
Cimetidine delays the elimination of xanthine and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)
Cimetidine, doxorubicine [2] ---> SPC of [2] of eMC
Cimetidine has been shown to reduce the plasma clearance and increase the AUC of doxorubicin.
Cimetidine, droperidol [2] ---> SPC of [2] of eMC
Substances inhibiting the activity of cytochrome P450 iso-enzymes CYP1A2 and CYP3A4 could decrease the rate at which droperidol is metabolised and prolong its pharmacological action.
Cimetidine, eliglustat [2] ---> SPC of [2] of EMA
It is predicted that concomitant use of moderate CYP3A inhibitors would increase eliglustat exposure approximately up to 3-fold. Caution should be used with moderate CYP3A inhibitors in intermediate and extensive metabolisers.
Cimetidine, empagliflozin/metformin [2] ---> SPC of [2] of EMA
Cationic substances that are eliminated by renal tubular secretion (e.g. cimetidine) may interact with metformin by competing for common renal tubular transport systems.
Cimetidine, emtricitabine/rilpivirine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Co-administration may cause significant decreases in rilpivirine plasma concentrations (reduced absorption, increase in gastric pH).
Cimetidine, emtricitabine/rilpivirine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
The increase of gastric pH decreases absorption, plasma level and effect of rilpivirine. The H2 antagonist should be administered at least 12 h before or 4 h after rilpivirine
Cimetidine, epirubicin [2] ---> SPC of [2] of eMC
Cimetidine 400 mg b.i.d given prior to epirubicin 100 mg/m² every 3 weeks led to a 50% increase in epirubicin AUC and a 41% increase in epirubicinol AUC. Administration of cimetidine should be discontinued during treatment with epirubicin.
Cimetidine, ergot derivatives
The co-administration increases the risk of ergotism and concomitant use should be avoided
Cimetidine, ertugliflozin/metformin [2] ---> SPC of [2] of EMA
Inhibitors of OCT2 may decrease the renal elimination of metformin and thus lead to an increase in metformin plasma concentration.
Cimetidine, erythromycin [2] ---> SPC of [2] of eMC
An increased plasma concentration of erythromycin has been reported with concomitant cimetidine treatment, leading to increased risk of toxicity, including reversible deafness.
Cimetidine, escitalopram [2] ---> SPC of [2] of eMC
Co-administration of escitalopram with cimetidine (moderately potent general enzyme inhibitor) resulted in a moderate increase in the plasma concentrations of escitalopram. Caution is advised when administering escitalopram in combination with cimetidine
Cimetidine, fampridine [2] ---> SPC of [2] of EMA
OCT2 is the transporter responsible for the active secretion of fampridine. Thus, the concomitant use of fampridine with medicinal products that are inhibitors of OCT2 for example, cimetidine is contraindicated
Cimetidine, felodipine ---> SPC of [felodipine/metoprolol] of eMC
Enzyme inhibiting substances of cytochrome P450 isoenzyme 3A4 may increase in felodipine plasma concentrations
Cimetidine, felodipine/metoprolol
It has been shown that inhibitors of cytochrome P450-3A4 system increase the plasma concentrations of felodipine. The concomitant use with strong CYP3A4 inhibitors should be avoided
Cimetidine, fentanyl
The CYP3A4 inhibition may increase plasma levels of fentanyl
Cimetidine, fesoterodine [2] ---> SPC of [2] of EMA
The effect of weak CYP3A4 inhibitors (e.g. cimetidine) on fesoterodine, was not examined; it is not expected to be in excess of the effect of moderate inhibitor.
Cimetidine, flecainide [2] ---> SPC of [2] of eMC
The H2 antagonist cimetidine inhibits metabolism of flecainide.
Cimetidine, flunitrazepam
Substances that inhibit hepatic enzymes may enhance the effect of benzodiazepines. Interactions with strong CYP3A4 inhibitors cannot be excluded
Cimetidine, fluorouracil [2] ---> SPC of [2] of eMC
Cimetidine may increase the plasma level of 5-fluorouracil, thereby increasing the toxicity of 5-fluorouracil.
Cimetidine, fluphenazine
The co-administration of cimetidine and fluphenazine may decrease the plasma levels of fluphenazine
Cimetidine, flurazepam ---> SPC of [2] of eMC
Known inhibitors of hepatic enzymes, eg cimetidine, have been shown to reduce the clearance of benzodiazepines and may potentiate their action
Cimetidine, fluvastatin [2] ---> SPC of [2] of eMC
Concomitant administration of fluvastatin with cimetidine results in an increase in the bioavailability of fluvastatin, which, however, is of no clinical relevance.
Cimetidine, gabapentin [2] ---> SPC of [2] of eMC
A slight decrease in renal excretion of gabapentin observed when co-administered with cimetidine is not expected to be of clinical importance.
Cimetidine, gallopamil
Increased plasma levels of phenylalkylamine
Cimetidine, glibenclamide [2] ---> SPC of [2] of EMA
Weakening of the blood-glucose-lowering effect
Cimetidine, glycopyrronium [2] ---> SPC of [2] of EMA
No clinically relevant drug interaction is expected when glycopyrronium is co-administered with cimetidine or other inhibitors of organic cation transport.
Cimetidine, granisetron [2] ---> SPC of [2] of EMA
In studies in healthy subjects, no evidence of any interaction has been indicated between granisetron and anti-ulcer medicinal products (cimetidine)
Cimetidine, H2 antagonists
In patients on treatment or with illnesses that can cause falls in blood cell count, should be borne in mind that H2-receptor antagonism can potentiate this effect
Cimetidine, haloperidol
Inhibition of the CYP2D6 by another drug may result in increased haloperidol concentrations and an increased risk of adverse events, including QT-prolongation.
Cimetidine, histamine
Cimetidine must not be used during treatment with histamine dihydrochloride
Cimetidine, histamine dihydrochloride [2] ---> SPC of [2] of EMA
H2 receptor antagonists with imidazole structures similar to histamine must not be used during treatment with histamine dihydrochloride
Cimetidine, hydrotalcite
The co-administration of hydrotalcite with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 1-2 hours
Cimetidine, hydroxychloroquine [2] ---> SPC of [2] of eMC
The inhibition of hydroxychloroquine metabolism by cimetidine may increase plasma concentration of the antimalarial
Cimetidine, hydroxyzine [2] ---> SPC of [2] of eMC
Cimetidine has been shown to increase the serum concentrations of hydroxyzine and to decrease peak concentrations of the metabolite cetirizine
Cimetidine, imipramine [2] ---> SPC of [2] of eMC
Cimetidine may increase the plasma levels of imipramine whose dosage should therefore be reduced.
Cimetidine, indacaterol/glycopyrronium [2] ---> SPC of [2] of EMA
No clinically relevant drug interaction is expected when glycopyrronium is co-administered with cimetidine or other inhibitors of the organic cation transport.
Cimetidine, indinavir [2] ---> SPC of [2] of EMA
Indinavir and cimetidine can be co-administered without dose adjustment.
Cimetidine, isradipine [2] ---> SPC of [2] of eMC
Concurrent administration of cimetidine increases the bioavailability of isradipine by about 50%. When isradipine is given concurrently with cimetidine, the dosage of isradipine should be reduced by 50%.
Cimetidine, labetalol
Cimetidine delays the elimination of betablocker and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)
Cimetidine, lacidipine [2] ---> SPC of [2] of eMC
The plasma level of lacidipine may be increased by simultaneous administration of cimetidine.
Cimetidine, lamivudine/zidovudine [2] ---> SPC of [2] of EMA
No dosage adjustment necessary.
Cimetidine, ledipasvir/sofosbuvir [2] ---> SPC of [2] of EMA
H2-receptor antagonists may be administered simultaneously with or staggered from ledipasvir/sofosbuvir at a dose that does not exceed doses comparable to famotidine 40 mg twice daily
Cimetidine, leflunomide [2] ---> SPC of [2] of EMA
A771726 is an inhibitor of OAT3 in vivo .Therefore, when co-administered leflunomide with substrates of OAT3 caution is recommended.
Cimetidine, lercanidipine [2] ---> SPC of [2] of eMC
At high doses of cimetidine caution is required since the bioavailability and the hypotensive effect of lercanidipine may be increased.
Cimetidine, letrozol
Cimetidine, a weak, unspecific inhibitor of CYP450 enzymes, did not affect the plasma concentrations of letrozole.
Cimetidine, levofloxacin [2] ---> SPC of [2] of EMA
Caution should be exercised when levofloxacin is coadministered with active substances that affect the tubular renal secretion such as probenecid and cimetidine, especially in patients with renal impairment
Cimetidine, levomethadone
The enzymatic inhibition may increase the plasma levels of levomethadone
Cimetidine, lidocaine [2] ---> SPC of [2] of eMC
Lidocaine toxicity is enhanced, by the co-administration of cimetidine requiring a reduction in the dosage of lidocaine.
Cimetidine, lidocaine/prilocaine [2] ---> SPC of [2] of EMA
Medicinal products that reduce the clearance of lidocaine may cause potentially toxic plasma concentrations when lidocaine is given intravenously in repeated high doses over a long time period (30 hours).
Cimetidine, linagliptin/metformin [2] ---> SPC of [2] of EMA
Cationic active substances that are eliminated by renal tubular secretion may interact with metformin by competing for common renal tubular transport systems and hence delay the elimination of metformin
Cimetidine, lomitapide [2] ---> SPC of [2] of EMA
Weak CYP3A4 inhibitors are expected to increase the exposure of lomitapide when taken simultaneously. Separate the dose of the medications by 12 hours OR decrease the dose of Lojuxta by half.
Cimetidine, lomustine ---> SPC of [2] of eMC
Lomustine use in combination with cimetidine may potentiate bone marrow toxicity.
Cimetidine, lorazepam [2] ---> SPC of [2] of eMC
Inhibitors reduce clearance and may potentiate the action of benzodiazepines.
Cimetidine, lornoxicam
Cimetidine, CYP2C9 inhibitor, may increase the plasma concentrations of lornoxicam
Cimetidine, lymecycline ---> SPC of [1] of eMC
Medicinal products which increase gastric pH may reduce the absorption of tetracycline, and should be taken at least 2 hours after tetracycline
Cimetidine, magaldrate
Decreased absorption of cimetidine. It is recommended to administer the two substances at least 2-3 hours apart.
Cimetidine, magnesium hydroxide
The magnesium hydroxide decreases the absorption of the co-administered active principle. Separate administration by at least 2 hours
Cimetidine, manidipine
Manidipine should not be administered with CYP3A4 inhibitors
Cimetidine, maprotiline
Cimetidine, enzymatic inhibitor, may increase the plasma levels of maprotiline. Dose adjustment may be necessary
Cimetidine, mebendazol ---> SPC of [1] of eMC
Concomitant treatment with cimetidine may inhibit the metabolism of mebendazole in the liver, resulting in increased plasma concentrations of the drug.
Cimetidine, medazepam
The co-administration of cimetidine may enhance and prolong the effect of medazepam
Cimetidine, mefloquine
Decreased clearance of mefloquine
Cimetidine, melatonin [2] ---> SPC of [2] of EMA
Caution should be exercised in patients on cimetidine a CYP2D inhibitor, which increases plasma melatonin levels, by inhibiting its metabolism.
Cimetidine, melphalan
Cimetidine may decrease the bioavailability and plasma half-life of oral melphalan
Cimetidine, memantin [2] ---> SPC of [2] of EMA
Active substances that use the same renal cationic transport system as amantadine may possibly interact with memantine leading to a potential risk of increased plasma levels.
Cimetidine, mephenytoin
Increased hydantoin plasma levels
Cimetidine, meptazinol ---> SPC of [1] of eMC
Cimetidine may inhibit metabolism of meptazinol resulting in increased plasma concentration.
Cimetidine, metformin ---> SPC of [vildagliptin/metformin] of EMA
Cationic active substances that are eliminated by renal tubular secretion may interact with metformin by competing for common renal tubular transport systems and hence delay the elimination of metformin
Cimetidine, methadone ---> SPC of [2] of eMC
Methadone clearance is decreased when co-administered with drugs which inhibit CYP3A4 activity. Cimetidine may lead to potentiation of opioid activity due to displacement of methadone from protein binding sites.
Cimetidine, methylergometrine
Caution is recommended when methylergometrine is used with less potent CYP3A inhibitors
Cimetidine, methylnaltrexone [2] ---> SPC of [2] of EMA
No meaningful change in AUC of methylnaltrexone bromide, in addition to Cmax, was observed before and after multiple-dose administration of cimetidine.
Cimetidine, methysergide ---> SPC of [2] of eMC
The concomitant use of cytochrome P450 3A (CYP3A) inhibitors, since this can result in an elevated exposure to methysergide and ergot toxicity (vasospasm and ischemia of the extremities and other tissues).
Cimetidine, metoclopramide
The co-administration may accelerate the intestinal transit and decrease the absorption and plasma levels of cimetidine
Cimetidine, metronidazole ---> SPC of [2] of eMC
Cimetidine inhibits the metabolism of metronidazole (increases plasma-metronidazole concentration).
Cimetidine, midazolam [2] ---> SPC of [2] of EMA
Cimetidine, ranitidine and omeprazole have been shown to reduce the clearance of midazolam and other benzodiazepines and may potentiate their actions.
Cimetidine, minocycline
Medicinal products which increase gastric pH may reduce the absorption of minocycline, and should be taken at least 2 hours after minocycline
Cimetidine, mirtazapine [2] ---> SPC of [2] of eMC
The moderate CYP3A4 inhibition may increase the plasma concentrations of mirtazapine
Cimetidine, mizolastine [2] ---> SPC of [2] of eMC
Concurrent use of other potent inhibitors or substrates of hepatic oxidation (cytochrome P450 3A4) with mizolastine should be approached with caution.
Cimetidine, moclobemide [2] ---> SPC of [2] of eMC
Cimetidine prolongs the metabolism of moclobemide
Cimetidine, morphine [2] ---> SPC of [2] of eMC
Cimetidine inhibits the metabolism of morphine sulphate.
Cimetidine, nabumetone [2] ---> SPC of [2] of eMC
Cimetidine doesn't affect nabumetone metabolism and bioavailability
Cimetidine, nebivolol [2] ---> SPC of [2] of eMC
Co-administration of cimetidine increased the plasma levels of nebivolol, without changing the clinical effect.
Cimetidine, neuroleptics
The effects of antipsychotic drugs may be enhanced by cimetidine
Cimetidine, nevirapine [2] ---> SPC of [2] of EMA
Cimetidine and nevirapine can be co-administered without dose adjustments.
Cimetidine, nicardipine [2] ---> SPC of [2] of eMC
Nicardipine is metabolized by cytochrome P450 3A4. Concomitant administration of nicardipine with inhibitors of cytochrome P450 3A4 may alter the plasma levels of nicardipine.
Cimetidine, nicomorphine
Cimetidine, enzymatic inhibitor, increases the plasma levels of morphine and its efficacy and prolongs its duration of effect
Cimetidine, nifedipine [2] ---> SPC of [2] of eMC
Due to its inhibition of cytochrome P450 3A4, cimetidine elevates the plasma concentrations of nifedipine and may potentiate the antihypertensive effect
Cimetidine, nilvadipine
Cimetidine delays the elimination of calcium antagonist and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)
Cimetidine, nimodipine [2] ---> SPC of [2] of eMC
The simultaneous administration of nimodipine with the H2-antagonist cimetidine can lead to an increase in the plasma concentration of nimodipine
Cimetidine, nisoldipine
Cimetidine delays the elimination of calcium antagonist and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)
Cimetidine, nitrazepam ---> SPC of [2] of eMC
Known inhibitors of hepatic enzymes, particularly cytochrome P450 have been shown to reduce the clearance of benzodiazepines and may potentiate their action
Cimetidine, nitrendipine
Cimetidine delays the elimination of calcium antagonist and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)
Cimetidine, nitrosourea
Cimetidine delays the elimination of nitrosourea and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)
Cimetidine, nortriptyline
Cimetidine inhibit nortriptyline metabolism and increases its toxicity
Cimetidine, octreotide [2] ---> SPC of [2] of eMC
Octreotide has been reported to delay the absorption of cimetidine.
Cimetidine, ofloxacin [2] ---> SPC of [2] of eMC
With high doses of quinolones, impairment of excretion and an increase in serum levels may occur when co-administered with other drugs that undergo renal tubular secretion
Cimetidine, olanzapine [2] ---> SPC of [2] of EMA
Fluoxetine (a CYP2D6 inhibitor), single doses of antacid (aluminium, magnesium) or cimetidine have not been found to significantly affect the pharmacokinetics of olanzapine.
Cimetidine, opioid analgesics
Cimetidine inhibits metabolism of opioid analgesics.
Cimetidine, opipramol
Cimetidine, enzymatic inhibitor (CYP2D6 and CYP3A4), increases the plasma levels of antidepressant and enhances or prolongs its effects and adverse effects
Cimetidine, oral anticoagulants
Enhancement of anticoagulant effect
Cimetidine, ornidazole
The enzymatic inhibitor may decrease the metabolism of ornidazole and increase its plasma levels
Cimetidine, oxcarbazepine [2] ---> SPC of [2] of eMC
Cimetidine had no effect on the pharmacokinetics of MHD.
Cimetidine, oxetacaine
Decreased absorption of cimetidine
Cimetidine, oxprenolol [2] ---> SPC of [2] of eMC
Cimetidine may reduce the hepatic metabolism of beta-blockers, resulting in increased plasma levels of beta-blocker and prolonged serum half-life. Marked bradycardia may occur.
Cimetidine, oxycodone [2] ---> SPC of [2] of eMC
Cimetidine can inhibit the metabolism of oxycodone.
Cimetidine, paclitaxel [2] ---> SPC of [2] of EMA
The metabolism of paclitaxel is catalysed, in part, by cytochrome P450 isoenzymes CYP2C8 and CYP3A4. Therefore, caution should be exercised when administering paclitaxel concomitantly with medicines known to inhibit either CYP2C8 or CYP3A4.
Cimetidine, pentoxifylline
The co-administration may increase the plasma levels of pentoxifylline
Cimetidine, pethidine [2] ---> SPC of [2] of eMC
Cimetidine inhibits metabolism of pethidine and therefore increases plasma concentration.
Cimetidine, phenazone
Concomitant use of phenazone and cimetidine delays the elimination of phenazone. There is the possibility of an accumulation
Cimetidine, phenindione ---> SPC of [1] of eMC
Cimetidine potentiates the effect of phenindione
Cimetidine, phenothiazines
Cimetidine may possibly enhance the effects of phenothiazines
Cimetidine, phenylalkylamines
Increased plasma levels of phenylalkylamine
Cimetidine, phenytoin [2] ---> SPC of [2] of eMC
Cimetidine may increase phenytoin serum levels
Cimetidine, pindolol ---> SPC of [2] of eMC
Cimetidine may induce increased plasma levels of hepatically metabolised beta-blockers.
Cimetidine, pindolol/clopamide
Cimetidine may induce increased plasma level of beta-blockers.
Cimetidine, pioglitazone/metformin [2] ---> SPC of [2] of EMA
The strong CYP2C8 inhibition may increase plasma concentrations of pioglitazone. Close monitoring of glycaemic control should be considered
Cimetidine, piroxicam ---> SPC of [2] of eMC
Results of two separate studies indicate a slight but significant increase in absorption of piroxicam following cimetidine administration but no significant changes in elimination rate constants or half-life.
Cimetidine, posaconazole
Cimetidine increases the pH und decreases the absorption of posaconazole.
Cimetidine, posaconazole [2] ---> SPC of [2] of EMA
Posaconazole plasma concentrations (Cmax and AUC) were reduced by 39 % when posaconazole was administered with cimetidine (400 mg twice a day) due to reduced absorption possibly secondary to a decrease in gastric acid production.
Cimetidine, pramipexole [2] ---> SPC of [2] of EMA
Medicines that are inhibitors of the cationic secretory transport system of renal tubules/are eliminated by this pathway may interact with pramipexole resulting in reduced clearance of pramipexole. Reduction of the pramipexole dose should be considered
Cimetidine, prazepam
Known inhibitors of hepatic enzymes, particularly cytochrome P450 have been shown to reduce the clearance of benzodiazepines and may potentiate their action
Cimetidine, praziquantel
Cimetidine, enzymatic inhibitor, may increase the plasma levels of praziquantel
Cimetidine, procainamide
Cimetidine delays the elimination of procainamide and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)
Cimetidine, prokinetics
Decreased effect of cimetidine by acceleration of intestinal passage
Cimetidine, promazine
The effects of antipsychotic drugs may be enhanced by cimetidine
Cimetidine, propafenone [2] ---> SPC of [2] of eMC
Drugs that inhibit CYP2D6, CYP1A2 and CYP3A4 may lead to increased levels of propafenone. When propafenone is administered with inhibitors of these enzymes, the patients should be closely monitored and the dose adjusted accordingly.
Cimetidine, propranolol [2] ---> SPC of [2] of eMC
Concomitant use of cimetidine will increase the plasma levels of propranolol.
Cimetidine, quetiapine [2] ---> SPC of [2] of eMC
The pharmacokinetics of quetiapine was not altered following co-administration with cimetidine.
Cimetidine, quinine
Cimetidine inhibits quinine metabolism leading to increased plasma-quinine concentrations.
Cimetidine, quinolones ---> SPC of [ofloxacin] of eMC
With high doses of quinolones, impairment of excretion and an increase in serum levels may occur when co-administered with other drugs that undergo renal tubular secretion
Cimetidine, radiotherapy
Cimetidine may potentiate the myelosuppressive effects (e.g. neutropenia, agranulocytosis) of radiotherapy
Cimetidine, repaglinide [2] ---> SPC of [2] of EMA
Co-administration of cimetidine, nifedipine, oestrogen, or simvastatin with repaglinide, all CYP3A4 substrates, did not significantly alter the pharmacokinetic parameters of repaglinide.
Cimetidine, rifabutin
The co-administration of rifabutin with enzymatic inhibitors, e.g. cimetidine, may increase the bioavailability of rifabutin. A reduction of the doses may be required
Cimetidine, rifampicin
Rifampicin, enzymatic inductor, may increase the metabolism of cimetidine and decrease its plasma levels and effect
Cimetidine, rilpivirine [2] ---> SPC of [2] of EMA
The increase of gastric pH decreases absorption, plasma level and effect of rilpivirine. The H2 antagonist should be administered at least 12 h before or 4 h after rilpivirine
Cimetidine, risperidone [2] ---> SPC of [2] of eMC
Cimetidine increased the bioavailability of risperidone, but only marginally that of the active antipsychotic fraction.
Cimetidine, roflumilast [2] ---> SPC of [2] of EMA
A combination of roflumilast with cimetidine might lead to an increase of exposure and persistent intolerability. In this case, roflumilast treatment should be reassessed
Cimetidine, ropinirole
The CYP1A2 inhibition may increase plasma concentrations of ropinirol
Cimetidine, ruxolitinib [2] ---> SPC of [2] of EMA
Mild or moderate CYP3A4 inhibitors may increase ruxolitinib exposition. No dose adjustment is recommended when ruxolitinib is co-administered with mild or moderate CYP3A4 inhibitors
Cimetidine, saxagliptin/metformin [2] ---> SPC of [2] of EMA
Cationic active substances that are eliminated by renal tubular secretion may interact with metformin by competing for common renal tubular transport systems and hence delay the elimination of metformin
Cimetidine, sertindole
The concomitant administration of CYP3A inhibitors and sertindole is contraindicated, as this may lead to significant increases in sertindole levels
Cimetidine, sertraline [2] ---> SPC of [2] of EMA
Co-administration with cimetidine caused a substantial decrease in sertraline clearance.
Cimetidine, sildenafil [2] ---> SPC of [2] of EMA
Population pharmacokinetic analysis of clinical trial data indicated a reduction in sildenafil clearance when co-administered with CYP3A4 inhibitors
Cimetidine, simeprevir [2] ---> SPC of [2] of EMA
No clinically relevant drug-drug interaction is expected. No dose adjustment is required
Cimetidine, sirolimus [2] ---> SPC of [2] of EMA
Inhibitors of CYP3A4 may decrease the metabolism of sirolimus and increase sirolimus blood levels.
Cimetidine, sitagliptin/metformin [2] ---> SPC of [2] of EMA
Cationic active substances that are eliminated by renal tubular secretion may interact with metformin by competing for common renal tubular transport systems and hence delay the elimination of metformin
Cimetidine, sodium valproate [2] ---> SPC of [2] of eMC
Valproic acid plasma levels may be increased (as a result of reduced hepatic metabolism) in case of concomitant use with cimetidine
Cimetidine, sofosbuvir/velpatasvir [2] ---> SPC of [2] of EMA
Increase in gastric pH. H2-receptor antagonists may be administered simultaneously with or staggered from Epclusa at a dose that does not exceed doses comparable to famotidine 40 mg twice daily.
Cimetidine, sofosbuvir/velpatasvir/voxilaprevir [2] ---> SPC of [2] of EMA
Increase in gastric pH decreases velpatasvir solubility. H2-receptor antagonists may be administered simultaneously with or staggered from Vosevi at a dose that does not exceed doses comparable with famotidine 40 mg twice daily.
Cimetidine, sucralfate
Concomitant administration of sucralfate may reduce the bioavailability of cimetidine. The bioavailability may be restored by separating the administration from sucralfate by 2 hours.
Cimetidine, tacrolimus [2] ---> SPC of [2] of EMA
Cimetidine delays the elimination of tacrolimus and increases the systemic exposure of tacrolimus
Cimetidine, tamsulosin [2] ---> SPC of [2] of eMC
Concomitant cimetidine raises plasma concentrations of tamsulosin but, as the concentration of tamsulosin remains within the normal range, posology need not be altered.
Cimetidine, tegafur/gimeracil/oteracil [2] ---> SPC of [2] of EMA
Co-administration may decrease clearance and, thus increase plasma levels of 5-FU. Caution is advised as co-administration may increase the toxicity of tegafur/gimeracil/oteracil.
Cimetidine, terbinafine [2] ---> SPC of [2] of eMC
Cimetidine decreases the clearance of terbinafine and may increase the effect or plasma concentration of terbinafine
Cimetidine, teriflunomide [2] ---> SPC of [2] of EMA
When teriflunomide (OAT3 inhibitor) is coadministered with substrates of OAT3 caution is recommended.
Cimetidine, tetracyclines ---> SPC of [1] of eMC
Medicinal products which increase gastric pH may reduce the absorption of tetracycline, and should be taken at least 2 hours after tetracycline
Cimetidine, theophylline [2] ---> SPC of [2] of eMC
Cimetidine reduces clearance of theophylline and a reduced dosage may therefore be necessary to avoid side-effects
Cimetidine, thioridazine
The strong CYP2D6 inhibition may increase the plasma levels of thioridazine and the risk of QT interval prolongation.
Cimetidine, tiagabine [2] ---> SPC of [2] of eMC
Cimetidine increases the bioavailability of tiagabine by about 5%. This finding isn't considered clinically important and do not warrant a dose modification
Cimetidine, ticlopidine
The chronic administration of cimetidine increases significantly the plasma levels of ticlopidine
Cimetidine, timolol [2] ---> SPC of [2] of eMC
The bioavailability of timolol will be increased by co-administration with cimetidine
Cimetidine, tizanidine [2] ---> SPC of [2] of eMC
Concomitant administration of drugs known to inhibit the activity of CYP1A2 may increase the plasma levels of tizanidine. Co-administration of tizanidine inhibitors of CYP1A2 is not recommended
Cimetidine, tolbutamide
Increased hypoglycaemic effects have occurred or might be expected
Cimetidine, tramadol ---> SPC of [2] of eMC
Simultaneous administration with cimetidine is associated with clinically insignificant changes in serum concentrations of tramadol.
Cimetidine, trandolapril/verapamil [2] ---> SPC of [2] of eMC
Verapamil concentrations may be increased by cimetidine
Cimetidine, trazodone [2] ---> SPC of [2] of eMC
The metabolism of antidepressants is inhibited by cimetidine.
Cimetidine, triazolam
It is recommended caution and, if necessary, a dose reduction should be considered when using triazolam with cimetidine
Cimetidine, trimipramine
The metabolism of antidepressants is inhibited by cimetidine.
Cimetidine, urapidil
The co-administration of urapidil and cimetidine may increase the plasma levels of urapidil
Cimetidine, valaciclovir [2] ---> SPC of [2] of eMC
The medicinal products eliminated by active tubular secretion can increase the plasma concentrations of aciclovir. Valaciclovir administration may increase plasma concentrations of the concurrently administered substance.
Cimetidine, valproic acid [2] ---> SPC of [2] of eMC
Valproic acid plasma levels may be increased (as a result of reduced hepatic metabolism) in case of concomitant use with cimetidine
Cimetidine, valsartan [2] ---> SPC of [2] of eMC
In drug interaction studies with valsartan, no interactions of clinical significance have been found with valsartan and cimetidine
Cimetidine, vardenafil [2] ---> SPC of [2] of EMA
The concomitant use of CYP3A4 inhibitors can be expected to increase vardenafil plasma levels. Vardenafil dose adjustment might be necessary
Cimetidine, varenicline [2] ---> SPC of [2] of EMA
Co-administration of cimetidine with varenicline increased the systemic exposure of varenicline due to a reduction in varenicline renal clearance. In patients with severe renal impairment, the concomitant use should be avoided.
Cimetidine, venlafaxine
Cimetidine inhibits the first-pass metabolism of venlafaxine
Cimetidine, verapamil ---> SPC of [trandolapril/verapamil] of eMC
Verapamil concentrations may be increased by cimetidine
Cimetidine, vildagliptin/metformin [2] ---> SPC of [2] of EMA
Cationic active substances that are eliminated by renal tubular secretion may interact with metformin by competing for common renal tubular transport systems and hence delay the elimination of metformin
Cimetidine, warfarin [2] ---> SPC of [2] of eMC
Cimetidine, enzyme inhibitor, may increase the plasma levels of coumarine and prolong the prothrombin time
Cimetidine, xanthines
Cimetidine delays the elimination of xanthine and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)
Cimetidine, zalcitabine
Cimetidine delays the elimination of zalcitabine and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)
Cimetidine, zaleplon [2] ---> SPC of [2] of EMA
The inhibition of CYP3A4 and aldehyde oxidase produces an increase in plasma concentrations of zaleplon. Caution is advisable in co-administering
Cimetidine, ziprasidone
Repeated administration of magnesium and aluminium containing antacids or cimetidine after eating had no significant effect on ziprasidone pharmacokinetics
Cimetidine, zofenopril
Cimetidine may increase the risk of acute hypotension
Cimetidine, zolmitriptan [2] ---> SPC of [2] of eMC
Following the administration of cimetidine, a general P450 inhibitor, the half-life of zolmitriptan was increased by 44% and the AUC increased by 48%.
Cimetidine, zonisamide [2] ---> SPC of [2] of EMA
Steady-state dosing of cimetidine had no clinically relevant effects on the single-dose pharmacokinetics of zonisamide given to healthy subjects.
Cimetidine, zopiclone [2] ---> SPC of [2] of eMC
Since zopiclone is metabolised by the cytochrome P450 (CYP) 3A4, plasma levels of zopiclone may be increased when co-administered with CYP3A4 inhibitors
CONTRAINDICATIONS of Cimetidine
- Hypersensitivity to Cimetidine or to any other of the tablet ingredients
http://www.medicines.org.uk/emc/
Cinacalcet (Mimpara)
Ability to drive, cinacalcet [2] ---> SmPC of [2] of EMA
Mimpara may have major influence on the ability to drive and use machines, since dizziness and seizures have been reported by patients taking this medicinal product (see section 4.4).
Breast-feeding, cinacalcet [2] ---> SmPC of [2] of EMA
Cinacalcet is excreted in the milk of lactating rats with a high milk to plasma ratio. Following careful benefit/risk assessment, a decision should be made to discontinue either breast-feeding or treatment with Mimpara.
Calcium carbonate, cinacalcet [2] ---> SmPC of [2] of EMA
Co-administration of calcium carbonate (single 1,500 mg dose) did not alter the pharmacokinetics of cinacalcet.
Cinacalcet [1], ciprofloxacin ---> SmPC of [1] of EMA
In vitro data indicate that cinacalcet is in part metabolised by CYP1A2. Smoking induces CYP1A2. Dose adjustment may be necessary when concomitant treatment with strong CYP1A2 inhibitors is initiated or discontinued.
Cinacalcet [1], clomipramine ---> SmPC of [1] of EMA
Dose adjustments of concomitant medicinal products may be required when Mimpara is administered with individually titrated, narrow therapeutic index substances that are predominantly metabolised by CYP2D6
Cinacalcet [1], desipramine ---> SmPC of [1] of EMA
Concurrent administration of cinacalcet with desipramine, metabolised primarily by CYP2D6, significantly increased desipramine exposure in CYP2D6 extensive metabolisers.
Cinacalcet [1], dextromethorphan ---> SmPC of [1] of EMA
Multiple doses of 50 mg cinacalcet increased the AUC of 30 mg dextromethorphan (metabolised primarily by CYP2D6) by 11-fold in CYP2D6 extensive metabolisers.
Cinacalcet [1], drugs primarily metabolised by CYP2D6 ---> SmPC of [1] of EMA
Cinacalcet is a strong inhibitor of CYP2D6. Dose adjustments of concomitant medicinal products may be required when cinacalcet is administered with substances that are predominantly metabolised by CYP2D6
Cinacalcet [1], drugs primarily metabolised by CYP2D6 with narrow therapeutic index ---> SmPC of [1] of EMA
Dose adjustments of concomitant medicinal products may be required when Mimpara is administered with individually titrated, narrow therapeutic index substances that are predominantly metabolised by CYP2D6
Cinacalcet [1], drugs primarily metabolised by CYP3A4 ---> SmPC of [1] of EMA
Cinacalcet would not affect the pharmacokinetics of those classes of medicines that are metabolized by CYP3A4 and CYP3A5, such as certain immunosuppressants, including cyclosporine and tacrolimus.
Cinacalcet [1], etelcalcetide ---> SmPC of [1] of EMA
Patients receiving Mimpara should not be given etelcalcetide. Concurrent administration may result in severe hypocalcaemia.
Cinacalcet [1], fertility ---> SmPC of [1] of EMA
There are no clinical data relating to the effect of cinacalcet on fertility. There were no effects on fertility in animal studies.
Cinacalcet [1], flecainide ---> SmPC of [1] of EMA
Dose adjustments of concomitant medicinal products may be required when Mimpara is administered with individually titrated, narrow therapeutic index substances that are predominantly metabolised by CYP2D6
Cinacalcet [1], fluvoxamine ---> SmPC of [1] of EMA
In vitro data indicate that cinacalcet is in part metabolised by CYP1A2. Smoking induces CYP1A2. Dose adjustment may be necessary when concomitant treatment with strong CYP1A2 inhibitors is initiated or discontinued.
Cinacalcet [1], foods ---> SmPC of [1] of EMA
It is recommended that Mimpara be taken with food or shortly after a meal, as studies have shown that bioavailability of cinacalcet is increased when taken with food
Cinacalcet [1], itraconazol ---> SmPC of [1] of EMA
Cinacalcet is metabolised in part by the enzyme CYP3A4. Co-administration of a strong inhibitor of CYP3A4 may increase cinacalcet levels. Dose adjustment of cinacalcet may be required
Cinacalcet [1], ketoconazole ---> SmPC of [1] of EMA
Cinacalcet is metabolised in part by the enzyme CYP3A4. Co-administration of a strong inhibitor of CYP3A4 may increase cinacalcet levels. Dose adjustment of cinacalcet may be required
Cinacalcet [1], lack of effect ---> SmPC of [1] of EMA
The lack of effect of cinacalcet on the pharmacokinetics of R-and S-warfarin and the absence of auto-induction upon multiple dosing in patients indicates that cinacalcet is not an inducer of CYP3A4, CYP1A2 or CYP2C9 in humans.
Cinacalcet [1], medicines that reduce serum calcium ---> SmPC of [1] of EMA
Concurrent administration of other medicinal products known to reduce serum calcium and Mimpara may result in an increased risk of hypocalcaemia (see section 4.4). Patients receiving Mimpara should not be given etelcalcetide (see section 4.4).
Cinacalcet [1], metoprolol ---> SmPC of [1] of EMA
Dose adjustments of concomitant medicinal products may be required when Mimpara is administered with individually titrated, narrow therapeutic index substances that are predominantly metabolised by CYP2D6
Cinacalcet [1], midazolam ---> SmPC of [1] of EMA
Cinacalcet would not affect the pharmacokinetics of those classes of medicines that are metabolized by CYP3A4 and CYP3A5, such as certain immunosuppressants, including cyclosporine and tacrolimus.
Cinacalcet [1], nicotine ---> SmPC of [1] of EMA
In vitro data indicate that cinacalcet is in part metabolised by CYP1A2. Smoking induces CYP1A2; the clearance of cinacalcet was observed to be 36-38% higher in smokers than non-smokers.
Cinacalcet [1], nortriptyline ---> SmPC of [1] of EMA
Dose adjustments of concomitant medicinal products may be required when Mimpara is administered with individually titrated, narrow therapeutic index substances that are predominantly metabolised by CYP2D6
Cinacalcet [1], pantoprazole ---> SmPC of [1] of EMA
Co-administration of pantoprazole (80 mg od) did not alter the pharmacokinetics of cinacalcet.
Cinacalcet [1], pregnancy ---> SmPC of [1] of EMA
Mimpara should be used during pregnancy only if the potential benefit justifies the potential risk to the foetus.
Cinacalcet [1], propafenone ---> SmPC of [1] of EMA
Dose adjustments of concomitant medicinal products may be required when Mimpara is administered with individually titrated, narrow therapeutic index substances that are predominantly metabolised by CYP2D6
Cinacalcet [1], QT interval prolonging drugs ---> SmPC of [1] of EMA
Caution is advised in patients with other risk factors for QT prolongation such as patients with known congenital long QT syndrome or patients receiving medicinal products known to cause QT prolongation.
Cinacalcet [1], rifampicin ---> SmPC of [1] of EMA
Cinacalcet is metabolised in part by the enzyme CYP3A4. Co-administration of a strong inductor of CYP3A4 may decrease cinacalcet levels. Dose adjustment of cinacalcet may be required
Cinacalcet [1], ritonavir ---> SmPC of [1] of EMA
Cinacalcet is metabolised in part by the enzyme CYP3A4. Co-administration of a strong inhibitor of CYP3A4 may increase cinacalcet levels. Dose adjustment of cinacalcet may be required
Cinacalcet [1], sevelamer ---> SmPC of [1] of EMA
Co-administration of sevelamer (2400 mg tid) did not affect the pharmacokinetics of cinacalcet.
Cinacalcet [1], strong CYP1A2 inhibitors ---> SmPC of [1] of EMA
In vitro data indicate that cinacalcet is in part metabolised by CYP1A2. Smoking induces CYP1A2. Dose adjustment may be necessary when concomitant treatment with strong CYP1A2 inhibitors is initiated or discontinued.
Cinacalcet [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA
Cinacalcet is metabolised in part by the enzyme CYP3A4. Co-administration of a strong inductor of CYP3A4 may decrease cinacalcet levels. Dose adjustment of cinacalcet may be required
Cinacalcet [1], strong CYP3A4 inhibitors ---> SmPC of [1] of EMA
Cinacalcet is metabolised in part by the enzyme CYP3A4. Co-administration of a strong inhibitor of CYP3A4 may increase cinacalcet levels. Dose adjustment of cinacalcet may be required
Cinacalcet [1], telithromycin ---> SmPC of [1] of EMA
Cinacalcet is metabolised in part by the enzyme CYP3A4. Co-administration of a strong inhibitor of CYP3A4 may increase cinacalcet levels. Dose adjustment of cinacalcet may be required
Cinacalcet [1], voriconazole ---> SmPC of [1] of EMA
Cinacalcet is metabolised in part by the enzyme CYP3A4. Co-administration of a strong inhibitor of CYP3A4 may increase cinacalcet levels. Dose adjustment of cinacalcet may be required
Cinacalcet [1], warfarin ---> SmPC of [1] of EMA
Multiple oral doses of cinacalcet did not affect the pharmacokinetics or pharmacodynamics (as measured by prothrombin time and clotting factor VII) of warfarin.
Cinacalcet, eliglustat [2] ---> SmPC of [2] of EMA
It is predicted that concomitant use of moderate CYP2D6 inhibitors would increase eliglustat exposure approximately up to 4-fold. Caution should be used with moderate CYP2D6 inhibitors in intermediate and extensive metabolisers
Cinacalcet, etelcalcetide [2] ---> SmPC of [2] of EMA
Concurrent administration of other medicinal products known to reduce serum calcium (e.g. cinacalcet and denosumab) and etelcalcetide may result in an increased risk of hypocalcaemia (see section 4.4).
Cinacalcet, mequitazine
Mequitazine should not be used with CYP2D6 inhibitor drugs. The increased plasma levels of mequitazine may increase the risk of QT interval prolongation
Cinacalcet, patiromer [2] ---> SmPC of [2] of EMA
Concomitant administration of patiromer did not affect the bioavailability as measured by the area under the curve (AUC). For these medicinal products no separation is needed.
Cinacalcet, pitolisant [2] ---> SmPC of [2] of EMA
Given the 2-fold increase of pitolisant exposure, its coadministration with CYP2D6 inhibitors should be done with caution. A dosage adjustment during the combination could eventually be considered.
Cinacalcet, sucroferric oxyhydroxide [2] ---> SmPC of [2] of EMA
In vitro studies did not show any relevant interaction
Cinacalcet, tamoxifen [2] ---> SmPC of [2] of eMC
Concomitant medications that inhibit CYP2D6 may lead to reduced concentrations of the active metabolite endoxifen. Therefore, potent inhibitors of CYP2D6 should whenever possible be avoided during tamoxifen treatment
CONTRAINDICATIONS of Cinacalcet (Mimpara)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Hypocalcaemia (see sections 4.2 and 4.4).
https://www.ema.europa.eu/en/documents/product-information/mimpara-epar-product-information_en.pdf 06/06/2024
Other trade names: Cinacalcet Accordpharma, Cinacalcet Mylan, Parareg,
Cinitapride
Ability to drive, cinitapride
Reduced mental alertness
Alcohol, cinitapride
The co-administration enhances the sedative effects
Anticholinergics, cinitapride
Decreased effects of cinitapride on the digestive canal
Atropine, cinitapride
Decreased effects of cinitapride on the digestive canal
Azole antifungals, cinitapride
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Breast-feeding, cinitapride
As a precautionary measure, it is preferable to avoid the use of cinitapride during breastfeeding.
Cinitapride, clarithromycin
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cinitapride, digoxin
Cinitapride can reduce the absorption of digoxin
Cinitapride, dopamine antagonists
Potentiation of dopamine antagonism effects on the CNS
Cinitapride, erythromycin
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cinitapride, fluconazole
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cinitapride, hypnotics
The co-administration enhances the sedative effects
Cinitapride, indinavir
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cinitapride, itraconazol
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cinitapride, ketoconazole
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cinitapride, macrolide antibiotics
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cinitapride, miconazole
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cinitapride, narcotics
The co-administration enhances the sedative effects
Cinitapride, nefazodone
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cinitapride, opioid analgesics
Decreased effects of cinitapride on the digestive canal
Cinitapride, phenothiazines
Potentiation of phenothiazine effects on the CNS
Cinitapride, pregnancy
As a precautionary measure, it is preferable to avoid the use of cinitapride during pregnancy.
Cinitapride, protease inhibitors
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cinitapride, ritonavir
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cinitapride, strong CYP3A4 inhibitors
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cinitapride, tranquilizers
The co-administration enhances the sedative effects
Cinitapride, troleandomycin
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cipaglucosidase alfa (Pombiliti)
Ability to drive, cipaglucosidase alfa [2] ---> SmPC of [2] of EMA
Dizziness, hypotension, and somnolence have been reported as adverse reactions. Caution is required when driving or using any tools or machines after receiving cipaglucosidase alfa.
Breast-feeding, cipaglucosidase alfa [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breast-feeding/to discontinue/abstain from cipaglucosidase alfa in combination with miglustat therapy taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.
Cipaglucosidase alfa [1], cytochrome P450 ---> SmPC of [1] of EMA
As cipaglucosidase alfa is a recombinant human protein, it is an unlikely candidate for cytochrome P450 or P-gP mediated interactions with other medicinal products.
Cipaglucosidase alfa [1], fertility ---> SmPC of [1] of EMA
There are no clinical data on the effects of cipaglucosidase alfa on fertility. Preclinical data did not reveal any significant adverse findings with cipaglucosidase alfa, see section 5.3.
Cipaglucosidase alfa [1], pregnancy ---> SmPC of [1] of EMA
Animal studies with miglustat alone as well as with cipaglucosidase alfa and miglustat have shown reproductive toxicity, see section 5.3. Cipaglucosidase alfa in combination with miglustat therapy is not recommended during pregnancy.
Cipaglucosidase alfa [1], women of childbearing potential ---> SmPC of [1] of EMA
Reliable contraceptive measures must be used by women of childbearing potential during treatment with cipaglucosidase alfa in combination with miglustat, and for 4 weeks after discontinuing treatment, see section 5.3.
CONTRAINDICATIONS of Cipaglucosidase alfa (Pombiliti)
- Life-threatening hypersensitivity to the active substance, or to any of the excipients listed in section 6.1, when rechallenge was unsuccessful, see sections 4.4 and 4.8.
- Contraindication to miglustat.
https://www.ema.europa.eu/en/documents/product-information/pombiliti-epar-product-information_en.pdf 22/11/2024
Ciprofloxacin
Ability to drive, ciprofloxacin [2] ---> SPC of [2] of eMC
Due to its neurological effects, ciprofloxacin may affect reaction time. Thus, the ability to drive or to operate machinery may be impaired.
Agomelatine [1], ciprofloxacin ---> SPC of [1] of EMA
The strong CYP1A2 inhibition may increase the plasma concentrations of agomelatine. Co-administration of agomelatine with potent CYP1A2 inhibitors is contraindicated.
Algeldrate/magnesium hydroxide, ciprofloxacin
The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs by chelate formation
Almasilate, ciprofloxacin
Absorption reduction of the active principle co-administered with almasilate due to formation of non-soluble complexes. It is recommended to administer the two substances at least 2 to 3 hours apart.
Aluminium hydroxide, ciprofloxacin
Decreased absorption of quinolone. The quinolone should be administered 2 hours before or 4 hours after the administration of the aluminium hydroxide
Aluminium oxide/magnesium hydroxide, ciprofloxacin
The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs by chelate formation
Aluminium, ciprofloxacin [2] ---> SPC of [2] of eMC
The co-administration should be avoided because absorption of ciprofloxacin may be reduced.
Aminophylline, ciprofloxacin ---> SPC of [1] of eMC
Quinolone antibiotics may decrease aminophylline clearance resulting in increased plasma theophylline concentrations and the potential for increased toxicity
Antacids, ciprofloxacin [2] ---> SPC of [2] of eMC
The co-administration should be avoided because absorption of ciprofloxacin may be reduced.
Ataluren [1], ciprofloxacin ---> SPC of [1] of EMA
Caution should be exercised when ataluren is co-administered with medicinal products that are substrates of UGT1A9, OAT1, OAT3, or OATP1B3 because of the risk of increase concentration of these medicinal products
Azithromycin, ciprofloxacin
The concomitant use with azithromycin may increase the risk of cardiac arrhythmia.
Bedaquiline [1], ciprofloxacin ---> SPC of [1] of EMA
Due to the potential risk of adverse reactions due to an increase in systemic exposure, prolonged co-administration of bedaquiline and moderate or strong CYP3A4 inhibitors used systemically for more than 14 consecutive days should be avoided.
Bendamustine [1], ciprofloxacin ---> SPC of [1] of eMC
Bendamustine metabolism involves cytochrome P450 (CYP) 1A2 isoenzyme. Therefore, the potential for interaction with CYP1A2 inhibitors
Binimetinib [1], ciprofloxacin ---> SPC of [1] of EMA
Binimetinib is a weak inhibitor of OAT3, and caution should be taken when it is used with sensitive substrates (such as pravastatin or ciprofloxacin).
Bosutinib [1], ciprofloxacin ---> SPC of [1] of EMA
The concomitant use of bosutinib with moderate CYP3A inhibitors should be avoided, as an increase in bosutinib plasma levels will occur. Selection of an alternate concomitant medicine with no or minimal CYP3A enzyme inhibition potential is recommended.
Breast-feeding, ciprofloxacin [2] ---> SPC of [2] of eMC
Ciprofloxacin is excreted in breast milk. Due to the potential risk of articular damage, ciprofloxacin should not be used during breast-feeding.
Caffeine, ciprofloxacin [2] ---> SPC of [2] of eMC
On concurrent administration of ciprofloxacin and caffeine raised serum concentrations of caffeine were reported.
Calcium acetate, ciprofloxacin [2] ---> SPC of [2] of eMC
Decreased absorption of ciprofloxacin. It is recommended to administer the two substances at least 1-2 hours apart.
Carbaldrate, ciprofloxacin
The aluminium salt decreases the absorption of the co-administered active principle. Separate administration by at least 2 hours
Cheese, ciprofloxacin [2] ---> SPC of [2] of eMC
The co-administration should be avoided because absorption of ciprofloxacin may be reduced.
Chlorpromazine, ciprofloxacin
The strong CYP1A2 inhibition may increase the plasma levels of chlorpromazine (small therapeutic range)
Cinacalcet [1], ciprofloxacin ---> SPC of [1] of EMA
In vitro data indicate that cinacalcet is in part metabolised by CYP1A2. Smoking induces CYP1A2. Dose adjustment may be necessary when concomitant treatment with strong CYP1A2 inhibitors is initiated or discontinued.
Ciprofloxacin [1], clozapine ---> SPC of [1] of eMC
Ciprofloxacin inhibits CYP1A2 and thus may cause increased serum concentration of concomitantly administered substances metabolised by this enzyme
Ciprofloxacin [1], dairy products ---> SPC of [1] of eMC
The co-administration should be avoided because absorption of ciprofloxacin may be reduced.
Ciprofloxacin [1], divalent cations ---> SPC of [1] of eMC
Decreased absorption of ciprofloxacin. It is recommended to administer the two substances at least 3 hours apart.
Ciprofloxacin [1], drugs primarily metabolised by CYP1A2 ---> SPC of [1] of eMC
Ciprofloxacin inhibits CYP1A2 and thus may cause increased serum concentration of concomitantly administered substances metabolised by this enzyme
Ciprofloxacin [1], fosphenytoin ---> SPC of [1] of eMC
Simultaneous administration of ciprofloxacin and phenytoin may result in increased or reduced serum levels of phenytoin such that monitoring of drug levels is recommended.
Ciprofloxacin [1], magnesium ---> SPC of [1] of eMC
The co-administration should be avoided because absorption of ciprofloxacin may be reduced.
Ciprofloxacin [1], magnesium hydroxide ---> SPC of [1] of eMC
The co-administration should be avoided because absorption of ciprofloxacin may be reduced.
Ciprofloxacin [1], milk ---> SPC of [1] of eMC
The co-administration should be avoided because absorption of ciprofloxacin may be reduced.
Ciprofloxacin [1], olanzapine ---> SPC of [1] of eMC
Ciprofloxacin inhibits CYP1A2 and thus may cause increased serum concentration of concomitantly administered substances metabolised by this enzyme
Ciprofloxacin [1], phenytoin ---> SPC of [1] of eMC
Simultaneous administration of ciprofloxacin and phenytoin may result in increased or reduced serum levels of phenytoin such that monitoring of drug levels is recommended.
Ciprofloxacin [1], pregnancy ---> SPC of [1] of eMC
In juvenile and prenatal animals exposed to quinolones, effects on immature cartilage have been observed, thus, it cannot be excluded that the drug could cause damage to articular cartilage in the human immature organism / foetus
Ciprofloxacin [1], probenecide ---> SPC of [1] of eMC
Probenecid interferes with renal secretion of ciprofloxacin. Co-administration of probenecid and ciprofloxacin increases ciprofloxacin serum concentrations.
Ciprofloxacin [1], QT interval prolonging drugs ---> SPC of [1] of eMC
Ciprofloxacin, like other fluoroquinolones, should be used with caution in patients receiving drugs known to prolong QT interval
Ciprofloxacin [1], sucralfate ---> SPC of [1] of eMC
The co-administration may decrease the absorption of quinolone. The quinolone should be administered 2 hours before or 4 hours after the administration of sucralfate.
Ciprofloxacin [1], sun ---> SPC of [1] of eMC
Ciprofloxacin has been shown to cause photosensitivity reactions. Patients taking ciprofloxacin should be advised to avoid direct exposure to either extensive sunlight or UV irradiation during treatment
Ciprofloxacin [1], theophylline ---> SPC of [1] of eMC
Ciprofloxacin inhibits CYP1A2 and thus may cause increased serum concentration of concomitantly administered substances metabolised by this enzyme
Ciprofloxacin [1], tizanidine ---> SPC of [1] of eMC
Tizanidine must not be administered together with ciprofloxacin. Increased serum tizanidine concentration is associated with a potentiated hypotensive and sedative effect.
Ciprofloxacin [1], trivalent cations ---> SPC of [1] of eMC
Decreased absorption of ciprofloxacin. It is recommended to administer the two substances at least 3 hours apart.
Ciprofloxacin [1], vitamin K antagonists ---> SPC of [1] of eMC
The INR should be monitored frequently during and shortly after co-administration of ciprofloxacin with a vitamin K antagonist
Ciprofloxacin [1], warfarin ---> SPC of [1] of eMC
Simultaneous administration of ciprofloxacin with a vitamin K antagonist may augment its anti-coagulant effects.
Ciprofloxacin, class IA antiarrhythmic agents ---> SPC of [2] of eMC
Ciprofloxacin, like other fluoroquinolones, should be used with caution in patients receiving drugs known to prolong QT interval
Ciprofloxacin, class III antiarrhythmic agents ---> SPC of [2] of eMC
Ciprofloxacin, like other fluoroquinolones, should be used with caution in patients receiving drugs known to prolong QT interval
Ciprofloxacin, colistimethate [2] ---> SPC of [2] of EMA
Co-treatment should be undertaken with caution in patients with myasthenia gravis
Ciprofloxacin, cyclophosphamide
The previous treatment with a quinolone may decrease the efficacy (the co-administration may delay the activation and decrease the efficacy) of cyclophosphamide.
Ciprofloxacin, cyclosporine [2] ---> SPC of [2] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Ciprofloxacin, daclatasvir [2] ---> SPC of [2] of EMA
No dose adjustment is required
Ciprofloxacin, dasabuvir with ombitasvir/paritaprevir/ritonavir ---> SPC of [ombitasvir/paritaprevir/ritonavir] of
Viekirax administered with or without dasabuvir. Exposures of cyclobenzaprine, a CYP1A2 substrate, were decreased. Clinical monitoring and dose adjustment may be needed for other CYP1A2 substrates (e.g. ciprofloxacin, theophylline and caffeine).
Ciprofloxacin, diazepam
The co-administration may decrease diazepam clearance and prolong its half life
Ciprofloxacin, didanosine [2] ---> SPC of [2] of eMC
The co-administration should be avoided because absorption of ciprofloxacin may be reduced.
Ciprofloxacin, droperidol [2] ---> SPC of [2] of eMC
Substances inhibiting the activity of cytochrome P450 iso-enzyme CYP1A2 could decrease the rate at which droperidol is metabolised and prolong its pharmacological action.
Ciprofloxacin, duloxetine [2] ---> SPC of [2] of EMA
YENTREVE should not be used in combination with CYP1A2 inhibitors, like fluvoxamine, ciprofloxacin or enoxacin since the combination results in elevated plasma concentrations of duloxetine
Ciprofloxacin, eliglustat [2] ---> SPC of [2] of EMA
It is predicted that concomitant use of moderate CYP3A inhibitors would increase eliglustat exposure approximately up to 3-fold. Caution should be used with moderate CYP3A inhibitors in intermediate and extensive metabolisers.
Ciprofloxacin, erlotinib [2] ---> SPC of [2] of EMA
Caution should be exercised when potent CYP1A2 inhibitors are combined with erlotinib. If adverse reactions related to erlotinib are observed, the dose of erlotinib may be reduced.
Ciprofloxacin, ferric citrate coordination complex [2] ---> SPC of [2] of EMA
Fexeric decreased the bioavailability of concomitantly administered ciprofloxacin by approximately 45%. Ciprofloxacin should not be taken at the same time, but at least 2 hours before or after Fexeric.
Ciprofloxacin, glibenclamide
The co-administration may increase the effect of glibenclamide (hypoglycemia)
Ciprofloxacin, guanfacin [2] ---> SPC of [2] of EMA
Co-administration of Intuniv with moderate and strong CYP3A4/5 inhibitors elevates plasma guanfacine concentrations and increases the risk of adverse reactions such as hypotension, bradycardia, and sedation.
Ciprofloxacin, hydrotalcite
The co-administration of hydrotalcite with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 1-2 hours
Ciprofloxacin, ibrutinib [2] ---> SPC of [2] of EMA
Ibrutinib is primarily metabolised by cytochrome P450 enzyme 3A4. Concomitant use of ibrutinib and medicinal products that moderately inhibit CYP3A4 can increase ibrutinib exposure and should be avoided.
Ciprofloxacin, ivacaftor [2] ---> SPC of [2] of EMA
Co-administration of ciprofloxacin with ivacaftor did not affect exposure of ivacaftor. No dose adjustment is required when ivacaftor is co-administered with ciprofloxacin.
Ciprofloxacin, lanthanum carbonate [2] ---> SPC of [2] of eMC
The co-administration decreases the bioavailability of quinolone. Separate administration by at least 2 hours
Ciprofloxacin, leflunomide [2] ---> SPC of [2] of EMA
A771726 is an inhibitor of OAT3 in vivo .Therefore, when co-administered leflunomide with substrates of OAT3 caution is recommended.
Ciprofloxacin, loxapine [2] ---> SPC of [2] of EMA
Concomitant use of loxapine with CYP1A2 inhibitors should be avoided, if possible.
Ciprofloxacin, macrolide antibiotics ---> SPC of [1] of eMC
Ciprofloxacin, like other fluoroquinolones, should be used with caution in patients receiving drugs known to prolong QT interval
Ciprofloxacin, magaldrate
Considerable decrease in the absorption of quinolone. During the treatment with a quinolone is not recommended la administration of magaldrate
Ciprofloxacin, meptazinol ---> SPC of [2] of eMC
Avoid premedication with meptazinol as a reduced plasma ciprofloxacin concentration may be experienced.
Ciprofloxacin, methadone
The CYP1A2 und CYP3A4 inhibition may increase plasma concentrations of methadone. Reduced serum concentrations of ciprofloxacin may occur
Ciprofloxacin, methotrexate [2] ---> SPC of [2] of EMA
Antibiotics can, in individual cases, reduce the renal clearance of methotrexate, so that increased serum concentrations of methotrexate with simultaneous haematological and gastro-intestinal toxicity may occur.
Ciprofloxacin, metoclopramide ---> SPC of [1] of eMC
Metoclopramide accelerates the absorption of ciprofloxacin (oral) resulting in a shorter time to reach maximum plasma concentrations. No effect was seen on the bioavailability of ciprofloxacin.
Ciprofloxacin, mexiletine
The co-administration may increase the plasma levels of mexiletine
Ciprofloxacin, mycophenolate mofetil [2] ---> SPC of [2] of EMA
A change in the dose of mycophenolate should not normally be necessary in the absence of clinical evidence of graft dysfunction. Close clinical monitoring
Ciprofloxacin, mycophenolate [2] ---> SPC of [2] of EMA
A change in the dose of mycophenolate should not normally be necessary in the absence of clinical evidence of graft dysfunction. Close clinical monitoring
Ciprofloxacin, neuroleptics ---> SPC of [1] of eMC
Ciprofloxacin, like other fluoroquinolones, should be used with caution in patients receiving drugs known to prolong QT interval
Ciprofloxacin, ombitasvir/paritaprevir/ritonavir [2] ---> SPC of [2] of EMA
Viekirax administered with or without dasabuvir. Exposures of cyclobenzaprine, a CYP1A2 substrate, were decreased. Clinical monitoring and dose adjustment may be needed for other CYP1A2 substrates (e.g. ciprofloxacin, theophylline and caffeine).
Ciprofloxacin, omeprazole ---> SPC of [1] of eMC
Concomitant administration of ciprofloxacin and omeprazole containing medicinal products results in a slight reduction of Cmax and AUC of ciprofloxacin.
Ciprofloxacin, patiromer [2] ---> SPC of [2] of EMA
Concomitant administration of Veltassa showed reduced bioavailability of ciprofloxacin, levothyroxine and metformin. However, there was no interaction when Veltassa and these medicinal products were taken 3 hours apart.
Ciprofloxacin, pentoxifylline [2] ---> SPC of [2] of eMC
On concurrent administration of ciprofloxacin and pentoxifylline (oxpentifylline) raised serum concentrations of pentoxifylline were reported.
Ciprofloxacin, phosphate binders
The phosphate binder decreases the bioavailability of the quinolone. Separate administration by at least 2 hours
Ciprofloxacin, pirfenidone [2] ---> SPC of [2] of EMA
Co-administration of pirfenidone and 750 mg of ciprofloxacin (a moderate inhibitor of CYP1A2) increased the exposure to pirfenidone by 81%.
Ciprofloxacin, pomalidomide [2] ---> SPC of [2] of EMA
If strong inhibitors of CYP1A2 (e.g. ciprofloxacin, enoxacin and fluvoxamine) are co-administered with pomalidomide, reduce the dose of pomalidomide by 50%.
Ciprofloxacin, prasugrel [2] ---> SPC of [2] of EMA
CYP3A inhibitors are not anticipated to have a significant effect on the pharmacokinetics of the prasugrel active metabolite.
Ciprofloxacin, rasagiline [2] ---> SPC of [2] of EMA
In vitro metabolism studies have indicated that cytochrome P450 1A2 (CYP1A2) is the major enzyme responsible for the metabolism of rasagiline. Thus, potent CYP1A2 inhibitors may alter rasagiline plasma levels and should be administered with caution.
Ciprofloxacin, ropinirole [2] ---> SPC of [2] of eMC
Ropinirole is principally metabolised by the CYP1A2. A pharmacokinetic study revealed that ciprofloxacin increased the Cmax and AUC of ropinirole by 60% and 84% respectively, with a potential risk of adverse events.
Ciprofloxacin, ruxolitinib [2] ---> SPC of [2] of EMA
Mild or moderate CYP3A4 inhibitors may increase ruxolitinib exposition. No dose adjustment is recommended when ruxolitinib is co-administered with mild or moderate CYP3A4 inhibitors
Ciprofloxacin, safinamide [2] ---> SPC of [2] of EMA
Safinamide may transiently inhibit BCRP in vitro. No precautions are necessary when safinamide is taken with medicinal products that are BCRP substrates (e.g., pitavastatin, pravastatin, ciprofloxacin, methotrexate, topotecan, diclofenac or glyburide).
Ciprofloxacin, sevelamer carbonate [2] ---> SPC of [2] of EMA
Decreased the bioavailability of ciprofloxacin by approximately 50% when co-administered with sevelamer hydrochloride in a single dose study. Consequently, Renvela should not be taken simultaneously with ciprofloxacin.
Ciprofloxacin, sevelamer hydrochloride [2] ---> SPC of [2] of EMA
Decreased bioavailability of ciprofloxacin. Sevelamer hydrochloride should not be taken simultaneously with ciprofloxacin.
Ciprofloxacin, sildenafil ---> SPC of [1] of eMC
Cmax and AUC of sildenafil were increased approximately twofold in healthy subjects after an oral dose of 50 mg given concomitantly with 500 mg ciprofloxacin.
Ciprofloxacin, strontium ranelate [2] ---> SPC of [2] of EMA
As divalent cations can form complexes with oral quinolone antibiotics at the gastro-intestinal level and thereby reduce their absorption, simultaneous administration is not recommended.
Ciprofloxacin, sucroferric oxyhydroxide [2] ---> SPC of [2] of EMA
In vitro studies did not show any relevant interaction
Ciprofloxacin, tacrine
Ciprofloxacin, strong CYP1A2 inhibitor, may increase the plasma concentrations of tacrine
Ciprofloxacin, tasimelteon [2] ---> SPC of [2] of EMA
Caution should be used when administering tasimelteon in combination with strong CYP1A2 inhibitors because of a potentially large increase in tasimelteon exposure and greater risk of adverse reactions
Ciprofloxacin, teriflunomide [2] ---> SPC of [2] of EMA
When teriflunomide (OAT3 inhibitor) is coadministered with substrates of OAT3 caution is recommended.
Ciprofloxacin, tricyclic antidepressant ---> SPC of [2] of eMC
Ciprofloxacin, like other fluoroquinolones, should be used with caution in patients receiving drugs known to prolong QT interval
Ciprofloxacin, ursodeoxycholic acid [2] ---> SPC of [2] of eMC
In isolated cases ursodeoxycholic acid can reduce the absorption of ciprofloxacin.
Ciprofloxacin, venetoclax [2] ---> SPC of [2] of EMA
At initiation and during the dose-titration phase, concomitant use of venetoclax with moderate CYP3A inhibitors should be avoided. Alternative treatments should be considered.
Ciprofloxacin, xanthines
Increased serum concentrations of the xanthine derivative
Ciprofloxacin, zolmitriptan [2] ---> SPC of [2] of eMC
Based on the overall interaction profile, an interaction of zolmitriptan with inhibitors of the cytochrome P450 isoenzyme CYP1A2 cannot be excluded.
Ciprofloxacin, zolpidem
Concomitant use of ciprofloxacin may increase plasma concentrations of zolpidem. Concomitant use is not recommended
QT interval prolonging drugs, quinolones ---> SPC of [ciprofloxacin] of eMC
The fluoroquinolones should be used with caution in patients receiving drugs known to prolong the QT interval
CONTRAINDICATIONS of Ciprofloxacin
- Hypersensitivity to the active substance, to other quinolones or to any of the excipients
- Concomitant administration of ciprofloxacin and tizanidine
http://www.medicines.org.uk/emc/
Cisapride
Ability to drive, cisapride
Do not undertake tasks requiring mental alertness
Acenocoumarol, cisapride
The co-administration may enhance the anticoagulant effect of acenocoumarol and increase the bleeding risk
Aliskiren/amlodipine/hydrochlorothiazide [1], cisapride ---> SPC of [1] of EMA
It is anticipated that prokinetic substances such as cisapride may decrease the bioavailability of thiazide-type diuretics.
Aliskiren/hydrochlorothiazide [1], cisapride ---> SPC of [1] of EMA
Prokinetic substances may decrease the bioavailability of thiazide-type diuretics.
Amantadine, cisapride
The co-administration of amantadine with drugs that prolong the QT interval is contraindicated
Amifampridine [1], cisapride ---> SPC of [1] of EMA
The concomitant use of amifampridine with medicinal products known to cause QT prolongation is contraindicated as this combination may lead to an enhanced risk of ventricular tachycardia, notably torsade de pointes
Amiodarone [1], cisapride ---> SPC of [1] of eMC
The co-administration may prolong the QT interval and/or induce torsades de pointes and is contraindicated
Amitriptyline, cisapride
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Amitriptylinoxide, cisapride
The concomitant use of drugs that also prolong the QT interval has to be avoided
Amlodipine/valsartan/hydrochlorothiazide [1], cisapride ---> SPC of [1] of EMA
It is anticipated that prokinetic substances such as cisapride may decrease the bioavailability of thiazide-type diuretics.
Amprenavir [1], cisapride ---> SPC of [1] of EMA
Amprenavir must not be administered concurrently with medicinal products with narrow therapeutic windows that are substrates of cytochrome P450 3A4 (CYP3A4).
Anticholinergics, cisapride
Anticholinergic drugs may antagonise the gastrointestinal effects of prokinetic drugs
Aprepitant [1], cisapride ---> SPC of [1] of EMA
EMEND 40 mg should be used with caution with pimozide, terfenadine, astemizole, cisapride, or ergot derivatives. Inhibition of CYP3A4 by aprepitant could result in elevated plasma levels of these active substances, potentially causing serious reactions.
Arsenic trioxide [1], cisapride ---> SPC of [1] of EMA
Caution is advised when arsenic trioxide is coadministered with other medicinal products known to cause QT/QTc interval prolongation
Artemether, cisapride
The co-administration of medicinal products that prolong the interval QT is contraindicated
Artemether/lumefantrine [1], cisapride ---> SPC of [1] of eMC
Artemether/lumefantrine is contraindicated in patients taking drugs that are known to prolong the QTc interval.
Astemizole, cisapride
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Atazanavir [1], cisapride ---> SPC of [1] of EMA
Atazanavir is metabolised in the liver through CYP3A4. It inhibits CYP3A4. Therefore, REYATAZ is contraindicated with medicinal products that are substrates of CYP3A4 and have a narrow therapeutic index
Atazanavir/cobicistat [1], cisapride ---> SPC of [1] of EMA
Co-administration of medicinal products that are substrates of CYP3A and have narrow therapeutic indexes and for which elevated plasma concentrations are associated with serious and/or life-threatening events are contraindicated with EVOTAZ.
Atenolol/nifedipine, cisapride ---> SPC of [1] of eMC
Simultaneous administration of cisapride and nifedipine may lead to increased plasma concentrations of nifedipine.
Atomoxetine, cisapride
There is the potential for an increased risk of QT interval prolongation when atomoxetine is administered with other QT prolonging drugs
Atropine, cisapride
Suppression of the cisapride effect
Azithromycin [1], cisapride ---> SPC of [1] of eMC
Azithromycin should be used with caution in patients currently receiving treatment with other active substances known to prolong QT interval
Azole antifungals, cisapride
The strong CYP3A4 inhibition may increase the plasma concentrations of cisapride and prolong the QT interval. The co-administration is contraindicated
Bepridil, cisapride
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Bicalutamide [1], cisapride ---> SPC of [1] of eMC
Bicalutamide, CYP3A4 inhibitor, may increase the plasma concentrations of cisapride. The co-administration is contraindicated.
Breast-feeding, cisapride
Mothers should discontinue breast-feeding
Budipine, cisapride
The co-administration of budipine with drugs known to prolong QT interval is contraindicated
Butylscopolamine, cisapride
Mutual weakening of effect on gastrointestinal motility
Carteolol, cisapride
The co-administration increases the risk of heart rhythm disorders, particularly torsades de pointes
Ceritinib [1], cisapride ---> SPC of [1] of EMA
Co-administration of ceritinib with CYP3A substrates known to have narrow therapeutic indices should be avoided.
Chlorpromazine [1], cisapride ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Cilostazol [1], cisapride ---> SPC of [1] of EMA
Caution is advised when cilostazol is co-administered with CYP3A4 substrates with a narrow therapeutic index
Cisapride [1], clarithromycin ---> SPC of [1] of eMC
Clarithromycin elevated cisapride levels. This may result in QT prolongation and cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation and torsades de pointes. Concomitant use is contraindicated
Cisapride, class IA antiarrhythmic agents
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, class III antiarrhythmic agents
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, clomipramine [2] ---> SPC of [2] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Cisapride, cobicistat [2] ---> SPC of [2] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Cisapride, crizotinib [2] ---> SPC of [2] of EMA
Coadministration of crizotinib (moderate inhibitor of CYP3A) with CYP3A substrates with narrow therapeutic indices should be avoided. If the combination is needed, then close clinical monitoring should be exercised.
Cisapride, darunavir/cobicistat [2] ---> SPC of [2] of EMA
Co-administration of darunavir/cobicistat with active substances that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Cisapride, darunavir/ritonavir ---> SPC of [darunavir] of EMA
Co-administration of darunavir boosted with ritonavir, with active substances that are highly dependent on CYP3A for clearance and for which elevated plasma levels are associated with serious and/or life-threatening events is contraindicated
Cisapride, dasabuvir with ombitasvir/paritaprevir/ritonavir ---> SPC of [ombitasvir/paritaprevir/ritonavir] of EMA
Ritonavir is a strong inhibitor of CYP3A. Medicinal products that are highly dependent on CYP3A for clearance and for which elevated plasma levels are associated with serious events are contraindicated
Cisapride, dasatinib [2] ---> SPC of [2] of EMA
Concomitant use of dasatinib and a CYP3A4 substrate may increase exposure to the CYP3A4 substrate. CYP3A4 substrates known to have a narrow therapeutic index should be administered with caution in patients receiving dasatinib
Cisapride, degarelix [2] ---> SPC of [2] of EMA
The combination of degarelix with medicinal products known to prolong the QTc interval or medicinal products able to induce torsades de pointes should be carefully evaluated
Cisapride, delamanid [2] ---> SPC of [2] of EMA
Treatment with delamanid should not be initiated in patients with risk factors like taking medicinal products that are known to prolong the QTc interval, unless the possible benefit is considered to outweigh the potential risks.
Cisapride, diamorphine ---> SPC of [2] of eMC
There may be antagonism of the gastrointestinal effects
Cisapride, diphemanil
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, dipotassium clorazepate
The co-administration may increase the absorption and the sedative effect of clorazepate
Cisapride, disopyramide [2] ---> SPC of [2] of eMC
Concomitant administration of disopyramide with other drugs liable to provoke ventricular arrythmias, especially Torsade de Pointes is contra-indicated
Cisapride, dofetilide [2] ---> SPC of [2] of EMA
The co-administration of dofetilide with drugs known to prolong the QT interval is contraindicated
Cisapride, dronedarone [2] ---> SPC of [2] of EMA
Medicinal products inducing torsades de pointes are contraindicated because of the potential risk of proarrhythmias
Cisapride, droperidol
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, efavirenz [2] ---> SPC of [2] of EMA
The combination is contraindicated since inhibition of metabolism by efavirenz (CYP3A4 inhibitor) may lead to serious, life-threatening events
Cisapride, efavirenz/emtricitabine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
The combination is contraindicated since inhibition of metabolism by efavirenz (CYP3A4 inhibitor) may lead to serious, life-threatening events
Cisapride, elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Co-administration of Genvoya and some medicinal products that are primarily metabolised by CYP3A may increase plasma concentrations of these products, which are associated with the potential for serious/life-threatening adverse reactions. Contraindicated
Cisapride, elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
Co-administration of Stribild and other medicinal products primarily metabolised by CYP3A such as amiodarone, quinidine, cisapride, pimozide, alfuzosin and sildenafil for pulmonary arterial hypertension is contraindicated
Cisapride, erythromycin [2] ---> SPC of [2] of eMC
The strong CYP3A4 inhibition may increase the plasma concentrations of cisapride and prolong the QT interval. The co-administration is contraindicated
Cisapride, esomeprazole [2] ---> SPC of [2] of EMA
The slightly prolonged QTc interval observed after administration of cisapride alone, was not further prolonged when cisapride was given in combination with esomeprazole.
Cisapride, everolimus [2] ---> SPC of [2] of EMA
Caution is advised during co-administration of everolimus and orally administered active principles metabolised primarily through CYP3A4 and with a narrow therapeutic range
Cisapride, fluconazole [2] ---> SPC of [2] of eMC
Coadministration of other medicinal products known to prolong the QT interval and which are metabolised via the cytochrome P450 (CYP) 3A4 are contraindicated in patients receiving fluconazole
Cisapride, flupentixol
Increases in the QT interval related to antipsychotic treatment may be exacerbated by the co-administration of other drugs known to significantly increase the QT interval. Co-administration of such drugs should be avoided.
Cisapride, fluvoxamine [2] ---> SPC of [2] of eMC
Fluvoxamine should not be co-administered with cisapride as plasma concentrations may be increased resulting in a higher risk for QT-prolongation/Torsade de Pointes.
Cisapride, fosamprenavir/ritonavir ---> SPC of [fosamprenavir] of EMA
Amprenavir must not be administered concurrently with medicinal products with narrow therapeutic windows that are substrates of cytochrome P450 3A4 (CYP3A4). Potential for serious and/or life-threatening reactions such as cardiac arrhythmias.
Cisapride, fosaprepitant [2] ---> SPC of [2] of EMA
Inhibition of CYP3A4 by fosaprepitant could result in elevated plasma concentrations of cisapride, potentially causing serious or life-threatening reactions. Concomitant use is contraindicated
Cisapride, gatifloxacin
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, grapefruit juice
The strong CYP3A4 inhibition may increase the plasma concentrations of cisapride and prolong the QT interval. The intake of grapefruit/grapefruit juice should be avoided
Cisapride, grepafloxacin
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, halofantrine
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, haloperidol
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, hydrochlorothiazide ---> SPC of [amlodipine/valsartan/hydrochlorothiazide] of EMA
It is anticipated that prokinetic substances such as cisapride may decrease the bioavailability of thiazide-type diuretics.
Cisapride, hydroquinidine
Concomitant use of hydroquinidine with drugs that can induce torsades de pointes is contraindicated due to increased risk of heart rhythm disorders (torsades de pointes)
Cisapride, ibutilide
Possible increase of proarrhythmic risk if ibutilide is used with drugs that prolong the QT interval. Contraindicated within 4 hours after completing infusion
Cisapride, idebenone [2] ---> SPC of [2] of EMA
CYP3A4 substrates known to have a narrow therapeutic index should be administered with caution in patients receiving idebenone.
Cisapride, idelalisib [2] ---> SPC of [2] of EMA
The co-administration of idelalisib with cisapride may increase the serum concentrations of cisapride. Idelalisib should not be co-administered with cisapride.
Cisapride, indapamide [2] ---> SPC of [2] of eMC
The co-administration may increase the risk of ventricular arrhythmias, particularly torsades de pointes (hypokalemia is a risk factor)
Cisapride, indinavir [2] ---> SPC of [2] of EMA
Indinavir with or without ritonavir should not be administered with medicinal products with narrow therapeutic ranges and which are CYP3A4 substrates. The elevated plasma concentrations of these medicines may cause serious or life-threatening reactions.
Cisapride, indinavir/ritonavir ---> SPC of [indinavir] of EMA
Indinavir with or without ritonavir should not be administered with medicinal products with narrow therapeutic ranges and which are CYP3A4 substrates. The elevated plasma concentrations of these medicines may cause serious or life-threatening reactions.
Cisapride, interferon
Caution should be used when administering interferon with medicines mainly metabolised by hepatic cytochrome P450 and have a narrow therapeutic window
Cisapride, itraconazol [2] ---> SPC of [2] of eMC
The co-administration of itraconazole with CYP3A4 metabolised substrates that can prolong the QT-interval is contraindicated
Cisapride, ivabradine [2] ---> SPC of [2] of EMA
The concomitant use of cardiovascular and non-cardiovascular QT prolonging medicinal products with ivabradine should be avoided since QT prolongation may be exacerbated by heart rate reduction.
Cisapride, ketoconazole
The strong CYP3A4 inhibition may increase the plasma concentrations of cisapride and prolong the QT interval. The co-administration is contraindicated
Cisapride, lapatinib [2] ---> SPC of [2] of EMA
Lapatinib inhibits CYP3A4 in vitro at clinically relevant concentrations. Co-administration of lapatinib with orally administered medicinal products with narrow therapeutic windows that are substrates of CYP3A4 should be avoided
Cisapride, lenvatinib [2] ---> SPC of [2] of EMA
CYP3A4 substrates known to have a narrow therapeutic index should be administered with caution in patients receiving lenvatinib.
Cisapride, levacetylmethadol [2] ---> SPC of [2] of EMA
The co-administration of levacetylmethadol with medicinal products that prolong the interval QT is contraindicated
Cisapride, levomepromazine [2] ---> SPC of [2] of eMC
There is an increased risk of arrhythmias when neuroleptics are used with drugs that prolong the QT interval
Cisapride, lithium ---> SPC of [lithium carbonate] of eMC
As a precautionary measure, lithium should be avoided in patients concomitantly treated with drugs that are known to prolong the QT interval
Cisapride, lopinavir/ritonavir [2] ---> SPC of [2] of EMA
Lopinavir/ritonavir should not be co-administered with medicinal products that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life threatening events.
Cisapride, losartan/hydrochlorothiazide [2] ---> SPC of [2] of eMC
Periodic monitoring of serum potassium and ECG is recommended when losartan/hydrochlorothiazide is administered with torsades de pointes-inducing medicinal products
Cisapride, lurasidone [2] ---> SPC of [2] of EMA
Monitoring is recommended when lurasidone and CYP3A4 substrates known to have a narrow therapeutic index are coadministered.
Cisapride, macrolide antibiotics
The strong CYP3A4 inhibition may increase the plasma concentrations of cisapride and prolong the QT interval. The co-administration is contraindicated
Cisapride, maprotiline
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, mequitazine
Concomitant use of mequitazine with drugs that prolong the QT interval is contraindicated
Cisapride, methadone
The risk of QT interval prolongation may be increased if methadone is administered with medicinal products affecting heart conduction
Cisapride, miconazole [2] ---> SPC of [2] of eMC
Oral miconazole is contraindicated with the coadministration of substrates known to prolong the QT-interval that are subject to metabolism by CYP3A4
Cisapride, moclobemide
The co-administration of moclobemide with drugs that prolong the QT interval should be avoided
Cisapride, moxifloxacin [2] ---> SPC of [2] of eMC
The co-administration may have an additive effect on the QT interval prolongation. This might lead to an increased risk of ventricular arrhythmias, including torsade de pointes. The combination is contraindicated.
Cisapride, nelfinavir [2] ---> SPC of [2] of EMA
Co-administration of nelfinavir with medicinal products with narrow therapeutic windows and which are substrates of CYP3A4 is contraindicated.
Cisapride, nifedipine
Simultaneous administration of cisapride and nifedipine may lead to increased plasma concentration of nifedipine.
Cisapride, nortriptyline
Concomitant use of nortriptyline with drugs known to prolong the QT interval should be avoided
Cisapride, olaparib [2] ---> SPC of [2] of EMA
Olaparib inhibits CYP3A4 in vitro and is predicted to be a mild CYP3A inhibitor in vivo. Therefore, caution should be exercised when sensitive CYP3A substrates or substrates with a narrow therapeutic margin are combined with olaparib.
Cisapride, ombitasvir/paritaprevir/ritonavir [2] ---> SPC of [2] of EMA
Ritonavir is a strong inhibitor of CYP3A. Medicinal products that are highly dependent on CYP3A for clearance and for which elevated plasma levels are associated with serious events are contraindicated
Cisapride, opipramol
The co-administration may prolong the QT interval. Concomitant use should be avoided
Cisapride, oral anticoagulants
The co-administration may enhance the anticoagulant effect and increase the bleeding risk
Cisapride, pasireotide [2] ---> SPC of [2] of EMA
Pasireotide should be used with caution in patients who are concomitantly receiving medicinal products that prolong the QT interval
Cisapride, pentamidine [2] ---> SPC of [2] of eMC
Caution is advised when pentamidine isetionate is concomitantly used with drugs that are known to prolong the QT interval
Cisapride, phenothiazines
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, phenprocoumon
The co-administration may enhance the anticoagulant effect and increase the bleeding risk
Cisapride, pimozide [2] ---> SPC of [2] of eMC
Concomitant use of pimozide with drugs known to prolong the QT interval is contra-indicated
Cisapride, piperaquine ---> SPC of [piperaquine/artenimol] of EMA
The combination of piperaquine with drugs that are known to prolong the QTc interval is contraindicated: additive effect on the QTc interval
Cisapride, piperaquine/artenimol [2] ---> SPC of [2] of EMA
The combination of piperaquine/dihydroartemisinin with drugs that are known to prolong the QTc interval is contraindicated: additive effect on the QTc interval
Cisapride, pitolisant [2] ---> SPC of [2] of EMA
The combination of pitolisant with substrates of CYP3A4 and having a narrow therapeutic margin (e.g. immunosuppressants, docetaxel, kinase inhibitors, cisapride, pimozide, halofantrine) should be avoided
Cisapride, pizotifen
Concomitant use of pizotifen and cisapride may decrease the effect of cisapride
Cisapride, posaconazole [2] ---> SPC of [2] of EMA
The CYP3A4 inhibition may increase the plasma concentrations of cisapride and prolong the QT interval. The co-administration is contraindicated
Cisapride, potent CYP3A4 inhibitors that prolong the QT interval ---> SPC of [posaconazole] of EMA
The CYP3A4 inhibition may increase the plasma concentrations of cisapride and prolong the QT interval. The co-administration is contraindicated
Cisapride, pregnancy
This medicinal product should be used during pregnancy only after careful weighing of the potential benefits compared to the potential risk to the foetus, especially in the first trimester.
Cisapride, procainamide
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, procyclidine
Anticholinergic drugs may antagonise the gastrointestinal effects of prokinetic drugs
Cisapride, promazine ---> SPC of [2] of eMC
Concomitant use of promazine with drugs known to prolong the QT interval may increase the risk of ventricular arrhythmias, including torsade de pointes. Therefore, concomitant use of these products is not recommended.
Cisapride, protease inhibitors
The strong CYP3A4 inhibition may increase the plasma concentrations of cisapride and prolong the QT interval. The co-administration is contraindicated
Cisapride, QT interval prolonging drugs
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, ribociclib [2] ---> SPC of [2] of EMA
Concomitant administration of ribociclib at the 600 mg dose this CYP3A4 substrates should be avoided
Cisapride, ritonavir [2] ---> SPC of [2] of EMA
Ritonavir co-administration is likely to result in increased plasma concentrations of cisapride and is therefore contraindicated
Cisapride, rivastigmine [2] ---> SPC of [2] of EMA
Since bradycardia constitutes a risk factor in the occurrence of torsades de pointes, the combination of rivastigmine with torsades de pointes-inducing medicinal products should be observed with caution and clinical monitoring (ECG) may also be required.
Cisapride, roxithromycin
Roxitromycin, moderate CYP3A4 inhibitor, may increase the plasma levels of astemizole, cisapride, pimozide y terfenadine (QT-interval prolongation). The co-administration is contraindicated
Cisapride, rucaparib [2] ---> SPC of [2] of EMA
Caution is advised when co-administering medicinal products that CYP3A substrates with a narrow therapeutic index. Dose adjustments may be considered, if clinically indicated based on observed adverse reactions.
Cisapride, saquinavir/ritonavir ---> SPC of [saquinavir] of EMA
Saquinavir, CYP3A4 inhibitor, may increase the plasma concentrations of cisapride. Contraindicated due to the potential for life threatening cardiac arrhythmia
Cisapride, sertindole
Increases in the QT interval related to sertindole treatment may be exacerbated by the co-administration of other drugs known to significantly increase the QT interval. Co-administration of such drugs is therefore contraindicated
Cisapride, simeprevir [2] ---> SPC of [2] of EMA
The intestinal CYP3A4 enzyme inhibition by simeprevir may increase the concentrations of cisapride, which has the potential to cause cardiac arrhythmias.
Cisapride, sirolimus [2] ---> SPC of [2] of EMA
Pharmacokinetic interactions may be observed with gastrointestinal prokinetic agents, such as cisapride and metoclopramide.
Cisapride, solifenacin [2] ---> SPC of [2] of eMC
Solifenacin can reduce the effect of medicinal products that stimulate the motility of the gastro-intestinal tract, such as metoclopramide and cisapride
Cisapride, sotalol [2] ---> SPC of [2] of eMC
Sotalol should be given with extreme caution in conjunction with other drugs known to prolong the QT-interval. Drugs that prolong the QT-interval may cause torsades de pointes. The co-administration with sotalol is contraindicated
Cisapride, sparfloxacin
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, stiripentol [2] ---> SPC of [2] of EMA
Increased risk of cardiac arrhythmias and torsades de pointes. The combination is to be avoided unless strictly necessary
Cisapride, strong CYP3A4 inhibitors
The strong CYP3A4 inhibition may increase the plasma concentrations of cisapride and prolong the QT interval. The co-administration is contraindicated
Cisapride, sulpiride [2] ---> SPC of [2] of eMC
Combination of sulpiride with drugs which could induce torsades de pointes or prolong the QT interval is not recommended
Cisapride, sultopride
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, tacrolimus [2] ---> SPC of [2] of EMA
The combination may increase systemic exposure of tacrolimus
Cisapride, telaprevir [2] ---> SPC of [2] of EMA
Concomitant administration of telaprevir is contraindicated with active substances that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events.
Cisapride, telithromycin [2] ---> SPC of [2] of EMA
Concomitant administration of telithromycin with medicinal products that prolong the QT interval and are CYP3A4 substrates is contraindicated
Cisapride, telmisartan/hydrochlorothiazide [2] ---> SPC of [2] of EMA
Periodic monitoring of serum potassium and ECG is recommended when MicardisPlus is administered with drugs affected by serum potassium disturbances (e.g. digitalis glycosides, antiarrhythmics) and torsades de pointes inducing medicinal products
Cisapride, terfenadine
The co-administration of terfenadine with drugs that may prolong the QT interval is contraindicated (risk of life-threatening arrythmias)
Cisapride, tetracyclic antidepressant
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, tetrazepam
The co-administration may enhance and prolong the effect of tetrazepam
Cisapride, thiazides ---> SPC of [aliskiren/hydrochlorothiazide] of EMA
Prokinetic substances may decrease the bioavailability of thiazide-type diuretics.
Cisapride, tiapride
Tiapride should not be combined with drugs that prolong the QT interval. These drugs (with the exception of anti-infectious) should be discontinued, if possible, if they induce torsades de pointes
Cisapride, ticagrelor [2] ---> SPC of [2] of EMA
Ticagrelor is a mild CYP3A4 inhibitor. Co-administration of ticagrelor and CYP3A4 substrates with narrow therapeutic indices is not recommended, as ticagrelor may increase the exposure to these medicinal products
Cisapride, tipranavir/ritonavir ---> SPC of [tipranavir] of EMA
Co-administration of tipranavir with low dose ritonavir, with active substances that are highly dependent on CYP3A for clearance, and for which elevated plasma concentrations are associated with serious and/or life-threatening events, is contraindicated.
Cisapride, tolterodine [2] ---> SPC of [2] of eMC
The effect of prokinetics may be decreased by tolterodine.
Cisapride, toremifene [2] ---> SPC of [2] of EMA
An additive effect on QT interval prolongation between toremifene and medicinal products that may prolong the QTc interval cannot be excluded. This might lead to an increased risk of ventricular arrhythmias. Co-administration is contraindicated
Cisapride, torsades de pointes inducing and QT interval prolonging drugs
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, torsades de pointes inducing drugs
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, tricyclic antidepressant
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, vandetanib [2] ---> SPC of [2] of EMA
The concomitant use of vandetanib with medicinal products known to also prolong the QTc interval and/or induce Torsades de pointes is either contraindicated or not recommended
Cisapride, vincamine
The co-administration of cisapride with drugs that may prolong the QT interval and/or induce torsades de pointes is contraindicated
Cisapride, voriconazole [2] ---> SPC of [2] of EMA
The combination of voriconazole, CYP3A4 inhibitor, with drugs metabolized by CYP3A4 and may prolong the QTc interval is contraindicated
Cisapride, warfarin
The enzymatic inhibitor may decrease the metabolism of warfarin and increase its plasma levels, the anticoagulant effect and the bleeding risk
Cisapride, xipamide
The combination increases the risk of ventricular arrhythmias, particularly torsades de pointes (favored by hypokaliemia). It is recommended a special caution
Cisapride, zafirlukast
The co-administration may decrease the bioavailability of zafirlukast
Cisapride, ziprasidone
The co-administration may prolong the QT interval and/or induce torsades de pointes and is contraindicated
Cisapride, zuclopenthixol [2] ---> SPC of [2] of eMC
Increases in the QT interval related to antipsychotic treatment may be exacerbated by the co-administration of other drugs known to significantly increase the QT interval. Co-administration of such drugs should be avoided.
Cisatracurium
Ability to drive, cisatracurium [2] ---> SPC of [2] of eMC
Cisatracurium will always be used in combination with a general anaesthetic and therefore the usual precautions relating to performance of tasks following general anaesthesia apply.
Acetazolamide, cisatracurium [2] ---> SPC of [2] of eMC
Diuretics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Aminoglycoside antibiotics, cisatracurium [2] ---> SPC of [2] of eMC
Antibiotics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Anaesthetics, cisatracurium [2] ---> SPC of [2] of eMC
Anaesthetics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Anaesthetics, muscle relaxants (non-depolarizing) ---> SPC of [cisatracurium] of eMC
Anaesthetics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Antiarrhythmics, cisatracurium [2] ---> SPC of [2] of eMC
Antiarrhythmics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Antibiotics, cisatracurium [2] ---> SPC of [2] of eMC
Antibiotics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Anticholinesterase, cisatracurium [2] ---> SPC of [2] of eMC
Treatment with anticholinesterases may shorten the duration and diminish the magnitude of neuromuscular blockade with cisatracurium.
Breast-feeding, cisatracurium [2] ---> SPC of [2] of eMC
It is not known whether cisatracurium or its metabolites are excreted in human milk.
Calcium antagonists, cisatracurium [2] ---> SPC of [2] of eMC
Calcium antagonists increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Carbamazepine [1], cisatracurium ---> SPC of [1] of eMC
Carbamazepine may antagonise the effects of non-depolarising muscle relaxants
Cisatracurium [1], clindamycin ---> SPC of [1] of eMC
Clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. It should be used with caution
Cisatracurium [1], depolarizing muscle relaxants ---> SPC of [1] of eMC
A depolarising muscle relaxant should not be administered to prolong the neuromuscular blocking effects of non-depolarising blocking agents, as this may result in a prolonged and complex block
Cisatracurium [1], diuretics ---> SPC of [1] of eMC
Diuretics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], donepezil ---> SPC of [1] of eMC
Treatment with donepezil may shorten the duration and diminish the magnitude of neuromuscular blockade with cisatracurium.
Cisatracurium [1], enflurane ---> SPC of [1] of eMC
Anaesthetics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], furosemide ---> SPC of [1] of eMC
Diuretics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], ganglionic blockers ---> SPC of [1] of eMC
Ganglion blocking drugs increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], halothane ---> SPC of [1] of eMC
Anaesthetics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], hexametonium ---> SPC of [1] of eMC
Ganglion blocking drugs increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], isoflurane ---> SPC of [1] of eMC
Anaesthetics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], ketamine ---> SPC of [1] of eMC
Anaesthetics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], lidocaine ---> SPC of [1] of eMC
Antiarrhythmics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], lincomycin ---> SPC of [1] of eMC
Antibiotics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], lithium ---> SPC of [1] of eMC
Lithium salts increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], magnesium ---> SPC of [1] of eMC
Magnesium salts increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], mannitol ---> SPC of [1] of eMC
Diuretics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], muscle relaxants (non-depolarizing) ---> SPC of [1] of eMC
Non-depolarising neuromuscular blocking agents increase the magnitude and/or duration of action of cisatracurium
Cisatracurium [1], phenytoin ---> SPC of [1] of eMC
Decreased muscle relaxant effect after chronic administration of phenytoin
Cisatracurium [1], polymyxin ---> SPC of [1] of eMC
Antibiotics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], pregnancy ---> SPC of [1] of eMC
Cisatracurium should not be used during pregnancy.
Cisatracurium [1], procainamide ---> SPC of [1] of eMC
Antiarrhythmics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], propranolol ---> SPC of [1] of eMC
Antiarrhythmics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], quinidine ---> SPC of [1] of eMC
Antiarrhythmics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], spectinomycin ---> SPC of [1] of eMC
Antibiotics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], tetracyclines ---> SPC of [1] of eMC
Antibiotics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], thiazides ---> SPC of [1] of eMC
Diuretics increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Cisatracurium [1], trimetaphan ---> SPC of [1] of eMC
Ganglion blocking drugs increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Magnesium, muscle relaxants (non-depolarizing) ---> SPC of [cisatracurium] of eMC
Magnesium salts increase the magnitude and/or duration of action of non-depolarising neuromuscular blocking agents
Muscle relaxants (non-depolarizing), phenytoin ---> SPC of [cisatracurium] of eMC
Decreased muscle relaxant effect after chronic administration of phenytoin
CONTRAINDICATIONS of Cisatracurium
- Cisatracurium is contra-indicated in patients known to be hypersensitive to cisatracurium, atracurium, or benzenesulfonic acid.
http://www.medicines.org.uk/emc/
Cisplatin
Ability to drive, cisplatin [2] ---> SPC of [2] of eMC
The profile of undesirable effects (like nephrotoxicity) may influence the ability to drive vehicles and use machinery.
Aldesleukin [1], cisplatin ---> SPC of [1] of eMC
Fatal tumour lysis syndrome has been reported in combination of aldesleukin with treatment with cis-platinum, vinblastine and dacarbazine. Concomitant use of the mentioned active substances is therefore not recommended.
Allopurinol, cisplatin
Cisplatin causes an increase in serum uric acid concentration
Altretamine/pyridoxine, cisplatin [2] ---> SPC of [2] of eMC
During a randomised study of the treatment of advanced ovarian cancer, the response time was unfavourably affected when pyridoxine was used in combination with altretamine (hexamethylmelamine) and cisplatin.
Aluminium containing equipment, cisplatin [2] ---> SPC of [2] of eMC
Cisplatin may interact with metal aluminium to form a black precipitate of platinum. All aluminium-containing IV sets, needles, catheters and syringes should be avoided.
Amikacine [1], cisplatin ---> SPC of [1] of eMC
Concurrent or serial use of amikacin with other neurotoxic, ototoxic or nephrotoxic agents should be avoided either systemically or topically because of the potential for additive effects.
Aminoglycoside antibiotics, cisplatin [2] ---> SPC of [2] of eMC
Concomitant administration of cisplatin and nephrotoxic and ototoxic medicinal products will potentiate the toxic effect of cisplatin on the kidneys and on auditory function
Amphotericin B, cisplatin [2] ---> SPC of [2] of eMC
Concomitant administration of cisplatin and nephrotoxic medicinal products will potentiate the toxic effect of cisplatin on the kidneys.
Amphotericin, cisplatin [2] ---> SPC of [2] of eMC
Concomitant administration of cisplatin and nephrotoxic medicinal products will potentiate the toxic effect of cisplatin on the kidneys.
Antiepileptics, cisplatin [2] ---> SPC of [2] of eMC
Serum concentrations of anticonvulsive medicines may remain at subtherapeutic levels during treatment with cisplatin.
Antihistamines, cisplatin [2] ---> SPC of [2] of eMC
Simultaneous use of cisplatin and antihistamines may mask ototoxicity symptoms (such as dizziness and tinnitus).
Bendroflumethiazide, cisplatin
Concomitant use of bendroflumethiazide with cisplatin can lead to an increased risk of nephrotoxicity and ototoxicity.
Bevacizumab [1], cisplatin ---> SPC of [1] of EMA
Trial results demonstrated no significant effect of bevacizumab on the pharmacokinetics of cisplatin.
Bleomycin [1], cisplatin ---> SPC of [1] of eMC
During or after treatment with cisplatin caution is advised with predominantly renal eliminated substances because of potentially reduced renal elimination.
Bleomycin/vinblastine, cisplatin
The combination can lead to a Raynaud-phenomenon
Breast-feeding, cisplatin [2] ---> SPC of [2] of eMC
Cisplatin is excreted in breast milk. Patients treated with cisplatin must not breastfeed.
Buclizine, cisplatin [2] ---> SPC of [2] of eMC
Simultaneous use of cisplatin and buclizine may mask ototoxicity symptoms (such as dizziness and tinnitus).
Carbamazepine [1], cisplatin ---> SPC of [1] of eMC
The carbamazepine plasma levels may be decreased.
Cephalosporins, cisplatin
The co-administration may potentiate the nephrotoxic effects of cisplatin
Chelating agents, cisplatin
Chelating agent may decrease the effectiveness of cisplatin
Cisplatin [1], cyclizine ---> SPC of [1] of eMC
Simultaneous use of cisplatin and cyclizine may mask ototoxicity symptoms (such as dizziness and tinnitus).
Cisplatin [1], hexamethylmelamine/pyridoxine ---> SPC of [1] of eMC
During a randomised study of the treatment of advanced ovarian cancer, the response time was unfavourably affected when pyridoxine was used in combination with altretamine (hexamethylmelamine) and cisplatin.
Cisplatin [1], ifosfamide ---> SPC of [1] of eMC
The renal toxicity of ifosfamide may be greater when used with cisplatin or in patients who have previously been given cisplatin. Ifosfamide may increase hearing loss due to cisplatin.
Cisplatin [1], loop diuretics ---> SPC of [1] of eMC
Concomitant administration of cisplatin and ototoxic medicinal products will potentiate the toxic effect of cisplatin on auditory function.
Cisplatin [1], loxapine ---> SPC of [1] of eMC
Simultaneous use of cisplatin and loxapine may mask ototoxicity symptoms (such as dizziness and tinnitus).
Cisplatin [1], meclozine ---> SPC of [1] of eMC
Simultaneous use of cisplatin and meclozine may mask ototoxicity symptoms (such as dizziness and tinnitus).
Cisplatin [1], methotrexate ---> SPC of [1] of eMC
During or after treatment with cisplatin caution is advised with predominantly renal eliminated substances because of potentially reduced renal elimination.
Cisplatin [1], neurotoxic substances ---> SPC of [1] of eMC
Cisplatin has been shown to be cumulatively neurotoxic (in particular ototoxic) and should not be given to patients with pre-existing hearing impairment.
Cisplatin [1], oral anticoagulants ---> SPC of [1] of eMC
In the event of simultaneous use of oral anticoagulants, it is advisable to regularly check the INR.
Cisplatin [1], ototoxic agents ---> SPC of [1] of eMC
Cisplatin has been shown to be cumulatively neurotoxic (in particular ototoxic) and should not be given to patients with pre-existing hearing impairment.
Cisplatin [1], paclitaxel ---> SPC of [1] of eMC
Treatment with cisplatin prior to an infusion with paclitaxel may reduce the clearance of paclitaxel by 33% and therefore can intensify neurotoxicity.
Cisplatin [1], phenothiazines ---> SPC of [1] of eMC
Simultaneous use of cisplatin and phenothiazines may mask ototoxicity symptoms (such as dizziness and tinnitus).
Cisplatin [1], phenytoin ---> SPC of [1] of eMC
In patients receiving cisplatin and phenytoin, the serum level of phenytoin might be reduced. This is probably due to reduced absorption and/or increased metabolism.
Cisplatin [1], pregnancy ---> SPC of [1] of eMC
Cisplatin may be toxic to the foetus when administered to a pregnant woman. Cisplatin should not be used during pregnancy unless the clinician considers the risk in an individual patient to be clinically justified.
Cisplatin [1], radiologic contrasts ---> SPC of [1] of eMC
Concomitant administration of cisplatin and nephrotoxic medicinal products will potentiate the toxic effect of cisplatin on the kidneys.
Cisplatin [1], renal excretion ---> SPC of [1] of eMC
During or after treatment with cisplatin caution is advised with predominantly renal eliminated substances because of potentially reduced renal elimination.
Cisplatin [1], thioxanthenes ---> SPC of [1] of eMC
Simultaneous use of cisplatin and thioxanthenes may mask ototoxicity symptoms (such as dizziness and tinnitus).
Cisplatin [1], trimethobenzamide ---> SPC of [1] of eMC
Simultaneous use of cisplatin and trimethobenzamide may mask ototoxicity symptoms (such as dizziness and tinnitus).
Cisplatin [1], yellow fever vaccine ---> SPC of [1] of eMC
Yellow fever vaccine is strictly contraindicated because of the risk of fatal systemic vaccinal disease
Cisplatin, colchicine
Cisplatin causes an increase in serum uric acid concentration
Cisplatin, cyclosporine
The co-administration may cause an excessive immunosuppression with risk of lymphoproliferation
Cisplatin, cytostatics
Caution should be exercised due to both active principles are eliminated by renal excretion
Cisplatin, diazoxide
The co-administration may intensify the nephrotoxic effects of cisplatin
Cisplatin, dimenhydrinate
The co-administration may mask the symptome of ototoxicity
Cisplatin, docetaxel
The co-administration may induce more severe neurotoxic effects than either drug as a single agent in similar doses
Cisplatin, doxorubicine [2] ---> SPC of [2] of eMC
The toxic effects of a doxorubicin therapy may be increased in a combination with other cytostatics
Cisplatin, epirubicin [2] ---> SPC of [2] of eMC
The use of epirubicin in combination chemotherapy with other potentially cardiotoxic drugs requires monitoring of cardiac function throughout treatment.
Cisplatin, etoposide
Etoposide is commonly used with other cytotoxic agents and can have synergic effects in most of the cases
Cisplatin, fluorouracil
The co-administration may increase the efficacy and toxicity of fluorouracil
Cisplatin, furosemide
The co-administration may intensify the nephrotoxic, ototoxic and cytotoxic effects. Strict indication
Cisplatin, gentamicin [2] ---> SPC of [2] of eMC
Cisplatin is potential enhancer of nephrotoxicity
Cisplatin, hydralazine
The co-administration may intensify the nephrotoxic effects of cisplatin
Cisplatin, lithium
Decreased plasma levels of lithium
Cisplatin, mifamurtide [2] ---> SPC of [2] of EMA
In a large controlled randomised study, mifamurtide used at the recommended dose and schedule with other medicinal products that have known renal or hepatic toxicities did not exacerbate those toxicities and there was no need to adjust mifamurtide dose.
Cisplatin, myelosuppressive agents
The co-administration may enhance the myelosuppressive effects of cisplatin
Cisplatin, nephrotoxic substances
The co-administration may potentiate the nephrotoxic effects of cisplatin
Cisplatin, penicillamine
Chelating agent may decrease the effectiveness of cisplatin
Cisplatin, piretanide
The co-administration may enhance the ototoxicity and/or nephrotoxicity
Cisplatin, pramipexole [2] ---> SPC of [2] of EMA
Medicines that are inhibitors of the cationic secretory transport system of renal tubules/are eliminated by this pathway may interact with pramipexole resulting in reduced clearance of pramipexole. Reduction of the pramipexole dose should be considered
Cisplatin, primidone
The co-administration may decrease the plasma levels of primidone
Cisplatin, probenecide
Cisplatin causes an increase in serum uric acid concentration
Cisplatin, propranolol
The co-administration may intensify the nephrotoxic effects of cisplatin
Cisplatin, pyridoxine
The co-administration may influence negatively the response duration to therapy
Cisplatin, radiotherapy
The radiotherapy may enhance the myelosuppressive effects of cisplatin
Cisplatin, sulfinpyrazone
Cisplatin causes an increase in serum uric acid concentration
Cisplatin, teicoplanin [2] ---> SPC of [2] of eMC
Teicoplanin should be used with care in conjunction with or sequentially with other medicinal products with known nephrotoxic or ototoxic potential.
Cisplatin, tiopronin
Increased risk of nephrotoxicity and ototoxicity
Cisplatin, tobramycin [2] ---> SPC of [2] of EMA
The co-administration may potentiate the nephrotoxic and ototoxic effects of both active principles
Cisplatin, trastuzumab [2] ---> SPC of [2] of EMA
The data suggested that the pharmacokinetics of cisplatin were not affected by concurrent use of capecitabine or by concurrent use of capecitabine plus trastuzumab.
Cisplatin, vaccinations with live organism vaccines
Use of living virus vaccinations is contraindicated within 3 months following cisplatin treatment
Cisplatin, vancomycin [2] ---> SPC of [2] of eMC
Concurrent or sequential systemic or topical use of other potentially neurotoxic or nephrotoxic drugs may potentiate the nephrotoxicity and/or ototoxicity of vancomycin and consequently requires careful monitoring.
Cisplatin, vinblastine
The co-administration may increase the plasma levels of vinblastine and the neurotoxicity of cisplatin
Cisplatin, vinorelbine [2] ---> SPC of [2] of eMC
A higher incidence of granulocytopenia has been reported in patients receiving combination therapy with vinorelbine and cisplatin than in those receiving vinorelbine alone.
CONTRAINDICATIONS of Cisplatin
- Cisplatin may give allergic reactions in some patients. Use is contraindicated in those patients with a history of allergic reaction to cisplatin or other platinum containing compounds, or any component of the formulation. Cisplatin induces nephrotoxicity which is cumulative. It is therefore contraindicated in patients with pre-existing renal impairment.
- Cisplatin has also been shown to be cumulatively neurotoxic (in particular ototoxic) and should not be given to patients with pre-existing hearing impairment.
Cisplatin is also contraindicated in myelosuppressed patients and those who are dehydrated.
- Patients receiving cisplatin should not breastfeed.
- Concurrent administration of yellow fever vaccine is contraindicated.
http://www.medicines.org.uk/emc/
Citalopram
Ability to drive, citalopram [2] ---> SPC of [2] of eMC
Psychoactive medicinal products can reduce the ability to make judgments and to react to emergencies.
Acenocoumarol [1], citalopram ---> SPC of [1] of eMC
The co-administration may enhance the anticoagulant effect of acenocoumarol and increase the bleeding risk
Acetylsalicylic acid, citalopram [2] ---> SPC of [2] of eMC
Caution is warranted for patients who are being treated simultaneously with anticoagulants, medicinal products that affect platelet function, or other medicines that can increase the risk of haemorrhage
Alcohol, citalopram [2] ---> SPC of [2] of eMC
The combination of citalopram and alcohol is not advisable.
Amitriptyline, citalopram ---> SPC of [2] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Anticoagulants, citalopram [2] ---> SPC of [2] of eMC
Caution is warranted for patients who are being treated simultaneously with anticoagulants, medicinal products that affect platelet function, or other medicines that can increase the risk of haemorrhage
Antimalarial agents, citalopram [2] ---> SPC of [2] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Astemizole, citalopram [2] ---> SPC of [2] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Atypical neuroleptics, citalopram [2] ---> SPC of [2] of eMC
Caution is warranted for patients who are being treated simultaneously with anticoagulants, medicinal products that affect platelet function, or other medicines that can increase the risk of haemorrhage
Azithromycin [1], citalopram ---> SPC of [1] of eMC
Azithromycin should be used with caution in patients currently receiving treatment with other active substances known to prolong QT interval
Breast-feeding, citalopram [2] ---> SPC of [2] of eMC
Citalopram is known to be excreted in breast milk. The existing information is insufficient for assessment of the risk to the child. Caution is recommended.
Bupropion, citalopram ---> SPC of [2] of eMC
Caution is advised when concomitantly using citalopram with other medicinal products capable of lowering the seizure threshold
Buspirone, citalopram [2] ---> SPC of [2] of eMC
At the pharmacodynamic level cases of serotonin syndrome with citalopram and buspirone have been reported.
Butyrophenones, citalopram ---> SPC of [2] of eMC
Caution is advised when concomitantly using citalopram with other medicinal products capable of lowering the seizure threshold
Carbamazepine, citalopram [2] ---> SPC of [2] of eMC
Thus no change or only very small changes of no clinical importance were observed when citalopram was given with CYP3A4 substrates
Central analgesics, citalopram
Citalopram potentiates the antinociceptive effect of central analgetics
Chlorpromazine [1], citalopram ---> SPC of [1] of eMC
The combination of citalopram and chlorpromazine is contraindicated
Chlorprothixene, citalopram
The enzymatic inhibition increases the plasma levels of chlorprothixene
Cimetidine, citalopram [2] ---> SPC of [2] of eMC
Cimetidine, a known enzyme-inhibitor, caused a slight rise in the average steady-state citalopram levels. Dose adjustment may be warranted.
Citalopram [1], class IA antiarrhythmic agents ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Citalopram [1], class III antiarrhythmic agents ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Citalopram [1], desipramine ---> SPC of [1] of eMC
When desipramine is combined with citalopram, an increase of the desipramine plasma concentration has been observed. A reduction of the desipramine dose may be needed.
Citalopram [1], erythromycin ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated (IV erythromycin)
Citalopram [1], halofantrine ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Citalopram [1], haloperidol ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Citalopram [1], hypokalemia ---> SPC of [1] of eMC
Caution is warranted for concomitant use of citalopram and hypokalaemia/hypomagnesaemia inducing medicinal products as these conditions increase the risk of malignant arrhythmias
Citalopram [1], hypomagnesemia ---> SPC of [1] of eMC
Caution is warranted for concomitant use of citalopram and hypokalaemia/hypomagnesaemia inducing medicinal products as these conditions increase the risk of malignant arrhythmias
Citalopram [1], IMAOs ---> SPC of [1] of eMC
Simultaneous use of citalopram and MAOI can result in severe side effects, including serotonin syndrome. Cases of serious and sometimes fatal reactions have been reported in patients who have recently discontinued an SSRI and have been started on a MAOI.
Citalopram [1], imipramine ---> SPC of [1] of eMC
In a pharmacokinetic study no effect was demonstrated on either citalopram or imipramine levels, although the level of desipramine, the primary metabolite of imipramine was increased.
Citalopram [1], lithium ---> SPC of [1] of eMC
There have been reports of enhanced serotonergic effects when SSRIs have been given with lithium
Citalopram [1], mizolastine ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Citalopram [1], moclobemide ---> SPC of [1] of eMC
At the pharmacodynamic level cases of serotonin syndrome with citalopram and moclobemide have been reported.
Citalopram [1], moxifloxacin ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Citalopram [1], non-selective MAO-inhibitors ---> SPC of [1] of eMC
Simultaneous use of citalopram and MAOI can result in severe side effects, including serotonin syndrome. Cases of serious and sometimes fatal reactions have been reported in patients who have recently discontinued an SSRI and have been started on a MAOI.
Citalopram [1], NSAID ---> SPC of [1] of eMC
Caution is warranted for patients who are being treated simultaneously with anticoagulants, medicinal products that affect platelet function, or other medicines that can increase the risk of haemorrhage
Citalopram [1], pentamidine ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Citalopram [1], phenothiazines ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Citalopram [1], pimozide ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Citalopram [1], platelet aggregation inhibitors ---> SPC of [1] of eMC
Caution is warranted for patients who are being treated simultaneously with anticoagulants, medicinal products that affect platelet function, or other medicines that can increase the risk of haemorrhage
Citalopram [1], pregnancy ---> SPC of [1] of eMC
Citalopram should not be used during pregnancy unless clearly necessary and only after careful consideration of the risk/benefit.
Citalopram [1], QT interval prolonging drugs ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Citalopram [1], selective-B MAO inhibitors ---> SPC of [1] of eMC
Simultaneous use of citalopram and MAOI can result in severe side effects, including serotonin syndrome. Cases of serious and sometimes fatal reactions have been reported in patients who have recently discontinued an SSRI and have been started on a MAOI.
Citalopram [1], selegiline ---> SPC of [1] of eMC
The concomitant use of citalopram and selegiline (in doses above 10 mg daily) is contraindicated
Citalopram [1], sparfloxacin ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Citalopram [1], ticlopidine ---> SPC of [1] of eMC
The co-administration may increase the bleeding risk. The CYP2C19 inhibition may increase the plasma levels of citalopram
Citalopram [1], tricyclic antidepressant ---> SPC of [1] of eMC
Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated
Citalopram, clomipramine ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, clozapine [2] ---> SPC of [2] of eMC
Cases have been reported of an interaction between citalopram and clozapine, which may increase the risk of adverse events associated with clozapine. The nature of this interaction has not been fully elucidated.
Citalopram, dipyridamole ---> SPC of [1] of eMC
Caution is warranted for patients who are being treated simultaneously with anticoagulants, medicinal products that affect platelet function, or other medicines that can increase the risk of haemorrhage
Citalopram, doxepin ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, drugs primarily metabolised by CYP2D6 with narrow therapeutic index ---> SPC of [1] of eMC
Escitalopram (active enantiomer of citalopram) is an inhibitor of the enzyme CYP2D6. Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by this enzyme, and that have a narrow therapeutic index
Citalopram, encainide ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, esomeprazole [2] ---> SPC of [2] of EMA
Esomeprazole inhibits CYP2C19, the major esomeprazole metabolising enzyme. Thus, when esomeprazole is combined with medicinal products metabolised by CYP2C19, the plasma concentrations of these medicinal products may be increased
Citalopram, flecainide ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, fluvoxamine ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, frovatriptan [2] ---> SPC of [2] of eMC
Potential risk of hypertension, coronary vasoconstriction or serotonin syndrome. Strict adherence to the recommended dose is an essential factor to prevent this syndrome.
Citalopram, hydroxyzine [2] ---> SPC of [2] of eMC
Co-administration of hydroxyzine with drugs known to prolong the QT interval and/or induce Torsade de Pointes increase the risk of cardiac arrhythmia. Therefore, the combination is contra-indicated
Citalopram, lansoprazole ---> SPC of [1] of eMC
The strong CYP2C19 inhibition may increase the plasma concentrations of citalopram. Caution should be exercised when used concomitantly with CYP2C19 inhibitors
Citalopram, lofepramine ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, lorcainide ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, lumacaftor/ivacaftor [2] ---> SPC of [2] of EMA
A higher dose of this antidepressant may be required to obtain the desired clinical effect. Lumacaftor/ivacaftor may decrease the exposures of this antidepressant, which may reduce its efficacy.
Citalopram, maprotiline ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, mefloquine ---> SPC of [1] of eMC
Caution is advised when concomitantly using citalopram with other medicinal products capable of lowering the seizure threshold
Citalopram, melitracen ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, metoprolol ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, nortriptyline ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, noxiptiline ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, perphenazine ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, propafenone ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, protriptyline ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, risperidone ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, rivastigmine [2] ---> SPC of [2] of EMA
Since bradycardia constitutes a risk factor in the occurrence of torsades de pointes, the combination of rivastigmine with torsades de pointes-inducing medicinal products should be observed with caution and clinical monitoring (ECG) may also be required.
Citalopram, roxithromycin
Caution is warranted for concomitant use of roxitromycin with other QT interval prolonging medicines
Citalopram, seizure-threshold lowering drugs ---> SPC of [1] of eMC
Caution is advised when concomitantly using citalopram with other medicinal products capable of lowering the seizure threshold
Citalopram, serotonergic medicines ---> SPC of [1] of eMC
Co-administration with serotonergic medicinal products may lead to enhancement of 5-HT associated effects. The combination is not recommended
Citalopram, serotonin agonists ---> SPC of [2] of eMC
Co-administration with serotonergic medicinal products may lead to enhancement of 5-HT associated effects. The combination is not recommended
Citalopram, St. John's wort [2] ---> SPC of [2] of eMC
Dynamic interactions between citalopram and the herbal remedy St John's wort (Hypericum perforatum) can occur, resulting in an increase in undesirable effects
Citalopram, stiripentol [2] ---> SPC of [2] of EMA
Stiripentol is an inhibitor of the enzymes CYP2C19 and may markedly increase the plasma concentrations of substances metabolised by these enzymes and increase the risk of adverse reactions
Citalopram, strong CYP2C19 inhibitors ---> SPC of [1] of eMC
The strong CYP2C19 inhibition may increase the plasma concentrations of citalopram. Caution should be exercised when used concomitantly with CYP2C19 inhibitors
Citalopram, sumatriptan ---> SPC of [1] of eMC
Co-administration with serotonergic medicinal products may lead to enhancement of 5-HT associated effects. The combination is not recommended
Citalopram, telithromycin [2] ---> SPC of [2] of EMA
Due to a potential to increase the QT interval, telithromycin should be used with care during concomitant administration with QT interval prolonging agents
Citalopram, terfenadine
The CYP3A4 inhibition may increase the terfenadine plasma levels and prolong the QT interval (risk of life-threatening arrythmias). The combination is contraindicated
Citalopram, thioridazine ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Citalopram, thioxanthenes ---> SPC of [1] of eMC
Caution is advised when concomitantly using citalopram with other medicinal products capable of lowering the seizure threshold
Citalopram, thrombolytics ---> SPC of [1] of eMC
Caution is warranted for patients who are being treated simultaneously with anticoagulants, medicinal products that affect platelet function, or other medicines that can increase the risk of haemorrhage
Citalopram, ticagrelor [2] ---> SPC of [2] of EMA
Due to reports of cutaneous bleeding abnormalities with SSRIs, caution is advised when administering SSRIs with ticagrelor as this may increase the risk of bleeding.
Citalopram, tramadol ---> SPC of [1] of eMC
Co-administration with serotonergic medicinal products may lead to enhancement of 5-HT associated effects. The combination is not recommended
Citalopram, trimipramine
The previous or concomitant treatment of SSRIs with trimipramine may increase the plasma levels of both antidepressants by substrate competition
Citalopram, triptans ---> SPC of [1] of eMC
Co-administration with serotonergic medicinal products may lead to enhancement of 5-HT associated effects. The combination is not recommended
Citalopram, tryptophan ---> SPC of [1] of eMC
There have been reports of enhanced serotonergic effects when SSRIs have been given with tryptophan
CONTRAINDICATIONS of Citalopram
- Hypersensitivity to citalopram or to any of the excipients
- MAOIs (monoamine oxidase inhibitors)
- Some cases presented with features resembling serotonin syndrome.
- Citalopram should not be given to patients receiving Monoamine Oxidase Inhibitors (MAOIs) including selegiline in daily doses exceeding 10 mg/day. Citalopram should not be given for 14 days after discontinuation of an irreversible MAOI or for the time specified after discontinuation of a reversible MAOI (RIMA) as stated in the prescribing text of the RIMA. MAOIs should not be introduced for seven days after discontinuation of citalopram
- Symptoms of a drug interaction with a MAOI include: hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, mental status changes that include confusion, irritability and extreme agitation progressing to delirium and coma.
- Citalopram is contraindicated in patients with known QT-interval prolongation or congenital long QT syndrome.
- Citalopram is contraindicated together with medicinal products that are known to prolong the QT interval. Citalopram is contraindicated in the combination with linezolid unless there are facilities for close observation and monitoring of blood pressure
- Citalopram should not be used concomitantly with pimozide
http://www.medicines.org.uk/emc/
Citicoline
Breast-feeding, citicoline
Strict indication
Centrophenoxine, citicoline
Concomitant use should be avoided
Citicoline, levodopa
Citicoline enhances the effects of levodopa
Citicoline, meclofenoxate
Concomitant use should be avoided
Citicoline, pregnancy
Strict indication
Cladribine (Litak)
Abacavir/lamivudine [1], cladribine ---> SmPC of [1] of EMA
In vitro lamivudine inhibits the intracellular phosphorylation of cladribine leading to a potential risk of cladribine loss of efficacy in case of combination in the clinical. Therefore, the concomitant use of lamivudine with cladribine is not recommended
Abacavir/lamivudine/zidovudine [1], cladribine ---> SmPC of [1] of EMA
In vitro lamivudine inhibits the intracellular phosphorylation of cladribine leading to a potential risk of cladribine loss of efficacy in case of combination in the clinical. Therefore, the concomitant use of lamivudine with cladribine is not recommended
Ability to drive, cladribine [2] ---> SmPC of [2] of EMA
In case certain adverse reactions with a potential impact on performance occur (e.g. dizziness, very common, or drowsiness, which may occur due to anaemia, which is very common), patients should be advised not to drive or use machines.
Adenosine deaminase inhibitors, cladribine [2] ---> SmPC of [2] of EMA
Since interactions with medicinal products undergoing intracellular phosphorylation, may be expected, their concomitant use with cladribine is not recommended.
Antineoplastics, cladribine [2] ---> SmPC of [2] of EMA
An influence of cladribine on the activity of other antineoplastic agents has not been observed in vitro (e.g. doxorubicin, vincristine, cytarabine, cyclophosphamide) and in vivo.
Breast-feeding, cladribine [2] ---> SmPC of [2] of EMA
Because of the potential for serious adverse reactions in nursing infants, lactation is contraindicated during treatment with cladribine and for 6 months after the last cladribine dose.
Chlormethine, cladribine [2] ---> SmPC of [2] of EMA
An in vitro study revealed cross-resistance between cladribine and chlormethine
Cladribine [1], corticosteroids ---> SmPC of [1] of EMA
Corticosteroids enhance the risk for severe infections when used in combination with cladribine and should not be given concomitantly with cladribine
Cladribine [1], fertility ---> SmPC of [1] of EMA
Antineoplastic agents, such as cladribine, which interfere with DNA, RNA and protein synthesis, might be expected to have adverse effects on human gametogenesis (see section 5.3).
Cladribine [1], medicinal products undergoing intracellular phosphorylation ---> SmPC of [1] of EMA
Since interactions with medicinal products undergoing intracellular phosphorylation, may be expected, their concomitant use with cladribine is not recommended.
Cladribine [1], men ---> SmPC of [1] of EMA
Men being treated with cladribine should be advised not to father a child up to 6 months after treatment and to seek advice of cryoconservation of sperm prior to treatment because of the possibility of infertility due to therapy with cladribine
Cladribine [1], myelosuppressive agents ---> SmPC of [1] of EMA
Due to a potential increase of haematological toxicity and bone marrow suppression, cladribine should not be used concomitantly with other myelosuppressive medicinal products
Cladribine [1], nitrogen mustard ---> SmPC of [1] of EMA
However, an in vitro study revealed cross-resistance between cladribine and nitrogen mustard (chlormethine); for cytarabine, one author has described an in vivo cross-reaction without loss of activity.
Cladribine [1], nucleoside analogues ---> SmPC of [1] of EMA
Due to the similar intracellular metabolism, cross-resistance with other nucleoside analogues, such as fludarabine or 2'-deoxycoformycin may occur. Therefore, simultaneous administration of nucleoside analogues with cladribine is not advisable.
Cladribine [1], pregnancy ---> SmPC of [1] of EMA
Cladribine causes serious birth defects when administered during pregnancy. Animal studies and in vitro studies with human cell lines demonstrated the teratogenicity and mutagenicity of cladribine. Cladribine is contraindicated in pregnancy.
Cladribine [1], pregnancy ---> SmPC of [1] of EMA
In case of pregnancy during therapy with cladribine, the woman should be informed about the potential hazard to the foetus.
Cladribine [1], women of childbearing potential ---> SmPC of [1] of EMA
Women of childbearing potential must use effective contraception during treatment with cladribine and for 6 months after the last cladribine dose.
Cladribine, direct acting antivirals
Concomitant use is not recommended
Cladribine, dolutegravir/abacavir/lamivudine [2] ---> SmPC of [2] of EMA
In vitro lamivudine inhibits the intracellular phosphorylation of cladribine leading to a potential risk of cladribine loss of efficacy in case of combination in the clinical setting. Concomitant use is not recommended
Cladribine, dolutegravir/lamivudine [2] ---> SmPC of [2] of EMA
Concomitant use of Dovato with cladribine is not recommended. In vitro lamivudine inhibits the intracellular phosphorylation of cladribine leading to a potential risk of cladribine loss of efficacy in case of combination in the clinical setting.
Cladribine, lamivudine [2] ---> SmPC of [2] of EMA
In vitro lamivudine inhibits the intracellular phosphorylation of cladribine leading to a potential risk of cladribine loss of efficacy in case of combination in the clinical setting.
Cladribine, lamivudine/raltegravir [2] ---> SmPC of [2] of EMA
In vitro lamivudine inhibits the intracellular phosphorylation of cladribine leading to a potential risk of cladribine loss of efficacy in case of combination in the clinical
Cladribine, lamivudine/zidovudine [2] ---> SmPC of [2] of EMA
In vitro lamivudine inhibits the intracellular phosphorylation of cladribine leading to a potential risk of cladribine loss of efficacy in case of combination in the clinical. The concomitant use of lamivudine with cladribine is not recommended
Cladribine, renal insufficiency
Contraindicated
CONTRAINDICATIONS of Cladribine (Litak)
- Hypersensitivity to the active substance or any of the excipients listed in section 6.1.
- Pregnancy and lactation.
- Patients less than 18 years of age.
- Moderate to severe renal impairment (creatinine clearance ≤ 50 ml/min) or moderate to severe hepatic impairment (Child-Pugh score > 6)
- Concomitant use of other myelosuppressive medicinal products.
https://www.ema.europa.eu/en/documents/product-information/litak-epar-product-information_en.pdf 03/04/2025
Other trade names: Leustatin Inyectable, Mavenclad,
Clarithromycin
Abacavir, clarithromycin
Separate administration by at least 2 hours
Abacavir/lamivudine/zidovudine [1], clarithromycin ---> SPC of [1] of EMA
Decreased zidovudine AUC. Separate administration of abacavir/lamivudine/zidovudine and clarithromycin by at least 2 hours
Abemaciclib [1], clarithromycin ---> SPC of [1] of EMA
Use of strong CYP3A4 inhibitors together with abemaciclib should be avoided. If strong CYP3A4 inhibitors need to be co-administered, the dose of abemaciclib should be reduced, followed by careful monitoring of toxicity.
Ability to drive, clarithromycin [2] ---> SPC of [2] of eMC
The potential for dizziness, vertigo, confusion and disorientation, which may occur with the medication, should be taken into account before patients drive or use machines.
Acenocoumarol, clarithromycin
The co-administration may enhance the anticoagulant effect of acenocoumarol and increase the bleeding risk
Alfentanyl, clarithromycin
Clarithromycin, CYP3A4 inhibitor, may increase the plasma concentrations of alfentanyl (small therapeutic range). Clarithromycin should be used with caution
Alfuzosin, clarithromycin
Clarithromycin, CYP3A4 inhibitor, may increase the plasma concentrations of alfuzosin (small therapeutic range). Clarithromycin should be used with caution
Aliskiren [1], clarithromycin ---> SPC of [1] of EMA
The moderate inhibition of P-glycoprotein may increase aliskiren gastrointestinal absorption and decrease its biliary excretion. Caution is recommended
Aliskiren/amlodipine [1], clarithromycin ---> SPC of [1] of EMA
Concomitant use of amlodipine with strong or moderate CYP3A4 inhibitors may give rise to significant increase in amlodipine exposure. Clinical monitoring and dose adjustment may thus be required.
Aliskiren/amlodipine/hydrochlorothiazide [1], clarithromycin ---> SPC of [1] of EMA
The moderate inhibition of P-glycoprotein may increase aliskiren gastrointestinal absorption and decrease its biliary excretion. Caution is recommended
Aliskiren/hydrochlorothiazide [1], clarithromycin ---> SPC of [1] of EMA
The moderate inhibition of P-glycoprotein may increase aliskiren gastrointestinal absorption and decrease its biliary excretion. Caution is recommended
Alprazolam [1], clarithromycin ---> SPC of [1] of eMC
Concomitant use of alprazolam and clarithromycin may increase the plasma levels of alprazolam. The co-administration should be avoided
Amantadine, clarithromycin
The co-administration of amantadine with drugs that prolong the QT interval is contraindicated
Aminophylline, clarithromycin ---> SPC of [1] of eMC
Macrolide antibiotics may decrease aminophylline clearance resulting in increased plasma theophylline concentrations and the potential for increased toxicity
Amiodarone, clarithromycin
Clarithromycin, CYP3A4 inhibitor, may increase the plasma concentrations of amiodarone (small therapeutic range). Clarithromycin should be used with caution
Amlodipine, clarithromycin ---> SPC of [amlodipine/valsartan] of EMA
Concomitant use of amlodipine with strong or moderate CYP3A4 inhibitors may give rise to significant increase in amlodipine exposure. Clinical monitoring and dose adjustment may thus be required.
Amlodipine/valsartan [1], clarithromycin ---> SPC of [1] of EMA
Concomitant use of amlodipine with strong or moderate CYP3A4 inhibitors may give rise to significant increase in amlodipine exposure. Clinical monitoring and dose adjustment may thus be required.
Amlodipine/valsartan/hydrochlorothiazide [1], clarithromycin ---> SPC of [1] of EMA
Concomitant use of amlodipine with strong or moderate CYP3A4 inhibitors may give rise to significant increase in amlodipine exposure.
Amprenavir [1], clarithromycin ---> SPC of [1] of EMA
The CYP3A4 inhibition may moderately increase the clarithromycin exposition. Use with caution
Amprenavir/ritonavir, clarithromycin ---> SPC of [amprenavir] of EMA
When ritonavir is co-administered with amprenavir an increase in clarithromycin concentrations may occur.
Antacids, clarithromycin
The co-administration may increase the plasma levels of clarithromycin
Aprepitant [1], clarithromycin ---> SPC of [1] of EMA
Concomitant administration of aprepitant with active substances that inhibit CYP3A4 activity should be approached cautiously, as the combination is expected to result several-fold in increased plasma concentrations of aprepitant
Astemizole, clarithromycin [2] ---> SPC of [2] of eMC
Clarithromycin elevated astemizole levels. This may result in QT prolongation and cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation and torsades de pointes. Concomitant use is contraindicated
Atazanavir [1], clarithromycin ---> SPC of [1] of EMA
A dose reduction of clarithromycin may result in subtherapeutic concentrations of 14-OH clarithromycin. The mechanism of the clarithromycin/atazanavir interaction is CYP3A4 inhibition.
Atazanavir/cobicistat [1], clarithromycin ---> SPC of [1] of EMA
Clarithromycin may increase atazanavir and cobicistat concentrations. Exposure to clarithromycin is expected to increase if co-administered with EVOTAZ. The mechanism of interaction is CYP3A4 inhibition by atazanavir and/or cobicistat and clarithromycin.
Atorvastatin [1], clarithromycin ---> SPC of [1] of eMC
Potent CYP3A4 inhibitors have been shown to lead to markedly increased concentrations of atorvastatin. Co-administration of potent CYP3A4 inhibitors should be avoided if possible.
Avanafil [1], clarithromycin ---> SPC of [1] of EMA
Avanafil is predominantly metabolised by CYP3A4. The strong CYP3A4 inhibitors may increase the exposition of avanafil. Co-administration of avanafil with potent CYP3A4 inhibitors is contraindicated
Axitinib [1], clarithromycin ---> SPC of [1] of EMA
Co-administration of axitinib with strong CYP3A4/5 inhibitors may increase axitinib plasma concentrations. Selection of concomitant medicinal products with no or minimal CYP3A4/5 inhibition potential is recommended.
Azithromycin, clarithromycin
The concomitant use with azithromycin may increase the risk of cardiac arrhythmia.
Azole antifungals, clarithromycin
Strong CYP3A4 inhibitors may increase the plasma concentrations of clarithromycin
Barnidipine, clarithromycin
The strong CYP3A4 inhibition may increase the plasma concentrations of barnidipine. Barnidipine should not be concomitantly prescribed with strong CYP3A4 inhibitors.
Bedaquiline [1], clarithromycin ---> SPC of [1] of EMA
Due to the potential risk of adverse reactions due to an increase in systemic exposure, prolonged co-administration of bedaquiline and moderate or strong CYP3A4 inhibitors used systemically for more than 14 consecutive days should be avoided.
Benzodiazepine primarily metabolised by CYP3A4, clarithromycin [2] ---> SPC of [2] of eMC
When midazolam was co-administered with clarithromycin tablets, midazolam AUC was increased 2.7-fold after IV administration of midazolam and 7-fold after oral administration. Co-administration of oral midazolam and clarithromycin should be avoided.
Bepridil, clarithromycin
Clarithromycin, CYP3A4 inhibitor, may increase the plasma concentrations of bepridil (small therapeutic range). Clarithromycin should be used with caution
Bexarotene [1], clarithromycin ---> SPC of [1] of EMA
On the basis of the oxidative metabolism of bexarotene by cytochrome P450 3A4 (CYP3A4), coadministration with other CYP3A4 substrates may theoretically lead to an increase in plasma bexarotene concentrations.
Bictegravir/emtricitabine/tenofovir alafenamide [1], clarithromycin ---> SPC of [1] of EMA
Interaction not studied. Coadministration of azithromycin or clarithromycin may increase bictegravir plasma concentrations.
Bosutinib [1], clarithromycin ---> SPC of [1] of EMA
The concomitant use of bosutinib with potent CYP3A inhibitors should be avoided, as an increase in bosutinib plasma levels will occur. Selection of an alternate concomitant medicine with no or minimal CYP3A enzyme inhibition potential is recommended.
Breast-feeding, clarithromycin [2] ---> SPC of [2] of eMC
Clarithromycin is excreted into human breast milk.
Budesonide [1], clarithromycin ---> SPC of [1] of EMA
Co-treatment with potent CYP3A inhibitors may cause a marked increase of the plasma concentration of budesonide and is expected to increase the risk of systemic adverse reactions. Therefore, concomitant use should be avoided
Budesonide/formoterol [1], clarithromycin ---> SPC of [1] of EMA
Potent inhibitors of CYP3A4 are likely to markedly increase plasma levels of budesonide and concomitant use should be avoided.
Budipine, clarithromycin
The co-administration of budipine with drugs known to prolong QT interval is contraindicated
Buspirone [1], clarithromycin ---> SPC of [1] of eMC
If buspirone is administered with a potent CYP3A4 inhibitor, the initial dose should be lowered and only increased gradually after medical evaluation
Cabazitaxel [1], clarithromycin ---> SPC of [1] of EMA
Repeated administration of ketoconazole, a strong CYP3A inhibitor, decreased cabazitaxel clearance. Therefore concomitant administration of strong CYP3A inhibitors should be avoided as an increase of plasma concentrations of cabazitaxel may occur
Cabozantinib [1], clarithromycin ---> SPC of [1] of EMA
Co-administration of cabozantinib with strong CYP3A4 inhibitors (increased plasma cabozantinib exposure (AUC) should be approached with caution.
Carbamazepine, clarithromycin [2] ---> SPC of [2] of eMC
Drugs that are inducers of CYP3A may induce the metabolism of clarithromycin. This may result in sub-therapeutic levels of clarithromycin leading to reduced efficacy.
Cariprazine [1], clarithromycin ---> SPC of [1] of EMA
Metabolism of cariprazine and its major active metabolites is mediated mainly by CYP3A4. The co-administration of cariprazine with strong or moderate inhibitors of CYP3A4 is contraindicated
Ceritinib [1], clarithromycin ---> SPC of [1] of EMA
Ceritinib should be used with caution in patients taking other medicinal products that may lead to QT prolongation. Monitoring of the QT interval is indicated in the event of combinations of such medicinal products
Cerivastatin, clarithromycin
Clarithromycin, a CYP3A4-inhibitor, may increase the efficacy of the cerivastatin. Should be monitored the signs and symptoms of myopathy
Cilostazol, clarithromycin
The co-administration may influence the therapeutic effect of both active principles. It may also increase the probability of experiencing side effects.
Cinitapride, clarithromycin
The strong CYP3A4 inhibition may increase the plasma concentrations of cinitapride
Cisapride [1], clarithromycin ---> SPC of [1] of eMC
Clarithromycin elevated cisapride levels. This may result in QT prolongation and cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation and torsades de pointes. Concomitant use is contraindicated
Clarithromycin [1], digoxin ---> SPC of [1] of eMC
When clarithromycin and digoxin are administered together, inhibition of Pgp by clarithromycin may lead to increased exposure to digoxin.
Clarithromycin [1], disopyramide ---> SPC of [1] of eMC
There have been post-marketed reports of torsade de points occurring with the concurrent use of clarithromycin and disopyramide. Electrocardiograms should be monitored for QTc prolongation during co-administration
Clarithromycin [1], drugs primarily metabolised by CYP3A4 ---> SPC of [1] of eMC
Co-administration of clarithromycin, CYP3A inhibitor, and a drug primarily metabolised by CYP3A may be associated with concentration elevations that could increase or prolong both therapeutic and adverse effects of the concomitant drug.
Clarithromycin [1], ergot derivatives ---> SPC of [1] of eMC
Post-marketing reports indicate that co-administration of clarithromycin with ergotamine or dihydroergotamine has been associated with acute ergot toxicity. Concomitant administration is contraindicated
Clarithromycin [1], ergotamine ---> SPC of [1] of eMC
Post-marketing reports indicate that co-administration of clarithromycin with ergotamine or dihydroergotamine has been associated with acute ergot toxicity. Concomitant administration is contraindicated
Clarithromycin [1], hypokalemia ---> SPC of [1] of eMC
Clarithromycin should not be given to patients with hypokalaemia (risk of prolongation of QT-time)
Clarithromycin [1], insulin ---> SPC of [1] of eMC
There have been rare reports of hypoglycaemia, some of which have occurred in patients on concomitant oral hypoglycaemic agents or insulin
Clarithromycin [1], itraconazol ---> SPC of [1] of eMC
Both clarithromycin and itraconazole are substrates and inhibitors of CYP3A, leading to a bidirectional drug interaction. Clarithromycin may increase the plasma levels of itraconazole, while itraconazole may increase the plasma levels of clarithromycin.
Clarithromycin [1], oral antidiabetics ---> SPC of [1] of eMC
There have been rare reports of hypoglycaemia, some of which have occurred in patients on concomitant oral hypoglycaemic agents or insulin
Clarithromycin [1], phenobarbital ---> SPC of [1] of eMC
Drugs that are inducers of CYP3A may induce the metabolism of clarithromycin. This may result in sub-therapeutic levels of clarithromycin leading to reduced efficacy.
Clarithromycin [1], phenytoin ---> SPC of [1] of eMC
There have been spontaneous or published reports of interactions of CYP3A inhibitors, including clarithromycin with drugs not thought to be metabolised by CYP3A (e.g. phenytoin and valproate)
Clarithromycin [1], pimozide ---> SPC of [1] of eMC
Clarithromycin elevated pimozide levels. This may result in QT prolongation and cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation and torsades de pointes. Concomitant use is contraindicated
Clarithromycin [1], pregnancy ---> SPC of [1] of eMC
Use during pregnancy is not advised without carefully weighing the benefits against risk.
Clarithromycin [1], QT interval prolonging drugs ---> SPC of [1] of eMC
Due to the risk for QT prolongation, clarithromycin should be used with caution when co-administered with other medicinal products associated with QT prolongation
Clarithromycin [1], quinidine ---> SPC of [1] of eMC
There have been post-marketed reports of torsade de points occurring with the concurrent use of clarithromycin and quinidine. Electrocardiograms should be monitored for QTc prolongation during co-administration
Clarithromycin [1], rifabutin ---> SPC of [1] of eMC
Concomitant administration of rifabutin and clarithromycin resulted in an increase in rifabutin, and decrease in clarithromycin serum levels together with an increased risk of uveitis.
Clarithromycin [1], rifampicin ---> SPC of [1] of eMC
Drugs that are inducers of CYP3A may induce the metabolism of clarithromycin. This may result in sub-therapeutic levels of clarithromycin leading to reduced efficacy.
Clarithromycin [1], rifapentine ---> SPC of [1] of eMC
Rifapentine, strong inducer of the cytochrome P450 metabolism system, may accelerate the metabolism of clarithromycin and thus lower the plasma levels of clarithromycin, while increasing those of 14-OH-clarithromycin
Clarithromycin [1], saquinavir ---> SPC of [1] of eMC
Both clarithromycin and saquinavir are substrates and inhibitors of CYP3A, and there is evidence of a bi-directional drug interaction. The mutual inhibition of CYP3A4 may increase the exposition to saquinavir and clarithromycin
Clarithromycin [1], sodium valproate ---> SPC of [1] of eMC
There have been spontaneous or published reports of interactions of CYP3A inhibitors, including clarithromycin with drugs not thought to be metabolised by CYP3A (e.g. phenytoin and valproate)
Clarithromycin [1], St. John's wort ---> SPC of [1] of eMC
Drugs that are inducers of CYP3A may induce the metabolism of clarithromycin. This may result in sub-therapeutic levels of clarithromycin leading to reduced efficacy.
Clarithromycin [1], strong CYP3A4 inductors ---> SPC of [1] of eMC
Drugs that are inducers of CYP3A may induce the metabolism of clarithromycin. This may result in sub-therapeutic levels of clarithromycin leading to reduced efficacy.
Clarithromycin [1], terfenadine ---> SPC of [1] of eMC
Clarithromycin elevated terfenadine levels. This may result in QT prolongation and cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation and torsades de pointes. Concomitant use is contraindicated
Clarithromycin [1], warfarin ---> SPC of [1] of eMC
There is a risk of serious haemorrhage and significant elevations in INR and prothrombin time when clarithromycin is co-administered with warfarin.
Clarithromycin [1], zidovudine ---> SPC of [1] of eMC
Simultaneous oral use of clarithromycin tablets and zidovudine may result in decreased steady-state zidovudine concentrations. This interaction can be largely avoided by staggering the doses to allow for a 4-hour interval between each medication.
Clarithromycin, cobicistat [2] ---> SPC of [2] of EMA
Concentrations of clarithromycin may be increased upon co-administration with cobicistat.
Clarithromycin, cobimetinib [2] ---> SPC of [2] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Clarithromycin, colchicine [2] ---> SPC of [2] of eMC
When clarithromycin and colchicine are administered together, inhibition of Pgp and/or CYP3A by clarithromycin may lead to increased exposure to colchicine. Patients should be monitored for clinical symptoms of colchicine toxicity
Clarithromycin, colistimethate [2] ---> SPC of [2] of EMA
Co-treatment should be undertaken with caution in patients with myasthenia gravis
Clarithromycin, crizotinib [2] ---> SPC of [2] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Clarithromycin, cyclosporine [2] ---> SPC of [2] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Clarithromycin, CYP3A4 inductors
The CYP3A4 induction may decrease the plasma concentrations of clarithromycin
Clarithromycin, CYP3A4 inhibitors
The CYP3A4 inhibition may increase the plasma concentrations of clarithromycin
Clarithromycin, dabigatran etexilate [2] ---> SPC of [2] of EMA
Dabigatran etexilate is a substrate for the efflux transporter P-gp. Close clinical surveillance (looking for signs of bleeding or anaemia) is required when dabigatran is co-administered with strong P-gp inhibitors.
Clarithromycin, dabigatran [2] ---> SPC of [2] of EMA
Dabigatran etexilate is a substrate for the efflux transporter P-gp. Close clinical surveillance (looking for signs of bleeding or anaemia) is required when dabigatran is co-administered with strong P-gp inhibitors.
Clarithromycin, dabrafenib [2] ---> SPC of [2] of EMA
Dabrafenib is a substrate for the metabolising enzymes CYP3A4. Medicines that are strong inhibitors of CYP3A4 are therefore likely to increase dabrafenib concentrations. Use caution if strong inhibitors are coadministered with dabrafenib.
Clarithromycin, daclatasvir [2] ---> SPC of [2] of EMA
Administration of daclatasvir with the antibacterial (CYP3A4 inhibition) may result in increased concentrations of daclatasvir. Caution is advised.
Clarithromycin, dalbavancin [2] ---> SPC of [2] of EMA
It is not known if dalbavancin is a substrate for hepatic uptake and efflux transporters. Co-administration with inhibitors of these transporters may increase the exposure to dalbavancin.
Clarithromycin, dapoxetine [2] ---> SPC of [2] of eMC
Concomitant treatment of dapoxetine with moderate CYP3A4 inhibitors may give rise to significantly increased exposure of dapoxetine and desmethyldapoxetine, especially in CYP2D6 poor metabolizers.
Clarithromycin, darifenacin [2] ---> SPC of [2] of EMA
When co-administered with moderate CYP3A4 inhibitors the recommended starting dose of darifenacin should be 7.5 mg daily.
Clarithromycin, darunavir/cobicistat [2] ---> SPC of [2] of EMA
Clarithromycin (CYP3A inhibition) is expected to increase darunavir and/or cobicistat plasma concentrations. Concentrations of clarithromycin may be increased upon co-administration with darunavir/cobicistat (CYP3A inhibition)
Clarithromycin, darunavir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Concentrations of clarithromycin may be increased upon co-administration with DRV/COBI. CYP3A inhibition. Caution should be exercised when clarithromycin is combined with Symtuza.
Clarithromycin, darunavir/ritonavir ---> SPC of [darunavir] of EMA
Increased clarithromycin exposition from CYP3A inhibition and possible Pgp inhibition. Caution is recommended
Clarithromycin, dasabuvir with ombitasvir/paritaprevir/ritonavir ---> SPC of [ombitasvir/paritaprevir/ritonavir] o
Co-administration of ombitasvir/paritaprevir/ritonavir with or without dasabuvir with medicinal products that are strong inhibitors of CYP3A4 is expected to increase paritaprevir plasma concentrations. The coadministration is contraindicated
Clarithromycin, dasatinib [2] ---> SPC of [2] of EMA
In vitro studies indicate that dasatinib is a CYP3A4 substrate. Concomitant use of dasatinib and medicinal products which potently inhibit CYP3A4 may increase exposure to dasatinib. Systemic administration of a potent CYP3A4 inhibitor is not recommended.
Clarithromycin, delamanid [2] ---> SPC of [2] of EMA
Treatment with delamanid should not be initiated in patients with risk factors like taking medicinal products that are known to prolong the QTc interval, unless the possible benefit is considered to outweigh the potential risks.
Clarithromycin, dextromethorphan/quinidine [2] ---> SPC of [2] of EMA
Concomitant administration of medicines that inhibit CYP3A4 can be expected to increase plasma levels of quinidine, which could increase risk relating to QTc prolongation. Strong and moderate CYP3A4 inhibitors should be avoided during treatment.
Clarithromycin, digitoxin
The CYP3A4 inhibition may increase the plasma levels of digitoxin
Clarithromycin, dihydroergotamine
Post-marketing reports indicate that co-administration of clarithromycin with ergotamine or dihydroergotamine has been associated with acute ergot toxicity. Concomitant administration is contraindicated
Clarithromycin, docetaxel [2] ---> SPC of [2] of EMA
In case of combination of docetaxel with CYP3A4 inhibitors, the occurrence of docetaxel adverse reactions may increase, as a result of reduced metabolism
Clarithromycin, dolutegravir/rilpivirine [2] ---> SPC of [2] of EMA
Increased exposure of rilpivirine is expected (inhibition of CYP3A enzymes). Where possible, alternatives such as azithromycin should be considered.
Clarithromycin, dronedarone [2] ---> SPC of [2] of EMA
Concomitant use of dronedarone with strong CYP3A4 inhibitors increases dronedarone exposure. The combination of dronedarone with strong CYP3A4 inhibitors is contraindicated
Clarithromycin, droperidol [2] ---> SPC of [2] of eMC
Medicinal products known to prolong the QTc interval should not be concomitantly administered with droperidol.
Clarithromycin, efavirenz [2] ---> SPC of [2] of EMA
The clinical significance of the changes in clarithromycin plasma levels is not known. Alternatives to clarithromycin (e.g. azithromycin) may be considered. No dose adjustment is necessary for efavirenz
Clarithromycin, efavirenz/emtricitabine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
CYP3A4 induction. Rash developed in 46% of uninfected volunteers receiving efavirenz and clarithromycin. Alternatives to clarithromycin (e.g. azithromycin) may be considered.
Clarithromycin, eletriptan [2] ---> SPC of [2] of eMC
In clinical studies with potent inhibitors of CYP3A4 significant increases in eletriptan Cmax and AUC were observed. Eletriptan should not be used together with potent CYP3A4 inhibitors
Clarithromycin, eliglustat [2] ---> SPC of [2] of EMA
Increased eliglustat exposition would be expected for strong inhibitors of CYP3A. Caution should be used with strong CYP3A inhibitors in intermediate and extensive metabolisers.
Clarithromycin, elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Patients with CrCl greater than or equal to 60 mL/min: No dose adjustment of clarithromycin is required. Patients with CrCl between 30 mL/min and 60 mL/min: The dose of clarithromycin should be reduced by 50%.
Clarithromycin, elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
Concentrations of clarithromycin and/or cobicistat may be altered with co-administration. No dose adjustment of clarithromycin is required for patients with normal renal function or mild renal impairment
Clarithromycin, emtricitabine/rilpivirine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
The combination of Odefsey with this macrolide antibiotic may cause an increase in the plasma concentrations of rilpivirine (inhibition of CYP3A) and tenofovir alafenamide (inhibition of P-gp). Co-administration is not recommended.
Clarithromycin, emtricitabine/rilpivirine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
The combination of Eviplera with clarithromycin may cause an increase in the plasma concentrations of rilpivirine (inhibition of CYP3A enzymes). Where possible, alternatives such as azithromycin should be considered.
Clarithromycin, encorafenib [2] ---> SPC of [2] of EMA
Concomitant administration of encorafenib with strong CYP3A4 inhibitors should be avoided (due to increased encorafenib exposure and potential increase in toxicity, see section 5.2).
Clarithromycin, enzalutamide [2] ---> SPC of [2] of EMA
Enzalutamide, enzymatic inductor, may increase the metabolism of clarithromycin and decrease its plasma levels and effect
Clarithromycin, enzyme inductors
The enzymatic induction may decrease the plasma concentrations of clarithromycin
Clarithromycin, eplerenone [2] ---> SPC of [2] of eMC
Strong CYP3A4 inhibitors may increase the AUC of eplerenone. The concomitant use of eplerenone with strong CYP3A4 inhibitors is contra-indicated
Clarithromycin, erlotinib [2] ---> SPC of [2] of EMA
Erlotinib is metabolised in the liver by the hepatic cytochromes in humans, primarily CYP3A4 and to a lesser extent by CYP1A2. Potent inhibitors of CYP3A4 activity decrease erlotinib metabolism and increase erlotinib plasma concentrations.
Clarithromycin, erythromycin
The co-administration may increase the plasma levels of clarithromycin and cause QT interval prolongation and cardiac arrhythmias
Clarithromycin, esomeprazole [2] ---> SPC of [2] of EMA
Esomeprazole is metabolised by CYP2C19 and CYP3A4. Concomitant administration of esomeprazole and a CYP3A4 inhibitor resulted in an increased exposure (AUC) to esomeprazole. A dose adjustment of esomeprazole is not regularly required
Clarithromycin, estrogens ---> SPC of [conjugated oestrogens/bazedoxifene] of EMA
Inhibitors of CYP3A4 may increase plasma concentrations of oestrogens and may result in adverse reactions.
Clarithromycin, etoposide
Clarithromycin, CYP3A4 inhibitor, may increase the plasma concentrations of etoposide (small therapeutic range). Clarithromycin should be used with caution
Clarithromycin, etravirine [2] ---> SPC of [2] of EMA
Clarithromycin exposure was decreased by etravirine; however, concentrations of the active metabolite, 14-OH-clarithromycin, were increased.
Clarithromycin, everolimus [2] ---> SPC of [2] of EMA
Large increase in everolimus concentration is expected. Concomitant treatment of everolimus and potent CYP3A4 inhibitors is not recommended.
Clarithromycin, ezetimibe/atorvastatin [2] ---> SPC of [2] of eMC
Potent CYP3A4 inhibitors have been shown to lead to markedly increased concentrations of atorvastatin. Coadministration of potent CYP3A4 inhibitors should be avoided if possible.
Clarithromycin, ezetimibe/simvastatine [2] ---> SPC of [2] of eMC
Potent inhibitors of cytochrome P450 3A4 with simvastatine increase the risk of myopathy and rhabdomyolysis. The co-administration of simvastatine with potent inhibitors of CYP3A4 is contraindicated
Clarithromycin, fenofibrate/simvastatin [2] ---> SPC of [2] of EMA
Potent inhibitors of cytochrome P450 3A4 increase the risk of myopathy and rhabdomyolysis by increasing the concentration of HMG-CoA reductase inhibitory activity in plasma during simvastatin therapy. Concomitant use is contraindicated
Clarithromycin, fentanyl [2] ---> SPC of [2] of EMA
The concomitant use of fentanyl with strong CYP3A4 inhibitors may result in increased fentanyl plasma concentrations, potentially causing serious adverse drug reactions including fatal respiratory depression.
Clarithromycin, fesoterodine [2] ---> SPC of [2] of EMA
The maximum dose of fesoterodine should be restricted to 4 mg when used concomitantly with potent CYP3A4 inhibitors
Clarithromycin, fidaxomicin [2] ---> SPC of [2] of EMA
Fidaxomicin is a substrate of P-gp. Co-administration of potent inhibitors of P-gp increases fidaxomicin exposure. Co-administration of potent inhibitors of P-gp is not recommended.
Clarithromycin, fingolimod [2] ---> SPC of [2] of EMA
Co-administration of fingolimod with CYP3A4 inhibitors may increase the fingolimod exposure. Caution should be exercised with substances that may inhibit CYP3A4
Clarithromycin, fluconazole
Strong CYP3A4 inhibitors may increase the plasma concentrations of clarithromycin
Clarithromycin, flunitrazepam
Substances that inhibit hepatic enzymes may enhance the effect of benzodiazepines. Interactions with strong CYP3A4 inhibitors cannot be excluded
Clarithromycin, fosamprenavir/ritonavir ---> SPC of [fosamprenavir] of EMA
The CYP3A4 inhibition may moderately increase the clarithromycin exposition. Use with caution
Clarithromycin, fosaprepitant [2] ---> SPC of [2] of EMA
Concomitant administration of fosaprepitant with active substances that inhibit CYP3A4 activity should be approached cautiously as the combination is expected to result in increased plasma concentrations of aprepitant
Clarithromycin, gefitinib [2] ---> SPC of [2] of EMA
Concomitant administration with potent inhibitors of CYP3A4 activity may increase gefitinib plasma concentrations. The increase may be clinically relevant since adverse reactions are related to dose and exposure.
Clarithromycin, glibenclamide [2] ---> SPC of [2] of EMA
Potentiation of the blood-glucose lowering
Clarithromycin, gliclazide [2] ---> SPC of [2] of eMC
Potentiation of the blood glucose lowering effect and thus, in some instances, hypoglycaemia may occur when clarithromycin is taken
Clarithromycin, glimepiride [2] ---> SPC of [2] of eMC
Potentiation of the blood-sugar-lowering effect and possible hypoglycaemia
Clarithromycin, guanfacin [2] ---> SPC of [2] of EMA
Co-administration of Intuniv with moderate and strong CYP3A4/5 inhibitors elevates plasma guanfacine concentrations and increases the risk of adverse reactions such as hypotension, bradycardia, and sedation.
Clarithromycin, hemp extract
The co-administration may increase the Cmax and THC and CBD.
Clarithromycin, hydrocortisone [2] ---> SPC of [2] of EMA
Potent CYP 3A4 inhibitors can inhibit the metabolism of hydrocortisone, and thus increase blood levels.
Clarithromycin, ibrutinib [2] ---> SPC of [2] of EMA
Ibrutinib is primarily metabolised by cytochrome P450 enzyme 3A4. Concomitant use of ibrutinib and medicinal products that strongly inhibit CYP3A4 can increase ibrutinib exposure and should be avoided.
Clarithromycin, idelalisib [2] ---> SPC of [2] of EMA
The co-administration of idelalisib with clarithromycin may increase the serum concentrations of clarithromycin. No dose adjustment of clarithromycin is required for patients with normal renal function or mild renal impairment
Clarithromycin, imatinib [2] ---> SPC of [2] of EMA
Substances that inhibit the cytochrome P450 isoenzyme CYP3A4 activity could decrease metabolism and increase imatinib concentrations. Caution should be taken when administering imatinib with inhibitors of the CYP3A4 family.
Clarithromycin, irinotecan [2] ---> SPC of [2] of EMA
Co-administration of ONIVYDE with other inhibitors of CYP3A4 may increase systemic exposure of ONIVYDE.
Clarithromycin, isavuconazole [2] ---> SPC of [2] of EMA
No dose adjustment of CRESEMBA is necessary when co-administered with strong CYP3A4/5 inhibitors, however caution is advised as adverse drug reactions may increase
Clarithromycin, isradipine [2] ---> SPC of [2] of eMC
Caution should be exercised when co-administering isradipine with strong CYP3A inhibitors
Clarithromycin, ivabradine [2] ---> SPC of [2] of EMA
The concomitant use of ivabradine and potent CYP3A4 inhibitors increases plasma concentrations of ivabradine (may be associated with the risk of excessive bradycardia). The concomitant use of ivabradine with these medicinal products is contraindicated
Clarithromycin, ivacaftor [2] ---> SPC of [2] of EMA
Ivacaftor is a sensitive CYP3A substrate. A reduction of the Kalydeco dose to 150 mg twice a week is recommended for co-administration with strong CYP3A inhibitors
Clarithromycin, ixabepilone
The strong CYP3A4 inhibition may increase the plasma concentrations of ixabepilone. The coadministration should be avoided
Clarithromycin, ketoconazole [2] ---> SPC of [2] of EMA
Concomitant therapy of ketoconazole with clarithromycin in patients with severe renal impairment is contraindicated due to an increased risk of hepatotoxicity and QT interval prolongation
Clarithromycin, lacosamide [2] ---> SPC of [2] of EMA
Caution is recommended in concomitant treatment of lacosamide with strong inhibitors of CYP3A4, which may lead to increased systemic exposure of lacosamide.
Clarithromycin, lamivudine
Separate administration by at least 2 hours
Clarithromycin, lamivudine/zidovudine [2] ---> SPC of [2] of EMA
Clarithromycin reduces AUC of zidovudine. Separate administration by at least 2 hours
Clarithromycin, laropiprant/nicotinic acid [2] ---> SPC of [2] of EMA
Clarithromycin (a potent inhibitor of CYP3A4 and P-gp) did not have a clinically meaningful effect on the pharmacokinetics of laropiprant. Laropiprant is not a substrate of human P-gp
Clarithromycin, letermovir [2] ---> SPC of [2] of EMA
Co-administration of PREVYMIS with medicinal products that are inhibitors of OATP1B1/3 transporters may result in increased letermovir plasma concentrations.
Clarithromycin, lidocaine
Clarithromycin, CYP3A4 inhibitor, may increase the plasma concentrations of lidocaine (small therapeutic range). Clarithromycin should be used with caution
Clarithromycin, lomitapide [2] ---> SPC of [2] of EMA
The strong CYP3A4 inhibition may increase lomitapide AUC. The combination of lomitapide with strong CYP3A4 inhibitors is contra-indicated
Clarithromycin, lopinavir/ritonavir [2] ---> SPC of [2] of EMA
Particular caution must be used when prescribing lopinavir/ritonavir and medicinal products known to induce QT interval prolongation
Clarithromycin, lovastatine
Strong CYP3A4 inhibitors may increase the plasma levels of lovastatin and the risk of myopathy and rhabdomyolysis. The co-administration of strong CYP3A4 inhibitors and lovastatin is contraindicated
Clarithromycin, lumacaftor/ivacaftor [2] ---> SPC of [2] of EMA
The dose of lumacaftor/ivacaftor should be reduced to one tablet daily for the first week of treatment when initiating lumacaftor/ivacaftor in patients currently taking clarithromycin. Lumacaftor/ivacaftor may decrease the exposures of clarithromycin
Clarithromycin, lurasidone [2] ---> SPC of [2] of EMA
Lurasidone and its active metabolite ID-14283 are primarily metabolised by CYP3A4. Lurasidone is contraindicated with strong CYP3A4 inhibitors
Clarithromycin, macitentan [2] ---> SPC of [2] of EMA
Caution should be exercised when macitentan (by CYP3A4 metabolized) is administered concomitantly with strong CYP3A4 inhibitors
Clarithromycin, manidipine
Manidipine should not be administered with CYP3A4 inhibitors
Clarithromycin, maraviroc [2] ---> SPC of [2] of EMA
The strong CYP3A4 inhibition by clarithromycin may increase the plasma concentrations of maraviroc. Dose adjustment of maraviroc is recommended
Clarithromycin, melagatran
The strong inhibition of P-glycoprotein may increase the plasma concentrations of mirabegron
Clarithromycin, methadone [2] ---> SPC of [2] of eMC
Methadone clearance is decreased when co-administered with drugs which inhibit CYP3A4 activity, since the metabolism of methadone is mediated by the CYP3A4 isoenzyme.
Clarithromycin, methylergometrine
The strong CYP3A4 inhibition may increase the plasma concentrations of methylergometrine. The concomitant use should be avoided
Clarithromycin, methylprednisolone
The strong CYP3A4 inhibition may increase the plasma concentrations of glucocorticoid
Clarithromycin, midazolam [2] ---> SPC of [2] of EMA
Clarithromycin increased the plasma concentrations of intravenous midazolam by up to 2.5-fold associated with an increase in terminal half-life by 1.5 to 2-fold.
Clarithromycin, mirabegron [2] ---> SPC of [2] of EMA
The strong CYP3A4 inhibition may increase the exposition of mirabegron. No dose-adjustment is needed when mirabegron is combined with inhibitors of CYP3A and/or P-gp.
Clarithromycin, naloxegol [2] ---> SPC of [2] of EMA
Concomitant use of naloxegol with CYP3A4 inhibitors increases naloxegol exposition. Concomitant use of naloxegol with strong CYP3A4 inhibitors is contraindicated
Clarithromycin, nelfinavir
Clarithromycin, CYP3A4 inhibitor, may increase the plasma concentrations of nelfinavir (small therapeutic range). Clarithromycin should be used with caution
Clarithromycin, neratinib [2] ---> SPC of [2] of EMA
Concomitant use of strong CYP3A4/Pgp inhibitors should be avoided.
Clarithromycin, nevirapine [2] ---> SPC of [2] of EMA
Clarithromycin exposure was significantly decreased, 14-OH metabolite exposure increased. Alternatives to clarithromycin, such as azithromycin should be considered.
Clarithromycin, nilotinib [2] ---> SPC of [2] of EMA
Significant prolongation of the QT interval may occur when nilotinib is inappropriately taken with strong CYP3A4 inhibitors. Prolongation of the QT interval may expose patients to the risk of fatal outcome.
Clarithromycin, niraparib [2] ---> SPC of [2] of EMA
No dose adjustment for Zejula is required when administered concomitantly with medicinal products known to inhibit (e.g. itraconazole, ritonavir, and clarithromycin) or induce CYP enzymes (e.g. rifampin, carbamazepine, and phenytoin)
Clarithromycin, olaparib [2] ---> SPC of [2] of EMA
Known strong or moderate CYP3A inhibitors are not recommended with olaparib
Clarithromycin, olmesartan medoxomil/amlodipine [2] ---> SPC of [2] of eMC
Concomitant use of amlodipine with strong or moderate CYP3A4 inhibitors may give rise to significant increase in amlodipine exposure.
Clarithromycin, ombitasvir/paritaprevir/ritonavir [2] ---> SPC of [2] of EMA
Co-administration of ombitasvir/paritaprevir/ritonavir with or without dasabuvir with medicinal products that are strong inhibitors of CYP3A4 is expected to increase paritaprevir plasma concentrations. The coadministration is contraindicated
Clarithromycin, omeprazole
Concomitant administration of omeprazole and a CYP2C19 and CYP3A4 inhibitor, increased the omeprazole exposure.
Clarithromycin, oral anticoagulants ---> SPC of [2] of eMC
There have been many reports of increases in the anti-coagulant effects of orally administered anti-coagulant agents, including warfarin in patients who are concomitantly receiving antibacterial agents.
Clarithromycin, palbociclib [2] ---> SPC of [2] of EMA
Strong inhibitors of CYP3A4 may lead to increased toxicity. Concomitant use of strong CYP3A inhibitors during treatment with palbociclib should be avoided.
Clarithromycin, panobinostat [2] ---> SPC of [2] of EMA
Based on preclinical and clinical data, panobinostat has the potential to prolong the QT interval. Concomitant use of panobinostat and other substances that are known to prolong the QT interval is not recommended.
Clarithromycin, pasireotide [2] ---> SPC of [2] of EMA
Pasireotide should be used with caution in patients who are concomitantly receiving medicinal products that prolong the QT interval
Clarithromycin, pazopanib [2] ---> SPC of [2] of EMA
Concomitant treatment with strong inhibitors of CYP3A4 should be avoided due to risk of increased exposure to pazopanib
Clarithromycin, pioglitazone/glimepiride [2] ---> SPC of [2] of EMA
Potentiation of the blood-glucose-lowering effect and, thus, in some instances hypoglycaemia may occur
Clarithromycin, piperaquine ---> SPC of [piperaquine/artenimol] of EMA
The combination of piperaquine with drugs that are known to prolong the QTc interval is contraindicated: additive effect on the QTc interval
Clarithromycin, piperaquine/artenimol [2] ---> SPC of [2] of EMA
The combination of piperaquine/dihydroartemisinin with drugs that are known to prolong the QTc interval is contraindicated: additive effect on the QTc interval
Clarithromycin, ponatinib [2] ---> SPC of [2] of EMA
Caution should be exercised and a reduction of the starting dose should be considered with concurrent use of ponatinib with strong CYP3A inhibitors (modest increases in ponatinib systemic exposure are possible)
Clarithromycin, posaconazole [2] ---> SPC of [2] of EMA
The strong inhibition of P-glycoprotein may increase the plasma concentrations of posaconazole
Clarithromycin, prasugrel [2] ---> SPC of [2] of EMA
CYP3A inhibitors are not anticipated to have a significant effect on the pharmacokinetics of the prasugrel active metabolite.
Clarithromycin, pravastatine [2] ---> SPC of [2] of eMC
Statistically significant increase in plasma concentrations of pravastatin
Clarithromycin, quetiapine [2] ---> SPC of [2] of eMC
The strong CYP3A4 inhibition may increase the plasma concentrations of quetiapine. Concomitant use of quetiapine with CYP3A4 inhibitors is contraindicated.
Clarithromycin, quinine
Clarithromycin, CYP3A4 inhibitor, may increase the plasma concentrations of quinine (small therapeutic range). Clarithromycin should be used with caution
Clarithromycin, quinolones
The co-administration may influence the therapeutic effect of both active principles. It may also increase the probability of experiencing side effects.
Clarithromycin, rabeprazole
The co-administration may increase the plasma levels of rabeprazole and of clarithromycin active metabolite
Clarithromycin, ranitidine
The co-administration may increase the plasma levels of clarithromycin
Clarithromycin, ranitidine/bismuth citrate
Increased plasma levels of clarithromycin. Concomitant use is not recommended if you suffer from certain kidney problems or you have a history of acute porphyria.
Clarithromycin, ranolazine [2] ---> SPC of [2] of EMA
Ranolazine is a substrate of cytochrome CYP3A4. Inhibitors of CYP3A4 increase plasma concentrations of ranolazine. Combining ranolazine with potent CYP3A4 inhibitors is contraindicated
Clarithromycin, regorafenib [2] ---> SPC of [2] of EMA
It is recommended to avoid concomitant use of strong inhibitors of CYP3A4 activity, as their influence on the steady-state exposure of regorafenib and its metabolites has not been studied.
Clarithromycin, repaglinide [2] ---> SPC of [2] of EMA
Clarithromycin may enhance and/or prolong the hypoglycaemic effect of repaglinide.
Clarithromycin, ribociclib [2] ---> SPC of [2] of EMA
Concomitant use of strong CYP3A4 inhibitors should be avoided and an alternative concomitant medicinal product with less potential to inhibit CYP3A4 inhibition should be considered.
Clarithromycin, rilpivirine [2] ---> SPC of [2] of EMA
The CYP3A4 inhibition by clarithromycin may increase the plasma concentrations of rilpivirine. Where possible, alternatives such as azithromycin should be considered.
Clarithromycin, rimonabant [2] ---> SPC of [2] of EMA
The strong CYP3A4 inhibition may increase the exposition of rimonabant. Caution is advised during concomitant use of rimonabant and potent CYP3A4 inhibitors
Clarithromycin, risperidone [2] ---> SPC of [2] of eMC
The CYP3A4 and P-glycoprotein inhibition may increase the plasma levels of risperidone
Clarithromycin, ritonavir [2] ---> SPC of [2] of EMA
Due to the large therapeutic window of clarithromycin no dose reduction should be necessary in patients with normal renal function.
Clarithromycin, rivaroxaban [2] ---> SPC of [2] of EMA
Active substances strongly inhibiting only one of the rivaroxaban elimination pathways, either CYP3A4 or P-gp, are expected to increase rivaroxaban plasma concentrations. This increase is not considered clinically relevant.
Clarithromycin, rupatadine [2] ---> SPC of [2] of eMC
The concomitant administration of rupatadine with inhibitors of the isozyme CYP3A4 increases the systemic exposure to rupatadine. Rupatadine should be used with caution when it is administered concomitantly with inhibitors of CYP3A4.
Clarithromycin, ruxolitinib [2] ---> SPC of [2] of EMA
The strong CYP3A4 inhibition may increase ruxolitinib exposition. When co-administering with strong CYP3A4 inhibitors the unit dose of ruxolitinib should be reduced
Clarithromycin, saquinavir/ritonavir ---> SPC of [saquinavir] of EMA
The combination is contraindicated due to the potential for life threatening cardiac arrhythmia
Clarithromycin, sertindole
The concomitant administration of CYP3A inhibitors and sertindole is contraindicated, as this may lead to significant increases in sertindole levels
Clarithromycin, sibutramine [2] ---> SPC of [2] of eMC
Caution should be exercised on concomitant administration of sibutramine with drugs which affect CYP3A4 enzyme activity (increased plasma concentrations (AUC) of sibutramine active metabolites)
Clarithromycin, sildenafil [2] ---> SPC of [2] of EMA
Population pharmacokinetic analysis of clinical trial data indicated a reduction in sildenafil clearance when co-administered with CYP3A4 inhibitors
Clarithromycin, simeprevir [2] ---> SPC of [2] of EMA
Co-administration of simeprevir with moderate or strong inhibitors of CYP3A4 may significantly increase the plasma exposure of simeprevir. Co-administration of simeprevir with these inhibitors is not recommended.
Clarithromycin, simvastatine ---> SPC of [fenofibrate/simvastatin] of EMA
The strong CYP3A4 inhibition may increase the plasma concentrations of simvastatine and the risk of myopathy and rhabdomyolysis. The co-administration is contraindicated
Clarithromycin, sirolimus [2] ---> SPC of [2] of EMA
Inhibitors of CYP3A4 may decrease the metabolism of sirolimus and increase sirolimus blood levels.
Clarithromycin, sitagliptin [2] ---> SPC of [2] of EMA
It is possible that potent CYP3A4 inhibitors (i.e. ketoconazole, itraconazole, ritonavir, clarithromycin) could alter the pharmacokinetics of sitagliptin in patients with severe renal impairment or ESRD.
Clarithromycin, sitagliptin/metformin [2] ---> SPC of [2] of EMA
It is possible that potent CYP3A4 inhibitors (i.e., ketoconazole, itraconazole, ritonavir, clarithromycin) could alter the pharmacokinetics of sitagliptin in patients with severe renal impairment or ESRD.
Clarithromycin, strong CYP3A4 inhibitors
Strong CYP3A4 inhibitors may increase the plasma concentrations of clarithromycin
Clarithromycin, sulfonylureas
There have been rare reports of hypoglycaemia, some of which have occurred in patients on concomitant oral hypoglycaemic agents or insulin
Clarithromycin, sunitinib [2] ---> SPC of [2] of EMA
Administration of sunitinib with potent CYP3A4 inhibitors may increase sunitinib concentrations. Combination with CYP3A4 inhibitors should therefore be avoided
Clarithromycin, tacrolimus [2] ---> SPC of [2] of EMA
Concomitant use of substances known to inhibit CYP3A4 may affect the metabolism of tacrolimus and thereby increase tacrolimus blood levels.
Clarithromycin, tadalafil [2] ---> SPC of [2] of EMA
Tadalafil is principally metabolised by CYP3A4. CYP3A4 inhibitors should be co-administered with caution as they would be expected to increase plasma concentrations of tadalafil
Clarithromycin, telaprevir [2] ---> SPC of [2] of EMA
The CYP3A4 inhibition increases the plasma levels of both principle actives. QT interval prolongation and Torsade de Pointes have been reported. Caution is recommended
Clarithromycin, temsirolimus [2] ---> SPC of [2] of EMA
Concomitant treatment with moderate CYP3A4 inhibitors should only be administered with caution in patients receiving 25 mg and should be avoided in patients receiving temsirolimus doses higher than 25 mg.
Clarithromycin, theophylline [2] ---> SPC of [2] of eMC
The macrolide antibiotics reduce clearance of theophylline and a reduced dosage may therefore be necessary to avoid side-effects
Clarithromycin, thiotepa [2] ---> SPC of [2] of EMA
Thiotepa appears to be metabolised via CYP2B6 and CYP3A4. Co-administration with inhibitors of CYP2B6 or CYP3A4 may increase the plasma concentrations of thiotepa and potentially decrease the concentrations of the active metabolite TEPA.
Clarithromycin, ticagrelor [2] ---> SPC of [2] of EMA
Co-administration of ticagrelor with strong CYP3A4 inhibitors is contraindicated, as co-administration may lead to a substantial increase in exposure to ticagrelor
Clarithromycin, tipranavir [2] ---> SPC of [2] of EMA
Decreased 14-OH metabolite AUC of clarithromycin and increased Cmin of tipranavir
Clarithromycin, tipranavir/ritonavir ---> SPC of [tipranavir] of EMA
CYP 3A4 inhibition by tipranavir/ritonavir and P-gp (an intestinal efflux transporter) inhibition by clarithromycin
Clarithromycin, tolterodine [2] ---> SPC of [2] of eMC
Concomitant systemic medication with potent CYP3A4 inhibitors is not recommended due to increased serum concentrations of tolterodine in poor CYP2D6 metabolisers with (subsequent) risk of overdosage
Clarithromycin, toremifene [2] ---> SPC of [2] of EMA
Theoretically the metabolism of toremifene is inhibited by drugs known to inhibit the CYP3A enzyme system which is reported to be responsible for its main metabolic pathways. Concomitant use should be carefully considered.
Clarithromycin, trabectedin [2] ---> SPC of [2] of EMA
Concomitant use of a strong CYP3A4 inhibitor with trabectedin may increase the plasma exposure of trabectedin. Concomitant use should be avoided. If the combination is needed, close monitoring of toxicities
Clarithromycin, trandolapril/verapamil [2] ---> SPC of [2] of eMC
Verapamil concentrations may be increased by clarithromycin
Clarithromycin, trastuzumab emtansine [2] ---> SPC of [2] of EMA
Concomitant use of strong CYP3A4 inhibitors with trastuzumab emtansine should be avoided due to the potential for an increase in DM1 exposure and toxicity.
Clarithromycin, triazolam [2] ---> SPC of [2] of eMC
Concomitant use of triazolam and clarithromycin may increase the plasma levels of triazolam. The co-administration should be avoided
Clarithromycin, tricyclic antidepressant
The co-administration may influence the therapeutic effect of both active principles. It may also increase the probability of experiencing side effects.
Clarithromycin, umeclidinium/vilanterol [2] ---> SPC of [2] of EMA
Concomitant administration of strong CYP3A4 inhibitors may inhibit the metabolism of, and increase the systemic exposure to, vilanterol. Care is advised
Clarithromycin, vandetanib [2] ---> SPC of [2] of EMA
In healthy subjects, no clinically significant interaction was shown between vandetanib (a single dose of 300 mg) and the potent CYP3A4 inhibitor, itraconazole
Clarithromycin, vardenafil [2] ---> SPC of [2] of EMA
The concomitant use of CYP3A4 inhibitors can be expected to increase vardenafil plasma levels. Vardenafil dose adjustment might be necessary
Clarithromycin, venetoclax [2] ---> SPC of [2] of EMA
Concomitant use of venetoclax with strong CYP3A inhibitors at initiation and during the dose-titration phase is contraindicated due to increased risk for TLS
Clarithromycin, venlafaxine [2] ---> SPC of [2] of eMC
Concomitant use of CYP3A4 inhibitors and venlafaxine may increase levels of venlafaxine and O-desmethylvenlafaxine. Therefore, caution is advised if a patient's therapy includes a CYP3A4 inhibitor and venlafaxine concomitantly.
Clarithromycin, verapamil [2] ---> SPC of [2] of eMC
Clarithromycin may increase the plasma concentrations of verapamil.
Clarithromycin, vilanterol ---> SPC of [umeclidinium/vilanterol] of EMA
Concomitant administration of strong CYP3A4 inhibitors may inhibit the metabolism of, and increase the systemic exposure to, vilanterol. Care is advised
Clarithromycin, vinorelbine [2] ---> SPC of [2] of eMC
CYP3A4 is the main enzyme involved in the metabolism of vinorelbine, and the combination with a drug that inhibits this iso-enzyme can affect the concentration of vinorelbine
Clarithromycin, vorapaxar [2] ---> SPC of [2] of EMA
Co-administration of ketoconazole with vorapaxar significantly increased the vorapaxar exposition. Concomitant use of vorapaxar with strong inhibitors of CYP3A should be avoided.
Clarithromycin, vortioxetine [2] ---> SPC of [2] of EMA
The strong CYP3A4 inhibition may increase the AUC of vortioxetine. No dosage adjustment necessary. It is caution recommended with CYP2D6 poor metabolisers
Clarithromycin, zopiclone [2] ---> SPC of [2] of eMC
Since zopiclone is metabolised by the cytochrome P450 (CYP) 3A4, plasma levels of zopiclone may be increased when co-administered with CYP3A4 inhibitors
CONTRAINDICATIONS of Clarithromycin
- Clarithromycin is contra-indicated in patients with known hypersensitivity to Clarithromycin, to any other macrolide antibiotic drug, or to any of the other ingredients
- Concomitant administration of clarithromycin and ergotamine or dihydroergotamine is contraindicated, as this may result in ergot toxicity.
- Concomitant administration of Clarithromycin and any of the following drugs is contraindicated: astemizole, cisapride, pimozide and terfenadine as this may result in QT prolongation and cardiac arrhythmias, including ventricular tachycardia, ventricular fibrillation, and torsades de pointe
- Clarithromycin should not be given to patients with history of QT prolongation or ventricular cardiac arrhythmia, including torsades de pointe
- Clarithromycin should not be used concomitantly with HMG-CoA reductase inhibitors (statins) that are extensively metabolized by CYP3A4 (lovastatin or simvastatin), due to increased risk of myopathy, including rhabdomyolysis. Treatment with these agents should be discontinued during clarithromycin treatment
- Colchicine is contraindicated in patients with renal or hepatic impairment who are taking P-glycoprotein or a strong CYP3A4 inhibitor.
- Clarithromycin should not be given to patients with hypokalaemia (risk of prolongation of QT-time).
- Clarithromycin should not be used in patients who suffer from severe hepatic failure in combination with renal impairment.
http://www.medicines.org.uk/emc/
Clebopride
Ability to drive, clebopride
Do not undertake tasks requiring mental alertness
Alcohol, clebopride
Clebopride may enhance the sedative effects
Anticholinergics, clebopride
Decreased effects of clebopride on the digestive canal
Anxiolytics, clebopride
Clebopride may enhance the sedative effects
Breast-feeding, clebopride
The lactation is not recommended
Butyrophenones, clebopride
Potentiation of phenothiazine effects on the CNS
Cimetidine, clebopride
Clebopride decreases the effects of cimetidine and digoxine
Clebopride, digoxin
Clebopride decreases the effects of cimetidine and digoxine
Clebopride, dopamine antagonists
Potentiation of dopamine antagonism effects on the CNS
Clebopride, hypnotics
Clebopride may enhance the sedative effects
Clebopride, IMAOs
The co-administration may increase the risk of adverse reactions
Clebopride, narcotics
Clebopride may enhance the sedative effects
Clebopride, opioid analgesics
Decreased effects of clebopride on the digestive canal
Clebopride, phenothiazines
Potentiation of phenothiazine effects on the CNS
Clebopride, pregnancy
Caution is recommended. In first trimester should not be administered
Clebopride, triptorelin ---> SPC of [2] of eMC
Drugs which raise prolactin levels should not be prescribed concomitantly as they reduce the level of GnRH receptors in the pituitary.
Clindamycin
Ability to drive, clindamycin
Dizziness, somnolence and headache may occur
Acenocoumarol, clindamycin
Clindamycin may enhance the anticoagulant effect of acenocoumarol
Aluminium hydroxide, clindamycin
The co-administration of aluminium-containing antacids with other drugs may decrease the absorption of these drugs. It is recommended to separate the times of administration by at least 2 hours
Amikacine, clindamycin
Concurrent administration of aminoglycoside antibiotics with clindamycin may increase the risk of nephrotoxicity
Aminoglycoside antibiotics, clindamycin
Concurrent administration of aminoglycoside antibiotics with clindamycin may increase the risk of nephrotoxicity
Atracurium, clindamycin [2] ---> SPC of [2] of eMC
Clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. It should be used with caution
Breast-feeding, clindamycin [2] ---> SPC of [2] of eMC
Clindamycin is excreted in human milk. If possible, mothers should stop breast-feeding during therapy.
Cisatracurium [1], clindamycin ---> SPC of [1] of eMC
Clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. It should be used with caution
Clindamycin [1], erythromycin ---> SPC of [1] of eMC
Antagonism has been demonstrated between clindamycin and erythromycin in vitro.
Clindamycin [1], muscle relaxants ---> SPC of [1] of eMC
Clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. It should be used with caution
Clindamycin [1], oral contraceptives ---> SPC of [1] of eMC
Clindamycin possibly reduces the contraceptive effect of oestrogen. Though the risk is small, additional contraceptive precautions are recommended during concomitant use and for 7 days after discontinuing clindamycin.
Clindamycin [1], pregnancy ---> SPC of [1] of eMC
Clindamycin crosses the placenta. Clindamycin should only be administered to pregnant women if the potential benefit is considered to outweigh the possible risk to the fetus.
Clindamycin, cotrimoxazole
Co-trimoxazole may inhibit the metabolism of clindamycin
Clindamycin, doxofylline
The co-administration may decrease the hepatic elimination of the xanthine and increase its plasma levels
Clindamycin, gentamicin [2] ---> SPC of [2] of eMC
Concurrent administration of gentamicin and other potentially ototoxic or nephrotoxic drugs should be avoided.
Clindamycin, lincomycin
Cross resistance
Clindamycin, macrolide antibiotics
Because there is a possibility of a clinically significant interaction, clindamycin should not be given in combination with macrolides
Clindamycin, mivacurium ---> SPC of [2] of eMC
As all non-depolarising neuromuscular blocking agents, the magnitude and/or duration of non-depolarising neuromuscular block may be increased and infusion requirements may be reduced as a result of interaction with antibiotics
Clindamycin, muscle relaxants (non-depolarizing) ---> SPC of [atracurium] of eMC
As with all non-depolarising neuromuscular blocking agents the magnitude and/or duration of a non-depolarising neuromuscular block may be increased as a result of interaction with antibiotics
Clindamycin, neostigmine
Clindamycin antagonizes the effects of neostigmine.
Clindamycin, pyridostigmine
Clindamycin antagonizes the effects of pyridostigmine.
Clindamycin, spiramycin
The co-administration of spiramycin and clindamycin may have an antagonistic effect. The combination should be avoided
Clindamycin, streptogramins
Because there is a possibility of a clinically significant interaction, clindamycin should not be given in combination with streptogramin antibacterial agents.
Clindamycin, succinylcholine ---> SPC of [suxamethonium] of eMC
Enhancement or prolongation of the neuromuscular effects of suxamethonium by mechanisms unrelated to plasma cholinesterase activity.
Clindamycin, suxamethonium [2] ---> SPC of [2] of eMC
Enhancement or prolongation of the neuromuscular effects of suxamethonium by mechanisms unrelated to plasma cholinesterase activity.
Clindamycin, warfarin
Clindamycin may increase the anticoagulant activity
Clindamycin, xanthines
The co-administration may decrease the hepatic elimination of the xanthine and increase its plasma levels
CONTRAINDICATIONS of Clindamycin
- Clindamycin is contra-indicated in patients with a history of hypersensitivity to clindamycin or lincomycin, or to any of the inactive ingredients in the capsules.
- Clindamycin should not be used in patients with existing diarrhoea.
http://www.medicines.org.uk/emc/
Clobazam
Ability to drive, clobazam [2] ---> SPC of [2] of eMC
Sedation, amnesia, impaired concentration and impaired muscular function may adversely affect the ability to drive or to use machines.
Alcohol, clobazam [2] ---> SPC of [2] of eMC
Alcohol can increase the bioavailability of clobazam. Enhancement of the central depressive effect may occur
Anaesthetics, clobazam [2] ---> SPC of [2] of eMC
Especially when clobazam is administered at higher doses, an enhancement of the central depressive effect may occur in cases of combination with other central depressive drugs
Antidepressants, clobazam [2] ---> SPC of [2] of eMC
Especially when clobazam is administered at higher doses, an enhancement of the central depressive effect may occur in cases of combination with other central depressive drugs
Antiepileptics, clobazam [2] ---> SPC of [2] of eMC
Especially when clobazam is administered at higher doses, an enhancement of the central depressive effect may occur in cases of combination with other central depressive drugs
Aprepitant, clobazam
Possible increase of plasma concentrations of benzodiazepines metabolised via CYP3A4. Caution is advised
Breast-feeding, clobazam [2] ---> SPC of [2] of eMC
Since benzodiazepines are found in the breast milk, benzodiazepines should not be given to breast feeding mothers.
Carbamazepine, clobazam [2] ---> SPC of [2] of eMC
Carbamazepine may cause an increase in the metabolic conversion of clobazam to the active metabolite N-desmethyl clobazam
Cimetidine, clobazam
The enzymatic inhibition may potentiate and prolong the effect of clobazam
Clobazam [1], CNS depressants ---> SPC of [1] of eMC
Especially when clobazam is administered at higher doses, an enhancement of the central depressive effect may occur in cases of combination with other central depressive drugs
Clobazam [1], dextromethorphan ---> SPC of [1] of eMC
Clobazam is a weak CYP2D6 inhibitor. Dose adjustment of drugs metabolized by CYP2D6 may be necessary.
Clobazam [1], drugs metabolised by CYP2D6 ---> SPC of [1] of eMC
Clobazam is a weak CYP2D6 inhibitor. Dose adjustment of drugs metabolized by CYP2D6 may be necessary.
Clobazam [1], drugs primarily metabolised by CYP2D6 ---> SPC of [1] of eMC
Clobazam is a weak CYP2D6 inhibitor. Dose adjustment of drugs metabolized by CYP2D6 may be necessary.
Clobazam [1], fluconazole ---> SPC of [1] of eMC
The potent CYP2C19 inhibition may increase the exposure to the active metabolite of clobazam. Dosage adjustment of clobazam may be necessary
Clobazam [1], fluvoxamine ---> SPC of [1] of eMC
The potent CYP2C19 inhibition may increase the exposure to the active metabolite of clobazam. Dosage adjustment of clobazam may be necessary
Clobazam [1], hypnotics ---> SPC of [1] of eMC
Especially when clobazam is administered at higher doses, an enhancement of the central depressive effect may occur in cases of combination with other central depressive drugs
Clobazam [1], moderate CYP2C19 inhibitors ---> SPC of [1] of eMC
The moderate CYP2C19 inhibition may increase the exposure to the active metabolite of clobazam. Dosage adjustment of clobazam may be necessary
Clobazam [1], muscle relaxants ---> SPC of [1] of eMC
The co-administration may enhance the effect of the muscle relaxant
Clobazam [1], nebivolol ---> SPC of [1] of eMC
Clobazam is a weak CYP2D6 inhibitor. Dose adjustment of drugs metabolized by CYP2D6 may be necessary.
Clobazam [1], neuroleptics ---> SPC of [1] of eMC
Especially when clobazam is administered at higher doses, an enhancement of the central depressive effect may occur in cases of combination with other central depressive drugs
Clobazam [1], nitrous oxide ---> SPC of [1] of eMC
The co-administration may enhance the effect of laughing gas
Clobazam [1], omeprazole ---> SPC of [1] of eMC
The moderate CYP2C19 inhibition may increase the exposure to the active metabolite of clobazam. Dosage adjustment of clobazam may be necessary
Clobazam [1], opioid analgesics ---> SPC of [1] of eMC
If clobazam is used concomitantly with narcotic analgesics, possible euphoria may be enhanced; this may lead to increased psychological dependence.
Clobazam [1], paroxetine ---> SPC of [1] of eMC
Clobazam is a weak CYP2D6 inhibitor. Dose adjustment of drugs metabolized by CYP2D6 may be necessary.
Clobazam [1], phenytoin ---> SPC of [1] of eMC
Addition of clobazam to established anticonvulsant medication (eg, phenytoin may cause a change in plasma levels of these drugs. Phenytoin may cause an increase in the metabolic conversion of clobazam to the active metabolite N-desmethyl clobazam.
Clobazam [1], pimozide ---> SPC of [1] of eMC
Clobazam is a weak CYP2D6 inhibitor. Dose adjustment of drugs metabolized by CYP2D6 may be necessary.
Clobazam [1], pregnancy ---> SPC of [1] of eMC
If it is prescribed to a woman of childbearing potential, she should be warned to contact her physician regarding discontinuation of product if she intends to become pregnant
Clobazam [1], sedating antihistamines ---> SPC of [1] of eMC
Especially when clobazam is administered at higher doses, an enhancement of the central depressive effect may occur in cases of combination with other central depressive drugs
Clobazam [1], sedatives ---> SPC of [1] of eMC
Especially when clobazam is administered at higher doses, an enhancement of the central depressive effect may occur in cases of combination with other central depressive drugs
Clobazam [1], stiripentol ---> SPC of [1] of eMC
Stiripentol increases plasma levels of clobazam and its active metabolite N-desmethylclobazam, through inhibition of CYP3A and CYP2C19.
Clobazam [1], strong CYP2C19 inhibitors ---> SPC of [1] of eMC
The potent CYP2C19 inhibition may increase the exposure to the active metabolite of clobazam. Dosage adjustment of clobazam may be necessary
Clobazam [1], ticlopidine ---> SPC of [1] of eMC
The potent CYP2C19 inhibition may increase the exposure to the active metabolite of clobazam. Dosage adjustment of clobazam may be necessary
Clobazam [1], valproic acid ---> SPC of [1] of eMC
The co-administration may increase the plasma levels of valproic acid.
Clobazam, enzyme inhibitors
The enzymatic inhibition may potentiate and prolong the effect of clobazam
Clobazam, erythromycin
The enzymatic inhibition may potentiate and prolong the effect of clobazam
Clobazam, retigabine [2] ---> SPC of [2] of EMA
Based on these pooled data, retigabine did not cause clinically significant effects on the plasma trough concentrations of this antiepileptic medicinal product
CONTRAINDICATIONS of Clobazam
Frisium must not be used:
- In patients with hypersensitivity to benzodiazepines or any of the excipients of Frisium.
- In patients with any history of drug or alcohol dependence (increased risk of development of dependence).
- In patients with myasthenia gravis (risk of aggravation of muscle weakness).
- In patients with severe respiratory insufficiency (risk of deterioration).
- In patients with sleep apnoea syndrome (risk of deterioration).
- In patients with severe hepatic insufficiencies (risk of precipitating encephalopathy).
- During the first trimester of pregnancy (for use during second and third trimester, see section 4.6 Pregnancy and Lactation).
- In breast-feeding women.
- Benzodiazepines must not be given to children without careful assessment of the need for their use. Frisium must not be used in children between the ages of 6 months and 3 years, other than in exceptional cases for anticonvulsant treatment where there is a compelling indication.
http://www.medicines.org.uk/emc/
Clobetasol
Breast-feeding, clobetasol [2] ---> SPC of [2] of eMC
The safe use of clobetasol propionate during lactation has not been established.
Clobetasol [1], pregnancy ---> SPC of [1] of eMC
Topical steroids should not be used extensively in pregnancy, i.e. in large amounts or for prolonged periods.
Clobetasol, itraconazol
The co-administration of clobetasol with CYP3A4 inhibitors inhibits the metabolism of corticosteroid and increases its systemic bioavailability
Clobetasol, ritonavir
The co-administration of clobetasol with CYP3A4 inhibitors inhibits the metabolism of corticosteroid and increases its systemic bioavailability
Clobetasol, strong CYP3A4 inhibitors
The co-administration of clobetasol with CYP3A4 inhibitors inhibits the metabolism of corticosteroid and increases its systemic bioavailability
CONTRAINDICATIONS of Clobetasol
- Rosacea.
- Acne vulgaris.
- Perianal and genital pruritus.
- Primary cutaneous viral infections (e.g. herpes simplex, chickenpox).
- Hypersensitivity to the preparation.
The use of clobetasol skin preparations is not indicated in the treatment of primary infected skin lesions caused by infection with fungi (e.g. candidiasis, tinea) or bacteria (e.g. impetigo); or dermatoses in children under one year of age, including dermatitis and napkin eruptions.
http://www.medicines.org.uk/emc/
Clobetasone
Breast-feeding, clobetasone [2] ---> SPC of [2] of eMC
Administration of clobetasone during lactation should only be considered if the expected benefit to the mother outweighs the risk to the infant. Clobetasone should not be applied to the breasts to avoid accidental ingestion by the infant.
Clobetasone [1], pregnancy ---> SPC of [1] of eMC
Administration of clobetasone during pregnancy should only be considered if the expected benefit to the mother outweighs the risk to the foetus. The minimum quantity should be used for the minimum duration.
Clobetasone, itraconazol ---> SPC of [1] of eMC
Co-administered drugs that can inhibit CYP3A4 have been shown to inhibit the metabolism of corticosteroids leading to increased systemic exposure.
Clobetasone, ritonavir ---> SPC of [1] of eMC
Co-administered drugs that can inhibit CYP3A4 have been shown to inhibit the metabolism of corticosteroids leading to increased systemic exposure.
Clobetasone, strong CYP3A4 inhibitors ---> SPC of [1] of eMC
Co-administered drugs that can inhibit CYP3A4 have been shown to inhibit the metabolism of corticosteroids leading to increased systemic exposure.
CONTRAINDICATIONS of Clobetasone
- Hypersensitivity to the active substance or any of the excipients
- The following conditions should not be treated with Eumovate:
- Untreated cutaneous infections.
- Rosacea
- Acne vulgaris
- Pruritus without inflammation.
http://www.medicines.org.uk/emc/
Clodronate
Aminoglycoside antibiotics, clodronate [2] ---> SPC of [2] of eMC
As aminoglycosides can cause hypocalcaemia concomitant clodronate should be administered with caution.
Antacids, clodronate [2] ---> SPC of [2] of eMC
Clodronate forms complexes with divalent metal ions, and therefore simultaneous administration with food, antacids and mineral supplements may impair absorption.
Biphosphonates, clodronate [2] ---> SPC of [2] of eMC
Concomitant use of other bisphosphonates is contraindicated.
Breast-feeding, clodronate [2] ---> SPC of [2] of eMC
A risk to the suckling child cannot be excluded. Breastfeeding should be discontinued during treatment
Clodronate [1], divalent cations ---> SPC of [1] of eMC
Clodronate forms complexes with divalent metal ions, and therefore simultaneous administration with food, antacids and mineral supplements may impair absorption.
Clodronate [1], estramustine ---> SPC of [1] of eMC
Concomitant use of estramustine phosphate with clodronate has been reported to increase the serum concentration of estramustine phosphate by 80% at the maximum.
Clodronate [1], foods ---> SPC of [1] of eMC
Clodronate should in no case be taken with milk, food or drugs containing calcium or other divalent cations because they impair the absorption of clodronate.
Clodronate [1], iron ---> SPC of [1] of eMC
Clodronate forms complexes with divalent metal ions, and therefore simultaneous administration with food, antacids and mineral supplements may impair absorption.
Clodronate [1], magnesium ---> SPC of [1] of eMC
Clodronate forms complexes with divalent metal ions, and therefore simultaneous administration with food, antacids and mineral supplements may impair absorption.
Clodronate [1], milk ---> SPC of [1] of eMC
Clodronate forms complexes with divalent metal ions, and therefore simultaneous administration with food, antacids and mineral supplements may impair absorption.
Clodronate [1], NSAID ---> SPC of [1] of eMC
Patients receiving NSAIDs in addition to sodium clodronate have developed renal dysfunction.
Clodronate [1], pregnancy ---> SPC of [1] of eMC
Clodronic acid is not recommended during pregnancy and in women of childbearing potential not using effective contraception.
Clodronate, diclofenac
Patients receiving NSAIDs in addition to sodium clodronate have developed renal dysfunction.
CONTRAINDICATIONS of Clodronate
- Clodronic acid is contraindicated in patients with severe renal failure (creatinine clearance below 10 ml/min), hypersensitivity to the active substance or to any of the excipients and in patients receiving concomitant treatment with other bisphosphonates.
http://www.medicines.org.uk/emc/
Clofarabine (Ivozall)
Ability to drive, clofarabine [2] ---> SmPC of [2] of EMA
Undesirable effects such as dizziness, light-headedness or fainting spells may occur
Aciclovir, clofarabine [2] ---> SmPC of [2] of EMA
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Aminoglycoside antibiotics, clofarabine [2] ---> SmPC of [2] of EMA
The concomitant use of medicinal products that have been associated with renal toxicity should be avoided
Amphotericin, clofarabine [2] ---> SmPC of [2] of EMA
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Antihypertensives, clofarabine [2] ---> SmPC of [2] of EMA
Patients taking medicinal products known to affect blood pressure or cardiac function should be closely monitored during treatment with clofarabine (see sections 4.4 and 4.8).
Breast-feeding, clofarabine [2] ---> SmPC of [2] of EMA
Because of the potential for serious adverse reactions in nursing infants, breastfeeding should be discontinued prior to, during and following treatment
Cardiac function, clofarabine [2] ---> SmPC of [2] of EMA
Patients taking medicinal products known to affect blood pressure or cardiac function should be closely monitored during treatment with clofarabine (see sections 4.4 and 4.8).
Cardiotonic drugs, clofarabine [2] ---> SmPC of [2] of EMA
Patients taking medicinal products known to affect cardiac function should be closely monitored during treatment with clofarabine
Clofarabine [1], cyclosporine ---> SmPC of [1] of EMA
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Clofarabine [1], cytochrome P450 ---> SmPC of [1] of EMA
Clofarabine is not detectably metabolised by the cytochrome P450 (CYP) enzyme system.
Clofarabine [1], fertility ---> SmPC of [1] of EMA
Dose related toxicities on male reproductive organs have been observed in mice, rats and dogs, and toxicities on female reproductive organs have been observed in mice (see section 5.3).
Clofarabine [1], foscarnet ---> SmPC of [1] of EMA
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Clofarabine [1], hepatotoxic drugs ---> SmPC of [1] of EMA
The concomitant use of medicinal products that have been associated with hepatic toxicity should be avoided wherever possible
Clofarabine [1], hypertensive drugs ---> SmPC of [1] of EMA
Patients taking medicinal products known to affect blood pressure or cardiac function should be closely monitored during treatment with clofarabine (see sections 4.4 and 4.8).
Clofarabine [1], men ---> SmPC of [1] of EMA
Men should use effective methods of contraception and be advised to not father a child while receiving clofarabine, and for 3 months following completion of treatment.
Clofarabine [1], methotrexate ---> SmPC of [1] of EMA
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Clofarabine [1], nephrotoxic substances ---> SmPC of [1] of EMA
The concomitant use of medicinal products that have been associated with renal toxicity should be avoided
Clofarabine [1], NSAID ---> SmPC of [1] of EMA
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Clofarabine [1], pentamidine ---> SmPC of [1] of EMA
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Clofarabine [1], platinum compounds ---> SmPC of [1] of EMA
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Clofarabine [1], pregnancy ---> SmPC of [1] of EMA
Clofarabine may cause serious birth defects when administered during pregnancy. Therefore, Ivozall should not be used during pregnancy, especially not during the first trimester, unless clearly necessary
Clofarabine [1], pregnancy ---> SmPC of [1] of EMA
If a patient becomes pregnant during treatment with clofarabine, she should be informed of the possible hazard to the foetus.
Clofarabine [1], tacrolimus ---> SmPC of [1] of EMA
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Clofarabine [1], tubular secretion ---> SmPC of [1] of EMA
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Clofarabine [1], valganciclovir ---> SmPC of [1] of EMA
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Clofarabine [1], women of childbearing potential ---> SmPC of [1] of EMA
Due to the genotoxic risk of clofarabine (see section 5.3), women of childbearing potential must use effective methods of contraception during treatment with clofarabine and for 6 months following completion of treatment.
CONTRAINDICATIONS of Clofarabine (Ivozall)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Use in patients with severe renal insufficiency or severe hepatic impairment.
- Breast-feeding
https://www.ema.europa.eu/en/documents/product-information/ivozall-epar-product-information_en.pdf 07/12/2023 (withdrawn)
Other trade names: Evoltra,
Clomipramine
Ability to drive, clomipramine [2] ---> SPC of [2] of eMC
Patients receiving clomipramine should be warned that blurred vision, drowsiness and other nervous system and psychiatric related disorders have been observed.
Adrenaline, clomipramine [2] ---> SPC of [2] of eMC
Clomipramine may potentiate the cardiovascular effects of adrenaline
Alcohol, clomipramine [2] ---> SPC of [2] of eMC
Tricyclic antidepressants may potentiate the effects of alcohol
Alpha-methyldopa, clomipramine [2] ---> SPC of [2] of eMC
Clomipramine may diminish or abolish the antihypertensive effects of alpha-methyldopa
Alprazolam, clomipramine
The co-administration may increase the plasma levels of antidepressant
Altretamine, clomipramine
Risk of severe hypotension
Amiodarone, clomipramine [2] ---> SPC of [2] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Amitriptyline, clomipramine [2] ---> SPC of [2] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Antiarrhythmics, tricyclic antidepressant
Tricyclic antidepressants should not be employed in combination with antiarrhythmic agents that are strong CYP2D6 inhibitors
Anticholinergics, clomipramine [2] ---> SPC of [2] of eMC
Tricyclic antidepressants may potentiate the effects of anticholinergic agents on the eye, central nervous system, bowel and bladder.
Antiepileptics, clomipramine
The enzymatic induction may decrease the plasma levels of the tricyclic antidepressant
Antihistamines, clomipramine [2] ---> SPC of [2] of eMC
Tricyclic antidepressants may potentiate the effects of anticholinergic agents on the eye, central nervous system, bowel and bladder.
Antimalarial agents, clomipramine [2] ---> SPC of [2] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Artemether/lumefantrine [1], clomipramine ---> SPC of [1] of eMC
Artemether/lumefantrine is contraindicated in patients who are taking any drug which is metabolised by the cytochrome enzyme CYP2D6. In vitro, lumefantrine significantly inhibits the activity of CYP2D6 at therapeutic plasma concentrations
Atazanavir, clomipramine
Atazanavir may increase the effect and toxicity of the clomipramine
Atropine, clomipramine [2] ---> SPC of [2] of eMC
Tricyclic antidepressants may potentiate the effects of anticholinergic agents on the eye, central nervous system, bowel and bladder.
Barbiturates, clomipramine [2] ---> SPC of [2] of eMC
CYP3A and CYP2C inducers may decrease clomipramine levels as co-administration of drugs known to induce cytochrome P450 enzymes, principally CYP3A4, CYP2C19 may accelerate the metabolism and decrease the efficacy of clomipramine
Benzodiazepines, clomipramine [2] ---> SPC of [2] of eMC
Tricyclic antidepressants may potentiate the effects of other central depressant substances
Betanidine, clomipramine [2] ---> SPC of [2] of eMC
Clomipramine may diminish or abolish the antihypertensive effects of betanidine
Bile-acid sequestrants, clomipramine ---> SPC of [1] of eMC
Co-administration of ion exchange resins may reduce the plasma levels of clomipramine. It is recommended to administer clomipramine at least 2 h before or 4-6 h after the administration of resins
Biperiden, clomipramine [2] ---> SPC of [2] of eMC
Tricyclic antidepressants may potentiate the effects of anticholinergic agents on the eye, central nervous system, bowel and bladder.
Breast-feeding, clomipramine [2] ---> SPC of [2] of eMC
The active substance of clomipramine passes into the breast milk in small quantities. Therefore nursing mothers should be advised to withdraw the medication or cease breast-feeding.
Carbamazepine [1], clomipramine ---> SPC of [1] of eMC
Carbamazepine may lower the plasma level of tricyclic antidepressant
Cholestyramine, clomipramine ---> SPC of [1] of eMC
Co-administration of ion exchange resins may reduce the plasma levels of clomipramine. It is recommended to administer clomipramine at least 2 h before or 4-6 h after the administration of resins
Cimetidine [1], clomipramine ---> SPC of [1] of eMC
Cimetidine, enzymatic inhibitor (CYP2D6 and CYP3A4), increases the plasma levels of antidepressant and enhances or prolongs its effects and adverse effects
Cinacalcet [1], clomipramine ---> SPC of [1] of EMA
Cinacalcet is a strong inhibitor of CYP2D6. Dose adjustments of concomitant medicinal products may be required when cinacalcet is administered with narrow therapeutic index substances that are predominantly metabolised by CYP2D6
Cisapride, clomipramine [2] ---> SPC of [2] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Citalopram, clomipramine ---> SPC of [1] of eMC
Caution is recommended when citalopram is co-administered with medicinal products that are mainly metabolised by CYP2D6, and that have a narrow therapeutic index
Class IA antiarrhythmic agents, clomipramine [2] ---> SPC of [2] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Class III antiarrhythmic agents, clomipramine [2] ---> SPC of [2] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine [1], clonidine ---> SPC of [1] of eMC
Clomipramine may diminish or abolish the antihypertensive effects of clonidine
Clomipramine [1], CNS depressants ---> SPC of [1] of eMC
Tricyclic antidepressants may potentiate the effects of other central depressant substances
Clomipramine [1], coumarin anticoagulants ---> SPC of [1] of eMC
Tricyclic antidepressants may potentiate the anti-coagulant effect of coumarin drugs by inhibiting hepatic metabolism of anticoagulants.
Clomipramine [1], CYP3A4 and CYP2C19 inductors ---> SPC of [1] of eMC
CYP3A and CYP2C inducers may decrease clomipramine levels as co-administration of drugs known to induce cytochrome P450 enzymes, principally CYP3A4, CYP2C19 may accelerate the metabolism and decrease the efficacy of clomipramine
Clomipramine [1], disopyramide ---> SPC of [1] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine [1], diuretics ---> SPC of [1] of eMC
Diuretics may lead to hypokalemia, which increases the risk of QTc prolongation and Torsade de Pointes
Clomipramine [1], ephedrine ---> SPC of [1] of eMC
Clomipramine may potentiate the cardiovascular effects of ephedrine
Clomipramine [1], fluoxetine ---> SPC of [1] of eMC
SSRIs which are inhibitors of CYP2D6, such as fluoxetine, paroxetine, or sertraline, and of others including CYP1A2 and CYP2C19 (e.g. fluvoxamine), may increase plasma concentrations of clomipramine, with corresponding adverse effects.
Clomipramine [1], fluvoxamine ---> SPC of [1] of eMC
SSRIs which are inhibitors of CYP2D6, such as fluoxetine, paroxetine, or sertraline, and of others including CYP1A2 and CYP2C19 (e.g. fluvoxamine), may increase plasma concentrations of clomipramine, with corresponding adverse effects.
Clomipramine [1], general anesthetics ---> SPC of [1] of eMC
Tricyclic antidepressants may potentiate the effects of other central depressant substances
Clomipramine [1], guanethidine ---> SPC of [1] of eMC
Clomipramine may diminish or abolish the antihypertensive effects of guanethidine
Clomipramine [1], IMAOs ---> SPC of [1] of eMC
Clomipramine must not be given in combination with or within 3 weeks before or after treatment with an MAO inhibitor
Clomipramine [1], isoprenaline ---> SPC of [1] of eMC
Clomipramine may potentiate the cardiovascular effects of isoprenaline
Clomipramine [1], lithium ---> SPC of [1] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine [1], maprotiline ---> SPC of [1] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine [1], methylphenidate ---> SPC of [1] of eMC
Methylphenidate may increase plasma concentrations of tricyclic antidepressants, whose dosage should therefore be reduced.
Clomipramine [1], moclobemide ---> SPC of [1] of eMC
The concomitant treatment of clomipramine with selective, reversible MAO-A inhibitors such as moclobemide, is also contraindicated.
Clomipramine [1], neuroleptics ---> SPC of [1] of eMC
Tricyclic antidepressants are known to lower the convulsion threshold and should therefore, be used with extreme caution in patients with concomitant use of neuroleptics or drugs with anticonvulsive properties (e.g. benzodiazepines).
Clomipramine [1], nicotine ---> SPC of [1] of eMC
Known inducers of CYP1A2 (e.g. nicotine/components in cigarette smoke), decrease plasma concentrations of tricyclic drugs
Clomipramine [1], noradrenaline ---> SPC of [1] of eMC
Clomipramine may potentiate the cardiovascular effects of noradrenaline
Clomipramine [1], pentamidine ---> SPC of [1] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine [1], phenobarbital ---> SPC of [1] of eMC
CYP3A and CYP2C inducers may decrease clomipramine levels as co-administration of drugs known to induce cytochrome P450 enzymes, principally CYP3A4, CYP2C19 may accelerate the metabolism and decrease the efficacy of clomipramine
Clomipramine [1], phenothiazines ---> SPC of [1] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine [1], phenylephrine ---> SPC of [1] of eMC
Clomipramine may potentiate the cardiovascular effects of phenylephrine
Clomipramine [1], phenytoin ---> SPC of [1] of eMC
CYP3A and CYP2C inducers may decrease clomipramine levels as co-administration of drugs known to induce cytochrome P450 enzymes, principally CYP3A4, CYP2C19 may accelerate the metabolism and decrease the efficacy of clomipramine
Clomipramine [1], pimozide ---> SPC of [1] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine [1], pregnancy ---> SPC of [1] of eMC
Clomipramine is not recommended during pregnancy and in women of childbearing potential not using contraception.
Clomipramine [1], procainamide ---> SPC of [1] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine [1], QT interval prolonging drugs ---> SPC of [1] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine [1], quinidine ---> SPC of [1] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine [1], quinine ---> SPC of [1] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine [1], reserpine ---> SPC of [1] of eMC
Clomipramine may diminish or abolish the antihypertensive effects of reserpine
Clomipramine [1], rifampicin ---> SPC of [1] of eMC
Rifampicin (CYP3A a. CYP2C inducer) may decrease clomipramine levels as co-administration of drugs known to induce cytochrome P450 enzymes, principally CYP3A4, CYP2C19 may accelerate the metabolism and decrease the efficacy of clomipramine
Clomipramine [1], serotonergic medicines ---> SPC of [1] of eMC
Serotonin Syndrome can possibly occur when clomipramine is administered with other serotonergic co-medications
Clomipramine [1], serotonin agonists ---> SPC of [1] of eMC
Serotonin Syndrome can possibly occur when clomipramine is administered with other serotonergic co-medications
Clomipramine [1], sertraline ---> SPC of [1] of eMC
SSRIs which are inhibitors of CYP2D6, such as fluoxetine, paroxetine, or sertraline, and of others including CYP1A2 and CYP2C19 (e.g. fluvoxamine), may increase plasma concentrations of clomipramine, with corresponding adverse effects.
Clomipramine [1], SNRIs ---> SPC of [1] of eMC
Serotonin Syndrome can possibly occur when clomipramine is administered with other serotonergic co-medications
Clomipramine [1], SSNRI ---> SPC of [1] of eMC
Serotonin Syndrome can possibly occur when clomipramine is administered with other serotonergic co-medications
Clomipramine [1], SSRI ---> SPC of [1] of eMC
Serotonin Syndrome can possibly occur when clomipramine is administered with other serotonergic co-medications
Clomipramine [1], strong CYP2D6 inhibitors ---> SPC of [1] of eMC
Clomipramine is metabolised by cytochrome P450 2D6 and the plasma concentration of clomipramine may therefore be increased by drugs that are either substrates and/or inhibitors of this P450 isoform.
Clomipramine [1], terfenadine ---> SPC of [1] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine [1], thyroid hormones ---> SPC of [1] of eMC
Caution is indicated during concomitant treatment of clomipramine with thyroid preparations since aggravation of unwanted cardiac effects may occur.
Clomipramine [1], tricyclic antidepressant ---> SPC of [1] of eMC
Serotonin Syndrome can possibly occur when clomipramine is administered with other serotonergic co-medications
Clomipramine, colestipol ---> SPC of [1] of eMC
Co-administration of ion exchange resins may reduce the plasma levels of clomipramine. It is recommended to administer clomipramine at least 2 h before or 4-6 h after the administration of resins
Clomipramine, cranberry juice
The co-administration may increase the plasma levels of clomipramine
Clomipramine, debrisoquine
The mutual inhibition of CYP2D6 may increase the plasma levels of both active principles
Clomipramine, disulfiram
The co-administration of clomipramine and disulfiram may increase the plasma levels of clomipramine. A dosage adjustment may be necessary
Clomipramine, duloxetine [2] ---> SPC of [2] of EMA
In rare cases, serotonin syndrome has been reported in patients using SSRIs/SNRIs concomitantly with serotonergic agents. Caution is advisable if duloxetine is used concomitantly with serotonergic agents
Clomipramine, enzyme inductors
The enzymatic induction may decrease the plasma concentrations of the clomipramine.
Clomipramine, ergonovine
Increased risk of serotonin syndrome.
Clomipramine, escitalopram [2] ---> SPC of [2] of eMC
Caution should be observed when co-administering escitalopram (CYP2D6 inhibitor) and drugs that are mainly metabolised by CYP2D6 and that have a narrow therapeutic index. Dosage adjustment may be warranted.
Clomipramine, esomeprazole [2] ---> SPC of [2] of EMA
Esomeprazole inhibits CYP2C19, the major esomeprazole metabolising enzyme. Thus, when esomeprazole is combined with medicinal products metabolised by CYP2C19, the plasma concentrations of these medicinal products may be increased
Clomipramine, estrogens ---> SPC of [estramustine] of eMC
Oestrogens have been reported to increase both therapeutic activity and toxicity of tricyclic antidepressants, probably via inhibition of their metabolism.
Clomipramine, grapefruit ---> SPC of [1] of eMC
Concomitant administration of clomipramine with grapefruit, or grapefruit juice may increase the plasma concentrations of clomipramine.
Clomipramine, grapefruit juice ---> SPC of [1] of eMC
Concomitant administration of clomipramine with grapefruit, or grapefruit juice may increase the plasma concentrations of clomipramine.
Clomipramine, interferon
Caution should be used when administering interferon with medicines mainly metabolised by hepatic cytochrome P450 and have a narrow therapeutic window
Clomipramine, isocarboxazid ---> SPC of [2] of eMC
Isocarboxazid should not be administered together with clomipramine. Hypotensive and other adverse reactions are likely to be increased.
Clomipramine, levomepromazine [2] ---> SPC of [2] of eMC
Co-administration of levomepromazine and drugs primarily metabolised by the CYP2D6 may result in increased plasma concentrations of the drugs that could increase or prolong both therapeutic or adverse effects of those drugs.
Clomipramine, lisdexamfetamine
Increased risk of serotonin syndrome.
Clomipramine, methylthioninium chloride
Methylthioninium chloride should be avoided in patients receiving medicinal products that enhance serotonergic transmission
Clomipramine, methylthioninium [2] ---> SPC of [2] of EMA
Methylthioninium should be avoided with medicinal products that enhance serotonergic transmission
Clomipramine, modafinil
The co-administration of clomipramine and modafinil may increase the plasma levels of clomipramine. A dosage adjustment may be necessary
Clomipramine, morphine
Increase of bioavailability and analgetic effect of morphine
Clomipramine, nicomorphine
Increase of bioavailability and analgetic effect of morphine
Clomipramine, non-selective monoamine reuptake inhibitor
The co-administration may have an additive effect on the serotoninergic system. The co-administration should be avoided
Clomipramine, norephedrine ---> SPC of [1] of eMC
Clomipramine may potentiate the cardiovascular effects of phenylpropanolamine
Clomipramine, paroxetine [2] ---> SPC of [2] of eMC
Paroxetine inhibits the hepatic cytochrome P450 enzyme CYP2D6. Inhibition of CYP2D6 may lead to increased plasma concentrations of co-administered drugs metabolised by this enzyme.
Clomipramine, phenelzine ---> SPC of [1] of eMC
Phenelzine should not be administered at the same time as, or within 3 weeks of, treatment with clomipramine
Clomipramine, phenylpropanolamine ---> SPC of [1] of eMC
Clomipramine may potentiate the cardiovascular effects of phenylpropanolamine
Clomipramine, pitolisant [2] ---> SPC of [2] of EMA
Tri or tetracyclic antidepressants may impair the efficacy of pitolisant because they display histamine H1-receptor antagonist activity and possibly cancel the effect of endogenous histamine released in brain by the treatment.
Clomipramine, propafenone
Tricyclic antidepressants should not be employed in combination with antiarrhythmic agents that are strong CYP2D6 inhibitors
Clomipramine, riluzole [2] ---> SPC of [2] of EMA
In vitro studies suggest that CYP1A2 is the principal isozyme involved in the initial oxidative metabolism of riluzole. Inhibitors of CYP1A2 could potentially decrease the rate of riluzole elimination
Clomipramine, saquinavir/ritonavir ---> SPC of [saquinavir] of EMA
The combination is contraindicated due to the potential for life threatening cardiac arrhythmia
Clomipramine, sodium valproate ---> SPC of [1] of eMC
Concomitant administration of valproate with clomipramine may cause inhibition of CYP2C and/or UGT enzymes resulting in increased serum levels of clomipramine and desmethylclomipramine.
Clomipramine, sotalol ---> SPC of [1] of eMC
The risk of QTc prolongation and Torsade de Pointes is likely to be increased if clomipramine is co-administered with other drugs that can cause QTc prolongation. Therefore concomitant use is not recommended
Clomipramine, sparteine
The mutual inhibition of CYP2D6 may increase the plasma levels of both active principles
Clomipramine, St. John's wort
Concomitant administration of clomipramine with St. John's wort during the treatment may decrease the plasma concentrations of clomipramine.
Clomipramine, stiripentol [2] ---> SPC of [2] of EMA
Stiripentol is an inhibitor of the enzymes CYP2D6 and may markedly increase the plasma concentrations of substances metabolised by these enzymes and increase the risk of adverse reactions
Clomipramine, sympathomimetics
Clomipramine may potentiate the cardiovascular effects of the sympathomimetic agent
Clomipramine, tramadol
Tramadol increases the risk of serotonin syndrome and seizures.
Clomipramine, tranylcypromine
Tranylcypromine should not be used concomitantly with drugs with marked serotonin-reuptake inhibition. Risk of serotonin syndrome with symptoms like hypertension, irritability, hyperthermia with possible fatal outcome
Clomipramine, yohimbine
Increased plasma levels of yohimbine
CNS depressants, tricyclic antidepressant ---> SPC of [clomipramine] of eMC
Tricyclic antidepressants may also potentiate the CNS depressant effects of central depressant drugs
Methylphenidate, tricyclic antidepressant ---> SPC of [clomipramine] of eMC
Methylphenidate may increase plasma concentrations of tricyclic antidepressants, whose dosage should therefore be reduced.
Neuroleptics, tricyclic antidepressant ---> SPC of [clomipramine] of eMC
Tricyclic antidepressants are known to lower the convulsion threshold and should therefore, be used with extreme caution in patients with concomitant use of neuroleptics or drugs with anticonvulsive properties (e.g. benzodiazepines).
Nicotine, tricyclic antidepressant ---> SPC of [clomipramine] of eMC
Known inducers of CYP1A2 (e.g. nicotine/components in cigarette smoke), decrease plasma concentrations of tricyclic drugs
Quinidine, tricyclic antidepressant ---> SPC of [clomipramine] of eMC
Tricyclic antidepressants should not be employed in combination with antiarrhythmic agents of the quinidine type.
Thyroid hormones, tricyclic antidepressant
Caution is indicated during concomitant treatment with thyroid preparations and tricyclic antidepressant, since aggravation of unwanted cardiac effects may occur.
CONTRAINDICATIONS of Clomipramine
- Known hypersensitivity to clomipramine or any of the excipients, or cross-sensitivity to tricyclic antidepressants of the dibenzazepine group.
- Recent myocardial infarction.
- Any degree of heart block or other cardiac arrhythmias.
- Mania,
- severe liver disease,
- narrow angle glaucoma.
- Retention of urine.
- Anafranil must not be given in combination with or within 3 weeks before or after treatment with an MAO inhibitor
- The concomitant treatment with selective, reversible MAO-A inhibitors such as moclobemide, is also contraindicated.
http://www.medicines.org.uk/emc/
Clonazepam
Ability to drive, clonazepam [2] ---> SPC of [2] of eMC
Even when adequately controlled on clonazepam, it should be remembered that any increase in dosage or alteration in timings of dosage may modify patients' reactions, depending on individual susceptibility.
ACE inhibitors, clonazepam
Enhanced hypotensive effect
AIIRA, clonazepam
Enhanced hypotensive effect
Alcohol, clonazepam [2] ---> SPC of [2] of eMC
In combination with clonazepam, alcohol may modify the effects of the drug, compromise the success of therapy or give rise to unpredictable side-effects
Alfa-adrenergic receptor blockers, clonazepam
The co-administration may enhance the hypotensive and sedative effects
Amprenavir, clonazepam
Increased risk of prolonged sedation and respiratory depression
Antiepileptics, clonazepam [2] ---> SPC of [2] of eMC
When clonazepam is used in conjunction with other antiepileptic drugs, side-effects such as sedation and apathy, and toxicity may be more evident
Aprepitant, clonazepam
Possible increase of plasma concentrations of benzodiazepines metabolised via CYP3A4. Caution is advised
Barbiturates, clonazepam
The enzymatic induction may decrease the plasma levels of clonazepam
Betablockers, clonazepam
Enhanced hypotensive effect
Breast-feeding, clonazepam [2] ---> SPC of [2] of eMC
Mothers undergoing treatment with this drug should not breastfeed. If there is a compelling indication for clonazepam, breastfeeding should be discontinued.
Calcium antagonists, clonazepam
Enhanced hypotensive effect
Carbamazepine [1], clonazepam ---> SPC of [1] of eMC
Carbamazepine may decrease the plasma levels of clonazepam. Clonazepam may decrease the levels of carbamazepine
Cimetidine, clonazepam
Known inhibitors of hepatic enzymes, e. g. cimetidine, have been shown to reduce the clearance of benzodiazepines and may potentiate their action
Clonazepam [1], CNS depressants ---> SPC of [1] of eMC
Enhanced effects on sedation, respiration and haemodynamics may occur when clonazepam is co-administered with any centrally acting depressants
Clonazepam [1], phenobarbital ---> SPC of [1] of eMC
When clonazepam is used in conjunction with other antiepileptic drugs, side-effects such as sedation and apathy, and toxicity may be more evident, particularly with phenobarbital
Clonazepam [1], pregnancy ---> SPC of [1] of eMC
During pregnancy, clonazepam may be administered only if there is a compelling indication.
Clonazepam [1], sodium valproate ---> SPC of [1] of eMC
The enzymatic induction may decrease the plasma levels of clonazepam. The combination of clonazepam and sodium valproate has, rarely, been associated with the development of absence status epilepticus.
Clonazepam [1], valproic acid ---> SPC of [1] of eMC
The enzymatic induction may decrease the plasma levels of clonazepam. The combination of clonazepam and sodium valproate has, rarely, been associated with the development of absence status epilepticus.
Clonazepam, CYP3A4 inhibitors
The CYP3A4 inhibition may increase the plasma concentrations of clonazepam
Clonazepam, darunavir/cobicistat [2] ---> SPC of [2] of EMA
Based on theoretical considerations REZOLSTA is expected to increase concentrations of clonazepam (inhibition of CYP3A). Clinical monitoring is recommended when co-administering REZOLSTA with clonazepam.
Clonazepam, disulfiram
The enzymatic inhibition may increase the plasma levels of clonazepam
Clonazepam, diuretics
Enhanced hypotensive effect
Clonazepam, enzalutamide [2] ---> SPC of [2] of EMA
Enzalutamide, enzymatic inductor, may increase the metabolism of clonazepam and decrease its plasma levels and effect
Clonazepam, enzyme inductors ---> SPC of [1] of eMC
Known inducers of hepatic enzymes may increase the clearance of benzodiazepines.
Clonazepam, enzyme inhibitors
Known inhibitors of hepatic enzymes, have been shown to reduce the clearance of benzodiazepines and may potentiate their action
Clonazepam, hydantoins ---> SPC of [1] of eMC
When clonazepam is used in conjunction with other antiepileptic drugs, side-effects such as sedation and apathy, and toxicity may be more evident, particularly with hydantoins
Clonazepam, hydralazine
Enhanced hypotensive effect
Clonazepam, organic nitrates
Enhanced hypotensive effect
Clonazepam, phenytoin
Clonazepam may increase or decrease the steady-state plasma levels of phenytoin. Phenytoin may increase the clearance of clonazepam
Clonazepam, primidone
Clonazepam may increase or decrease the steady-state plasma levels of primidone
Clonazepam, retigabine [2] ---> SPC of [2] of EMA
Based on these pooled data, retigabine did not cause clinically significant effects on the plasma trough concentrations of this antiepileptic medicinal product
Clonazepam, rifampicin ---> SPC of [1] of eMC
Known inducers of hepatic enzymes, e.g. rifampicin, may increase the clearance of benzodiazepines.
Clonazepam, strong CYP3A4 inductors
The strong CYP3A4 induction enhances the metabolism of clonazepam
Clonazepam, strong CYP3A4 inhibitors
The strong CYP3A4 inhibition may increase the plasma concentrations of clonazepam
CONTRAINDICATIONS of Clonazepam
- Patients with known sensitivity to benzodiazepines; or any of the drug's excipients;
- acute pulmonary insufficiency;
- severe respiratory insufficiency,
- sleep apnoea syndrome,
- myasthenia gravis,
- severe hepatic insufficiency.
- Rivotril must not be used in patients in a coma, or in patients known to be abusing pharmaceuticals, drugs or alcohol.
http://www.medicines.org.uk/emc/
Clonidine
Ability to drive, clonidine [2] ---> SPC of [2] of eMC
Patients should be advised that they may experience undesirable effects such as dizziness, sedation and accommodation disorder during treatment
ACE inhibitors, clonidine [2] ---> SPC of [2] of eMC
Concurrent administration of antihypertensive agents may lead to an increased hypotensive effect.
Alcohol, clonidine [2] ---> SPC of [2] of eMC
The effect of alcohol could theoretically be potentiated by clonidine.
Alfa2-adrenergic receptor blockers, clonidine [2] ---> SPC of [2] of eMC
Substances with alpha2-receptor blocking properties may abolish the alpha2-receptor mediated effects of clonidine in a dose-dependent manner.
Amisulpride [1], clonidine ---> SPC of [1] of eMC
Caution is advised when coadministering amisulpride with CNS depressants
Amitriptyline, clonidine
Risk of a rebound hypertension
Antihypertensives, clonidine [2] ---> SPC of [2] of eMC
Concurrent administration of antihypertensive agents may lead to an increased hypotensive effect.
Atenolol, clonidine
Bradycardia, delayed conduction of cardiac stimulus. Atenolol may exacerbate the rebound hypertension after withdrawing clonidine
Atenolol/chlortalidone, clonidine
Enhanced antihypertensive effect and bradycardia
Atenolol/nifedipine, clonidine
Bradycardia, delayed conduction of cardiac stimulus
Betablockers, clonidine [2] ---> SPC of [2] of eMC
Concomitant use of clonidine with beta-blockers can cause bradycardia or dysrhythmia (AV-block) in isolated cases. It cannot be ruled out that concomitant administration will cause or potentiate peripheral vascular disorders.
Bisoprolol [1], clonidine ---> SPC of [1] of eMC
Concomitant use of centrally-acting antihypertensive and bisoprolol may worsen heart failure by a decrease in the central sympathetic tonus (reduction of heart rate and cardiac output, vasodilation)
Breast-feeding, clonidine [2] ---> SPC of [2] of eMC
Clonidine is excreted in human milk. However, there is insufficient information on the effect on newborns. The use of clonidine is therefore not recommended during breast feeding.
Bromperidol, clonidine
Decreased hypotensive effect
Buprenorphine [1], clonidine ---> SPC of [1] of eMC
This combination increases central nervous system depression
Buprenorphine/naloxone [1], clonidine ---> SPC of [1] of EMA
The combination increases the central nervous system depression
Butyrophenones, clonidine
Decreased hypotensive effect
Calcium antagonists, clonidine [2] ---> SPC of [2] of eMC
Concurrent administration of antihypertensive agents may lead to an increased hypotensive effect.
Carvedilol [1], clonidine ---> SPC of [1] of eMC
In case of withdrawal of both carvedilol and clonidine, carvedilol should be withdrawn several days before the stepwise withdrawal of clonidine.
Celiprolol, clonidine
The co-administration may increase the hypotensive effect and the negative chronotropic and dromotropic effect
Chlorpromazine [1], clonidine ---> SPC of [1] of eMC
The co-administration may increase the CNS depressant effect
Chlorprothixene, clonidine
Decreased hypotensive effect
Clomipramine [1], clonidine ---> SPC of [1] of eMC
Clomipramine may diminish or abolish the antihypertensive effects of clonidine
Clonidine [1], digital glycosides ---> SPC of [1] of eMC
Concomitant use of clonidine with cardiac glycosides can cause bradycardia or dysrhythmia (AV-block) in isolated cases.
Clonidine [1], diuretics ---> SPC of [1] of eMC
Concurrent administration of antihypertensive agents may lead to an increased hypotensive effect.
Clonidine [1], hypnotics ---> SPC of [1] of eMC
The effect of hypnotics could theoretically be potentiated by clonidine.
Clonidine [1], neuroleptics ---> SPC of [1] of eMC
Orthostatic hypotension may be provoked or aggravated by concomitant administration of clonidine and neuroleptics with alpha-receptor blocking properties.
Clonidine [1], phentolamine ---> SPC of [1] of eMC
Substances with alpha2-receptor blocking properties may abolish the alpha2-receptor mediated effects of clonidine in a dose-dependent manner.
Clonidine [1], pregnancy ---> SPC of [1] of eMC
As with all medicines, clonidine should not be used in pregnancy, especially the first trimester, unless the expected benefit is thought to outweigh any possible risk to the foetus.
Clonidine [1], sedatives ---> SPC of [1] of eMC
The effect of tranquillisers could theoretically be potentiated by clonidine.
Clonidine [1], tolazoline ---> SPC of [1] of eMC
Substances with alpha2-receptor blocking properties may abolish the alpha2-receptor mediated effects of clonidine in a dose-dependent manner.
Clonidine [1], tricyclic antidepressant ---> SPC of [1] of eMC
Orthostatic hypotension may be provoked or aggravated by concomitant administration of clonidine and tricyclic antidepressants
Clonidine [1], vasodilators ---> SPC of [1] of eMC
Concurrent administration of antihypertensive agents may lead to an increased hypotensive effect.
Clonidine, CNS depressants
Clonidine may potentiate the effects of CNS depressants
Clonidine, crizotinib [2] ---> SPC of [2] of EMA
Bradycardia has been reported during clinical studies; therefore, use crizotinib with caution due to the risk of excessive bradycardia when used in combination with other bradycardic agents
Clonidine, dexchlorpheniramine
The combination of dexchlorpheniramine with other CNS depressants may enhance the CNS depressant effect
Clonidine, dipotassium clorazepate
The combination of CNS depressors may mutually potentiate the depressor effect on the CNS
Clonidine, doxepin
The co-administration may weaken the hypotensive effect. Risk of rebound hypertension
Clonidine, doxylamine
Enhanced sedation
Clonidine, esmolol
Concomitant use of beta-blockers with moxonidine or alfa2-antagonists (e. g. clonidine) increases the risk of "rebound" hypertension
Clonidine, flupentixol ---> SPC of [2] of eMC
Antipsychotics may reverse the antihypertensive effects
Clonidine, fluphenazine [2] ---> SPC of [2] of eMC
Fluphenazine reverses the blood-pressure lowering effects of adrenergic-blocking agents such as guanethidine and clonidine.
Clonidine, glibenclamide [2] ---> SPC of [2] of EMA
Under the influence of sympatholytic medicinal products, the signs of adrenergic counter-regulation to hypoglycaemia may be reduced or absent.
Clonidine, glimepiride [2] ---> SPC of [2] of eMC
The combination may lead to either potentiation or weakening of the blood glucose lowering effect. Under the influence of sympatholytic medicinal products the signs of adrenergic counter-regulation to hypoglycaemia may be reduced or absent.
Clonidine, gliquidone
Clonidine may increase or decrease the hypoglycemic effect of gliquidone
Clonidine, haloperidol
High intravenous doses of clonidine enhance the arrhytmogenic potential (QT-prolongation, ventricular fibrillation) of high intravenous doses of haloperidol
Clonidine, histamine
Clonidine must not be used during treatment with histamine dihydrochloride
Clonidine, histamine dihydrochloride [2] ---> SPC of [2] of EMA
H2 receptor antagonists with imidazole structures similar to histamine must not be used during treatment with histamine dihydrochloride
Clonidine, hydroquinidine
Concomitant use of hydroquinidine and bradycardiac agents increases the risk of heart rhythm disorders (torsades de pointes)
Clonidine, hypertensive drugs
The co-administration of clonidine and hypertensive drugs may decrease the hypotensive effect of clonidine
Clonidine, imipramine [2] ---> SPC of [2] of eMC
Imipramine may diminish or abolish the antihypertensive effects of adrenergic blocker
Clonidine, insulin ---> SPC of [apraclonidine] of eMC
Systemic clonidine may inhibit the production of catecholamine in response to insulin-induced hypoglycaemia and mask the signs and symptoms of hypoglycaemia.
Clonidine, insulin glargin [2] ---> SPC of [2] of EMA
Clonidine may either potentiate or weaken the blood-glucose-lowering effect of insulin. Under the influence of clonidin, the signs of adrenergic counter-regulation may be reduced or absent.
Clonidine, insulin glargine/lixisenatide [2] ---> SPC of [2] of EMA
This combination may either potentiate or weaken the blood-glucose-lowering effect of insulin.
Clonidine, insulin glulisin [2] ---> SPC of [2] of EMA
The signs of adrenergic counter-regulation may be reduced or absent.
Clonidine, latanoprost/timolol [2] ---> SPC of [2] of eMC
The hypertensive reaction to sudden withdrawal of clonidine can be potentiated when taking beta-blockers.
Clonidine, levodopa
The co-administration of levodopa and clonidine causes a reduction of levodopa effect by lowering the dopamine release
Clonidine, levodopa/carbidopa
The co-administration of levodopa and clonidine causes a reduction of levodopa effect by lowering the dopamine release
Clonidine, levomepromazine
The co-administration of levomepromazine with other central nervous depressants will cause a greater depressant effect on central nervous system
Clonidine, levomethadone
Possible enhancement of levomethadone effect
Clonidine, lofepramine ---> SPC of [2] of eMC
The effect of antihypertensive agents of clonidine type may be weakened.
Clonidine, maprotiline
Maprotiline may decrease or abolish the antihypertensive effects of the antiadrenergic agents
Clonidine, mequitazine
Central nervous system depressants may enhance the sedative effects of mequitazine
Clonidine, metformin
Increased or decreased hypoglycemic effect of metformin
Clonidine, methylphenidate [2] ---> SPC of [2] of eMC
Serious adverse events, incl. sudden death, have been reported in combination with clonidine. The safety of using methylphenidate in combination with clonidine or other central acting alfa-2 agonists has not been systematically evaluated
Clonidine, metoclopramide
The co-administration may mutually enhance the sedative effects of the CNS. The combination requires caution
Clonidine, metoprolol [2] ---> SPC of [2] of eMC
Beta-blockers used in conjunction with clonidine increase the risk of "rebound hypertension".
Clonidine, nadolol [2] ---> SPC of [2] of eMC
If nadolol and clonidine are given concurrently, clonidine should not be discontinued until several days after nadolol withdrawal.
Clonidine, nalbuphine
Other central nervous system depressant drugs may increase the risk of respiratory depression, which can be life-threatening in the case of an overdose
Clonidine, naloxone
Severe hypertension has been reported on administration of naloxone in cases of coma due to a clonidine overdose.
Clonidine, nebivolol [2] ---> SPC of [2] of eMC
Concomitant use of nebivolol with centrally acting antihypertensive drugs may worsen heart failure by a decrease in the central sympathetic tonus (reduction of heart rate and cardiac output, vasodilation)
Clonidine, negative dromotropic
The co-administration may cause or potentiate bradycardic rhythm disorders
Clonidine, non-selective betablockers ---> SPC of [oxprenolol] of eMC
When clonidine is used in conjunction with non-selective beta-blockers, treatment with clonidine should be continued for some time after beta-blocker has been discontinued to reduce the danger of rebound hypertension.
Clonidine, nortriptyline [2] ---> SPC of [2] of eMC
Nortriptyline may decrease the antihypertensive effect of clonidine. Risk of hypertension rebound
Clonidine, NSAID
The co-administration of clonidine and drugs that retain water or sodium may decrease the hypotensive effect of clonidine
Clonidine, oxprenolol [2] ---> SPC of [2] of eMC
When clonidine is used in conjunction with non-selective beta-blockers, treatment with clonidine should be continued for some time after beta-blocker has been discontinued to reduce the danger of rebound hypertension.
Clonidine, penbutolol
The combination may enhance the hypotensive effect and decrease the central sympathetic tonus (reduction of heart rate and cardiac output, vasodilation)
Clonidine, perphenazine
Possible weakening of the hypotensive effect
Clonidine, phenothiazines ---> SPC of [fluphenazine] of eMC
The action of clonidine may be opposed by the phenothiazine
Clonidine, pindolol
Concomitant use of pindolol and clonidin may cause strong decrease in the heart rate or delay in conduction. Risk of hypertension rebound
Clonidine, pindolol/clopamide
Concomitant use of pindolol/clopamide and clonidin may further decrease the heart frequency. Risk of hypertension rebound
Clonidine, pioglitazone/glimepiride [2] ---> SPC of [2] of EMA
Clonidin may lead to either potentiation or weakening of the blood glucose lowering effect.
Clonidine, pipotiazine [2] ---> SPC of [2] of eMC
The action of clonidine may be opposed by phenothiazine neuroleptics
Clonidine, propranolol
The co-administration may enhance the hypotensive effect (hypertensive reaction to sudden withdrawal!) and cause or potentiate bradycardic rhythm disorders
Clonidine, somatorelin [2] ---> SPC of [2] of eMC
Concomitant use of somatorelin and substances influencing the release of growth hormone should be avoided.
Clonidine, sotalol
The co-administration of sotalol and clonidine may increase the negative chronotropic and dromotropic effects of sotalol
Clonidine, sulfonylureas
May lead to either potentiation or weakening of the blood glucose lowering effect.
Clonidine, sulpiride [2] ---> SPC of [2] of eMC
The combination of sulpiride with bradycardia-inducing medications is not recommended
Clonidine, talinolol
Strong decrease in the heart rate or delay in conduction
Clonidine, terazosine ---> SPC of [2] of eMC
Terazosin may reduce the anti-hypertensive effect of intravenously administered clonidine.
Clonidine, tetrazepam
The co-administration may mutually enhance the CNS depressant effects
Clonidine, thioxanthenes
Decreased hypotensive effect
Clonidine, tiapride
Tiapride should not be combined with drugs that prolong the QT interval. These drugs (with the exception of anti-infectious) should be discontinued, if possible, if they induce torsades de pointes
Clonidine, timolol [2] ---> SPC of [2] of eMC
Beta blockers increase the risk of "rebound hypertension" when taken with clonidine.
Clonidine, tizanidine
The co-administration of tizanidine with other alfa2-adrenergic agonists (e. g. clonidine) should be avoided due to additive hypotensive effects
Clonidine, trazodone [2] ---> SPC of [2] of eMC
Studies in laboratory animals suggest that trazodone may inhibit most of the acute actions of clonidine.
Clonidine, triamterene ---> SPC of [2] of eMC
The co-administration of triamterene and clonidine may enhance the hypotensive effect
Clonidine, trifluoperazine [2] ---> SPC of [2] of eMC
The anti-hypertensive action of guanethidine and related compounds may be reduced by phenothiazine derivatives
Clonidine, trimipramine
Trimipramine may decrease the antihypertensive effect of clonidine.
Clonidine, yohimbine
The co-administration may cause mutual abolition of effects
Clonidine, ziconotide [2] ---> SPC of [2] of EMA
An increased incidence of somnolence has been observed. The simultaneous use is discouraged.
Clonidine, zuclopenthixol [2] ---> SPC of [2] of eMC
Antipsychotics may reverse the antihypertensive effects of guanethidine and similar adrenergic-blocking agents.
CONTRAINDICATIONS of Clonidine
- Dixarit should not be used in patients with severe bradyarrhythmia resulting from either sick-sinus syndrome or AV block of 2nd or 3rd degree, or in patients with known hypersensitivity to the active ingredient, clonidine, or other components of the product.
- In case of rare hereditary conditions that may be incompatible with an excipient of the product the use of the product is contraindicated.
http://www.medicines.org.uk/emc/
Cloperastine
Ability to drive, cloperastine
Somnolence may occur
Alcohol, cloperastine
Cloperastine may enhance the effects of alcohol
Anticholinergics, cloperastine
Antihistaminics enhance the anticholinergic effect
Barbiturates, cloperastine
Increased CNS depressant effect
Benzodiazepines, cloperastine
Increased CNS depressant effect
Breast-feeding, cloperastine
It is recommended not to use during breastfeeding
Cloperastine, CNS depressants
Increased CNS depressant effect
Cloperastine, expectorants
The cough reflex inhibition may cause secretion congestion
Cloperastine, hypnotics
Increased CNS depressant effect
Cloperastine, IMAOs
Antihistaminics enhance the antimuscarinic effect. Cloperastine should not be used with MAO inhibitors
Cloperastine, mucolytics
The cough reflex inhibition may cause secretion congestion
Cloperastine, neuroleptics
Antihistaminics enhance the anticholinergic effect
Cloperastine, opioid analgesics
Increased CNS depressant effect
Cloperastine, pregnancy
Cloperastine should not be used during the first trimester of pregnancy
Cloperastine, sedatives
Increased CNS depressant effect
Cloperastine, tricyclic antidepressant
Antihistaminics enhance the anticholinergic effect
Clopidogrel (Iscover)
ACE inhibitors, clopidogrel [2] ---> SmPC of [2] of EMA
Without evidence of clinically significant adverse interactions.
Acenocoumarol [1], clopidogrel ---> SmPC of [1] of eMC
The co-administration, on strict indication, may enhance the anticoagulant effect and increase the bleeding risk.
Acetylsalicylic acid, clopidogrel [2] ---> SmPC of [2] of EMA
ASA did not modify the clopidogrel-mediated inhibition of ADP-induced platelet aggregation, but clopidogrel potentiated the effect of ASA on collagen-induced platelet aggregation.
Antacids, clopidogrel [2] ---> SmPC of [2] of EMA
There is no evidence that other medicinal products that reduce stomach acid such as H2 blockers or antacids interfere with antiplatelet activity of clopidogrel.
Antidiabetics, clopidogrel [2] ---> SmPC of [2] of EMA
Without evidence of clinically significant adverse interactions.
Antiepileptics, clopidogrel [2] ---> SmPC of [2] of EMA
Without evidence of clinically significant adverse interactions.
Antiretrovirals, clopidogrel
A significantly reduced platelet inhibition has been shown in HIV patients treated with ritonavir-or cobicistat-boosted ART. Therefore, concomitant use of clopidogrel with ART boosted therapies should be discouraged.
Antiretrovirals, clopidogrel [2] ---> SmPC of [2] of EMA
HIV patients treated with boosted anti-retroviral therapies (ART) are at high-risk of vascular events.
Apalutamide [1], clopidogrel ---> SmPC of [1] of EMA
No initial dose adjustment is necessary when Erleada is co-administered with a strong inhibitor of CYP2C8 (e.g., gemfibrozil, clopidogrel) however, a reduction of the Erleada dose based on tolerability should be considered
Apixaban [1], clopidogrel ---> SmPC of [1] of EMA
As such agents increase the bleeding risk, co-administration of these medicinal products with apixaban is not recommended
Atenolol, clopidogrel [2] ---> SmPC of [2] of EMA
No clinically significant pharmacodynamic interactions were observed when clopidogrel was co-administered with atenolol, nifedipine, or both atenolol and nifedipine.
Bemiparin, clopidogrel
The concomitant administration of bemiparin and clopidogrel is not advisable. Increased risk of bleeding.
Betablockers, clopidogrel [2] ---> SmPC of [2] of EMA
Without evidence of clinically significant adverse interactions.
Breast-feeding, clopidogrel [2] ---> SmPC of [2] of EMA
As a precautionary measure, breast-feeding should not be continued during treatment with Iscover.
Bupropion [1], clopidogrel ---> SmPC of [1] of eMC
Co-administration of medicinal products that may affect the metabolism of bupropion via CYP2B6 isoenzyme may result in increased bupropion plasma levels and lower levels of active metabolite hydroxy-bupropion.
Calcium antagonists, clopidogrel [2] ---> SmPC of [2] of EMA
Without evidence of clinically significant adverse interactions.
Cangrelor [1], clopidogrel ---> SmPC of [1] of EMA
When clopidogrel is administered during infusion of cangrelor, the expected inhibitory effect of clopidogrel on platelets is not achieved.
Carbamazepine, clopidogrel [2] ---> SmPC of [2] of EMA
As a precaution, concomitant use of strong CYP2C19 inducers should be discouraged (see section 4.4).
Chloramphenicol, clopidogrel [2] ---> SmPC of [2] of EMA
Since clopidogrel is metabolised to its active metabolite partly by CYP2C19, use of medicinal products that inhibit the activity of this enzyme would be expected to result in reduced drug levels of the active metabolite of clopidogrel.
Cholesterol lowering medication, clopidogrel [2] ---> SmPC of [2] of EMA
Without evidence of clinically significant adverse interactions.
Clopidogrel [1], coronary vasodilator ---> SmPC of [1] of EMA
Without evidence of clinically significant adverse interactions.
Clopidogrel [1], coxibs ---> SmPC of [1] of EMA
NSAIDs including Cox-2 inhibitors and clopidogrel should be co-administered with caution
Clopidogrel [1], CYP2C19 inductors ---> SmPC of [1] of EMA
Since clopidogrel is metabolised to its active metabolite partly by CYP2C19, use of medicinal products that induce the activity of this enzyme would be expected to result in increased drug levels of the active metabolite of clopidogrel.
Clopidogrel [1], digoxin ---> SmPC of [1] of EMA
The pharmacokinetics of digoxin or theophylline were not modified by the co-administration of clopidogrel.
Clopidogrel [1], diuretics ---> SmPC of [1] of EMA
Without evidence of clinically significant adverse interactions.
Clopidogrel [1], drugs primarily metabolised by CYP2C8 ---> SmPC of [1] of EMA
Due to the risk of increased plasma concentrations, concomitant administration of clopidogrel and drugs primarily cleared by CYP2C8 metabolism (e.g., repaglinide, paclitaxel) should be undertaken with caution
Clopidogrel [1], efavirenz ---> SmPC of [1] of EMA
As a precaution, concomitant use of strong CYP2C19 inducers should be discouraged (see section 4.4).
Clopidogrel [1], esomeprazole ---> SmPC of [1] of EMA
As a precaution, concomitant use of esomeprazole and clopidogrel should be discouraged.
Clopidogrel [1], estrogens ---> SmPC of [1] of EMA
The pharmacodynamic activity of clopidogrel was not significantly influenced by the co-administration of phenobarbital or oestrogen.
Clopidogrel [1], fertility ---> SmPC of [1] of EMA
Clopidogrel was not shown to alter fertility in animal studies.
Clopidogrel [1], fluconazole ---> SmPC of [1] of EMA
As a precaution, concomitant use of strong CYP2C19 inducers should be discouraged (see section 4.4).
Clopidogrel [1], fluoxetine ---> SmPC of [1] of EMA
As a precaution, concomitant use of strong CYP2C19 inducers should be discouraged (see section 4.4).
Clopidogrel [1], fluvoxamine ---> SmPC of [1] of EMA
As a precaution, concomitant use of strong CYP2C19 inducers should be discouraged (see section 4.4).
Clopidogrel [1], H2 antagonists ---> SmPC of [1] of EMA
There is no evidence that other medicinal products that reduce stomach acid such as H2 blockers or antacids interfere with antiplatelet activity of clopidogrel.
Clopidogrel [1], haemorrhage ---> SmPC of [1] of EMA
There is an increased risk of bleeding due to the potential additive effect. The concomitant administration of medicinal products associated with bleeding risk should be undertaken with caution (see section 4.4).
Clopidogrel [1], heparin ---> SmPC of [1] of EMA
Co-administration of heparin had no effect on the inhibition of platelet aggregation induced by clopidogrel. A pharmacodynamic interaction between clopidogrel and heparin is possible, leading to increased risk of bleeding.
Clopidogrel [1], medicinal products associated with bleeding risk ---> SmPC of [1] of EMA
Clopidogrel should be used with caution in patients receiving medicinal products associated with bleeding risk such as pentoxifylline
Clopidogrel [1], moclobemide ---> SmPC of [1] of EMA
As a precaution, concomitant use of strong CYP2C19 inducers should be discouraged (see section 4.4).
Clopidogrel [1], moderate CYP2C19 inhibitors ---> SmPC of [1] of EMA
As a precaution, concomitant use of strong CYP2C19 inducers should be discouraged (see section 4.4).
Clopidogrel [1], naproxen ---> SmPC of [1] of EMA
In a clinical study conducted in healthy volunteers, the concomitant administration of clopidogrel and naproxen increased occult gastrointestinal blood loss.
Clopidogrel [1], nifedipine ---> SmPC of [1] of EMA
No clinically significant pharmacodynamic interactions were observed when clopidogrel was co-administered with atenolol, nifedipine, or both atenolol and nifedipine.
Clopidogrel [1], NSAID ---> SmPC of [1] of EMA
NSAIDs including Cox-2 inhibitors and clopidogrel should be co-administered with caution
Clopidogrel [1], omeprazole ---> SmPC of [1] of EMA
Omeprazole 80 mg once daily administered either at the same time as clopidogrel or with 12 hours between the administrations of the two drugs decreased the exposure of the active metabolite by 45% (loading dose) and 40% (maintenance dose).
Clopidogrel [1], opiate agonists ---> SmPC of [1] of EMA
As with other oral P2Y12 inhibitors, co-administration of opioid agonists has the potential to delay and reduce the absorption of clopidogrel presumably because of slowed gastric emptying.
Clopidogrel [1], oral anticoagulants ---> SmPC of [1] of EMA
The concomitant administration of clopidogrel with oral anticoagulants is not recommended since it may increase the intensity of bleedings
Clopidogrel [1], oxcarbazepine ---> SmPC of [1] of EMA
Since clopidogrel is metabolised to its active metabolite partly by CYP2C19, use of medicinal products that inhibit the activity of this enzyme would be expected to result in reduced drug levels of the active metabolite of clopidogrel.
Clopidogrel [1], paclitaxel ---> SmPC of [1] of EMA
Due to the risk of increased plasma concentrations, concomitant administration of clopidogrel and drugs primarily cleared by CYP2C8 metabolism (e.g., repaglinide, paclitaxel) should be undertaken with caution
Clopidogrel [1], pantoprazole ---> SmPC of [1] of EMA
These results indicate that clopidogrel can be administered with pantoprazole.
Clopidogrel [1], pentoxifylline ---> SmPC of [1] of EMA
Clopidogrel should be used with caution in patients receiving medicinal products associated with bleeding risk such as pentoxifylline
Clopidogrel [1], phenobarbital ---> SmPC of [1] of EMA
The pharmacodynamic activity of clopidogrel was not significantly influenced by the co-administration of phenobarbital or oestrogen.
Clopidogrel [1], phenytoin ---> SmPC of [1] of EMA
Data from the CAPRIE study indicate that phenytoin which is metabolised by CYP2C9 can be safely co-administered with clopidogrel.
Clopidogrel [1], pregnancy ---> SmPC of [1] of EMA
It is preferable not to use clopidogrel during pregnancy as a precautionary measure.
Clopidogrel [1], repaglinide ---> SmPC of [1] of EMA
Due to the risk of increased plasma concentrations, concomitant administration of clopidogrel and drugs primarily cleared by CYP2C8 metabolism (e.g., repaglinide, paclitaxel) should be undertaken with caution
Clopidogrel [1], rifampicin ---> SmPC of [1] of EMA
Rifampicin strongly induces CYP2C19, resulting in both an increased level of clopidogrel active metabolite and platelet inhibition, which in particular might potentiate the risk of bleeding.
Clopidogrel [1], rosuvastatin ---> SmPC of [1] of EMA
Clopidogrel has been shown to increase rosuvastatin exposure in patients by 2-fold (AUC) and 1.3-fold (Cmax) after administration of a 300 mg clopidogrel dose
Clopidogrel [1], SSRI ---> SmPC of [1] of EMA
Since SSRIs affect platelet activation and increase the risk of bleeding, the concomitant administration of SSRIs with clopidogrel should be undertaken with caution.
Clopidogrel [1], strong CYP2C19 inductors ---> SmPC of [1] of EMA
As a precaution, concomitant use of strong CYP2C19 inducers should be discouraged (see section 4.4).
Clopidogrel [1], strong CYP2C19 inhibitors ---> SmPC of [1] of EMA
Since clopidogrel is metabolised to its active metabolite partly by CYP2C19, use of medicinal products that inhibit the activity of this enzyme would be expected to result in reduced drug levels of the active metabolite of clopidogrel.
Clopidogrel [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA
As a precaution, concomitant use of strong CYP2C19 inducers should be discouraged (see section 4.4).
Clopidogrel [1], theophylline ---> SmPC of [1] of EMA
The pharmacokinetics of digoxin or theophylline were not modified by the co-administration of clopidogrel.
Clopidogrel [1], thrombolytics ---> SmPC of [1] of EMA
The incidence of clinically significant bleeding with the concomitant administration of clopidogrel and thrombolytic agents was similar to that observed when thrombolytic agents and heparin are co-administered with ASA
Clopidogrel [1], ticlopidine ---> SmPC of [1] of EMA
As a precaution, concomitant use of strong CYP2C19 inducers should be discouraged (see section 4.4).
Clopidogrel [1], tolbutamide ---> SmPC of [1] of EMA
Data from the CAPRIE study indicate that tolbutamide which is metabolised by CYP2C9 can be safely co-administered with clopidogrel.
Clopidogrel [1], voriconazole ---> SmPC of [1] of EMA
As a precaution, concomitant use of strong CYP2C19 inducers should be discouraged (see section 4.4).
Clopidogrel [1], warfarin ---> SmPC of [1] of EMA
Coadministration of clopidogrel with warfarin increases the risk of bleeding because of independent effects on hemostasis.
Clopidogrel, dabigatran ---> SmPC of [dabigatran etexilate] of EMA
The co-administration may increase the risk of bleeding
Clopidogrel, dabigatran etexilate [2] ---> SmPC of [2] of EMA
Concomitant use of antiplatelets, ASA or clopidogrel approximately doubled major bleeding rates with both dabigatran etexilate and warfarin (see section 4.4).
Clopidogrel, desirudin [2] ---> SmPC of [2] of EMA
Desirudin should be used with caution in conjunction with medicinal products which affect platelet function
Clopidogrel, dronedarone [2] ---> SmPC of [2] of EMA
Dronedarone does not affect the pharmacokinetics of clopidogrel and its active metabolite.
Clopidogrel, drotrecogin alfa [2] ---> SmPC of [2] of EMA
Caution should be employed when using drotrecogin alfa with other drugs that affect haemostasis
Clopidogrel, drugs metabolised by CYP2C9
The carboxylic acid metabolite of clopidogrel can inhibit the CYP2C9 and increase the plasma levels of drugs metabolized by CYP2C9
Clopidogrel, edoxaban [2] ---> SmPC of [2] of EMA
In ENGAGE AF-TIMI 48 concomitant use of thienopyridines (e.g. clopidogrel) monotherapy was permitted and resulted in increased clinically relevant bleeding although with a lower risk of bleeding on edoxaban compared to warfarin
Clopidogrel, enoxaparin sodium [2] ---> SmPC of [2] of EMA
This medicinal product may be administered with caution concomitantly with enoxaparin sodium
Clopidogrel, enzalutamide [2] ---> SmPC of [2] of EMA
The risk for liver injury is suspected to be higher in patients concomitantly treated with enzyme inducers.
Clopidogrel, etravirine [2] ---> SmPC of [2] of EMA
It is possible that etravirine may inhibit the metabolism of clopidogrel to its active metabolite by the inhibition of CYP2C19. As a precaution it is recommended that concomitant use of etravirine and clopidogrel should be discouraged.
Clopidogrel, ferric citrate coordination complex [2] ---> SmPC of [2] of EMA
Fexeric did not alter the bioavailability of the following medicinal products when concomitantly administered: clopidogrel, digoxin, diltiazem, glimepiride, losartan.
Clopidogrel, fondaparinux [2] ---> SmPC of [2] of EMA
Other antiplatelet medicinal products (acetylsalicylic acid, dipyridamole, sulfinpyrazone, ticlopidine or clopidogrel), and NSAIDs should be used with caution. If co-administration is essential, close monitoring is necessary.
Clopidogrel, iloprost [2] ---> SmPC of [2] of EMA
Since iloprost inhibits platelet function its use with anticoagulants or other inhibitors of platelet aggregation may increase the risk of bleeding. A careful monitoring of the patients is recommended.
Clopidogrel, inotersen [2] ---> SmPC of [2] of EMA
Caution should be used with antithrombotic medicinal products, antiplatelet medicinal products, and medicinal products that may lower platelet count
Clopidogrel, ketoprofen [2] ---> SmPC of [2] of eMC
Increased risk of bleeding
Clopidogrel, ketorolac [2] ---> SmPC of [2] of eMC
There is an increased risk of gastrointestinal bleeding when anti-platelet agents are combined with NSAIDs.
Clopidogrel, moderate CYP3A4 inductors
The moderate CYP3A4 induction may increase plasma concentrations of the active metabolite and the effect of clopidogrel. The co-administration should be discouraged
Clopidogrel, moderate CYP3A4 inhibitors
The moderate CYP3A4 inhibition may decrease plasma concentrations of the active metabolite and the effect of clopidogrel. The co-administration should be discouraged
Clopidogrel, nevirapine
The CYP3A and CYP2B6 inductions may decrease the plasma levels of clopidogrel
Clopidogrel, ozanimod [2] ---> SmPC of [2] of EMA
Caution should be exercised for concomitant use of ozanimod with strong CYP2C8 inhibitors (e.g. gemfibrozil, clopidogrel).
Clopidogrel, parnaparin
Increased risk of bleeding (inhibition of platelet function)
Clopidogrel, patiromer [2] ---> SmPC of [2] of EMA
Concomitant administration of patiromer did not affect the bioavailability as measured by the area under the curve (AUC). For these medicinal products no separation is needed.
Clopidogrel, reteplase [2] ---> SmPC of [2] of EMA
Caution should be employed when used reteplase with other medicinal products affecting haemostasis
Clopidogrel, retinol
Concomitant use of antiplatelet drugs with vitamin A may increase the anticoagulant effect and the risk of bleeding
Clopidogrel, reviparin
Caution is recommended when coadministering reviparin with drugs that influence the platelet function due to increased bleeding risk
Clopidogrel, rivaroxaban [2] ---> SmPC of [2] of EMA
Clopidogrel did not show a pharmacokinetic interaction with rivaroxaban but a relevant increase in bleeding time was observed in a subset of patients
Clopidogrel, selexipag [2] ---> SmPC of [2] of EMA
The total daily dose of Uptravi should be decreased by reducing each dose to half when co-administered with moderate CYP2C8 inhibitors (e.g., clopidogrel, deferasirox, teriflunomide).
Clopidogrel, sodium zirconium cyclosilicate [2] ---> SmPC of [2] of EMA
In a clinical drug-drug interaction study conducted in healthy subjects co-administration did not result in clinically meaningful drug-drug interactions and no dose adjustments are required.
Clopidogrel, strong CYP3A4 inhibitors
The strong CYP3A4 inhibition may decrease plasma concentrations of the active metabolite and the effect of clopidogrel. The co-administration should be discouraged
Clopidogrel, sucroferric oxyhydroxide [2] ---> SmPC of [2] of EMA
In vitro studies did not show any relevant interaction
Clopidogrel, tenecteplase [2] ---> SmPC of [2] of EMA
Medicinal products that affect coagulation or those that alter platelet function may increase the risk of bleeding prior to, during or after tenecteplase therapy.
Clopidogrel, thiotepa [2] ---> SmPC of [2] of EMA
Thiotepa appears to be metabolised via CYP2B6 and CYP3A4. Co-administration with inhibitors of CYP2B6 or CYP3A4 may increase the plasma concentrations of thiotepa and potentially decrease the concentrations of the active metabolite TEPA.
Clopidogrel, tiaprofenic acid [2] ---> SmPC of [2] of eMC
It is considered unsafe to take NSAIDs in combination with platelet aggregation inhibitors due to increased risk of bleeding. If coadministration is unavoidable, patient should be closely monitored.
Clopidogrel, urokinase [2] ---> SmPC of [2] of eMC
Due to increased risk of haemorrhage, concomitant use of urokinase and active substances that affect platelet function should be avoided
Clopidogrel, vitamin A
Concomitant use of antiplatelet drugs with vitamin A may increase the anticoagulant effect and the risk of bleeding
CONTRAINDICATIONS of Clopidogrel (Iscover)
- Hypersensitivity to the active substance or to any of the excipients listed in section 2 or section 6.1.
- Severe hepatic impairment.
- Active pathological bleeding such as peptic ulcer or intracranial haemorrhage.
https://www.ema.europa.eu/en/documents/product-information/iscover-epar-product-information_en.pdf 26/08/2025
Other trade names: Clopidogrel Apotex, Clopidogrel BGR, Clopidogrel Krka, Clopidogrel ratiopharm, Clopidogrel TAD, Clopidogrel Taw Pharma, Clopidogrel Teva (hydrogen sulphate), Clopidogrel Zentiva, Grepid, Klandryn, Lagreden, Maboclop, Clopidogrel Viatris, Plavix, Zyllt,
Clopidogrel/acetylsalicylic acid (DuoPlavin)
ACE inhibitors, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
Interactions with angiotensin converting enzyme (ACE) inhibitors and higher (anti-inflammatory) doses of ASA have been reported
Acetazolamide, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
Caution is recommended when co-administering salicylates with acetazolamide as there is an increased risk of metabolic acidosis.
Acetylsalicylic acid, benzbromarone ---> SmPC of [clopidogrel/acetylsalicylic acid] of EMA
Caution is required because ASA may inhibit the effect of uricosuric agents through competitive elimination of uric acid.
Alcohol, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
Patients should be counseled about the risks of gastrointestinal injury and bleeding while taking clopidogrel plus ASA with alcohol, especially if alcohol consumption is chronic or heavy.
Antacids, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
Antacids did not modify the extent of clopidogrel absorption.
Antiepileptics, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
Interactions with anticonvulsants (phenytoin and valproic acid) and higher (anti-inflammatory) doses of ASA have been reported
Atenolol, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
No clinically significant pharmacodynamic interactions were observed when clopidogrel was co-administered with atenolol, nifedipine, or both atenolol and nifedipine.
Atherothrombotic disease, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
Apart from the specific medicinal product interaction information described above, interaction studies with DuoPlavin and some medicinal products commonly administered in patients with atherothrombotic disease have not been performed.
Benzbromarone, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
Caution is required because ASA may inhibit the effect of uricosuric agents through competitive elimination of uric acid.
Betablockers, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
Interactions with betablockers and higher (anti-inflammatory) doses of ASA have been reported
Bleeding risk, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
There is an increased risk of bleeding due to the potential additive effect. The concomitant administration of medicinal products associated with bleeding risk should be undertaken with caution (see section 4.4).
Boosted anti-retroviral therapy, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
Therefore, concomitant use of clopidogrel with ART boosted therapies should be discouraged.
Boosted anti-retroviral therapy, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
HIV patients treated with boosted anti-retroviral therapies (ART) are at high risk of vascular events.
Breast-feeding, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
Breast-feeding should be discontinued during treatment with DuoPlavin.
Carbamazepine, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
The clinical relevance of this interaction is uncertain. As a precaution concomitant use of strong or moderate CYP2C19 inhibitors should be discouraged (see sections 4.4 and 5.2).
Chloramphenicol, clopidogrel/acetylsalicylic acid [2] ---> SmPC of [2] of EMA
The clinical relevance of this interaction is uncertain. As a precaution concomitant use of strong or moderate CYP2C19 inhibitors should be discouraged (see sections 4.4 and 5.2).
Clopidogrel/acetylsalicylic acid [1], coxibs ---> SmPC of [1] of EMA
In a clinical study conducted in healthy volunteers, the concomitant administration of clopidogrel and naproxen increased occult gastrointestinal blood loss. Consequently, the concomitant use of NSAIDs including Cox-2 inhibitors is not recommended
Clopidogrel/acetylsalicylic acid [1], CYP2C19 inductors ---> SmPC of [1] of EMA
Since clopidogrel is metabolised to its active metabolite partly by CYP2C19, use of medicinal products that induce the activity of this enzyme would be expected to result in increased drug levels of the active metabolite of clopidogrel.
Clopidogrel/acetylsalicylic acid [1], digoxin ---> SmPC of [1] of EMA
The pharmacokinetics of digoxin or theophylline were not modified by the co-administration of clopidogrel.
Clopidogrel/acetylsalicylic acid [1], diuretics ---> SmPC of [1] of EMA
Interactions with diuretics and higher (anti-inflammatory) doses of ASA have been reported
Clopidogrel/acetylsalicylic acid [1], drugs primarily metabolised by CYP2C8 ---> SmPC of [1] of EMA
Due to the risk of increased plasma concentrations, concomitant administration of clopidogrel and drugs primarily cleared by CYP2C8 metabolism (e.g., repaglinide, paclitaxel) should be undertaken with caution
Clopidogrel/acetylsalicylic acid [1], efavirenz ---> SmPC of [1] of EMA
The clinical relevance of this interaction is uncertain. As a precaution concomitant use of strong or moderate CYP2C19 inhibitors should be discouraged (see sections 4.4 and 5.2).
Clopidogrel/acetylsalicylic acid [1], esomeprazole ---> SmPC of [1] of EMA
As a precaution, concomitant use of omeprazole or esomeprazole should be discouraged (see section 4.4).
Clopidogrel/acetylsalicylic acid [1], estrogens ---> SmPC of [1] of EMA
The pharmacodynamic activity of clopidogrel was not significantly influenced by the co-administration of phenobarbital or oestrogen.
Clopidogrel/acetylsalicylic acid [1], fertility ---> SmPC of [1] of EMA
There are no fertility data with DuoPlavin. Clopidogrel was not shown to alter fertility in animal studies. It is unknown whether ASA dose in DuoPlavin alters fertility.
Clopidogrel/acetylsalicylic acid [1], fluconazole ---> SmPC of [1] of EMA
The clinical relevance of this interaction is uncertain. As a precaution concomitant use of strong or moderate CYP2C19 inhibitors should be discouraged (see sections 4.4 and 5.2).
Clopidogrel/acetylsalicylic acid [1], fluoxetine ---> SmPC of [1] of EMA
The clinical relevance of this interaction is uncertain. As a precaution concomitant use of strong or moderate CYP2C19 inhibitors should be discouraged (see sections 4.4 and 5.2).
Clopidogrel/acetylsalicylic acid [1], fluvoxamine ---> SmPC of [1] of EMA
The clinical relevance of this interaction is uncertain. As a precaution concomitant use of strong or moderate CYP2C19 inhibitors should be discouraged (see sections 4.4 and 5.2).
Clopidogrel/acetylsalicylic acid [1], GP IIb/IIIa inhibitors ---> SmPC of [1] of EMA
Clopidogrel should be used with caution in patients who receive concomitant glycoprotein IIb/IIIa inhibitors
Clopidogrel/acetylsalicylic acid [1], heparin ---> SmPC of [1] of EMA
Co-administration of heparin had no effect on the inhibition of platelet aggregation induced by clopidogrel.
Clopidogrel/acetylsalicylic acid [1], heparin ---> SmPC of [1] of EMA
A pharmacodynamic interaction between DuoPlavin and heparin is possible, leading to increased risk of bleeding. Therefore, concomitant use should be undertaken with caution (see section 4.4).
Clopidogrel/acetylsalicylic acid [1], ibuprofen ---> SmPC of [1] of EMA
Experimental data suggest that ibuprofen may inhibit the effect of low dose aspirin on platelet aggregation when they are dosed concomitantly.
Clopidogrel/acetylsalicylic acid [1], medicinal products associated with bleeding risk ---> SmPC of [1] of EMA
There is an increased risk of bleeding due to the potential additive effect. The concomitant administration of medicinal products associated with bleeding risk should be undertaken with caution
Clopidogrel/acetylsalicylic acid [1], metamizole ---> SmPC of [1] of EMA
Metamizole may reduce the effect of ASA on platelet aggregation when taken concomitantly. Therefore, this combination should be used with caution in patients taking low dose ASA for cardioprotection
Clopidogrel/acetylsalicylic acid [1], methotrexate ---> SmPC of [1] of EMA
Due to the presence of ASA, methotrexate used at doses higher than 20 mg/week should be used with caution as ASA can inhibit renal clearance of methotrexate, which may lead to bone marrow toxicity.
Clopidogrel/acetylsalicylic acid [1], moclobemide ---> SmPC of [1] of EMA
The clinical relevance of this interaction is uncertain. As a precaution concomitant use of strong or moderate CYP2C19 inhibitors should be discouraged (see sections 4.4 and 5.2).
Clopidogrel/acetylsalicylic acid [1], moderate CYP2C19 inhibitors ---> SmPC of [1] of EMA
Since clopidogrel is metabolised to its active metabolite partly by CYP2C19, use of medicinal products that inhibit the activity of this enzyme would be expected to result in reduced drug levels of the active metabolite of clopidogrel.
Clopidogrel/acetylsalicylic acid [1], morphine ---> SmPC of [1] of EMA
Consider the use of a parenteral antiplatelet agent in acute coronary syndrome patients requiring co-administration of morphine or other opioid agonists.
Clopidogrel/acetylsalicylic acid [1], nicorandil ---> SmPC of [1] of EMA
In patients concomitantly receiving nicorandil and NSAIDs including ASA and LAS, there is an increased risk for severe complications such as gastrointestinal ulceration, perforation and haemorrhage
Clopidogrel/acetylsalicylic acid [1], nifedipine ---> SmPC of [1] of EMA
No clinically significant pharmacodynamic interactions were observed when clopidogrel was co-administered with atenolol, nifedipine, or both atenolol and nifedipine.
Clopidogrel/acetylsalicylic acid [1], NSAID ---> SmPC of [1] of EMA
In a clinical study conducted in healthy volunteers, the concomitant administration of clopidogrel and naproxen increased occult gastrointestinal blood loss. Consequently, the concomitant use of NSAIDs including Cox-2 inhibitors is not recommended
Clopidogrel/acetylsalicylic acid [1], omeprazole ---> SmPC of [1] of EMA
As a precaution, concomitant use of omeprazole or esomeprazole should be discouraged (see section 4.4).
Clopidogrel/acetylsalicylic acid [1], opiate agonists ---> SmPC of [1] of EMA
As with other oral P2Y12 inhibitors, co-administration of opioid agonists has the potential to delay and reduce the absorption of clopidogrel presumably because of slowed gastric emptying.
Clopidogrel/acetylsalicylic acid [1], oral anticoagulants ---> SmPC of [1] of EMA
The concomitant administration of DuoPlavin with oral anticoagulants is not recommended since it may increase the intensity of bleeding (see section 4.4).
Clopidogrel/acetylsalicylic acid [1], oral antidiabetics ---> SmPC of [1] of EMA
Interactions with oral hypoglycemic agents and higher (anti-inflammatory) doses of ASA have been reported
Clopidogrel/acetylsalicylic acid [1], paclitaxel ---> SmPC of [1] of EMA
Due to the risk of increased plasma concentrations, concomitant administration of clopidogrel and drugs primarily cleared by CYP2C8 metabolism (e.g., repaglinide, paclitaxel) should be undertaken with caution
Clopidogrel/acetylsalicylic acid [1], pantoprazole ---> SmPC of [1] of EMA
The plasma concentrations of the active metabolite was 20% reduced (loading dose) and 14% reduced (maintenance dose) during concomitant treatment with pantoprazole 80 mg once daily. Clopidogrel can be administered with pantoprazole.
Clopidogrel/acetylsalicylic acid [1], phenobarbital ---> SmPC of [1] of EMA
The pharmacodynamic activity of clopidogrel was not significantly influenced by the co-administration of phenobarbital or oestrogen.
Clopidogrel/acetylsalicylic acid [1], phenytoin ---> SmPC of [1] of EMA
Interactions with anticonvulsants (phenytoin and valproic acid) and higher (anti-inflammatory) doses of ASA have been reported. Phenytoin and tolbutamide which are metabolised by CYP2C9 can be safely co-administered with clopidogrel.
Clopidogrel/acetylsalicylic acid [1], pregnancy ---> SmPC of [1] of EMA
It should not be used during the 1st and 2nd trimester of pregnancy unless the clinical condition of the woman requires treatment. Contraindicated during the 3rd trimester.
Clopidogrel/acetylsalicylic acid [1], probenecide ---> SmPC of [1] of EMA
Caution is required because ASA may inhibit the effect of uricosuric agents through competitive elimination of uric acid.
Clopidogrel/acetylsalicylic acid [1], repaglinide ---> SmPC of [1] of EMA
Due to the risk of increased plasma concentrations, concomitant administration of clopidogrel and drugs primarily cleared by CYP2C8 metabolism (e.g., repaglinide, paclitaxel) should be undertaken with caution
Clopidogrel/acetylsalicylic acid [1], rifampicin ---> SmPC of [1] of EMA
Rifampicin strongly induces CYP2C19 resulting to both an increase level of clopidogrel active metabolite and platelet inhibition, which in particular might potentiate the risk of bleeding.
Clopidogrel/acetylsalicylic acid [1], rosuvastatin ---> SmPC of [1] of EMA
Clopidogrel has been shown to increase rosuvastatin exposure in patients by 1.4-fold (AUC) without effect on Cmax, after repeated administration of a 75 mg clopidogrel dose.
Clopidogrel/acetylsalicylic acid [1], SSRI ---> SmPC of [1] of EMA
Since SSRIs affect platelet activation and increase the risk of bleeding, the concomitant administration of SSRIs with clopidogrel should be undertaken with caution.
Clopidogrel/acetylsalicylic acid [1], strong CYP2C19 inductors ---> SmPC of [1] of EMA
As a precaution, concomitant use of strong CYP2C19 inducers should be discouraged (see section 4.4).
Clopidogrel/acetylsalicylic acid [1], strong CYP2C19 inhibitors ---> SmPC of [1] of EMA
Since clopidogrel is metabolised to its active metabolite partly by CYP2C19, use of medicinal products that inhibit the activity of this enzyme would be expected to result in reduced drug levels of the active metabolite of clopidogrel.
Clopidogrel/acetylsalicylic acid [1], sulfinpyrazone ---> SmPC of [1] of EMA
Caution is required because ASA may inhibit the effect of uricosuric agents through competitive elimination of uric acid.
Clopidogrel/acetylsalicylic acid [1], theophylline ---> SmPC of [1] of EMA
The pharmacokinetics of digoxin or theophylline were not modified by the co-administration of clopidogrel.
Clopidogrel/acetylsalicylic acid [1], thrombolytics ---> SmPC of [1] of EMA
The incidence of clinically significant bleeding was similar to that observed when thrombolytic agents and heparin are co-administered with ASA (see section 4.8).
Clopidogrel/acetylsalicylic acid [1], ticlopidine ---> SmPC of [1] of EMA
The clinical relevance of this interaction is uncertain. As a precaution concomitant use of strong or moderate CYP2C19 inhibitors should be discouraged (see sections 4.4 and 5.2).
Clopidogrel/acetylsalicylic acid [1], tolbutamide ---> SmPC of [1] of EMA
Data from the CAPRIE study indicate that tolbutamide which is metabolised by CYP2C9 can be safely co-administered with clopidogrel. Phenytoin and tolbutamide which are metabolised by CYP2C9 can be safely co-administered with clopidogrel.
Clopidogrel/acetylsalicylic acid [1], uricosuric agents ---> SmPC of [1] of EMA
Caution is required because ASA may inhibit the effect of uricosuric agents through competitive elimination of uric acid.
Clopidogrel/acetylsalicylic acid [1], valproic acid ---> SmPC of [1] of EMA
The concomitant administration of salicylates and valproic acid may result in decreased valproic acid protein binding and inhibition of valproic acid metabolism resulting in increased serum levels of total and free valproic acid.
Clopidogrel/acetylsalicylic acid [1], varicella vaccine ---> SmPC of [1] of EMA
It is recommended that patients not be given salicylates for an interval of six weeks after receiving the varicella vaccine. Cases of Reye's syndrome have occurred following the use of salicylates during varicella infections
Clopidogrel/acetylsalicylic acid [1], voriconazole ---> SmPC of [1] of EMA
The clinical relevance of this interaction is uncertain. As a precaution concomitant use of strong or moderate CYP2C19 inhibitors should be discouraged (see sections 4.4 and 5.2).
Clopidogrel/acetylsalicylic acid [1], warfarin ---> SmPC of [1] of EMA
Coadministration of clopidogrel with warfarin increases the risk of bleeding because of independent effects on hemostasis.
Clopidogrel/acetylsalicylic acid, nicorandil [2] ---> SmPC of [2] of EMA
In patients concomitantly receiving nicorandil and NSAIDs including ASA and LAS, there is an increased risk for severe complications such as gastrointestinal ulceration, perforation and haemorrhage (see section 4.4).
CONTRAINDICATIONS of Clopidogrel/acetylsalicylic acid (DuoPlavin)
Due to the presence of both components of the medicinal product, clopidogrel/acetylsalicylic acid is contraindicated in case of:
- Hypersensitivity to the active substances or to any of the excipients listed in section 6.1.
- Severe hepatic impairment.
- Active pathological bleeding such as peptic ulcer or intracranial haemorrhage.
In addition, due to the presence of ASA, its use is also contraindicated in:
- Hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) and syndrome of asthma, rhinitis, and nasal polyps. Patients with pre-existing mastocytosis, in whom the use of acetylsalicylic acid may induce severe hypersensitivity reactions (including circulatory shock with flushing, hypotension, tachycardia and vomiting).
- Severe renal impairment (creatinine clearance < 30 ml/min).
- Third trimester of pregnancy
https://www.ema.europa.eu/en/documents/product-information/duoplavin-epar-product-information_en.pdf 19/07/2024
Other trade names: Clopidogrel/Acetylsalicylic acid Zentiva (previously DuoCover), Clopidogrel / Acetylsalicylic acid Mylan,
Clotrimazole
Amphotericin, clotrimazole
Clotrimazole decreases the efficacy of amphotericin and other polyene antibiotics
Breast-feeding, clotrimazole ---> SPC of [1] of eMC
A risk to the suckling child cannot be excluded. A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from clotrimazole therapy
Brinzolamide [1], clotrimazole ---> SPC of [1] of EMA
It is expected that inhibitors of CYP3A4 will inhibit the metabolism of brinzolamide by CYP3A4. Caution is advised if CYP3A4 inhibitors are given concomitantly.
Brinzolamide/brimonidine [1], clotrimazole ---> SPC of [1] of EMA
It is expected that inhibitors of CYP3A4 will inhibit the metabolism of brinzolamide by CYP3A4. Caution is advised if CYP3A4 inhibitors are given concomitantly.
Brinzolamide/timolol [1], clotrimazole ---> SPC of [1] of EMA
It is expected that inhibitors of CYP3A4 will inhibit the metabolism of brinzolamide by CYP3A4. Caution is advised if CYP3A4 inhibitors are given concomitantly.
Buspirone [1], clotrimazole ---> SPC of [1] of eMC
If buspirone is administered with a potent CYP3A4 inhibitor, the initial dose should be lowered and only increased gradually after medical evaluation
Clotrimazole [1], latex ---> SPC of [1] of eMC
Laboratory tests have suggested that, when used together, this product may cause damage to latex contraceptives. Consequently the effectiveness of such contraceptives may be reduced.
Clotrimazole [1], pregnancy ---> SPC of [1] of eMC
Clotrimazole can be used during pregnancy, but only under the supervision of a physician or midwife.
Clotrimazole, cyproterone [2] ---> SPC of [2] of eMC
Since cyproterone acetate is metabolised by CYP3A4, it is expected strong inhibitors of CYP3A4 inhibit the metabolism of cyproterone acetate.
Clotrimazole, darunavir/cobicistat [2] ---> SPC of [2] of EMA
Based on theoretical considerations darunavir/cobicistat (CYP3A inhibition) is expected to increase the antifungal plasma concentrations, and darunavir and/or cobicistat plasma concentrations may be increased by the antifungal (CYP3A inhibition)
Clotrimazole, darunavir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Co-administration of Symtuza and other medicinal products that inhibit CYP3A may decrease the clearance of darunavir and cobicistat and may result in increased plasma concentrations of darunavir and cobicistat
Clotrimazole, darunavir/ritonavir ---> SPC of [darunavir] of EMA
Concomitant systemic use of clotrimazole and boosted darunavir may increase plasma concentrations of darunavir and/or clotrimazole.
Clotrimazole, everolimus
Clotrimazole may increase everolimus plasma levels.
Clotrimazole, lomitapide [2] ---> SPC of [2] of EMA
Weak CYP3A4 inhibitors are expected to increase the exposure of lomitapide when taken simultaneously. Separate the dose of the medications by 12 hours OR decrease the dose of Lojuxta by half.
Clotrimazole, natamycin
Clotrimazole decreases the efficacy of amphotericin and other polyene antibiotics
Clotrimazole, nystatin
Clotrimazole decreases the efficacy of amphotericin and other polyene antibiotics
Clotrimazole, polyene antifungals
Clotrimazole decreases the efficacy of amphotericin and other polyene antibiotics
Clotrimazole, sirolimus [2] ---> SPC of [2] of EMA
Inhibitors of CYP3A4 may decrease the metabolism of sirolimus and increase sirolimus blood levels.
Clotrimazole, tacrolimus [2] ---> SPC of [2] of EMA
Concomitant use of substances known to inhibit CYP3A4 may affect the metabolism of tacrolimus and thereby increase tacrolimus blood levels.
Clotrimazole, tegafur
The co-administration of a CYP2A6 inhibitor and tegafur should be avoided as effectiveness of tegafur can be decreased
Clotrimazole, verapamil ---> SPC of [2] of eMC
Clinically significant interactions have been reported with inhibitors of CYP3A4 causing elevation of plasma levels of verapamil hydrochloride, therefore, patients should be monitored for drug interactions.
CONTRAINDICATIONS of Clotrimazole
Hypersensitivity to the active substance or to any of the excipients
http://www.medicines.org.uk/emc/
Clozapine
Ability to drive, clozapine [2] ---> SPC of [2] of eMC
Owing to the ability of clozapine to cause sedation and lower the seizure threshold, activities such as driving or operating machinery should be avoided, especially during the initial weeks of treatment.
Adrenaline, clozapine [2] ---> SPC of [2] of eMC
Owing to its anti-alpha-adrenergic properties, clozapine may reverse the pressor effect of epinephrine.
Agranulocytosis, clozapine [2] ---> SPC of [2] of eMC
Clozapine treatment must not be started concurrently with substances known to have a substantial potential for causing agranulocytosis
Alcohol, clozapine [2] ---> SPC of [2] of eMC
Alcohol should not be used concomitantly with clozapine due to possible potentiation of sedation.
Alfa-adrenergic agonists, clozapine [2] ---> SPC of [2] of eMC
Owing to its anti-alpha-adrenergic properties, clozapine may reduce the blood-pressure-increasing effect of other predominantly alpha-adrenergic agents
Alprazolam, clozapine
The co-administration of alprazolam with clozapine increases the risk of respiratory and/or cardiac arrest
Amifampridine [1], clozapine ---> SPC of [1] of EMA
The concomitant use of amifampridine and medicinal products with atropinic effects may reduce the effect of both active substances
Amprenavir [1], clozapine ---> SPC of [1] of EMA
Amprenavir may increase the plasma concentrations of clozapine
Anticholinergics, clozapine [2] ---> SPC of [2] of eMC
Because of the possibility of additive effects, caution is essential in the concomitant administration of clozapine with substances possessing anticholinergic effects
Antihistamines, clozapine [2] ---> SPC of [2] of eMC
Clozapine may enhance the central effects of CNS depressants
Antihypertensives, clozapine [2] ---> SPC of [2] of eMC
Because of the possibility of additive effects, caution is essential in the concomitant administration of clozapine with substances possessing hypotensive effects
Apomorphine, clozapine
There is a potential interaction; however clozapine may also be used to reduce the symptoms of neuropsychiatric complications.
Benzodiazepines, clozapine [2] ---> SPC of [2] of eMC
Particular caution is advised when clozapine therapy is initiated in patients who are receiving a benzodiazepine or any other psychotropic agent. These patients may have an increased risk of circulatory collapse
Breast-feeding, clozapine [2] ---> SPC of [2] of eMC
Animal studies suggest that clozapine is excreted in breast milk and has an effect in the nursing infant; therefore, mothers receiving clozapine should not breast-feed.
Caffeine, clozapine [2] ---> SPC of [2] of eMC
Concomitant administration of substances known to inhibit the activity of some cytochrome P450 isozymes (CYP1A2) may increase the levels of clozapine, and the dose of clozapine may need to be reduced to prevent undesirable effects.
Carbamazepine, clozapine [2] ---> SPC of [2] of eMC
Carbamazepine should not to be used concomitantly with clozapine, due to its myelosuppressive potential
Chloramphenicol, clozapine [2] ---> SPC of [2] of eMC
Substances known to have a substantial potential to depress bone marrow function must not be used concurrently with clozapine
Ciprofloxacin [1], clozapine ---> SPC of [1] of eMC
Ciprofloxacin inhibits CYP1A2 and thus may cause increased serum concentration of concomitantly administered substances metabolised by this enzyme
Citalopram, clozapine [2] ---> SPC of [2] of eMC
Cases have been reported of an interaction between citalopram and clozapine, which may increase the risk of adverse events associated with clozapine. The nature of this interaction has not been fully elucidated.
Clozapine [1], CNS depressants ---> SPC of [1] of eMC
Clozapine may enhance the central effects of CNS depressants
Clozapine [1], cotrimoxazole ---> SPC of [1] of eMC
Substances known to have a substantial potential to depress bone marrow function must not be used concurrently with clozapine
Clozapine [1], cytotoxic agents ---> SPC of [1] of eMC
Substances known to have a substantial potential to depress bone marrow function must not be used concurrently with clozapine
Clozapine [1], digoxin ---> SPC of [1] of eMC
Clozapine may increase the plasma concentrations of digoxin due to displacement from plasma proteins.
Clozapine [1], drugs with high protein binding ---> SPC of [1] of eMC
Clozapine may increase the plasma concentration of highly protein bound substances due to displacement from plasma proteins.
Clozapine [1], electrolyte imbalance ---> SPC of [1] of eMC
As with other antipsychotics, caution should be exercised when clozapine is prescribed with medicines causing electrolyte imbalance.
Clozapine [1], enzyme inductors ---> SPC of [1] of eMC
Concomitant administration of clozapine with substances known to induce cytochrome P450 enzymes may decrease the plasma levels of clozapine, leading to reduced efficacy.
Clozapine [1], enzyme inhibitors ---> SPC of [1] of eMC
Concomitant administration of substances known to inhibit the activity of some cytochrome P450 isozymes may increase the levels of clozapine, and the dose of clozapine may need to be reduced to prevent undesirable effects.
Clozapine [1], epinephrine ---> SPC of [1] of eMC
Owing to its anti-alpha-adrenergic properties, clozapine may reverse the pressor effect of epinephrine.
Clozapine [1], erythromycin ---> SPC of [1] of eMC
Concomitant administration of substances known to inhibit the activity of some cytochrome P450 isozymes may increase the levels of clozapine, and the dose of clozapine may need to be reduced to prevent undesirable effects.
Clozapine [1], fluoxetine ---> SPC of [1] of eMC
Concomitant administration of substances known to inhibit the activity of some cytochrome P450 isozymes (CYP2D6) may increase the levels of clozapine, and the dose of clozapine may need to be reduced to prevent undesirable effects.
Clozapine [1], fluvoxamine ---> SPC of [1] of eMC
Concomitant administration of substances known to inhibit the activity of some cytochrome P450 isozymes (CYP1A2) may increase the levels of clozapine, and the dose of clozapine may need to be reduced to prevent undesirable effects.
Clozapine [1], IMAOs ---> SPC of [1] of eMC
Clozapine may enhance the central effects of CNS depressants
Clozapine [1], lithium ---> SPC of [1] of eMC
Co-administration of antipsychotics and lithium may increase the risk of neuroleptic malignant syndrome, which may be fatal.
Clozapine [1], myelosuppressive agents ---> SPC of [1] of eMC
Substances known to have a substantial potential to depress bone marrow function must not be used concurrently with clozapine
Clozapine [1], myelosuppressive agents ---> SPC of [1] of eMC
Substances known to have a substantial potential to depress bone marrow function must not be used concurrently with clozapine
Clozapine [1], narcotics ---> SPC of [1] of eMC
Clozapine may enhance the central effects of CNS depressants
Clozapine [1], neuroleptics ---> SPC of [1] of eMC
Long-acting depot antipsychotics (which have myelosuppressive potential) must not be used concurrently with clozapine because these cannot be rapidly removed from the body in situations where this may be required, e.g. neutropenia
Clozapine [1], nicotine ---> SPC of [1] of eMC
In cases of sudden cessation of smoking, the plasma clozapine concentration may be increased, thus leading to an increase in adverse effects.
Clozapine [1], noradrenaline ---> SPC of [1] of eMC
Owing to its anti-alpha-adrenergic properties, clozapine may reduce the blood-pressure-increasing effect of norepinephrine
Clozapine [1], norepinephrine ---> SPC of [1] of eMC
Owing to its anti-alpha-adrenergic properties, clozapine may reduce the blood-pressure-increasing effect of norepinephrine
Clozapine [1], omeprazole ---> SPC of [1] of eMC
Concomitant administration of substances known to inhibit the activity of some cytochrome P450 isozymes (CYP1A2) may increase the levels of clozapine, and the dose of clozapine may need to be reduced to prevent undesirable effects.
Clozapine [1], paroxetine ---> SPC of [1] of eMC
Concomitant administration of substances known to inhibit the activity of some cytochrome P450 isozymes (CYP2D6) may increase the levels of clozapine, and the dose of clozapine may need to be reduced to prevent undesirable effects.
Clozapine [1], penicillamine ---> SPC of [1] of eMC
Substances known to have a substantial potential to depress bone marrow function must not be used concurrently with clozapine
Clozapine [1], phenylbutazone ---> SPC of [1] of eMC
Substances known to have a substantial potential to depress bone marrow function must not be used concurrently with clozapine
Clozapine [1], phenytoin ---> SPC of [1] of eMC
Concomitant administration of clozapine with substances known to induce cytochrome P450 enzymes may decrease the plasma levels of clozapine, leading to reduced efficacy.
Clozapine [1], pregnancy ---> SPC of [1] of eMC
Caution should be exercised when prescribing to pregnant women.
Clozapine [1], pyrazolones ---> SPC of [1] of eMC
Substances known to have a substantial potential to depress bone marrow function must not be used concurrently with clozapine
Clozapine [1], QT interval prolonging drugs ---> SPC of [1] of eMC
As with other antipsychotics, caution should be exercised when clozapine is prescribed with medicines known to increase QTc interval
Clozapine [1], respiratory depressants ---> SPC of [1] of eMC
Because of the possibility of additive effects, caution is essential in the concomitant administration of clozapine with substances possessing respiratory depressant effects
Clozapine [1], rifampicin ---> SPC of [1] of eMC
Concomitant administration of clozapine with substances known to induce cytochrome P450 enzymes may decrease the plasma levels of clozapine, leading to reduced efficacy.
Clozapine [1], sertraline ---> SPC of [1] of eMC
Concomitant administration of substances known to inhibit the activity of some cytochrome P450 isozymes (CYP2D6) may increase the levels of clozapine, and the dose of clozapine may need to be reduced to prevent undesirable effects.
Clozapine [1], strong CYP1A2 inductors ---> SPC of [1] of eMC
Concomitant administration of clozapine with substances known to induce cytochrome P450 enzymes (CYP1A2) may decrease the plasma levels of clozapine, leading to reduced efficacy.
Clozapine [1], strong CYP1A2 inhibitors ---> SPC of [1] of eMC
Concomitant administration of substances known to inhibit the activity of some cytochrome P450 isozymes (CYP1A2) may increase the levels of clozapine, and the dose of clozapine may need to be reduced to prevent undesirable effects.
Clozapine [1], sulphamides ---> SPC of [1] of eMC
Substances known to have a substantial potential to depress bone marrow function must not be used concurrently with clozapine
Clozapine [1], sulphonamides ---> SPC of [1] of eMC
Substances known to have a substantial potential to depress bone marrow function must not be used concurrently with clozapine
Clozapine [1], trimethoprim/sulfamethoxazol ---> SPC of [1] of eMC
Substances known to have a substantial potential to depress bone marrow function must not be used concurrently with clozapine
Clozapine [1], valproic acid ---> SPC of [1] of eMC
Rare but serious reports of seizures, including onset of seizures in non-epileptic patients, and isolated cases of delirium where clozapine was co-administered with valproic acid have been reported.
Clozapine [1], warfarin ---> SPC of [1] of eMC
Clozapine may increase the plasma concentration of warfarin due to displacement from plasma proteins
Clozapine, deferasirox [2] ---> SPC of [2] of EMA
Concomitant use of deferasirox with substances that are predominantly metabolised by CYP1A2 and that have a narrow therapeutic index is not recommended.
Clozapine, diazepam
Pharmacodynamic synergism: severe hypotension, respiratory depression, unconsciousness and potentially fatal respiratory and/or cardiac arrest. The combination should be avoided
Clozapine, dipotassium clorazepate
The co-administration may increase the risk of respiratory and/or circulatory failure
Clozapine, doxorubicine [2] ---> SPC of [2] of eMC
Clozapine may increase the risk and severity of the hematologic toxicity of doxorubicin.
Clozapine, esmolol [2] ---> SPC of [2] of eMC
Concomitant administration of esmolol and antipsychotics may increase the blood pressure lowering effect.
Clozapine, ethosuximide
Concomitant use of clozapine and ethosuximide should be avoided
Clozapine, fesoterodine
Caution should be exercised. The combination may lead to more pronounced therapeutic and side effects
Clozapine, flecainide [2] ---> SPC of [2] of eMC
Increased risk of arrhythmias.
Clozapine, fluorouracil ---> SPC of [2] of eMC
Fluorouracil should be avoided in combination with clozapine due to increased risk of agranulocytosis.
Clozapine, fosphenytoin [2] ---> SPC of [2] of eMC
Blood levels and/or effects of clozapine may be altered by phenytoin
Clozapine, indinavir/ritonavir ---> SPC of [indinavir] of EMA
Indinavir/ritonavir should not be administered with clozapine
Clozapine, insulin glargin [2] ---> SPC of [2] of EMA
Reduced blood-glucose-lowering effect
Clozapine, insulin glulisin [2] ---> SPC of [2] of EMA
Possible decrease in blood-glucose-lowering activity
Clozapine, interferon
Caution should be used when administering interferon with medicines mainly metabolised by hepatic cytochrome P450 and have a narrow therapeutic window
Clozapine, lorazepam [2] ---> SPC of [2] of eMC
Reports of marked sedation, excessive salivation, hypotension, ataxia, delirium and respiratory arrest when given concurrently clozapine with lorazepam
Clozapine, loxapine [2] ---> SPC of [2] of EMA
Caution is advised if loxapine is combined with other medicinal products known to lower the seizure threshold
Clozapine, niraparib [2] ---> SPC of [2] of EMA
Caution is recommended when niraparib is combined with active substances the metabolism of which is CYP1A2-dependent and, notably, those having a narrow therapeutic range (e.g. clozapine, theophylline, and ropinirole).
Clozapine, oxybutynine [2] ---> SPC of [2] of EMA
The anticholinergic activity of oxybutynin is increased by concurrent use of other anticholinergics or medicinal products with anticholinergic activity
Clozapine, paliperidone [2] ---> SPC of [2] of EMA
Caution is advised if paliperidone is combined with other medicines known to lower the seizure threshold
Clozapine, perphenazine
The co-administration may increase the risk of blood count alterations. The combination should be avoided
Clozapine, pixantrone [2] ---> SPC of [2] of EMA
Clozapine is metabolised by CYP1A2, and therefore, a theoretical concern exists that co-administration of pixantrone may increase blood levels of this medicinal product.
Clozapine, prazepam [2] ---> SPC of [2] of eMC
Particular caution is advised when clozapine therapy is initiated in patients who are receiving a benzodiazepine or any other psychotropic agent. These patients may have an increased risk of circulatory collapse,
Clozapine, primidone ---> SPC of [2] of eMC
Primidone therapy may lead to altered pharmacokinetics in concomitantly administered drugs, whose metabolism may be increased and lead to lowered plasma levels and/or a shorter half-life.
Clozapine, procarbazine
Concomitant use of procarbazine und clozapine may increase the risk of agranulocytosis.
Clozapine, procyclidine ---> SPC of [2] of eMC
Drugs with anticholinergic properties may increase the anticholinergic action
Clozapine, ritonavir [2] ---> SPC of [2] of EMA
The co-administration may increase the plasma concentrations of clozapine, increasing the risk of serious haematologic abnormalities and other and is therefore contraindicated
Clozapine, saquinavir/ritonavir ---> SPC of [saquinavir] of EMA
The combination is contraindicated due to the potential for life threatening cardiac arrhythmia
Clozapine, tegafur/gimeracil/oteracil [2] ---> SPC of [2] of EMA
Due to possible additive pharmacodynamic effects (myelotoxicity), caution is advised as co-administration may increase the risk and severity of haematologic toxicity of tegafur/gimeracil/oteracil.
Clozapine, tetrazepam
Particular caution is advised when clozapine therapy is initiated in patients who are receiving a benzodiazepine or any other psychotropic agent. These patients may have an increased risk of circulatory collapse,
Clozapine, venlafaxine
Increased plasma levels of clozapine
Electrolyte imbalance, neuroleptics ---> SPC of [clozapine] of eMC
Caution should be exercised when antipsychotics are prescribed with medicines causing electrolyte imbalance
Neuroleptics, QT interval prolonging drugs ---> SPC of [clozapine] of eMC
Caution should be exercised when antipsychotics are prescribed with medicines known to increase QTc interval
CONTRAINDICATIONS of Clozapine
- Hypersensitivity to the active substance or to any of the excipients.
- Patients unable to undergo regular blood tests.
- History of toxic or idiosyncratic granulocytopenia/agranulocytosis (with the exception of granulocytopenia/agranulocytosis from previous chemotherapy).
- History of Clozaril-induced agranulocytosis.
- Impaired bone marrow function.
- Uncontrolled epilepsy.
- Alcoholic and other toxic psychoses, drug intoxication, comatose conditions.
- Circulatory collapse and/or CNS depression of any cause.
- Severe renal or cardiac disorders (e.g. myocarditis).
- Active liver disease associated with nausea, anorexia or jaundice; progressive liver disease, hepatic failure.
- Paralytic ileus.
- Clozaril treatment must not be started concurrently with substances known to have a substantial potential for causing agranulocytosis; concomitant use of depot antipsychotics is to be discouraged.
http://www.medicines.org.uk/emc/
Coagulation factor IX (Nonafact)
Breast-feeding, coagulation factor IX [2] ---> SPC of [2] of EMA
Factor IX should be used during lactation only if clearly indicated.
Coagulation factor IX [1], pregnancy ---> SPC of [1] of EMA
Factor IX should be used during pregnancy only if clearly indicated.
Coagulation factor IX, medroxyprogesterone
The coagulation factor IX levels may increase and therefore it is possible a loss of anticoagulant efficacy
CONTRAINDICATIONS of Coagulation factor IX (Nonafact)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Known allergic reaction to mouse protein.
https://www.ema.europa.eu/en/documents/product-information/nonafact-epar-product-information_en.pdf. 18/02/2020 (withdrawn)
Coagulation factor VIII/von Willebrand factor (Voncento)
Breast-feeding, coagulation factor VIII/von Willebrand factor [2] ---> SPC of [2] of EMA
The coagulation factor VIII should be administered to breast-feeding VWF deficient women only if clearly indicated
Coagulation factor VIII/von Willebrand factor [1], pregnancy ---> SPC of [1] of EMA
The coagulation factor VIII should be administered to pregnant VWF deficient women only if clearly indicated
Coagulation factor VIII/von Willebrand factor, medroxyprogesterone
The coagulation factor VIII levels may increase and therefore it is possible a loss of anticoagulant efficacy
CONTRAINDICATIONS of Coagulation factor VIII/von Willebrand factor (Voncento)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/voncento-epar-product-information_en.pdf. 13/05/2022
Human coagulation factor X (Coagadex)
Antithrombotics, human coagulation factor X [2] ---> SmPC of [2] of EMA
Coagadex is likely to be counteracted by factor Xa inhibitors, direct or indirect. These antithrombotic agents should not be used in patients with factor X deficiency.
Breast-feeding, human coagulation factor X [2] ---> SmPC of [2] of EMA
Coagadex should be used during breastfeeding only if clearly indicated.
Fertility, human coagulation factor X [2] ---> SmPC of [2] of EMA
Animal reproduction studies have not been conducted with Coagadex.
Human coagulation factor X [1], pregnancy ---> SmPC of [1] of EMA
Coagadex should be used during pregnancy only if clearly indicated.
CONTRAINDICATIONS of Human coagulation factor X (Coagadex)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/coagadex-epar-product-information_en.pdf 15/12/2025
Cobicistat (Tybost)
Ability to drive, cobicistat [2] ---> SmPC of [2] of EMA
Tybost has no or negligible influence on the ability to drive and use machines. However, patients should be informed that dizziness has been reported during treatment with cobicistat-containing regimens.
Alfuzosin, cobicistat [2] ---> SmPC of [2] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Amiodarone, cobicistat [2] ---> SmPC of [2] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Amlodipine, cobicistat [2] ---> SmPC of [2] of EMA
Concentrations of calcium channel blockers may be increased when co-administered with cobicistat. Clinical monitoring of therapeutic effect and adverse events is recommended when these medicinal products are co-administered with Tybost.
Antiretrovirals, cobicistat [2] ---> SmPC of [2] of EMA
Cobicistat co-administered with atazanavir or darunavir should not be used in combination with another antiretroviral agent that requires pharmacoenhancement by means of co-administration with an inhibitor of CYP3A4
Apixaban, cobicistat [2] ---> SmPC of [2] of EMA
Interaction not studied. Co-administration with cobicistat may result in increased plasma concentrations of the DOAC, which may lead to an increased bleeding risk. Co-administration of apixaban, rivaroxaban or edoxaban is not recommended with Tybost.
Atazanavir, cobicistat [2] ---> SmPC of [2] of EMA
Cobicistat is a strong mechanism-based CYP3A inhibitor. Increased plasma concentrations of medicinal products that are metabolised by CYP3A (including atazanavir and darunavir) are observed on co-administration with cobicistat.
Atazanavir/cobicistat [1], cobicistat ---> SmPC of [1] of EMA
Co-administration of EVOTAZ with medicinal products containing ritonavir or cobicistat, which are strong inhibitors of CYP3A, may result in additional boosting and increased plasma concentration of atazanavir. Concomitant use not recommended
Atorvastatin, cobicistat [2] ---> SmPC of [2] of EMA
Co-administration of atorvastatin with cobicistat is not recommended. If the use of atorvastatin is considered strictly necessary, the lowest possible dose of atorvastatin should be administered with careful monitoring.
Avapritinib [1], cobicistat ---> SmPC of [1] of EMA
Co-administration with strong or moderate CYP3A inhibitors should be avoided because it may increase the plasma concentration of avapritinib
BCRP substrates, cobicistat [2] ---> SmPC of [2] of EMA
Cobicistat inhibits the transporters BCRP. Co-administration of cobicistat with medicinal products that are substrates of these transporters can result in increased plasma concentrations of the co-administered medicinal products
Beclometasone/formoterol/glycopyrronium [1], cobicistat ---> SmPC of [1] of EMA
Beclometasone is less dependent on CYP3A metabolism than some other corticosteroids; however, the possibility of systemic effects with concomitant use of strong CYP3A inhibitors (e.g. ritonavir, cobicistat) cannot be excluded
Betamethasone, cobicistat [2] ---> SmPC of [2] of EMA
Corticosteroids primarily metabolised by CYP3A. Plasma concentrations of these medicinal products may be increased when co-administered with cobicistat, resulting in reduced serum cortisol concentrations.
Boceprevir, cobicistat [2] ---> SmPC of [2] of EMA
Co-administration of cobicistat with medicines that are moderate to weak inducers of CYP3A may result in decreased cobicistat plasma level and that of atazanavir/darunavir being boosted, leading to loss of therapeutic effect
Boosted protease-inhibitors, darunavir/cobicistat ---> SmPC of [cobicistat] of EMA
The combination may result in decreased plasma concentrations of darunavir and/or the other antiretroviral agent that require pharmacoenhancement leading to loss of antiviral activity and development of resistance.
Bosentan, cobicistat [2] ---> SmPC of [2] of EMA
Co-administration of cobicistat with medicines that are moderate to weak inducers of CYP3A may result in decreased cobicistat plasma level and that of atazanavir/darunavir being boosted, leading to loss of therapeutic effect
Breast-feeding, cobicistat [2] ---> SmPC of [2] of EMA
A risk to the newborns/infants cannot be excluded. Therefore, Tybost should not be used during breast-feeding.
Budesonide, cobicistat [2] ---> SmPC of [2] of EMA
Corticosteroids primarily metabolised by CYP3A. Plasma concentrations of these medicinal products may be increased when co-administered with cobicistat, resulting in reduced serum cortisol concentrations.
Buprenorphine/naloxone, cobicistat [2] ---> SmPC of [2] of EMA
No dosage adjustment necessary.
Buspirone, cobicistat [2] ---> SmPC of [2] of EMA
Concentrations of this sedative/hypnotic may be increased when co-administered with cobicistat.
Capivasertib [1], cobicistat ---> SmPC of [1] of EMA
Co-administration of TRUQAP with strong CYP3A4 inhibitors increases capivasertib concentration, which may increase the risk of TRUQAP toxicity. Co-administration with strong CYP3A4 inhibitors should be avoided
Carbamazepine, cobicistat [2] ---> SmPC of [2] of EMA
Co-administration of cobicistat with medicinal products that are strong inducers of CYP3A may result in decreased plasma levels of cobicistat and consequently that of atazanavir or darunavir being boosted, leading to loss of therapeutic effect
Cariprazine [1], cobicistat ---> SmPC of [1] of EMA
Therefore, co-administration of cariprazine with strong CYP3A4 inhibitors (e.g. boceprevir, clarithromycin, cobicistat, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, telithromycin, voriconazole
Cisapride, cobicistat [2] ---> SmPC of [2] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Clarithromycin, cobicistat [2] ---> SmPC of [2] of EMA
Concentrations of clarithromycin may be increased upon co-administration with cobicistat.
Clopidogrel, cobicistat [2] ---> SmPC of [2] of EMA
Co-administration of clopidogrel with cobicistat is expected to decrease clopidogrel active metabolite plasma concentrations, which may reduce the antiplatelet activity of clopidogrel. Co-administration of clopidogrel with cobicistat is not recommended.
Clorazepate, cobicistat [2] ---> SmPC of [2] of EMA
Concentrations of this sedative/hypnotic may be increased when co-administered with cobicistat.
Cobicistat [1], colchicine ---> SmPC of [1] of EMA
The co-administration may increase the plasma levels of colchicine. Dose reductions of colchicine may be required.
Cobicistat [1], corticosteroids primarily metabolised by CYP3A ---> SmPC of [1] of EMA
Corticosteroids primarily metabolised by CYP3A. Plasma concentrations of these medicinal products may be increased when co-administered with cobicistat, resulting in reduced serum cortisol concentrations.
Cobicistat [1], cyclosporine ---> SmPC of [1] of EMA
The co-administration may increase the plasma levels of immunosuppressive
Cobicistat [1], CYP3A4 inductors ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicines that are moderate to weak inducers of CYP3A may result in decreased cobicistat plasma level and that of atazanavir/darunavir being boosted, leading to loss of therapeutic effect
Cobicistat [1], CYP3A4 inhibitors ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products that inhibit CYP3A may result in increased plasma concentration of cobicistat. Some examples include, but are not limited to, itraconazole, ketoconazole, and voriconazole (see Table 3).
Cobicistat [1], dabigatran ---> SmPC of [1] of EMA
Co-administration with Tybost may increase dabigatran plasma concentrations with similar effects as seen with other strong P-gp inhibitors. Co-administration of cobicistat with dabigatran is contraindicated.
Cobicistat [1], darunavir ---> SmPC of [1] of EMA
Cobicistat is a strong mechanism-based CYP3A inhibitor. Increased plasma concentrations of medicinal products that are metabolised by CYP3A (including atazanavir and darunavir) are observed on co-administration with cobicistat.
Cobicistat [1], dasatinib ---> SmPC of [1] of EMA
Concentrations of dasatinib may be increased when co-administered with cobicistat resulting in the potential for increased adverse events usually associated with this anticancer medicinal product.
Cobicistat [1], diazepam ---> SmPC of [1] of EMA
Concentrations of this sedative/hypnotic may be increased when co-administered with cobicistat.
Cobicistat [1], digoxin ---> SmPC of [1] of EMA
The co-administration may increase the plasma levels of digoxin
Cobicistat [1], dihydroergotamine ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Cobicistat [1], diltiazem ---> SmPC of [1] of EMA
Concentrations of calcium channel blockers may be increased when co-administered with cobicistat. Clinical monitoring of therapeutic effect and adverse events is recommended when these medicinal products are co-administered with Tybost.
Cobicistat [1], disopyramide ---> SmPC of [1] of EMA
The co-administration with cobicistat may increase the concentrations of antiarrhythmic
Cobicistat [1], drugs primarily metabolised by CYP2D6 ---> SmPC of [1] of EMA
Cobicistat is a weak CYP2D6 inhibitor. Co-administration with cobicistat can increase plasma concentrations of medicinal products that are metabolised by CYP2D6
Cobicistat [1], drugs primarily metabolised by CYP3A4 ---> SmPC of [1] of EMA
Cobicistat is a strong mechanism-based CYP3A inhibitor. Increased plasma concentrations of medicinal products that are metabolised by CYP3A (including atazanavir and darunavir) are observed on co-administration with cobicistat.
Cobicistat [1], edoxaban ---> SmPC of [1] of EMA
Interaction not studied. Co-administration with cobicistat may result in increased plasma concentrations of the DOAC, which may lead to an increased bleeding risk. Co-administration of apixaban, rivaroxaban or edoxaban is not recommended with Tybost.
Cobicistat [1], efavirenz ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicines that are moderate to weak inducers of CYP3A may result in decreased cobicistat plasma level and that of atazanavir/darunavir being boosted, leading to loss of therapeutic effect
Cobicistat [1], ergometrine ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Cobicistat [1], ergotamine ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Cobicistat [1], estazolam ---> SmPC of [1] of EMA
Concentrations of this sedative/hypnotic may be increased when co-administered with cobicistat.
Cobicistat [1], ethinyl estradiol ---> SmPC of [1] of EMA
Concentrations of contraceptive components may be affected on co-administration with cobicistat. Alternative forms of contraception should be used.
Cobicistat [1], etravirine ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicines that are moderate to weak inducers of CYP3A may result in decreased cobicistat plasma level and that of atazanavir/darunavir being boosted, leading to loss of therapeutic effect
Cobicistat [1], felodipine ---> SmPC of [1] of EMA
Concentrations of calcium channel blockers may be increased when co-administered with cobicistat. Clinical monitoring of therapeutic effect and adverse events is recommended when these medicinal products are co-administered with Tybost.
Cobicistat [1], fertility ---> SmPC of [1] of EMA
No human data on the effect of cobicistat on fertility are available. Animal studies do not indicate harmful effects of cobicistat on fertility.
Cobicistat [1], flecainide ---> SmPC of [1] of EMA
The co-administration with cobicistat may increase the concentrations of antiarrhythmic
Cobicistat [1], fluconazole ---> SmPC of [1] of EMA
Concentrations of fluconazole may be increased when co-administered with cobicistat.
Cobicistat [1], flurazepam ---> SmPC of [1] of EMA
Concentrations of this sedative/hypnotic may be increased when co-administered with cobicistat.
Cobicistat [1], fluticasone ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicines that are moderate to weak inducers of CYP3A may result in decreased cobicistat plasma level and that of atazanavir/darunavir being boosted, leading to loss of therapeutic effect
Cobicistat [1], fluvastatin ---> SmPC of [1] of EMA
Plasma concentrations of HMG Co-A reductase inhibitor may be increased when co-administered with cobicistat.
Cobicistat [1], itraconazol ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products that inhibit CYP3A may result in increased plasma concentration of cobicistat. Some examples include, but are not limited to, itraconazole, ketoconazole, and voriconazole (see Table 3).
Cobicistat [1], ketoconazole ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products that inhibit CYP3A may result in increased plasma concentration of cobicistat. Some examples include, but are not limited to, itraconazole, ketoconazole, and voriconazole (see Table 3).
Cobicistat [1], lidocaine ---> SmPC of [1] of EMA
The co-administration with cobicistat may increase the concentrations of antiarrhythmic
Cobicistat [1], lovastatine ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Cobicistat [1], MATE1 substrates ---> SmPC of [1] of EMA
Cobicistat inhibits the transporters MATE1. Co-administration of cobicistat with medicinal products that are substrates of these transporters can result in increased plasma concentrations of the co-administered medicinal products
Cobicistat [1], metformin ---> SmPC of [1] of EMA
Cobicistat, MATE1 inhibitor, may increase the plasma levels of metformin
Cobicistat [1], methadone ---> SmPC of [1] of EMA
No dosage adjustment necessary.
Cobicistat [1], metoprolol ---> SmPC of [1] of EMA
The co-administration with cobicistat may increase the concentrations of betablocker
Cobicistat [1], mexiletine ---> SmPC of [1] of EMA
The co-administration with cobicistat may increase the concentrations of antiarrhythmic
Cobicistat [1], midazolam ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Cobicistat [1], moderate CYP3A4 inductors ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicines that are moderate to weak inducers of CYP3A may result in decreased cobicistat plasma level and that of atazanavir/darunavir being boosted, leading to loss of therapeutic effect
Cobicistat [1], mometasone ---> SmPC of [1] of EMA
Corticosteroids primarily metabolised by CYP3A. Plasma concentrations of these medicinal products may be increased when co-administered with cobicistat, resulting in reduced serum cortisol concentrations.
Cobicistat [1], nevirapine ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicines that are moderate to weak inducers of CYP3A may result in decreased cobicistat plasma level and that of atazanavir/darunavir being boosted, leading to loss of therapeutic effect
Cobicistat [1], nicardipine ---> SmPC of [1] of EMA
Concentrations of calcium channel blockers may be increased when co-administered with cobicistat. Clinical monitoring of therapeutic effect and adverse events is recommended when these medicinal products are co-administered with Tybost.
Cobicistat [1], nifedipine ---> SmPC of [1] of EMA
Concentrations of calcium channel blockers may be increased when co-administered with cobicistat. Clinical monitoring of therapeutic effect and adverse events is recommended when these medicinal products are co-administered with Tybost.
Cobicistat [1], nilotinib ---> SmPC of [1] of EMA
Concentrations of nilotinib may be increased when co-administered with cobicistat resulting in the potential for increased adverse events usually associated with this anticancer medicinal product.
Cobicistat [1], norgestimate ---> SmPC of [1] of EMA
Concentrations of contraceptive components may be affected on co-administration with cobicistat. Alternative forms of contraception should be used.
Cobicistat [1], OATP1B1 substrates ---> SmPC of [1] of EMA
Cobicistat inhibits the transporters OATP1B1. Co-administration of cobicistat with medicinal products that are substrates of these transporters can result in increased plasma concentrations of the co-administered medicinal products
Cobicistat [1], OATP1B3 substrates ---> SmPC of [1] of EMA
Cobicistat inhibits the transporters OATP1B3. Co-administration of cobicistat with medicinal products that are substrates of these transporters can result in increased plasma concentrations of the co-administered medicinal products
Cobicistat [1], oral contraceptives ---> SmPC of [1] of EMA
Concentrations of contraceptive components may be affected on co-administration with cobicistat. Alternative forms of contraception should be used.
Cobicistat [1], P-glycoprotein substrates ---> SmPC of [1] of EMA
Cobicistat inhibits the transporters p-glycoprotein (P-gp). Co-administration of cobicistat with medicinal products that are substrates of these transporters can result in increased plasma concentrations of the co-administered medicinal products
Cobicistat [1], perphenazine ---> SmPC of [1] of EMA
The co-administration may increase the plasma levels of neuroleptic
Cobicistat [1], pharmacoenhancer ---> SmPC of [1] of EMA
If switching pharmacoenhancer from ritonavir to cobicistat, caution is required during the first 2 weeks, particularly if doses of any coadministered medicinal products have been titrated or adjusted during use of ritonavir as pharmacoenhancer
Cobicistat [1], phenobarbital ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products that are strong inducers of CYP3A may result in decreased plasma levels of cobicistat and consequently that of atazanavir or darunavir being boosted, leading to loss of therapeutic effect
Cobicistat [1], phenytoin ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products that are strong inducers of CYP3A may result in decreased plasma levels of cobicistat and consequently that of atazanavir or darunavir being boosted, leading to loss of therapeutic effect
Cobicistat [1], pimozide ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Cobicistat [1], pitavastatin ---> SmPC of [1] of EMA
Plasma concentrations of HMG Co-A reductase inhibitor may be increased when co-administered with cobicistat.
Cobicistat [1], posaconazole ---> SmPC of [1] of EMA
Concentrations of posaconazole may be increased when co-administered with cobicistat.
Cobicistat [1], prasugrel ---> SmPC of [1] of EMA
Cobicistat is not expected to have a clinically relevant effect on plasma concentrations of the active metabolite of prasugrel. No dose adjustment of prasugrel is required.
Cobicistat [1], pravastatine ---> SmPC of [1] of EMA
The co-administration may increase the plasma levels of statine
Cobicistat [1], prednisone ---> SmPC of [1] of EMA
Corticosteroids primarily metabolised by CYP3A. Plasma concentrations of these medicinal products may be increased when co-administered with cobicistat, resulting in reduced serum cortisol concentrations.
Cobicistat [1], pregnancy ---> SmPC of [1] of EMA
Therapy with cobicistat and atazanavir or darunavir should not be initiated during pregnancy, and women who become pregnant during therapy with cobicistat and atazanavir or darunavir should be switched to an alternative regimen
Cobicistat [1], propafenone ---> SmPC of [1] of EMA
The co-administration with cobicistat may increase the concentrations of antiarrhythmic
Cobicistat [1], quinidine ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Cobicistat [1], rifabutin ---> SmPC of [1] of EMA
Co-administration of rifabutin, a potent CYP3A inducer, may significantly decrease cobicistat plasma concentrations. The combination is not recommended
Cobicistat [1], rifampicin ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products that are strong inducers of CYP3A may result in decreased plasma levels of cobicistat and consequently that of atazanavir or darunavir being boosted, leading to loss of therapeutic effect
Cobicistat [1], rilpivirine ---> SmPC of [1] of EMA
Co-administration of rilpivirine and cobicistat is expected to increase the plasma concentration of rilpivirine. No dosage adjustment necessary.
Cobicistat [1], risperidone ---> SmPC of [1] of EMA
The co-administration may increase the plasma levels of neuroleptic
Cobicistat [1], ritonavir ---> SmPC of [1] of EMA
Cobicistat should not be used concurrently with ritonavir due to similar effects of cobicistat and ritonavir on CYP3A.
Cobicistat [1], rivaroxaban ---> SmPC of [1] of EMA
Inhibition of CYP3A and intestinal P-gp may lead to increased plasma levels and pharmacodynamic effects of rivaroxaban which may lead to an increased bleeding risk.
Cobicistat [1], rosuvastatin ---> SmPC of [1] of EMA
Plasma concentrations of HMG Co-A reductase inhibitors may be increased when co-administered with cobicistat
Cobicistat [1], salmeterol ---> SmPC of [1] of EMA
Co-administration of salmeterol with cobicistat may result in increased plasma concentrations of salmeterol. Increased plasma concentrations of salmeterol are associated with the potential for serious and/or life-threatening reactions.
Cobicistat [1], sildenafil ---> SmPC of [1] of EMA
Co-administration with cobicistat may result in increased sildenafil plasma concentrations, which may result in PDE-5 inhibitor-associated adverse reactions. Co-administration for the treatment of pulmonary arterial hypertension is contraindicated
Cobicistat [1], simvastatine ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Cobicistat [1], sirolimus ---> SmPC of [1] of EMA
The co-administration may increase the plasma levels of immunosuppressive
Cobicistat [1], SSRI ---> SmPC of [1] of EMA
Dose titration may be required for most medicinal products of the SSRI class, when co-administered with cobicistat.
Cobicistat [1], St. John's wort ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products that are strong inducers of CYP3A may result in decreased plasma levels of cobicistat and consequently that of atazanavir or darunavir being boosted, leading to loss of therapeutic effect
Cobicistat [1], statins ---> SmPC of [1] of EMA
Plasma concentrations of HMG Co-A reductase inhibitors may be increased when co-administered with cobicistat
Cobicistat [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products that are strong inducers of CYP3A may result in decreased plasma levels of cobicistat and consequently that of atazanavir or darunavir being boosted, leading to loss of therapeutic effect
Cobicistat [1], strong CYP3A4 inhibitors ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products that inhibit CYP3A may result in increased plasma concentration of cobicistat. Some examples include, but are not limited to, itraconazole, ketoconazole, and voriconazole (see Table 3).
Cobicistat [1], tacrolimus ---> SmPC of [1] of EMA
The co-administration may increase the plasma levels of immunosuppressive
Cobicistat [1], tadalafil ---> SmPC of [1] of EMA
Co-administration with cobicistat may result in increased tadalafil plasma concentrations, which may result in PDE-5 inhibitor-associated adverse reactions.
Cobicistat [1], telaprevir ---> SmPC of [1] of EMA
No dose adjustment is required when cobicistat is co-administered with telaprevir.
Cobicistat [1], tenofovir ---> SmPC of [1] of EMA
Co-administration of tenofovir disoproxil fumarate with cobicistat is expected to increase tenofovir plasma concentration. No dosage adjustment necessary.
Cobicistat [1], thioridazine ---> SmPC of [1] of EMA
The co-administration may increase the plasma levels of neuroleptic
Cobicistat [1], timolol ---> SmPC of [1] of EMA
The co-administration with cobicistat may increase the concentrations of betablocker
Cobicistat [1], trazodone ---> SmPC of [1] of EMA
Plasma concentrations of trazodone may be increased when co-administered with cobicistat.
Cobicistat [1], triamcinolone ---> SmPC of [1] of EMA
Corticosteroids primarily metabolised by CYP3A. Plasma concentrations of these medicinal products may be increased when co-administered with cobicistat, resulting in reduced serum cortisol concentrations.
Cobicistat [1], triazolam ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products which are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated
Cobicistat [1], vardenafil ---> SmPC of [1] of EMA
Co-administration with cobicistat may result in increased vardenafil plasma concentrations, which may result in PDE-5 inhibitor-associated adverse reactions.
Cobicistat [1], verapamil ---> SmPC of [1] of EMA
Concentrations of calcium channel blockers may be increased when co-administered with cobicistat. Clinical monitoring of therapeutic effect and adverse events is recommended when these medicinal products are co-administered with Tybost.
Cobicistat [1], vinblastine ---> SmPC of [1] of EMA
Concentrations of vinblastine may be increased when co-administered with cobicistat resulting in the potential for increased adverse events usually associated with this anticancer medicinal product.
Cobicistat [1], vincristine ---> SmPC of [1] of EMA
Concentrations of vincristine may be increased when co-administered with cobicistat resulting in the potential for increased adverse events usually associated with this anticancer medicinal product.
Cobicistat [1], voriconazole ---> SmPC of [1] of EMA
Co-administration of cobicistat with medicinal products that inhibit CYP3A may result in increased plasma concentration of cobicistat. Some examples include, but are not limited to, itraconazole, ketoconazole, and voriconazole (see Table 3).
Cobicistat [1], warfarin ---> SmPC of [1] of EMA
Concentrations of warfarin may be affected upon co-administration with cobicistat.
Cobicistat [1], zolpidem ---> SmPC of [1] of EMA
Concentrations of this sedative/hypnotic may be increased when co-administered with cobicistat.
Cobicistat, cobicistat [2] ---> SmPC of [2] of EMA
Cobicistat should not be used in combination with other medicinal products containing cobicistat (such as the fixed-dose combination tablet elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil).
Cobicistat, cobimetinib [2] ---> SmPC of [2] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobicistat, daclatasvir [2] ---> SmPC of [2] of EMA
Strong inhibitors of CYP3A4 may increase the plasma levels of daclatasvir. Dose adjustment of daclatasvir is recommended when coadministered with strong inhibitors of CYP3A4
Cobicistat, darunavir/cobicistat [2] ---> SmPC of [2] of EMA
Darunavir/cobicistat should not be used in combination with the individual components (darunavir or cobicistat)
Cobicistat, darunavir/ritonavir ---> SmPC of [darunavir] of EMA
Co-administration of darunavir boosted with cobicistat with systemic lidocaine is contraindicated
Cobicistat, dasabuvir with ombitasvir/paritaprevir/ritonavir ---> SmPC of [ombitasvir/paritaprevir/ritonavir] of E
Co-administration of ombitasvir/paritaprevir/ritonavir with or without dasabuvir with medicinal products that are strong inhibitors of CYP3A4 is expected to increase paritaprevir plasma concentrations. The coadministration is contraindicated
Cobicistat, doravirine [2] ---> SmPC of [2] of EMA
No dose adjustment is required.
Cobicistat, duvelisib [2] ---> SmPC of [2] of EMA
Duvelisib dose should be reduced to 15 mg twice daily when co-administered with a strong CYP3A4 inhibitor
Cobicistat, eliglustat [2] ---> SmPC of [2] of EMA
Increased eliglustat exposition would be expected for strong inhibitors of CYP3A. Caution should be used with strong CYP3A inhibitors in intermediate and extensive metabolisers.
Cobicistat, elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil ---> SmPC of [cobicistat] of EMA
Cobicistat should not be used in combination with other medicinal products containing cobicistat (such as the fixed-dose combination tablet elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil).
Cobicistat, emtricitabine/tenofovir alafenamide [2] ---> SmPC of [2] of EMA
Co-administration of Descovy with other medicinal products that inhibit P-gp (e.g., cobicistat, ritonavir, ciclosporin) are expected to increase the absorption and plasma concentration of tenofovir alafenamide.
Cobicistat, enfortumab vedotin [2] ---> SmPC of [2] of EMA
Patients receiving concomitant strong CYP3A4 inhibitors should be monitored more closely for signs of toxicities.
Cobicistat, finerenone [2] ---> SmPC of [2] of EMA
Concomitant use of Kerendia with strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir, nelfinavir, cobicistat, telithromycin or nefazodone) is contraindicated (see section 4.3), since a marked increase in finerenone exposure is expected.
Cobicistat, fluticasone furoate [2] ---> SmPC of [2] of EMA
Caution is recommended when co-administering fluticasone furoate with potent CYP3A inhibitors including cobicistat-containing products as an increase in the risk of systemic side effects is expected.
Cobicistat, fluticasone furoate/umeclidinium/vilanterol [2] ---> SmPC of [2] of EMA
Caution is advised when co-administering with strong CYP 3A4 inhibitors (e.g. ketoconazole, ritonavir, cobicistat-containing products) as there is potential for increased systemic exposure to both fluticasone furoate and vilanterol.
Cobicistat, formoterol/glycopyrronium/budesonide [2] ---> SmPC of [2] of EMA
The metabolism of budesonide is primarily mediated by CYP3A4. Co-treatment with strong CYP3A inhibitors are expected to increase the risk of systemic side effects, and should be avoided
Cobicistat, fostamatinib [2] ---> SmPC of [2] of EMA
Concomitant use of fostamatinib with strong CYP3A4 inhibitors increases exposure to R406 (the major active metabolite), which may increase the risk of adverse reactions.
Cobicistat, fostemsavir [2] ---> SmPC of [2] of EMA
Temsavir (inhibition of CYP3A enzymes, P-gp and/or BCRP). Cobicistat increased temsavir plasma concentrations. No dose adjustment is necessary
Cobicistat, glasdegib [2] ---> SmPC of [2] of EMA
Caution should be used when administering concomitantly with strong CYP3A4 inhibitors as an increase in glasdegib plasma concentration may occur.
Cobicistat, glecaprevir/pibrentasvir [2] ---> SmPC of [2] of EMA
Co-administration of Maviret with medicinal products that inhibit P-gp and BCRP may slow elimination of glecaprevir and pibrentasvir and thereby increase plasma exposure of the antivirals.
Cobicistat, glycopyrronium/indacaterol/mometasone [2] ---> SmPC of [2] of EMA
However, there may be a potential for increased systemic exposure to mometasone furoate when strong CYP3A4 inhibitors (e.g. ketoconazole, itraconazole, nelfinavir, ritonavir, cobicistat) are co-administered.
Cobicistat, ibrutinib [2] ---> SmPC of [2] of EMA
Concomitant use of IMBRUVICA and medicinal products that strongly or moderately inhibit CYP3A4 can increase ibrutinib exposure and strong CYP3A4 inhibitors should be avoided.
Cobicistat, indacaterol/mometasone [2] ---> SmPC of [2] of EMA
There may be a potential for increased systemic exposure to mometasone furoate when strong CYP3A4 inhibitors (e.g. ketoconazole, itraconazole, nelfinavir, ritonavir, cobicistat) are co-administered.
Cobicistat, lenacapavir [2] ---> SmPC of [2] of EMA
Strong inhibitors of CYP3A4 and P-gp together (e.g. cobicistat) do not result in a clinically meaningful increase in lenacapavir exposures.
Cobicistat, lorlatinib [2] ---> SmPC of [2] of EMA
CYP3A4/5 inhibitors may increase lorlatinib plasma concentrations and should be avoided
Cobicistat, lurasidone [2] ---> SmPC of [2] of EMA
Lurasidone and its active metabolite ID-14283 are primarily metabolised by CYP3A4. Lurasidone is contraindicated with strong CYP3A4 inhibitors
Cobicistat, maraviroc [2] ---> SmPC of [2] of EMA
The strong CYP3A4 inhibition by cobicistat may increase the plasma concentrations of maraviroc. Dose adjustment of maraviroc is recommended
Cobicistat, neratinib [2] ---> SmPC of [2] of EMA
Concomitant use of strong or moderate CYP3A4/P-gp inhibitors significantly increased neratinib systemic exposure, therefore, concomitant use of neratinib with strong and moderate CYP3A4/P-gp inhibitors is not recommended
Cobicistat, ombitasvir/paritaprevir/ritonavir [2] ---> SmPC of [2] of EMA
Co-administration of ombitasvir/paritaprevir/ritonavir with or without dasabuvir with medicinal products that are strong inhibitors of CYP3A4 is expected to increase paritaprevir plasma concentrations. The coadministration is contraindicated
Cobicistat, polatuzumab vedotin [2] ---> SmPC of [2] of EMA
Caution is advised in case of concomitant treatment with CYP3A4 inhibitor. Patients receiving concomitant strong CYP3A4 inhibitors should be monitored more closely for signs of toxicities.
Cobicistat, saquinavir [2] ---> SmPC of [2] of EMA
It is not recommended to coadminister Invirase/ritonavir with cobicistat containing products
Cobicistat, simeprevir [2] ---> SmPC of [2] of EMA
The strong CYP3A4 enzyme inhibition can significantly increase plasma concentrations of simeprevir. It is not recommended to co-administer OLYSIO with cobicistat-containing medicinal products.
Cobicistat, talazoparib [2] ---> SmPC of [2] of EMA
Concomitant use of strong P-gp inhibitors should be avoided. If co-administration with a strong P-gp inhibitor is unavoidable, the Talzenna dose should be reduced (see section 4.2).
Cobicistat, tipranavir [2] ---> SmPC of [2] of EMA
When co-administered, tipranavir and cobicistat exposures are much lower compared to that of tipranavir when boosted with low dose ritonavir. Tipranavir/ritonavir should not be administered concomitantly with cobicistat or cobicistat-containing products.
Cobicistat, tipranavir/ritonavir ---> SmPC of [tipranavir] of EMA
When co-administered, tipranavir and cobicistat exposures are much lower compared to that of tipranavir when boosted with low dose ritonavir. Tipranavir/ritonavir should not be administered concomitantly with cobicistat or cobicistat-containing products.
CONTRAINDICATIONS of Cobicistat (Tybost)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Co-administration is contraindicated with medicinal products that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening
Co-administration is contraindicated with medicinal products that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening
- alpha 1-adrenoreceptor antagonists: alfuzosin
- antiarrhythmics: amiodarone, quinidine
- ergot derivatives: dihydroergotamine, ergometrine, ergotamine
- HMG Co-A reductase inhibitors: lovastatin, simvastatin
- neuroleptics/antipsychotics: pimozide, lurasidone
- PDE-5 inhibitors: sildenafil for treatment of pulmonary arterial hypertension
- sedatives/hypnotics: orally administered midazolam, triazolam
- Co-administration is contraindicated with medicinal products that are strong inducers of CYP3A due to the potential for loss of therapeutic effect. Therefore, Tybost should not be co-administered with medicinal products that include, but are not limited to, the following (see sections 4.4 and 4.5):
- anticonvulsants: carbamazepine, phenobarbital, phenytoin
- antimycobacterials: rifampicin
- herbal products: St. John's wort (Hypericum perforatum)
- Co-administration with dabigatran etexilate, a P-glycoprotein (P-gp) substrate, is contraindicated (see section 4.5).
https://www.ema.europa.eu/en/documents/product-information/tybost-epar-product-information_en.pdf 14/02/2023
Cobimetinib (Cotellic)
Ability to drive, cobimetinib [2] ---> SmPC of [2] of EMA
Patients should be advised not to drive or use machines if they experience visual disturbances or any other adverse effects that may affect their ability.
Amiodarone, cobimetinib [2] ---> SmPC of [2] of EMA
Caution should be exercised if cobimetinib is coadministered with moderate CYP3A inhibitors. When cobimetinib is co-administered with a moderate CYP3A inhibitor, patients should be carefully monitored for safety.
Amprenavir, cobimetinib [2] ---> SmPC of [2] of EMA
Caution should be exercised if cobimetinib is coadministered with moderate CYP3A inhibitors. When cobimetinib is co-administered with a moderate CYP3A inhibitor, patients should be carefully monitored for safety.
BCRP substrates, cobimetinib [2] ---> SmPC of [2] of EMA
In vitro, cobimetinib is a moderate inhibitor of BCRP (Breast Cancer Resistance Protein). Clinically relevant inhibition of intestinal BCRP cannot be ruled out.
Breast-feeding, cobimetinib [2] ---> SmPC of [2] of EMA
A decision should be made whether to discontinue breast-feeding or discontinue Cotellic therapy, taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.
Carbamazepine, cobimetinib [2] ---> SmPC of [2] of EMA
Concomitant use of moderate and strong CYP3A inducers should be avoided. Given that cobimetinib concentrations are likely to be significantly reduced when co-administered with moderate to strong CYP3A inducers, patient's efficacy may be compromised.
Clarithromycin, cobimetinib [2] ---> SmPC of [2] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobicistat, cobimetinib [2] ---> SmPC of [2] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobimetinib [1], cyclosporine ---> SmPC of [1] of EMA
Cobimetinib is a substrate of P-glycoprotein (P-gp). Concomitant administration of P-gp inhibitors such as ciclosporin and verapamil may have the potential to increase plasma concentrations of cobimetinib.
Cobimetinib [1], CYP1A2 substrates ---> SmPC of [1] of EMA
In vitro, cobimetinib is a potential inducer of CYP1A2 and may therefore reduce the exposure of substrates of this enzyme e.g., theophylline.
Cobimetinib [1], CYP3A4 inhibitors ---> SmPC of [1] of EMA
Cobimetinib can be co-administered with mild inhibitors of CYP3A without dose adjustment.
Cobimetinib [1], delavirdine ---> SmPC of [1] of EMA
Caution should be exercised if cobimetinib is coadministered with moderate CYP3A inhibitors. When cobimetinib is co-administered with a moderate CYP3A inhibitor, patients should be carefully monitored for safety.
Cobimetinib [1], dextromethorphan ---> SmPC of [1] of EMA
A clinical drug-drug interaction (DDI) study in cancer patients showed that plasma concentrations of midazolam (a sensitive CYP3A substrate) and dextromethorphan (a sensitive CYP2D6 substrate) were not altered in the presence of cobimetinib.
Cobimetinib [1], diltiazem ---> SmPC of [1] of EMA
Caution should be exercised if cobimetinib is coadministered with moderate CYP3A inhibitors. When cobimetinib is co-administered with a moderate CYP3A inhibitor, patients should be carefully monitored for safety.
Cobimetinib [1], drug transport systems ---> SmPC of [1] of EMA
In vitro studies show that cobimetinib is not a substrate of the liver uptake transporters OATP1B1, OATP1B3 and OCT1, however, it weakly inhibits these transporters. The clinical relevance of these findings has not been investigated.
Cobimetinib [1], erythromycin ---> SmPC of [1] of EMA
Caution should be exercised if cobimetinib is coadministered with moderate CYP3A inhibitors. When cobimetinib is co-administered with a moderate CYP3A inhibitor, patients should be carefully monitored for safety.
Cobimetinib [1], fertility ---> SmPC of [1] of EMA
There are no data in humans for cobimetinib. In animals, no fertility studies have been performed, but adverse effects were seen on reproductive organs (see section 5.3). The clinical relevance of this is unknown.
Cobimetinib [1], fluconazole ---> SmPC of [1] of EMA
Caution should be exercised if cobimetinib is coadministered with moderate CYP3A inhibitors. When cobimetinib is co-administered with a moderate CYP3A inhibitor, patients should be carefully monitored for safety.
Cobimetinib [1], fosamprenavir ---> SmPC of [1] of EMA
Caution should be exercised if cobimetinib is coadministered with moderate CYP3A inhibitors. When cobimetinib is co-administered with a moderate CYP3A inhibitor, patients should be carefully monitored for safety.
Cobimetinib [1], grapefruit juice ---> SmPC of [1] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobimetinib [1], imatinib ---> SmPC of [1] of EMA
Caution should be exercised if cobimetinib is coadministered with moderate CYP3A inhibitors. When cobimetinib is co-administered with a moderate CYP3A inhibitor, patients should be carefully monitored for safety.
Cobimetinib [1], itraconazol ---> SmPC of [1] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobimetinib [1], lopinavir ---> SmPC of [1] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobimetinib [1], miconazole ---> SmPC of [1] of EMA
Caution should be exercised if cobimetinib is coadministered with moderate CYP3A inhibitors. When cobimetinib is co-administered with a moderate CYP3A inhibitor, patients should be carefully monitored for safety.
Cobimetinib [1], midazolam ---> SmPC of [1] of EMA
A clinical drug-drug interaction (DDI) study in cancer patients showed that plasma concentrations of midazolam (a sensitive CYP3A substrate) and dextromethorphan (a sensitive CYP2D6 substrate) were not altered in the presence of cobimetinib.
Cobimetinib [1], moderate CYP3A4 inductors ---> SmPC of [1] of EMA
Concomitant use of moderate and strong CYP3A inducers should be avoided. Given that cobimetinib concentrations are likely to be significantly reduced when co-administered with moderate to strong CYP3A inducers, patient's efficacy may be compromised.
Cobimetinib [1], moderate CYP3A4 inhibitors ---> SmPC of [1] of EMA
Caution should be exercised if cobimetinib is coadministered with moderate CYP3A inhibitors. When cobimetinib is co-administered with a moderate CYP3A inhibitor, patients should be carefully monitored for safety.
Cobimetinib [1], nefazodone ---> SmPC of [1] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobimetinib [1], P-gp inhibitors ---> SmPC of [1] of EMA
Cobimetinib is a substrate of P-glycoprotein (P-gp). Concomitant administration of P-gp inhibitors such as ciclosporin and verapamil may have the potential to increase plasma concentrations of cobimetinib.
Cobimetinib [1], phenytoin ---> SmPC of [1] of EMA
Concomitant use of moderate and strong CYP3A inducers should be avoided. Given that cobimetinib concentrations are likely to be significantly reduced when co-administered with moderate to strong CYP3A inducers, patient's efficacy may be compromised.
Cobimetinib [1], posaconazole ---> SmPC of [1] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobimetinib [1], pregnancy ---> SmPC of [1] of EMA
Cotellic should not be used during pregnancy unless clearly necessary and after a careful consideration of the needs of the mother and the risk to the foetus.
Cobimetinib [1], QT interval prolonging drugs ---> SmPC of [1] of EMA
If during treatment the QTc exceeds 500 msec, please refer to the vemurafenib SmPC (section 4.2) for dose modifications for vemurafenib. No dose modification of Cotellic is required when taken in combination with vemurafenib.
Cobimetinib [1], rifampicin ---> SmPC of [1] of EMA
Concomitant use of moderate and strong CYP3A inducers should be avoided. Given that cobimetinib concentrations are likely to be significantly reduced when co-administered with moderate to strong CYP3A inducers, patient's efficacy may be compromised.
Cobimetinib [1], ritonavir ---> SmPC of [1] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobimetinib [1], St. John's wort ---> SmPC of [1] of EMA
Concomitant use of moderate and strong CYP3A inducers should be avoided. Given that cobimetinib concentrations are likely to be significantly reduced when co-administered with moderate to strong CYP3A inducers, patient's efficacy may be compromised.
Cobimetinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA
Concomitant use of moderate and strong CYP3A inducers should be avoided. Given that cobimetinib concentrations are likely to be significantly reduced when co-administered with moderate to strong CYP3A inducers, patient's efficacy may be compromised.
Cobimetinib [1], strong CYP3A4 inhibitors ---> SmPC of [1] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobimetinib [1], strong CYP3A4 inhibitors ---> SmPC of [1] of EMA
For strong CYP3A inhibitors used short-term (7 days or less), consider interrupting cobimetinib therapy during the duration of inhibitor use.
Cobimetinib [1], telaprevir ---> SmPC of [1] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobimetinib [1], telithromycin ---> SmPC of [1] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobimetinib [1], theophylline ---> SmPC of [1] of EMA
In vitro, cobimetinib is a potential inducer of CYP1A2 and may therefore reduce the exposure of substrates of this enzyme e.g., theophylline.
Cobimetinib [1], vemurafenib ---> SmPC of [1] of EMA
There is no evidence of any clinically significant drug-drug interaction between cobimetinib and vemurafenib in unresectable or metastatic melanoma patients and therefore no dose adjustments is recommended.
Cobimetinib [1], verapamil ---> SmPC of [1] of EMA
Caution should be exercised if cobimetinib is coadministered with moderate CYP3A inhibitors. When cobimetinib is co-administered with a moderate CYP3A inhibitor, patients should be carefully monitored for safety.
Cobimetinib [1], voriconazole ---> SmPC of [1] of EMA
Avoid concurrent use of strong CYP3A inhibitors during treatment with cobimetinib. If concomitant use of a strong CYP3A inhibitor is unavoidable, patients should be carefully monitored for safety.
Cobimetinib [1], women of childbearing potential ---> SmPC of [1] of EMA
Women of childbearing potential should use two effective contraceptive methods, such as a condom or other barrier method (with spermicide, if available) during treatment with Cotellic and for at least three months following treatment discontinuation.
CONTRAINDICATIONS of Cobimetinib (Cotellic)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/cotellic-epar-product-information_en.pdf 27/03/2024
Codeine
Ability to drive, codeine [2] ---> SPC of [2] of eMC
Codeine may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery.
Abiraterone [1], codeine ---> SPC of [1] of EMA
Caution is advised when administering abiraterone with medicinal products activated by or metabolised by CYP2D6, particularly with medicinal products that have a narrow therapeutic index.
Alcohol, codeine [2] ---> SPC of [2] of eMC
Enhanced sedative and hypotensive effect, increased risk of respiratory depression
Amitriptyline, codeine
The co-administration may cause additive depression of CNS and may enhance the respiratory depressor effect
Analgesics, codeine
Possible mutual potentiation of the analgetic effect
Anticholinergics, codeine [2] ---> SPC of [2] of eMC
Risk of severe constipation which may lead to paralytic ileus, and /or urinary retention
Antidiarrheals, codeine [2] ---> SPC of [2] of eMC
Increased risk of severe constipation
Antihistamines, codeine ---> SPC of [2] of eMC
Enhanced sedative and hypotensive effect, increased risk of respiratory depression
Antihypertensives, codeine ---> SPC of [1] of eMC
Enhanced hypotensive effect.
Anxiolytics, codeine [2] ---> SPC of [2] of eMC
Enhanced sedative and hypotensive effect, increased risk of respiratory depression
Breast-feeding, codeine [2] ---> SPC of [2] of eMC
Codeine should not be used during breastfeeding
Buprenorphine [1], codeine ---> SPC of [1] of eMC
This combination increases central nervous system depression
Chlorpromazine, codeine
The co-administration may enhance the sedative and respiratory depressor effect
Cimetidine, codeine ---> SPC of [2] of eMC
Cimetidine inhibits the metabolism of opioid analgesics causing increased plasma concentration of codeine.
CNS depressants, codeine
The co-administration may cause additive depression of CNS
Codeine [1], IMAOs ---> SPC of [1] of eMC
MAOIs due to the possible risk of excitation or depression - avoid concomitant use and for 2 weeks after discontinuation of MAOI
Codeine [1], moclobemide ---> SPC of [1] of eMC
MAOIs due to the possible risk of excitation or depression - avoid concomitant use and for 2 weeks after discontinuation of MAOI
Codeine [1], naltrexone ---> SPC of [1] of eMC
Opioid antagonists eg buprenorphine, naltrexone, naloxone - may precipitate withdrawal symptoms
Codeine [1], neuroleptics ---> SPC of [1] of eMC
Enhanced sedative and hypotensive effect
Codeine [1], opioid agonist/antagonists ---> SPC of [1] of eMC
Opioid antagonists eg buprenorphine, naltrexone, naloxone - may precipitate withdrawal symptoms
Codeine [1], pregnancy ---> SPC of [1] of eMC
Risk benefit must be considered because opioid analgesics cross the placenta.
Codeine [1], tricyclic antidepressant ---> SPC of [1] of eMC
Enhanced sedative effect
Codeine, dextromethorphan/quinidine [2] ---> SPC of [2] of EMA
In the case of pro-drugs whose actions are mediated by the CYP2D6-produced metabolites, efficacy may be substantially reduced by dextromethorphan/quinidine due to inhibition of CYP2D6 and hence impaired formation of the active metabolite.
Codeine, enzyme inhibitors
The enzymatic inhibition may increase the codeine effect
Codeine, hypnotics ---> SPC of [1] of eMC
Enhanced sedative and hypotensive effect, increased risk of respiratory depression
Codeine, imipramine
The co-administration may cause additive depression of CNS and may enhance the respiratory depressor effect
Codeine, kaolin ---> SPC of [2] of eMC
Increased risk of severe constipation
Codeine, meclozine
The co-administration may enhance the sedative and respiratory depressor effect
Codeine, mexiletine ---> SPC of [1] of eMC
Delayed absorption of mexiletine
Codeine, midostaurin [2] ---> SPC of [2] of EMA
Medicinal products with a narrow therapeutic range that are substrates of CYP2D6 (e.g. codeine) should be used with caution when administered concomitantly with midostaurin and may need dose adjustment to maintain optimal exposure
Codeine, muscle relaxants
The co-administration may cause additive depression of CNS and additive respiratory depression
Codeine, opioid analgesics
The co-administration may cause additive depression of CNS
Codeine, opipramol
The co-administration may enhance the respiratory depressor effect
Codeine, pentazocine
Opioid antagonists eg buprenorphine, naltrexone, naloxone - may precipitate withdrawal symptoms
Codeine, perphenazine
The co-administration may enhance the sedative and respiratory depressor effect
Codeine, phenothiazines
The co-administration may enhance the sedative and respiratory depressor effect
Codeine, promethazine
The co-administration may enhance the sedative and respiratory depressor effect
Codeine, quinidine ---> SPC of [dextromethorphan/quinidine] of EMA
In the case of pro-drugs whose actions are mediated by the CYP2D6-produced metabolites, efficacy may be substantially reduced by quinidine due to inhibition of CYP2D6 and hence impaired formation of the active metabolite.
Codeine, secretolytics
The cough reflex inhibition may cause secretion congestion
Codeine, sedatives
The co-administration may enhance the sedative and respiratory depressor effect
Codeine, stiripentol [2] ---> SPC of [2] of EMA
Stiripentol is an inhibitor of the enzymes CYP2D6 and may markedly increase the plasma concentrations of substances metabolised by these enzymes and increase the risk of adverse reactions
Codeine, thioridazine
The co-administration may enhance the sedative and respiratory depressor effect
CONTRAINDICATIONS of Codeine
- Known hypersensitivity to codeine, other opioids or any of the excipients in the tablets
- Acute respiratory depression
- Obstructive airways disease- e.g. emphysema
- Asthma-Opioids should not be administered during an asthma attack
- Hepatic failure
- Head injuries or conditions where intracranial pressure is raised
- Acute alcoholism
- Risk of paralytic ileus
- In all paediatric patients (0-18 years of age) who undergo tonsillectomy and/or adenoidectomy for obstructive sleep apnoea syndrome due to an increased risk of
developing serious and life-threatening adverse reactions
- In women during breastfeeding
- In patients for whom it is known they are CYP2D6 ultra-rapid metabolisers
http://www.medicines.org.uk/emc/
Colchicine
Alcohol, colchicine
The co-administration may increase the colchicine toxicity
Anticoagulants, colchicine
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Antineoplastics, colchicine
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Atazanavir, colchicine ---> SPC of [2] of eMC
Colchicine is contraindicated in patients with renal or hepatic impairment who are taking a strong CYP3A4 inhibitor
Atazanavir/cobicistat [1], colchicine ---> SPC of [1] of EMA
Co-administration of medicinal products that are substrates of CYP3A and have narrow therapeutic indexes and for which elevated plasma concentrations are associated with serious and/or life-threatening events are contraindicated with EVOTAZ.
Atorvastatin, colchicine
Concomitant use of medicinal products that may cause rhabdomyolysis, in particular fibrates and statins, may increase the risk of rhabdomyolysis
Atorvastatin, colchicine ---> SPC of [ezetimibe/atorvastatin] of eMC
Cases of myopathy have been reported with atorvastatin coadministered with colchicine, and caution should be exercised when prescribing atorvastatin with colchicine
Bezafibrate, colchicine
Concomitant use of medicinal products that may cause rhabdomyolysis, in particular fibrates and statins, may increase the risk of rhabdomyolysis
Breast-feeding, colchicine [2] ---> SPC of [2] of eMC
Colchicine is distributed into breast milk. Colchicine may be used with caution during breast-feeding.
Cabozantinib [1], colchicine ---> SPC of [1] of EMA
Cabozantinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp. Subjects should be cautioned regarding taking a P-gp substrate while receiving cabozantinib.
Carfilzomib [1], colchicine ---> SPC of [1] of EMA
Carfilzomib is a P-glycoprotein (P-gp) but not a BCRP substrate. Caution should be observed when carfilzomib is combined with substrates of P-gp (e.g. digoxin, colchicine).
Ceritinib [1], colchicine ---> SPC of [1] of EMA
Based on in vitro data, ceritinib is predicted to inhibit intestinal P-gp. Therefore, ceritinib may have the potential to increase plasma concentrations of co-administered medicinal products transported by P-gp.
Cisplatin, colchicine
Cisplatin causes an increase in serum uric acid concentration
Clarithromycin, colchicine [2] ---> SPC of [2] of eMC
When clarithromycin and colchicine are administered together, inhibition of Pgp and/or CYP3A by clarithromycin may lead to increased exposure to colchicine. Patients should be monitored for clinical symptoms of colchicine toxicity
Cobicistat [1], colchicine ---> SPC of [1] of EMA
The co-administration may increase the plasma levels of colchicine
Colchicine [1], cyanocobalamin ---> SPC of [1] of eMC
The absorption of Vitamin B 12 may be impaired by chronic administration or high doses of colchicine; requirement may be increased.
Colchicine [1], cyclosporine ---> SPC of [1] of eMC
Colchicine should be used with caution with ciclosporin due to the possible increased risk of nephrotoxicity and myotoxicity.
Colchicine [1], CYP3A4 and P-glycoprotein-inhibitors ---> SPC of [1] of eMC
When clarithromycin and colchicine are administered together, inhibition of Pgp and/or CYP3A by clarithromycin may lead to increased exposure to colchicine. Patients should be monitored for clinical symptoms of colchicine toxicity
Colchicine [1], grapefruit juice ---> SPC of [1] of eMC
Colchicine is contraindicated in patients with renal or hepatic impairment who are taking a strong CYP3A4 inhibitor
Colchicine [1], indinavir ---> SPC of [1] of eMC
Colchicine is contraindicated in patients with renal or hepatic impairment who are taking a strong CYP3A4 inhibitor
Colchicine [1], itraconazol ---> SPC of [1] of eMC
Colchicine is contraindicated in patients with renal or hepatic impairment who are taking a strong CYP3A4 inhibitor
Colchicine [1], P-gp inhibitors ---> SPC of [1] of eMC
Colchicine is contraindicated in patients with renal or hepatic impairment who are taking a P-glycoprotein inhibitor
Colchicine [1], pregnancy ---> SPC of [1] of eMC
Do not use in pregnancy as there is a risk of foetal chromosome damage.
Colchicine [1], strong CYP3A4 inhibitors ---> SPC of [1] of eMC
Colchicine is contraindicated in patients with renal or hepatic impairment who are taking a P-glycoprotein inhibitor
Colchicine [1], strong P-gp inhibitors ---> SPC of [1] of eMC
Colchicine is contraindicated in patients with renal or hepatic impairment who are taking a P-glycoprotein or a strong CYP3A4 inhibitor
Colchicine [1], vitamin B12 ---> SPC of [1] of eMC
The absorption of Vitamin B 12 may be impaired by chronic administration or high doses of colchicine; requirement may be increased.
Colchicine, crizotinib [2] ---> SPC of [2] of EMA
Administration of crizotinib (intestinal P-gp inhibitor) with medicinal products that are substrates of P-gp may increase their therapeutic effect and adverse reactions. Close clinical surveillance is recommended
Colchicine, cyclophosphamide
The CYP2B6 and CYP3A4 inhibition may decrease the efficacy of cyclophosphamide (prodrug)
Colchicine, CYP3A4 inhibitors
The CYP3A4 inhibition may increase the plasma concentrations of colchicine
Colchicine, darunavir/cobicistat [2] ---> SPC of [2] of EMA
Based on theoretical considerations darunavir/cobicistat (CYP3A and/or P-glycoprotein inhibition) is expected to increase colchicine plasma concentrations. The combination is contraindicated in patients with renal or hepatic impairment
Colchicine, darunavir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Co-administration is contraindicated (colchicine when used in patients with renal and/or hepatic impairment) due to the potential for serious and/or life-threatening adverse reactions
Colchicine, darunavir/ritonavir ---> SPC of [darunavir] of EMA
Life-threatening and fatal drug interactions have been reported in patients treated with colchicine and strong inhibitors of CYP3A and P-glycoprotein
Colchicine, dasabuvir with ombitasvir/paritaprevir/ritonavir ---> SPC of [ombitasvir/paritaprevir/ritonavir] of EM
The strong CYP3A inhibition by ritonavir may increase the plasma levels of colchicine. Concomitant use is contraindicated in patients with renal or hepatic impairment
Colchicine, diazoxide
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Colchicine, eliglustat [2] ---> SPC of [2] of EMA
Concomitant administration of eliglustat with P-gp substrates may increase the exposition of the P-gp substrates. Lower doses of substances which are P-gp substrates may be required.
Colchicine, elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Co-administration with Genvoya may result in increased plasma concentrations of this medicinal product. Dose reductions of colchicine may be required.
Colchicine, elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
The co-administration may increase the plasma levels of colchicine
Colchicine, enzalutamide [2] ---> SPC of [2] of EMA
Medicinal products with a narrow therapeutic range that are substrates for P-gp should be used with caution when administered concomitantly with enzalutamide and may require dose adjustment to maintain optimal plasma concentrations.
Colchicine, erythromycin
When clarithromycin and colchicine are administered together, inhibition of Pgp and/or CYP3A by erythromycin may lead to increased exposure to colchicine. Patients should be monitored for clinical symptoms of colchicine toxicity
Colchicine, ethacrynic acid
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Colchicine, ezetimibe/simvastatine ---> SPC of [2] of eMC
There have been reports of myopathy and rhabdomyolysis with the concomitant administration of colchicine and simvastatin, in patients with renal insufficiency.
Colchicine, febuxostat [2] ---> SPC of [2] of EMA
Febuxostat can be co-administered with colchicine with no dose adjustment of febuxostat or colchicine being necessary.
Colchicine, fenofibrate
Concomitant use of medicinal products that may cause rhabdomyolysis, in particular fibrates and statins, may increase the risk of rhabdomyolysis
Colchicine, fenofibrate/simvastatin [2] ---> SPC of [2] of EMA
There have been reports of myopathy and rhabdomyolysis with the concomitant administration of colchicine and simvastatin in patients with renal insufficiency.
Colchicine, fenofibric acid
Concomitant use of medicinal products that may cause rhabdomyolysis, in particular fibrates and statins, may increase the risk of rhabdomyolysis
Colchicine, fibrates ---> SPC of [1] of eMC
Acute myopathy has been reported in patients given colchicine with statins. Patients should be advised to report muscle pain or weakness.
Colchicine, fluvastatin [2] ---> SPC of [2] of eMC
Myotoxicity, including muscle pain and weakness and rhabdomyolysis, has been reported in isolated cases with concomitant administration of colchicines.
Colchicine, furosemide
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Colchicine, gemfibrozil
Risk of myopathy and rhabdomyolysis may be increased with concomitant administration of colchicine and gemfibrozil.
Colchicine, glucocorticoids
The co-administration of colchicine and glucocorticoids may increase the risk of myopathies
Colchicine, heparin
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Colchicine, idelalisib [2] ---> SPC of [2] of EMA
The co-administration of idelalisib with colchicine may increase the serum concentrations of colchicine. Dose reductions of colchicine may be required. Idelalisib should not be co-administered with colchicine to patients with renal or hepatic impairment.
Colchicine, interferon alfa
Caution is recommend when administering colchicine and interferon-alfa as the effectiveness of interferon-alfa may be decreased
Colchicine, isavuconazole [2] ---> SPC of [2] of EMA
Dose adjustment of medicinal products that are P-gp substrates, especially medicinal products with a narrow therapeutic index such as digoxin, colchicine and dabigatran etexilate, may be needed when concomitantly administered with CRESEMBA
Colchicine, isoniazid
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Colchicine, ketoconazole [2] ---> SPC of [2] of EMA
Increasing in plasma concentrations of colchicine have been observed. Not recommended due to a potential increase in colchicine-related toxicity.
Colchicine, lesinurad [2] ---> SPC of [2] of EMA
Based on interaction studies in healthy subjects or gout patients, Zurampic does not have clinically significant interactions with NSAIDs (naproxen and indomethacin), colchicine, repaglinide, tolbutamide, febuxostat or allopurinol.
Colchicine, lomitapide [2] ---> SPC of [2] of EMA
Lomitapide, P-glycoprotein inhibitor, may increase the absorption of the P-glycoprotein substrate
Colchicine, lopinavir/ritonavir [2] ---> SPC of [2] of EMA
Increased plasma concentrations of colchicine. Potential for serious and/or life-threatening reactions in patients with renal and/or hepatic impairment
Colchicine, mecamylamine
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Colchicine, moderate CYP3A4 inhibitors
The moderate CYP3A4 inhibition may increase the plasma concentrations of colchicine. Co-administration is contraindicated in case of renal or hepatic insufficiency
Colchicine, myelosuppressive agents
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Colchicine, myopathy ---> SPC of [1] of eMC
Acute myopathy has been reported in patients given colchicine with statins. Patients should be advised to report muscle pain or weakness.
Colchicine, nelfinavir [2] ---> SPC of [2] of EMA
Concomitant use of colchicine and nelfinavir may increase plasma levels of colchicine. Patients with renal or hepatic impairment should not be given colchicine with nelfinavir
Colchicine, netupitant/palonosetron [2] ---> SPC of [2] of EMA
In vitro data show that netupitant is a P-gp inhibitor. Caution is recommended when netupitant is combined with digoxin or with other P-gp substrates such as dabigatran, or colchicine.
Colchicine, NSAID
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Colchicine, olaparib [2] ---> SPC of [2] of EMA
In vitro, olaparib inhibits the efflux transporter P-gp (IC50 = 76 µM), therefore it cannot be excluded that olaparib may cause clinically relevant drug interactions with substrates of P-gp
Colchicine, ombitasvir/paritaprevir/ritonavir [2] ---> SPC of [2] of EMA
The strong CYP3A inhibition by ritonavir may increase the plasma levels of colchicine. Concomitant use is contraindicated in patients with renal or hepatic impairment
Colchicine, palbociclib [2] ---> SPC of [2] of EMA
Administration of palbociclib with medicinal products that are substrates of P-gp (e.g., digoxin, dabigatran, colchicine, pravastatin) may increase their therapeutic effect and adverse reactions.
Colchicine, phenylbutazone
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Colchicine, ponatinib [2] ---> SPC of [2] of EMA
In vitro, ponatinib is an inhibitor of P-gp. Therefore, ponatinib may have the potential to increase plasma concentrations of co-administered substrates of P-gp and may increase their therapeutic effect and adverse reactions.
Colchicine, pravastatine
Concomitant use of medicinal products that may cause rhabdomyolysis, in particular fibrates and statins, may increase the risk of rhabdomyolysis
Colchicine, quinidine
The strong inhibition of CYP3A4 and P-glycoprotein may increase the exposition to colchicine. Life-threatening and fatal reactions
Colchicine, repaglinide
The CYP3A4 and CYP2C8 inhibition/induction may increase/decrease the plasma concentrations of repaglinide. Special care should be taken
Colchicine, ritonavir [2] ---> SPC of [2] of EMA
Life-threatening and fatal drug interactions have been reported in patients treated with colchicine and strong inhibitors of CYP3A like ritonavir
Colchicine, rolapitant [2] ---> SPC of [2] of EMA
Rolapitant is an inhibitor of P-glycoprotein (P-gp). Clinical monitoring of adverse reactions and, if possible, biological monitoring are recommended when rolapitant is combined with digoxin or with other P-gp substrates
Colchicine, saquinavir
The P-glycoprotein and CYP3A4 inhibition by lopinavir/ritonavir may increase the plasma concentrations of colchicine. Concomitant use is not recommended
Colchicine, saquinavir/ritonavir ---> SPC of [saquinavir] of EMA
The strong inhibition of CYP3A4 and P-glycoprotein by saquinavir may increase the exposition to colchicine. Concomitant use is not recommended
Colchicine, simvastatine ---> SPC of [fenofibrate/simvastatin] of EMA
There have been reports of myopathy and rhabdomyolysis with the concomitant administration of colchicine and simvastatin in patients with renal insufficiency.
Colchicine, statins ---> SPC of [1] of eMC
Acute myopathy has been reported in patients given colchicine with statins. Patients should be advised to report muscle pain or weakness.
Colchicine, strong CYP3A4 and P-glycoprotein-inhibitors ---> SPC of [darunavir] of EMA
Life-threatening and fatal drug interactions have been reported in patients treated with colchicine and strong inhibitors of CYP3A and P-glycoprotein
Colchicine, telaprevir [2] ---> SPC of [2] of EMA
Telaprevir, CYP3A4 inhibitor, may increase the plasma levels of colchicine. Patients with renal or hepatic impairment should not be given colchicine with telaprevir, due to the risk of colchicine toxicity.
Colchicine, telithromycin [2] ---> SPC of [2] of EMA
Exposure to colchicine, a CYP3A4 and P-glycoprotein substrate, may be expected to increase if telithromycin and colchicine are co-administered. Concomitant administration is contraindicated in patients with renal and/or hepatic impairment
Colchicine, temsirolimus [2] ---> SPC of [2] of EMA
When temsirolimus is co-administered with medicinal products which are P-gp substrates close monitoring for adverse events related to the co-administered medicinal products should be observed.
Colchicine, thiazides
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Colchicine, tipranavir [2] ---> SPC of [2] of EMA
The inhibition of CYP3A4 and P-glycoprotein may increase the exposition to colchicine. The coadministration is not recommended. Co-administration is contraindicated in case of renal or hepatic insufficiency
Colchicine, tipranavir/ritonavir ---> SPC of [tipranavir] of EMA
In patients with renal or hepatic impairment, co-administration of colchicine in patients on Aptivus/ritonavir is contraindicated
Colchicine, trandolapril/verapamil [2] ---> SPC of [2] of eMC
When verapamil and colchicine are administered together, inhibition of P-gp and/or CYP3A by verapamil may lead to increased exposure to colchicine. Combined use is not recommended.
Colchicine, triamterene
The co-administration may decrease the effect of colchicine and/or increase its toxicity
Colchicine, vemurafenib [2] ---> SPC of [2] of EMA
Caution should be exercised when dosing vemurafenib concurrently with P-gp substrates and dose reduction of the concomitant medicinal product may be considered, if clinically indicated.
Colchicine, verapamil [2] ---> SPC of [2] of eMC
When verapamil and colchicine are administered together, inhibition of P-gp and/or CYP3A by verapamil may lead to increased exposure to colchicine. Combined use is not recommended.
CONTRAINDICATIONS of Colchicine
- The use of colchicine is contraindicated in pregnancy.
- Colchicine should not be used in patients undergoing haemodialysis since it cannot be removed by dialysis or exchange transfusion.
- Colchicine should not be used in patients with severe renal impairment (creatinine clearance less than 10 ml/minute).
- Colchicine is contraindicated in patients with renal or hepatic impairment who are taking a P-glycoprotein or a strong CYP3A4 inhibitor
http://www.medicines.org.uk/emc/
Colesevelam (Cholestagel)
Amiodarone, colesevelam
Bile acid sequestrants may decrease the bioavailability of amiodarone.
Anticoagulants, colesevelam [2] ---> SmPC of [2] of EMA
Anticoagulant therapy should be monitored closely in patients receiving warfarin or similar agents, since bile acid sequestrants have been shown to reduce absorption of vitamin K and therefore interfere with warfarin's anticoagulant effect.
Breast-feeding, colesevelam [2] ---> SmPC of [2] of EMA
Caution should be exercised when prescribing to breast-feeding women
Cabozantinib [1], colesevelam ---> SmPC of [1] of EMA
Bile salt-sequestering agents such as cholestyramine and cholestagel may interact with cabozantinib and may impact absorption (or reabsorption) resulting in potentially decreased exposure
Cholic acid [1], colesevelam ---> SmPC of [1] of EMA
The dose of bile acid sequestrants or antacids must be separated from the dose of cholic acid by an interval of 5 hours, regardless of which medicinal product is administered first.
Colesevelam [1], cyclosporine ---> SmPC of [1] of EMA
In addition, based on theoretical grounds Cholestagel should be administered at least 4 hours after ciclosporin in order to further minimise the risks related to the concomitant administration of ciclosporin and Cholestagel.
Colesevelam [1], cyclosporine ---> SmPC of [1] of EMA
Furthermore, Cholestagel should always be administered at the same times consistently since the timing of intake of Cholestagel and ciclosporin could theoretically influence the degree of reduced bioavailability of ciclosporin.
Colesevelam [1], digoxin ---> SmPC of [1] of EMA
In interaction studies in healthy volunteers, colesevelam had no effect on the bioavailability of digoxin
Colesevelam [1], ethinyl estradiol ---> SmPC of [1] of EMA
The bile-acid sequestrant may decrease the bioavailability of ethinyl estradiol. Administer colesevelam 4 hours after ethinyl estradiol
Colesevelam [1], fat-soluble vitamins ---> SmPC of [1] of EMA
Colesevelam did not induce any clinically significant reduction in the absorption of vitamins A, D, E or K during clinical studies of up to one year.
Colesevelam [1], fertility ---> SmPC of [1] of EMA
There are no data on the effect of Cholestagel on fertility in humans. A study conducted in rats did not result in any differences in reproductive parameters between the groups that might imply reproductive effects attributable to colesevelam.
Colesevelam [1], foods ---> SmPC of [1] of EMA
You should take your Cholestagel tablets with food and liquid. The tablets should be swallowed whole. Do not break, crush or chew the tablets.
Colesevelam [1], glibenclamide ---> SmPC of [1] of EMA
Co-administration of colesevelam and glyburide caused a decrease in the AUC0-inf and Cmax of glyburide. No interaction was observed when colesevelam was administered 4 hours after glyburide.
Colesevelam [1], glimepiride ---> SmPC of [1] of EMA
Co-administration of colesevelam and glipizide decreases the exposure of glipizide. Glipizide should be administered at least 4 hours prior to colesevelam.
Colesevelam [1], glipizide ---> SmPC of [1] of EMA
Co-administration of colesevelam and glipizide decreases the exposure of glipizide. Glipizide should be administered at least 4 hours prior to colesevelam.
Colesevelam [1], levothyroxine ---> SmPC of [1] of EMA
Decreased Cmax and AUC of levothyroxine. No interaction was observed when Cholestagel was administered at least four hours after levothyroxine.
Colesevelam [1], lovastatine ---> SmPC of [1] of EMA
Colesevelam had no effect on the bioavailability of lovastatin in an interaction study.
Colesevelam [1], medicinal products ---> SmPC of [1] of EMA
Cholestagel may affect the bioavailability of other medicinal products. When a drug interaction cannot be excluded with a concomitant medicine, Cholestagel should be administered at least 4 hours before/after the concomitant medication
Colesevelam [1], metformin ---> SmPC of [1] of EMA
Co-administration of colesevelam and metformin extended-release (ER) tablets increases the exposure of metformin.
Colesevelam [1], metoprolol ---> SmPC of [1] of EMA
In interaction studies in healthy volunteers, colesevelam had no effect on the bioavailability of metoprolol
Colesevelam [1], norethisterone ---> SmPC of [1] of EMA
The bile-acid sequestrant may decrease the bioavailability of norethisterone. Administer colesevelam 4 hours after norethisterone
Colesevelam [1], olmesartan ---> SmPC of [1] of EMA
Co-administration of colesevelam and olmesartan decreases the exposure of olmesartan. Olmesartan should be administered at least 4 hours prior to colesevelam.
Colesevelam [1], oral contraceptives ---> SmPC of [1] of EMA
This interaction was also observed when Cholestagel was administered one hour after the oral contraceptive pill. However no interaction was observed when Cholestagel was administered four hours after the oral contraceptive pill.
Colesevelam [1], phenytoin ---> SmPC of [1] of EMA
There have been very rare reports of reduced phenytoin levels in patients who have received colesevelam administered with phenytoin.
Colesevelam [1], pioglitazone ---> SmPC of [1] of EMA
No interaction was observed when Cholestagel and pioglitazone were administered simultaneously in healthy volunteers
Colesevelam [1], pregnancy ---> SmPC of [1] of EMA
Caution should be exercised when prescribing to pregnant women
Colesevelam [1], quinine ---> SmPC of [1] of EMA
In interaction studies in healthy volunteers, colesevelam had no effect on the bioavailability of quinine
Colesevelam [1], repaglinide ---> SmPC of [1] of EMA
Co-administration of colesevelam and repaglinide caused a 19% reduction in the Cmax of repaglinide. No interaction was observed when colesevelam was administered 1 hour after repaglinide.
Colesevelam [1], statins ---> SmPC of [1] of EMA
When colesevelam was co-administered with statins in clinical studies, an expected add-on LDL-C lowering effect was observed, and no unexpected effects were observed.
Colesevelam [1], ursodeoxycholic acid ---> SmPC of [1] of EMA
Cholestagel predominantly binds hydrophobic bile acids. In a clinical study Cholestagel did not affect the faecal excretion of endogenous (hydrophilic) ursodeoxycholic acid.
Colesevelam [1], valproic acid ---> SmPC of [1] of EMA
In interaction studies in healthy volunteers, colesevelam had no effect on the bioavailability of valproic acid
Colesevelam [1], verapamil ---> SmPC of [1] of EMA
Cholestagel decreased the Cmax and AUC of sustained-release verapamil by approximately 31% and 11%, respectively. Since there is a high degree of variability in the bioavailability of verapamil, the clinical significance of this finding is unclear.
Colesevelam [1], warfarin ---> SmPC of [1] of EMA
Anticoagulant therapy should be monitored closely in patients receiving warfarin or similar agents, since bile acid sequestrants have been shown to reduce absorption of vitamin K and therefore interfere with warfarin's anticoagulant effect.
Colesevelam, ethinylestradiol/norgestimate [2] ---> SmPC of [2] of eMC
Colesevelam, given together with a combined oral hormonal contraceptive, has been shown to significantly decrease the AUC of ethinylestradiol. No interaction was seen when the contraceptive was given 4 hours before colesevelam.
Colesevelam, furosemide
Colesevelam may decrease the absorption of furosemide.
Colesevelam, glibenclamide [2] ---> SmPC of [2] of EMA
Colesevelam binds to glibenclamide and reduces glibenclamide absorption from the gastrointestinal tract. No interaction was observed when glibenclamide was taken at least 4 hours before colesevelam.
Colesevelam, lomitapide [2] ---> SmPC of [2] of EMA
Because bile acid sequestrants can interfere with the absorption of oral medicines, bile acid sequestrants should be taken at least 4 hours before or at least 4 hours after lomitapide.
Colesevelam, obeticholic acid [2] ---> SmPC of [2] of EMA
Bile acid binding resins such as cholestyramine reduce bile acid absorption and may reduce efficacy of obeticholic acid. When co-administered, obeticholic acid should be taken at least 4-6 hours before or 4-6 hours after taking a bile acid binding resin
Colesevelam, olmesartan medoxomil [2] ---> SmPC of [2] of EMA
Co-administration of colesevelam and olmesartan decreases the exposure of olmesartan. Olmesartan should be administered at least 4 hours prior to colesevelam.
Colesevelam, olmesartan medoxomil/amlodipine [2] ---> SmPC of [2] of EMA
Co-administration of colesevelam and olmesartan decreases the exposure of olmesartan. Olmesartan should be administered at least 4 hours prior to colesevelam.
Colesevelam, regorafenib [2] ---> SmPC of [2] of EMA
Bile salt-sequestering agents may interact with regorafenib by forming insoluble complexes which may impact absorption (or reabsorption), thus resulting in potentially decreased exposure.
CONTRAINDICATIONS of Colesevelam (Cholestagel)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Bowel or biliary obstruction
Colestilan (BindRen)
Antiepileptics, colestilan [2] ---> SmPC of [2] of EMA
Patients with seizure disorders were excluded from clinical trials with BindRen. Caution should be exercised when prescribing BindRen to patients also taking anti-seizure medicinal products.
Breast-feeding, colestilan [2] ---> SmPC of [2] of EMA
No data are available to assess the safety and efficacy in breast-feeding women. A supplementation of vitamins may be required
Colestilan [1], digoxin ---> SmPC of [1] of EMA
BindRen lowered the bioavailability of digoxin by 16% and Cmax by 17%
Colestilan [1], drugs with a narrow therapeutic window ---> SmPC of [1] of EMA
The cotreatment of colestilan with medicinal products with a narrow therapeutic window requires close monitoring of drug concentrations or adverse reactions
Colestilan [1], enterohepatic circulation ---> SmPC of [1] of EMA
Reduced bioavailability of other medicinal products been reported. You should the other medicine up to 1 hour prior to or 3 hours following colestilan
Colestilan [1], fertility ---> SmPC of [1] of EMA
No data are available to assess the potential influence of BindRen on fertility.
Colestilan [1], immunosuppressives ---> SmPC of [1] of EMA
Caution should be exercised when prescribing colestilan to patients receiving immunosuppressants.
Colestilan [1], levothyroxine ---> SmPC of [1] of EMA
Due to the high in vitro binding potential between colestilan and levothyroxine, closer monitoring of thyroid stimulating hormone (TSH) levels is recommended.
Colestilan [1], oral contraceptives ---> SmPC of [1] of EMA
Reduced bioavailability of other medicinal products been reported. You should the other medicine up to 1 hour prior to or 3 hours following colestilan
Colestilan [1], pregnancy ---> SmPC of [1] of EMA
No data are available to assess the safety and efficacy in pregnant women. A supplementation of vitamins may be required
Colestilan [1], steroid hormones ---> SmPC of [1] of EMA
Reduced bioavailability of other medicinal products been reported. You should the other medicine up to 1 hour prior to or 3 hours following colestilan
Colestilan [1], warfarin ---> SmPC of [1] of EMA
Single dose interaction studies demonstrated that the bioavailability of ciprofloxacin, warfarin and enalapril were not affected when co-administered with BindRen (6-9 g/day).
CONTRAINDICATIONS of Colestilan (BindRen)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Bowel obstruction
https://www.ema.europa.eu/en/documents/product-information/bindren-epar-product-information_en.pdf 01/04/2015 (withdrawn)
Colistimethate (Colobreathe)
Ability to drive, colistimethate [2] ---> SmPC of [2] of EMA
Based on the safety profile of colistimethate sodium, neurotoxity may occur with the possibility of dizziness, confusion or visual disturbances.
Aminoglycoside antibiotics, colistimethate [2] ---> SmPC of [2] of EMA
Concomitant use of inhaled colistimethate sodium with other medications that are potentially nephrotoxic or neurotoxic should be undertaken with caution.
Atracurium, colistimethate [2] ---> SmPC of [2] of EMA
Concomitant use of inhaled colistimethate sodium with neuromuscular blocking products should be undertaken with caution.
Azithromycin, colistimethate [2] ---> SmPC of [2] of EMA
Co-treatment should be undertaken with caution in patients with myasthenia gravis
Breast-feeding, colistimethate [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breastfeeding or to discontinue/abstain from colistimethate sodium therapy taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman.
Ciprofloxacin, colistimethate [2] ---> SmPC of [2] of EMA
Co-treatment should be undertaken with caution in patients with myasthenia gravis
Clarithromycin, colistimethate [2] ---> SmPC of [2] of EMA
Co-treatment should be undertaken with caution in patients with myasthenia gravis
Colistimethate [1], colistin ---> SmPC of [1] of EMA
Treatment with colistimethate sodium or colistin did not induce the activity of any enzyme tested (CYP1A2, 2B6, 2C8, 2C9, 2C19 and 3A4/5).
Colistimethate [1], curare-type muscle relaxants ---> SmPC of [1] of EMA
Concomitant use of inhaled colistimethate sodium with neuromuscular blocking products should be undertaken with caution.
Colistimethate [1], enzyme tested ---> SmPC of [1] of EMA
Treatment with colistimethate sodium or colistin did not induce the activity of any enzyme tested (CYP1A2, 2B6, 2C8, 2C9, 2C19 and 3A4/5).
Colistimethate [1], fertility ---> SmPC of [1] of EMA
Colistimethate sodium has no notable effects on fertility in male or female rats or mice.
Colistimethate [1], macrolide antibiotics ---> SmPC of [1] of EMA
Co-treatment should be undertaken with caution in patients with myasthenia gravis
Colistimethate [1], muscle relaxants ---> SmPC of [1] of EMA
Concomitant use of inhaled colistimethate sodium with neuromuscular blocking products should be undertaken with caution.
Colistimethate [1], nephrotoxic substances ---> SmPC of [1] of EMA
Concomitant use of inhaled colistimethate sodium with other medications that are potentially nephrotoxic or neurotoxic should be undertaken with caution.
Colistimethate [1], neurotoxic substances ---> SmPC of [1] of EMA
Concomitant use of inhaled colistimethate sodium with other medications that are potentially nephrotoxic or neurotoxic should be undertaken with caution.
Colistimethate [1], norfloxacin ---> SmPC of [1] of EMA
Co-treatment should be undertaken with caution in patients with myasthenia gravis
Colistimethate [1], pancuronium ---> SmPC of [1] of EMA
Concomitant use of inhaled colistimethate sodium with neuromuscular blocking products should be undertaken with caution.
Colistimethate [1], pregnancy ---> SmPC of [1] of EMA
Colistimethate sodium is not recommended during pregnancy and in women of childbearing potential not using contraception.
Colistimethate [1], quinolones ---> SmPC of [1] of EMA
Co-treatment should be undertaken with caution in patients with myasthenia gravis
Colistimethate, colistimethate [2] ---> SmPC of [2] of EMA
Caution should be taken with concomitant use with other formulations of colistimethate sodium as there is little experience and there is a possibility of summative toxicity.
Colistimethate, ether
Pay attention to neurotoxic reactions
Colistimethate, halogenated anaesthetics
Pay attention to neurotoxic reactions
Colistimethate, halothane
Pay attention to neurotoxic reactions
CONTRAINDICATIONS of Colistimethate (Colobreathe)
- Hypersensitivity to the active substance, colistin sulphate or polymyxin B.
Collagenase Clostridium histolyticum (Xiapex)
Ability to drive, collagenase clostridium histolyticum [2] ---> SPC of [2] of EMA
Patients must be instructed to avoid potentially hazardous tasks such as driving or using machines until it is safe to do so or as advised by the physician.
Anthracyclines, collagenase clostridium histolyticum [2] ---> SPC of [2] of EMA
Such derivatives have been shown to inhibit matrix metalloproteinase-mediated collagen degradation at pharmacologically relevant concentrations in vitro.
Anthraquinones, collagenase clostridium histolyticum [2] ---> SPC of [2] of EMA
Such derivatives have been shown to inhibit matrix metalloproteinase-mediated collagen degradation at pharmacologically relevant concentrations in vitro.
Antiseptics, collagenase clostridium histolyticum
Inhibition of collagenase activity
Breast-feeding, collagenase clostridium histolyticum [2] ---> SPC of [2] of EMA
It is not known whether collagenase clostridium histolyticum is excreted in human milk. Caution should be exercised when Xiapex is administered to a nursing woman.
Chelating agents, collagenase clostridium histolyticum
Inhibition of collagenase activity
Collagenase clostridium histolyticum [1], doxycycline ---> SPC of [1] of EMA
Use of Xiapex in patients who have received tetracycline antibiotics (e.g., doxycycline) within 14 days prior to receiving an injection of Xiapex is not recommended.
Collagenase clostridium histolyticum [1], PDE5 inhibitors ---> SPC of [1] of EMA
There were no clinically meaningful differences in the incidence of adverse events following treatment with Xiapex based on the severity of baseline erectile dysfunction or concomitant phosphodiesterase type 5 (PDE5) inhibitor use.
Collagenase clostridium histolyticum [1], pregnancy ---> SPC of [1] of EMA
The use of Xiapex is not recommended during the pregnancy and treatment should be postponed until after pregnancy.
Collagenase clostridium histolyticum [1], tetracyclines ---> SPC of [1] of EMA
Use of Xiapex in patients who have received tetracycline antibiotics (e.g., doxycycline) within 14 days prior to receiving an injection of Xiapex is not recommended.
Collagenase clostridium histolyticum, gramicidin
Local incompatibility
Collagenase clostridium histolyticum, hexachlorophene
Inhibition of collagenase activity
Collagenase clostridium histolyticum, nitrofurazone
Inhibition of collagenase activity
Collagenase clostridium histolyticum, solutions containing heavy metals
Inhibition of collagenase activity
Collagenase clostridium histolyticum, tyrothricin
Local incompatibility
CONTRAINDICATIONS of Collagenase clostridium histolyticum (Xiapex)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Treatment of Peyronie’s plaques that involve the penile urethra due to potential risk to this structure.
https://www.ema.europa.eu/en/documents/product-information/xiapex-epar-product-information_en.pdf. 02/03/2020 (withdrawn)
Conestat alfa (Ruconest)
Ability to drive, conestat alfa [2] ---> SmPC of [2] of EMA
However, headache, vertigo and dizziness have been reported following the use of Ruconest, but may also occur as a result of an attack of HAE. Patients should be advised not to drive and use machines if they experience headache, vertigo or dizziness.
Breast-feeding, conestat alfa [2] ---> SmPC of [2] of EMA
In one animal study reproductive toxicity was observed (see section 5.3). Ruconest is not recommended for use during pregnancy or breast-feeding, unless the treating physician judges the benefits to outweigh the possible risks.
C1-esterase inhibitor, tissue plasminogen activator ---> SmPC of [conestat alfa] of EMA
Scientific literature indicates an interaction of tissue-type plasminogen activator (tPA) and C1INH containing medicinal products. Conestat alfa should not be administered simultaneously with tPA.
Conestat alfa [1], fertility ---> SmPC of [1] of EMA
There are no data on the effects of Ruconest on male or female fertility.
Conestat alfa [1], pregnancy ---> SmPC of [1] of EMA
In one animal study reproductive toxicity was observed (see section 5.3). Ruconest is not recommended for use during pregnancy or breast-feeding, unless the treating physician judges the benefits to outweigh the possible risks.
Conestat alfa [1], tissue-type plasminogen activator ---> SmPC of [1] of EMA
Scientific literature indicates an interaction of tissue-type plasminogen activator (tPA) and C1INH containing medicinal products. Conestat alfa should not be administered simultaneously with tPA.
CONTRAINDICATIONS of Conestat alfa (Ruconest)
- Known or suspected allergy to rabbits
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/ruconest-epar-product-information_en.pdf 30/08/2024
Copper chloride (Cuprymina)
Ability to drive, copper chloride [2] ---> SmPC of [2] of EMA
Effects on ability to drive and to use machines following treatment by Copper-64-labelled medicinal products is specified in the Summary of Product Characteristics/package leaflet of the particular medicinal product to be radiolabelled.
Breast-feeding, copper chloride [2] ---> SmPC of [2] of EMA
Before administering radiopharmaceuticals to a mother who is breast-feeding, consideration should be given to the possibility of delaying the administration of radionuclide until the mother has ceased breast-feeding
Chelating agents, copper chloride [2] ---> SmPC of [2] of EMA
The possible use of chelating therapies could interfere with the use of 64 Cu-labelled medicinal products.
Copper chloride [1], fertility ---> SmPC of [1] of EMA
According to literature reports, it may be considered that both spermatogenetic and genetic damage in male test is are unlikely at the dose of 1,000 MBq.
Copper chloride [1], pregnancy ---> SmPC of [1] of EMA
The use of 64 Cu-labelled medicinal products is contraindicated during established or suspected pregnancy or when pregnancy has not been excluded
Copper chloride [1], women of childbearing potential ---> SmPC of [1] of EMA
When an administration of radiopharmaceuticals to a woman of childbearing potential is intended, it is important to determine whether or not she is pregnant.
CONTRAINDICATIONS of Copper chloride (Cuprymina)
Cuprymina is contraindicated in the following cases:
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Established or suspected pregnancy or when pregnancy has not been excluded (see section 4.6).
For information on contraindications to particular 64 Cu-labelled medicinal products prepared by radiolabelling with Cuprymina refer to the Summary of Product Characteristics/package leaflet of each particular medicinal product to be radiolabelled.
https://www.ema.europa.eu/en/documents/product-information/cuprymina-epar-product-information_en.pdf 01/07/2022
Corifollitropin alfa (Elonva)
Ability to drive, corifollitropin alfa [2] ---> SmPC of [2] of EMA
Elonva may cause dizziness. Patients should be advised that if they feel dizzy, they should not drive or use machines.
Breast-feeding, corifollitropin alfa [2] ---> SmPC of [2] of EMA
The use of Elonva during breast-feeding is not indicated.
Corifollitropin alfa [1], fertility ---> SmPC of [1] of EMA
Elonva is indicated for use in infertility in women: In women Elonva is used in the treatment of Controlled Ovarian Stimulation in combination with GnRH in ART programs (see section 4.1).
Corifollitropin alfa [1], men ---> SmPC of [1] of EMA
In adolescent males (14 years and older), Elonva is used in treatment of hypogonadotropic hypogonadism in combination with hCG (see section 4.1). However, whether this treatment has effect on fertility is unknown.
Corifollitropin alfa [1], pregnancy ---> SmPC of [1] of EMA
Clinical data are not sufficient to exclude an adverse outcome of pregnancy. In animal studies reproductive toxicity has been observed (see section 5.3). The use of Elonva during pregnancy is not indicated.
CONTRAINDICATIONS of Corifollitropin alfa (Elonva)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Tumours of the ovary, breast, uterus, pituitary or hypothalamus.
- Abnormal (not menstrual) vaginal bleeding without a known/diagnosed cause.
- Primary ovarian failure.
- Ovarian cysts or enlarged ovaries.
- Fibroid tumours of the uterus incompatible with pregnancy.
- Malformations of the reproductive organs incompatible with pregnancy.
- Risk factors for OHSS:
A history of Ovarian Hyperstimulation Syndrome (OHSS).
A previous COS cycle that resulted in more than 30 follicles ≥ 11 mm measured by ultrasound examination.
A basal antral follicle count > 20.
Polycystic ovarian syndrome (PCOS).
https://www.ema.europa.eu/en/documents/product-information/elonva-epar-product-information_en.pdf 05/04/2023
Cotrimoxazole
Abacavir/lamivudine [1], cotrimoxazole ---> SPC of [1] of EMA
No Kivexa dosage adjustment necessary. When concomitant administration with co-trimoxazole is warranted, patients should be monitored clinically.
Abacavir/lamivudine/zidovudine [1], cotrimoxazole ---> SPC of [1] of EMA
Concomitant treatment, especially acute therapy, with potentially nephrotoxic or myelosuppressive medicinal products may increase the risk of adverse reactions to zidovudine
Acenocoumarol [1], cotrimoxazole ---> SPC of [1] of eMC
The co-administration may enhance the anticoagulant effect of acenocoumarol and increase the bleeding risk
Amantadine, cotrimoxazole
The co-administration of amantadine with drugs that prolong the QT interval is contraindicated
Antacids, cotrimoxazole
Antacid may decrease the absorption of cotrimoxazole
Azathioprine [1], cotrimoxazole ---> SPC of [1] of eMC
There are conflicting clinical reports of interactions, resulting in serious haematological abnormalities, between azathioprine and co-trimoxazole.
Barbiturates, cotrimoxazole
The administration of barbiturates increases toxicity of cotrimoxazole
Breast-feeding, cotrimoxazole [2] ---> SPC of [2] of eMC
Co-Trimoxazole appears in breast milk in negligible amounts and the risk appears to be low. However, there is a risk of kernicterus if the infant is at increased risk of hyperbilirubinaemia.
Budipine, cotrimoxazole
The co-administration of budipine with drugs known to prolong QT interval is contraindicated
Calcium folinate [1], cotrimoxazole ---> SPC of [1] of eMC
Leucovorin should not be given simultaneously with a folic acid antagonist, for the purpose of reducing or preventing clinical toxicity, as the therapeutic effect of the antagonist may be nullified.
Cationic substances eliminated by renal tubular secretion, cotrimoxazole [2] ---> SPC of [2] of eMC
The co-administration of trimethoprim with drugs that form cations at physiological pH can increase plasma concentrations of trimethoprim and/or procainamide
Cationic substances eliminated by renal tubular secretion, trimethoprim/sulfamethoxazol ---> SPC of [cotrimoxazole
The co-administration of trimethoprim with drugs that form cations at physiological pH can increase plasma concentrations of trimethoprim and/or procainamide
Chlorpromazine [1], cotrimoxazole ---> SPC of [1] of eMC
There is an increased risk of arrhythmias when chlorpromazine is used concomitant with QT prolonging drugs. The combination is not recommended
Clindamycin, cotrimoxazole
Co-trimoxazole may inhibit the metabolism of clindamycin
Clozapine [1], cotrimoxazole ---> SPC of [1] of eMC
Substances known to have a substantial potential to depress bone marrow function must not be used concurrently with clozapine
Cotrimoxazole [1], cyclosporine ---> SPC of [1] of eMC
Reversible deterioration in renal function has been observed in patients treated with co-trimoxazole and ciclosporin following renal transplantation.
Cotrimoxazole [1], digoxin ---> SPC of [1] of eMC
The co-administration of trimethoprim and digoxin increases digoxin levels in a proportion of elderly patients
Cotrimoxazole [1], diuretics ---> SPC of [1] of eMC
Elderly patients concurrently receiving diuretics, mainly thiazides, there is an increased risk of thrombocytopenia with or without purpura.
Cotrimoxazole [1], dofetilide ---> SPC of [1] of EMA
Drugs that inhibit the renal cation transport system (e. g. trimethoprim) are contraindicated with dofetilide
Cotrimoxazole [1], folic acid antagonists ---> SPC of [1] of eMC
If considered appropriate therapy in patients receiving anti-folates, a folate supplement should be considered.
Cotrimoxazole [1], phenylalanine ---> SPC of [1] of eMC
Trimethoprim has been noted to impair phenylalanine metabolism
Cotrimoxazole [1], phenytoin ---> SPC of [1] of eMC
Cotrimoxazole prolongs the half-life of phenytoin and co-administration could result in excessive phenytoin effect.
Cotrimoxazole [1], pregnancy ---> SPC of [1] of eMC
Co-trimoxazole should not be used in pregnancy as the safety in pregnancy has not been established. Co-trimoxazole interferes with folate metabolism and can cause teratogenic effects if given in the first trimester.
Cotrimoxazole [1], procainamide ---> SPC of [1] of eMC
The co-administration of trimethoprim with drugs that form cations at physiological pH can increase plasma concentrations of trimethoprim and/or procainamide
Cotrimoxazole [1], pyrimethamine ---> SPC of [1] of eMC
Risk of megaloblastic anaemia with doses of pyrimethamine in excess of 25 mg per week.
Cotrimoxazole [1], rifampicin ---> SPC of [1] of eMC
Concomitant use of cotrimoxazole and rifampicin can result in increased rifampicin serum levels and reduced plasma half-life of trimethoprim.
Cotrimoxazole [1], sulfonylureas ---> SPC of [1] of eMC
Effect of sulphonylureas enhanced.
Cotrimoxazole [1], thiazides ---> SPC of [1] of eMC
Elderly patients concurrently receiving diuretics, mainly thiazides, there is an increased risk of thrombocytopenia with or without purpura.
Cotrimoxazole [1], warfarin ---> SPC of [1] of eMC
Effects of warfarin enhanced.
Cotrimoxazole, coumarin anticoagulants
Cotrimoxazole may enhance the effect of oral anticoagulants (enhanced hypoprothrombinemic effect of coumarins)
Cotrimoxazole, disodium folinate
The co-administration may decrease or neutralize the efficacy of folic acid antagonist
Cotrimoxazole, folic acid
Acid folic effect can be decreased or nullified in the treatment of megaloblastic anemia with the co-administration of cotrimoxazole
Cotrimoxazole, hyperkalemia
Caution is recommended when receiving other drugs that may cause hyperkaliemia
Cotrimoxazole, imipramine [2] ---> SPC of [2] of eMC
Increased risk of ventricular arrhythmias with the combination of imipramine and drugs, which prolong the QT interval.
Cotrimoxazole, indometacin
The effect of trimethoprim/sulfamethoxazol is enhanced by indometacin, with increased risk of adverse reactions
Cotrimoxazole, isoniazid
Co-trimoxazole may inhibit the metabolism of isoniazid
Cotrimoxazole, lamivudine [2] ---> SPC of [2] of EMA
Administration of trimethoprim/sulphamethoxazole 160 mg/800 mg increased lamivudine exposure by about 40 %. Lamivudine had no effect on the pharmacokinetics of trimethoprim or sulphamethoxazole.
Cotrimoxazole, lamivudine/zidovudine [2] ---> SPC of [2] of EMA
Concomitant treatment, especially acute therapy, with potentially nephrotoxic or myelosuppressive medicinal products may increase the risk of adverse reactions to zidovudine.
Cotrimoxazole, levomepromazine [2] ---> SPC of [2] of eMC
There is an increased risk of arrhythmias when neuroleptics are used with drugs that prolong the QT interval
Cotrimoxazole, mandelic acid
The co-administration may crystallize the sulphonamide in the kidneys
Cotrimoxazole, mercaptopurine
Decreased absorption of mercaptopurine
Cotrimoxazole, methenamine
Urinary acidifying agents decrease renal elimination of co-trimoxazole and may crystallize the sulphonamide in the kidneys
Cotrimoxazole, methotrexate [2] ---> SPC of [2] of eMC
Concomitant administration of folate antagonists have been reported to cause acute megaloblastic pancytopenia in rare instances. Methotrexate should be used with caution in patients taking drugs with an anti-folate potential, including nitrous oxide.
Cotrimoxazole, oral anticoagulants ---> SPC of [moxifloxacin] of eMC
A large number of cases showing an increase in oral anticoagulant activity have been reported in patients receiving antibacterial agents, especially fluoroquinolones, macrolides, tetracyclines, cotrimoxazole and some cephalosporins.
Cotrimoxazole, para-aminobenzoic acid ester
The co-administration of local anesthetics (para-aminobenzoic acid ester derivatives) is to be avoided due to they decrease the effect of cotrimoxazole
Cotrimoxazole, para-aminosalicylic acid
The administration of para-aminosalicylic acid increases toxicity of cotrimoxazole
Cotrimoxazole, paraldehyde
Paraldehyde may decrease the effect of cotrimoxazole
Cotrimoxazole, phenprocoumon
Enhancement of phenprocoumon effect and increased bleeding risk with the concomitant administration of trimethoprim-sulfamethoxazol
Cotrimoxazole, phenylbutazone
The effect of trimethoprim/sulfamethoxazol is enhanced by phenylbutazone, with increased risk of adverse reactions
Cotrimoxazole, primidone
The administration of primidone increases toxicity of cotrimoxazole
Cotrimoxazole, probenecide
The effect of trimethoprim/sulfamethoxazol is enhanced by probenecid, with increased risk of adverse reactions
Cotrimoxazole, promazine ---> SPC of [2] of eMC
The concomitant administration of promazine with myelosuppressive drugs increases the risk of toxicity
Cotrimoxazole, rifabutin [2] ---> SPC of [2] of eMC
Rifabutin has been shown to induce the enzymes of the cytochrome P450 3A subfamily and therefore may affect the pharmacokinetic behaviour of drugs metabolised by the enzymes belonging to this subfamily.
Cotrimoxazole, salicylates
The effect of trimethoprim/sulfamethoxazol is enhanced by salicylates, with increased risk of adverse reactions
Cotrimoxazole, sulfinpyrazone
The effect of trimethoprim/sulfamethoxazol is enhanced by sulfinpyrazone, with increased risk of adverse reactions
Cotrimoxazole, tacrolimus [2] ---> SPC of [2] of EMA
Concurrent use of tacrolimus with medicinal products known to have nephrotoxic or neurotoxic effects may increase these effects
Cotrimoxazole, terbinafine ---> SPC of [2] of eMC
There was no clinically relevant interaction between terbinafine and the potential comedications cotrimoxazole (trimethoprim and sulfamethoxazole)
Cotrimoxazole, urinary acidifying agents
Urinary acidifying agents decrease renal elimination of co-trimoxazole and may crystallize the sulphonamide in the kidneys
Cotrimoxazole, urinary alkalinizing agents
Urinary alkalinizing agents increase renal elimination of co-trimoxazole
Cotrimoxazole, zidovudine ---> SPC of [lamivudine/zidovudine] of EMA
Concomitant treatment, especially acute therapy, with potentially nephrotoxic or myelosuppressive medicinal products may increase the risk of adverse reactions to zidovudine.
Digoxin, trimethoprim/sulfamethoxazol ---> SPC of [cotrimoxazole] of eMC
The co-administration of trimethoprim and digoxin increases digoxin levels in a proportion of elderly patients
Procainamide, trimethoprim ---> SPC of [cotrimoxazole] of eMC
The co-administration of trimethoprim with drugs that form cations at physiological pH can increase plasma concentrations of trimethoprim and/or procainamide
Procainamide, trimethoprim/sulfamethoxazol ---> SPC of [cotrimoxazole] of eMC
The co-administration of trimethoprim with drugs that form cations at physiological pH can increase plasma concentrations of trimethoprim and/or procainamide
CONTRAINDICATIONS of Cotrimoxazole
- Known hypersensitivity to trimethoprim, sulphonamides or any other ingredients
- Pregnancy - especially in the period prior to birth
- Severe hepatic failure or marked liver parenchymal damage, jaundice.
- Serious haematological disorders and porphyria.
- Severe renal insufficiency where repeated measurements of the plasma concentration cannot be performed.
- Co-trimoxazole should not be given to neonates during the first 6 weeks, except for the treatment/prophylaxis of Pneumocytosis jiroveci (P. carinii) in infants of 4 weeks of age or greater.
http://www.medicines.org.uk/emc/
COVID-19 vaccine (Nuvaxovid)
Ability to drive, COVID-19 vaccine [2] ---> SmPC of [2] of EMA
Nuvaxovid has no or negligible influence on the ability to drive and use machines. However, some of the effects mentioned under section 4.8 may temporarily affect the ability to drive or use machines.
Breast-feeding, COVID-19 vaccine [2] ---> SmPC of [2] of EMA
No effects on the breast-fed newborn/infant are anticipated since the systemic exposure of the breast- feeding woman to Nuvaxovid is negligible.
COVID-19 vaccine [1], fertility ---> SmPC of [1] of EMA
Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity
COVID-19 vaccine [1], influenza vaccine ---> SmPC of [1] of EMA
The binding antibody response to SARS-CoV-2 was lower when Nuvaxovid was given concomitantly with inactivated influenza vaccine.
COVID-19 vaccine [1], pregnancy ---> SmPC of [1] of EMA
Administration of Nuvaxovid in pregnancy should only be considered when the potential benefits outweigh any potential risks for the mother and foetus.
COVID-19 vaccine [1], vaccinations ---> SmPC of [1] of EMA
Concomitant administration of Nuvaxovid with other vaccines has not been studied.
CONTRAINDICATIONS of COVID-19 vaccine (Nuvaxovid)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/nuvaxovid-epar-product-information_en.pdf 02/09/2025
Other trade names: Bimervax,
COVID-19 mRNA vaccine (Comirnaty)
Ability to drive, COVID-19 mRNA vaccine [2] ---> SmPC of [2] of EMA
Some of the effects mentioned under section 4.8 may temporarily affect the ability to drive or use machines.
Breast-feeding, COVID-19 mRNA vaccine [2] ---> SmPC of [2] of EMA
Observational data from women who were breast-feeding after vaccination have not shown a risk for adverse effects in breastfed newborns/infants. Comirnaty can be used during breast-feeding.
COVID-19 mRNA vaccine [1], fertility ---> SmPC of [1] of EMA
Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity
COVID-19 mRNA vaccine [1], pregnancy ---> SmPC of [1] of EMA
Comirnaty can be used during pregnancy.
COVID-19 mRNA vaccine [1], vaccinations ---> SmPC of [1] of EMA
Concomitant administration of Comirnaty with other vaccines has not been studied.
CONTRAINDICATIONS of COVID-19 mRNA vaccine (Comirnaty)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/comirnaty-epar-product-information_en.pdf 05/07/2024
Other trade names: Moderna, Spikevax (previously COVID-19 Vaccine Moderna),
Crisaborole (Staquis)
Breast-feeding, crisaborole [2] ---> SmPC of [2] of EMA
Because of the potential for adverse reactions in breastfed infants, Staquis should not be used in breast-feeding women.
Ciprofloxacin, crisaborole [2] ---> SmPC of [2] of EMA
Based on in vitro data, concomitant administration of Staquis and CYP1A2 inhibitors (e.g., ciprofloxacin, fluvoxamine) can increase systemic crisaborole concentrations
Clarithromycin, crisaborole [2] ---> SmPC of [2] of EMA
Based on in vitro data, concomitant administration of Staquis and CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, erythromycin, clarithromycin, ritonavir) can increase systemic crisaborole concentrations
Crisaborole [1], cytochrome P450 ---> SmPC of [1] of EMA
Neither crisaborole nor its two main metabolites are expected to cause drug interactions by induction or inhibition of cytochrome P450 (CYP) enzymes based on in vitro and in vivo data (see section 5.2).
Crisaborole [1], drugs primarily metabolised by UGT ---> SmPC of [1] of EMA
Metabolite 2 showed moderate inhibition of UGT1A9 and may result in a moderate increase of the concentrations of sensitive UGT1A9 substrates, such as propofol.
Crisaborole [1], erythromycin ---> SmPC of [1] of EMA
Based on in vitro data, concomitant administration of Staquis and CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, erythromycin, clarithromycin, ritonavir) can increase systemic crisaborole concentrations
Crisaborole [1], fertility ---> SmPC of [1] of EMA
Reproduction studies in male or female rats using oral administration of crisaborole revealed no effects on fertility (see section 5.3).
Crisaborole [1], fluvoxamine ---> SmPC of [1] of EMA
Based on in vitro data, concomitant administration of Staquis and CYP1A2 inhibitors (e.g., ciprofloxacin, fluvoxamine) can increase systemic crisaborole concentrations
Crisaborole [1], itraconazol ---> SmPC of [1] of EMA
Based on in vitro data, concomitant administration of Staquis and CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, erythromycin, clarithromycin, ritonavir) can increase systemic crisaborole concentrations
Crisaborole [1], ketoconazole ---> SmPC of [1] of EMA
Based on in vitro data, concomitant administration of Staquis and CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, erythromycin, clarithromycin, ritonavir) can increase systemic crisaborole concentrations
Crisaborole [1], pregnancy ---> SmPC of [1] of EMA
As a precautionary measure, it is preferable to avoid the use of Staquis during pregnancy.
Crisaborole [1], propofol ---> SmPC of [1] of EMA
Metabolite 2 showed moderate inhibition of UGT1A9 and may result in a moderate increase of the concentrations of sensitive UGT1A9 substrates, such as propofol.
Crisaborole [1], ritonavir ---> SmPC of [1] of EMA
Based on in vitro data, concomitant administration of Staquis and CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, erythromycin, clarithromycin, ritonavir) can increase systemic crisaborole concentrations
Crisaborole [1], strong CYP1A2 inhibitors ---> SmPC of [1] of EMA
Based on in vitro data, concomitant administration of Staquis and CYP1A2 inhibitors (e.g., ciprofloxacin, fluvoxamine) can increase systemic crisaborole concentrations
Crisaborole [1], strong CYP3A4 inhibitors ---> SmPC of [1] of EMA
Based on in vitro data, concomitant administration of Staquis and CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, erythromycin, clarithromycin, ritonavir) can increase systemic crisaborole concentrations
CONTRAINDICATIONS of Crisaborole (Staquis)
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/staquis-epar-product-information_en.pdf 08/02/2022 (withdrawn)
Crizanlizumab (Adakveo)
Ability to drive, crizanlizumab [2] ---> SmPC of [2] of EMA
Adakveo may have a minor influence on the ability to drive and use machines. Dizziness, fatigue and somnolence may occur following administration of crizanlizumab.
Breast-feeding, crizanlizumab [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breast-feeding or to discontinue Adakveo therapy, taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.
Crizanlizumab [1], cytochrome P450 ---> SmPC of [1] of EMA
Monoclonal antibodies are not metabolised by cytochrome P450 (CYP450) enzymes. Therefore, medicinal products that are substrates, inhibitors or inducers of CYP450 are not expected to affect the pharmacokinetics of crizanlizumab.
Crizanlizumab [1], metabolic pathway ---> SmPC of [1] of EMA
No effect on exposure of co-administered medicinal products is expected based on the metabolic pathways of monoclonal antibodies.
Crizanlizumab [1], pregnancy ---> SmPC of [1] of EMA
As a precautionary measure, it is preferable to avoid the use of Adakveo during pregnancy and in woman of childbearing potential not using contraception.
CONTRAINDICATIONS of Crizanlizumab (Adakveo)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Hypersensitivity to Chinese Hamster Ovary (CHO) cell products.
https://www.ema.europa.eu/es/documents/product-information/adakveo-epar-product-information_en.pdf 21/08/2023 (withdraw)
Crizotinib (Xalkori)
Ability to drive, crizotinib [2] ---> SmPC of [2] of EMA
Caution should be exercised when driving or operating machines as patients may experience symptomatic bradycardia (e.g., syncope, dizziness, hypotension), vision disorder, or fatigue while taking XALKORI
Alfentanyl, crizotinib [2] ---> SmPC of [2] of EMA
Coadministration of crizotinib (moderate inhibitor of CYP3A) with CYP3A substrates with narrow therapeutic indices should be avoided. If the combination is needed, then close clinical monitoring should be exercised.
Amiodarone, crizotinib [2] ---> SmPC of [2] of EMA
Concomitant use of crizotinib (prolongs QT interval) with medicinal products known to prolong QT interval or medicinal products able to induce Torsades de pointes should be carefully considered.
Antacids, crizotinib [2] ---> SmPC of [2] of EMA
The aqueous solubility of crizotinib is pH dependent, with low (acidic) pH resulting in higher solubility. Starting dose adjustment is not required when crizotinib is coadministered with agents that increase gastric pH
Anticholinesterase, crizotinib [2] ---> SmPC of [2] of EMA
Bradycardia has been reported during clinical studies; therefore, use crizotinib with caution due to the risk of excessive bradycardia when used in combination with other bradycardic agents
Atazanavir, crizotinib [2] ---> SmPC of [2] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Benzothiazepines, crizotinib [2] ---> SmPC of [2] of EMA
Bradycardia has been reported during clinical studies; therefore, use crizotinib with caution due to the risk of excessive bradycardia when used in combination with other bradycardic agents
Betablockers, crizotinib [2] ---> SmPC of [2] of EMA
Bradycardia has been reported during clinical studies; therefore, use crizotinib with caution due to the risk of excessive bradycardia when used in combination with other bradycardic agents
Bosutinib [1], crizotinib ---> SmPC of [1] of EMA
The concomitant use of bosutinib with moderate CYP3A inhibitors should be avoided, as an increase in bosutinib plasma levels will occur. Selection of an alternate concomitant medicine with no or minimal CYP3A enzyme inhibition potential is recommended.
Breast-feeding, crizotinib [2] ---> SmPC of [2] of EMA
It is not known whether crizotinib and its metabolites are excreted in human milk. Because of the potential harm to the infant, mothers should be advised to avoid breast-feeding while receiving XALKORI (see section 5.3).
Bupropion, crizotinib [2] ---> SmPC of [2] of EMA
In vitro studies indicated that crizotinib is an inhibitor of CYP2B6. Therefore, crizotinib may have the potential to increase plasma concentrations of coadministered drugs that are metabolized by CYP2B6
Carbamazepine, crizotinib [2] ---> SmPC of [2] of EMA
Coadministration of crizotinib with strong CYP3A inducers may decrease crizotinib plasma concentrations. The concurrent use of strong CYP3A inducers should be avoided
Cisapride, crizotinib [2] ---> SmPC of [2] of EMA
Coadministration of crizotinib (moderate inhibitor of CYP3A) with CYP3A substrates with narrow therapeutic indices should be avoided. If the combination is needed, then close clinical monitoring should be exercised.
Clarithromycin, crizotinib [2] ---> SmPC of [2] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Class IA antiarrhythmic agents, crizotinib [2] ---> SmPC of [2] of EMA
Concomitant use of crizotinib (prolongs QT interval) with medicinal products known to prolong QT interval or medicinal products able to induce Torsades de pointes should be carefully considered.
Class III antiarrhythmic agents, crizotinib [2] ---> SmPC of [2] of EMA
Concomitant use of crizotinib (prolongs QT interval) with medicinal products known to prolong QT interval or medicinal products able to induce Torsades de pointes should be carefully considered.
Clonidine, crizotinib [2] ---> SmPC of [2] of EMA
Bradycardia has been reported during clinical studies; therefore, use crizotinib with caution due to the risk of excessive bradycardia when used in combination with other bradycardic agents
Colchicine, crizotinib [2] ---> SmPC of [2] of EMA
Administration of crizotinib (intestinal P-gp inhibitor) with medicinal products that are substrates of P-gp may increase their therapeutic effect and adverse reactions. Close clinical surveillance is recommended
Crizotinib [1], cyclosporine ---> SmPC of [1] of EMA
Coadministration of crizotinib (moderate inhibitor of CYP3A) with CYP3A substrates with narrow therapeutic indices should be avoided. If the combination is needed, then close clinical monitoring should be exercised.
Crizotinib [1], dabigatran ---> SmPC of [1] of EMA
Administration of crizotinib (intestinal P-gp inhibitor) with medicinal products that are substrates of P-gp may increase their therapeutic effect and adverse reactions. Close clinical surveillance is recommended
Crizotinib [1], digoxin ---> SmPC of [1] of EMA
Administration of crizotinib (intestinal P-gp inhibitor) with medicinal products that are substrates of P-gp may increase their therapeutic effect and adverse reactions. Close clinical surveillance is recommended
Crizotinib [1], diltiazem ---> SmPC of [1] of EMA
Bradycardia has been reported during clinical studies; therefore, use crizotinib with caution due to the risk of excessive bradycardia when used in combination with other bradycardic agents
Crizotinib [1], disopyramide ---> SmPC of [1] of EMA
Concomitant use of crizotinib (prolongs QT interval) with medicinal products known to prolong QT interval or medicinal products able to induce Torsades de pointes should be carefully considered.
Crizotinib [1], dofetilide ---> SmPC of [1] of EMA
Concomitant use of crizotinib (prolongs QT interval) with medicinal products known to prolong QT interval or medicinal products able to induce Torsades de pointes should be carefully considered.
Crizotinib [1], drugs inducing bradycardia ---> SmPC of [1] of EMA
Bradycardia has been reported during clinical studies; therefore, use crizotinib with caution due to the risk of excessive bradycardia when used in combination with other bradycardic agents
Crizotinib [1], drugs primarily metabolised by CYP2B6 ---> SmPC of [1] of EMA
In vitro studies indicated that crizotinib is an inhibitor of CYP2B6. Therefore, crizotinib may have the potential to increase plasma concentrations of coadministered drugs that are metabolized by CYP2B6
Crizotinib [1], drugs primarily metabolised by CYP2C8 ---> SmPC of [1] of EMA
Caution should be exercised in administering crizotinib, CYP2C8 inductor, in combination with medicinal products that are predominantly metabolized by CYP2C8
Crizotinib [1], drugs primarily metabolised by CYP2C9 ---> SmPC of [1] of EMA
Caution should be exercised in administering crizotinib, CYP2C9 inductor, in combination with medicinal products that are predominantly metabolized by CYP2C9
Crizotinib [1], drugs primarily metabolised by CYP3A4 ---> SmPC of [1] of EMA
Caution should be exercised in administering crizotinib, CYP3A4 inductor, in combination with medicinal products that are metabolized by CYP3A4
Crizotinib [1], drugs primarily metabolised by CYP3A4 with narrow therapeutic index ---> SmPC of [1] of EMA
Coadministration of crizotinib (moderate inhibitor of CYP3A) with CYP3A substrates with narrow therapeutic indices should be avoided. If the combination is needed, then close clinical monitoring should be exercised.
Crizotinib [1], drugs primarily metabolised by UGT1A1 ---> SmPC of [1] of EMA
Crizotinib, weak UGT1A1 inhibitor, may increase the plasma concentrations of the medicinal products mainly metabolized by UGT1A1
Crizotinib [1], drugs primarily metabolised by UGT2B7 ---> SmPC of [1] of EMA
Crizotinib, weak UGT2B7 inhibitor, may increase the plasma concentrations of the medicinal products mainly metabolized by UGT2B7
Crizotinib [1], efavirenz ---> SmPC of [1] of EMA
The effect of a moderate inducer including but not limited to efavirenz or rifabutin is not clearly established; therefore, their combination with crizotinib should be also avoided (see section 4.4).
Crizotinib [1], ergot derivatives ---> SmPC of [1] of EMA
Coadministration of crizotinib (moderate inhibitor of CYP3A) with CYP3A substrates with narrow therapeutic indices should be avoided. If the combination is needed, then close clinical monitoring should be exercised.
Crizotinib [1], esomeprazole ---> SmPC of [1] of EMA
Administration of a single 250 mg crizotinib dose of oral granules in capsules for opening following treatment with esomeprazole 40 mg once daily for 5 days resulted in an approximately 19% decrease in crizotinib AUCinf and 23% decrease in Cmax.
Crizotinib [1], fentanyl ---> SmPC of [1] of EMA
Coadministration of crizotinib (moderate inhibitor of CYP3A) with CYP3A substrates with narrow therapeutic indices should be avoided. If the combination is needed, then close clinical monitoring should be exercised.
Crizotinib [1], fertility ---> SmPC of [1] of EMA
Based on non-clinical safety findings, male and female fertility may be compromised by treatment with XALKORI (see section 5.3). Both men and women should seek advice on fertility preservation before treatment.
Crizotinib [1], gastric pH increasing medication ---> SmPC of [1] of EMA
The aqueous solubility of crizotinib is pH dependent, with low (acidic) pH resulting in higher solubility. Starting dose adjustment is not required when crizotinib is coadministered with agents that increase gastric pH
Crizotinib [1], gastrointestinal perforation ---> SmPC of [1] of EMA
Crizotinib should be used with caution in patients at risk for gastrointestinal perforation (e. g., concomitant use of medications with a recognized risk of gastrointestinal perforation)
Crizotinib [1], grapefruit ---> SmPC of [1] of EMA
Grapefruit or grapefruit juice may also increase plasma concentrations of crizotinib and should be avoided (see sections 4.2 and 4.4).
Crizotinib [1], grapefruit juice ---> SmPC of [1] of EMA
Grapefruit or grapefruit juice may also increase plasma concentrations of crizotinib and should be avoided (see sections 4.2 and 4.4).
Crizotinib [1], guanfacin ---> SmPC of [1] of EMA
Bradycardia has been reported during clinical studies; therefore, use crizotinib with caution due to the risk of excessive bradycardia when used in combination with other bradycardic agents
Crizotinib [1], H2 antagonists ---> SmPC of [1] of EMA
The aqueous solubility of crizotinib is pH dependent, with low (acidic) pH resulting in higher solubility. Starting dose adjustment is not required when crizotinib is coadministered with agents that increase gastric pH
Crizotinib [1], hepatotoxic drugs ---> SmPC of [1] of EMA
Drug-induced hepatotoxicity (including cases with fatal outcome) has been reported in patients treated with crizotinib across clinical trials
Crizotinib [1], ibutilide ---> SmPC of [1] of EMA
Concomitant use of crizotinib (prolongs QT interval) with medicinal products known to prolong QT interval or medicinal products able to induce Torsades de pointes should be carefully considered.
Crizotinib [1], indinavir ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Crizotinib [1], irinotecan ---> SmPC of [1] of EMA
Therefore, crizotinib may have the potential to increase plasma concentrations of coadministered medicinal products that are metabolised predominantly by UGT1A1 (e.g., raltegravir, irinotecan) or UGT2B7 (e.g., morphine, naloxone).
Crizotinib [1], itraconazol ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Crizotinib [1], ketoconazole ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Crizotinib [1], mefloquine ---> SmPC of [1] of EMA
Bradycardia has been reported during clinical studies; therefore, use crizotinib with caution due to the risk of excessive bradycardia when used in combination with other bradycardic agents
Crizotinib [1], men ---> SmPC of [1] of EMA
Contraception in males and females: Adequate contraceptive methods should be used during therapy, and for at least 90 days after completing therapy (see section 4.5).
Crizotinib [1], metformin ---> SmPC of [1] of EMA
Crizotinib is an inhibitor of OCT1 and OCT2 in vitro. Therefore, crizotinib may have the potential to increase plasma concentrations of coadministered drugs that are substrates of OCT1 or OCT2
Crizotinib [1], methadone ---> SmPC of [1] of EMA
Concomitant use of crizotinib (prolongs QT interval) with medicinal products known to prolong QT interval or medicinal products able to induce Torsades de pointes should be carefully considered.
Crizotinib [1], midazolam ---> SmPC of [1] of EMA
Coadministration of crizotinib (moderate inhibitor of CYP3A) with CYP3A substrates with narrow therapeutic indices should be avoided. If the combination is needed, then close clinical monitoring should be exercised.
Crizotinib [1], moderate CYP3A4 inductors ---> SmPC of [1] of EMA
The effect of a moderate inducer including but not limited to efavirenz or rifabutin is not clearly established; therefore, their combination with crizotinib should be also avoided (see section 4.4).
Crizotinib [1], moderate CYP3A4 inhibitors ---> SmPC of [1] of EMA
Caution is therefore recommended in case of coadministration of crizotinib with moderate CYP3A inhibitors.
Crizotinib [1], morphine ---> SmPC of [1] of EMA
Therefore, crizotinib may have the potential to increase plasma concentrations of coadministered medicinal products that are metabolised predominantly by UGT1A1 (e.g., raltegravir, irinotecan) or UGT2B7 (e.g., morphine, naloxone).
Crizotinib [1], moxifloxacin ---> SmPC of [1] of EMA
Concomitant use of crizotinib (prolongs QT interval) with medicinal products known to prolong QT interval or medicinal products able to induce Torsades de pointes should be carefully considered.
Crizotinib [1], naloxone ---> SmPC of [1] of EMA
Therefore, crizotinib may have the potential to increase plasma concentrations of coadministered medicinal products that are metabolised predominantly by UGT1A1 (e.g., raltegravir, irinotecan) or UGT2B7 (e.g., morphine, naloxone).
Crizotinib [1], nelfinavir ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Crizotinib [1], OCT1 substrates ---> SmPC of [1] of EMA
Crizotinib is an inhibitor of OCT1 and OCT2 in vitro. Therefore, crizotinib may have the potential to increase plasma concentrations of coadministered drugs that are substrates of OCT1 or OCT2
Crizotinib [1], OCT2 substrates ---> SmPC of [1] of EMA
Crizotinib is an inhibitor of OCT1 and OCT2 in vitro. Therefore, crizotinib may have the potential to increase plasma concentrations of coadministered drugs that are substrates of OCT1 or OCT2
Crizotinib [1], oral contraceptives ---> SmPC of [1] of EMA
Of note, the effectiveness of concomitant administration of oral contraceptives may be reduced.
Crizotinib [1], P-glycoprotein substrates ---> SmPC of [1] of EMA
Administration of crizotinib (intestinal P-gp inhibitor) with medicinal products that are substrates of P-gp may increase their therapeutic effect and adverse reactions. Close clinical surveillance is recommended
Crizotinib [1], phenobarbital ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inducers may decrease crizotinib plasma concentrations. The concurrent use of strong CYP3A inducers should be avoided
Crizotinib [1], phenylalkylamines ---> SmPC of [1] of EMA
Bradycardia has been reported during clinical studies; therefore, use crizotinib with caution due to the risk of excessive bradycardia when used in combination with other bradycardic agents
Crizotinib [1], phenytoin ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inducers may decrease crizotinib plasma concentrations. The concurrent use of strong CYP3A inducers should be avoided
Crizotinib [1], pilocarpine ---> SmPC of [1] of EMA
Bradycardia has been reported during clinical studies; therefore, use crizotinib with caution due to the risk of excessive bradycardia when used in combination with other bradycardic agents
Crizotinib [1], pimozide ---> SmPC of [1] of EMA
Coadministration of crizotinib (moderate inhibitor of CYP3A) with CYP3A substrates with narrow therapeutic indices should be avoided. If the combination is needed, then close clinical monitoring should be exercised.
Crizotinib [1], pravastatine ---> SmPC of [1] of EMA
Administration of crizotinib (intestinal P-gp inhibitor) with medicinal products that are substrates of P-gp may increase their therapeutic effect and adverse reactions. Close clinical surveillance is recommended
Crizotinib [1], pregnancy ---> SmPC of [1] of EMA
XALKORI may cause foetal harm when administered to a pregnant woman. Studies in animals have shown reproductive toxicity (see section 5.3).
Crizotinib [1], pregnancy ---> SmPC of [1] of EMA
Pregnant women, or patients becoming pregnant while receiving crizotinib, or treated male patients as partners of pregnant women, should be apprised of the potential hazard to the foetus.
Crizotinib [1], procainamide ---> SmPC of [1] of EMA
Crizotinib is an inhibitor of OCT1 and OCT2 in vitro. Therefore, crizotinib may have the potential to increase plasma concentrations of coadministered drugs that are substrates of OCT1 or OCT2
Crizotinib [1], proton pump inhibitors ---> SmPC of [1] of EMA
The aqueous solubility of crizotinib is pH dependent, with low (acidic) pH resulting in higher solubility. Starting dose adjustment is not required when crizotinib is coadministered with agents that increase gastric pH
Crizotinib [1], QT interval prolonging drugs ---> SmPC of [1] of EMA
Concomitant use of crizotinib (prolongs QT interval) with medicinal products known to prolong QT interval or medicinal products able to induce Torsades de pointes should be carefully considered.
Crizotinib [1], quinidine ---> SmPC of [1] of EMA
Concomitant use of crizotinib (prolongs QT interval) with medicinal products known to prolong QT interval or medicinal products able to induce Torsades de pointes should be carefully considered.
Crizotinib [1], raltegravir ---> SmPC of [1] of EMA
Therefore, crizotinib may have the potential to increase plasma concentrations of coadministered medicinal products that are metabolised predominantly by UGT1A1 (e.g., raltegravir, irinotecan) or UGT2B7 (e.g., morphine, naloxone).
Crizotinib [1], rifabutin ---> SmPC of [1] of EMA
The effect of a moderate inducer including but not limited to efavirenz or rifabutin is not clearly established; therefore, their combination with crizotinib should be also avoided (see section 4.4).
Crizotinib [1], rifampicin ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inducers may decrease crizotinib plasma concentrations. The concurrent use of strong CYP3A inducers should be avoided
Crizotinib [1], ritonavir ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Crizotinib [1], saquinavir ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Crizotinib [1], sirolimus ---> SmPC of [1] of EMA
Coadministration of crizotinib (moderate inhibitor of CYP3A) with CYP3A substrates with narrow therapeutic indices should be avoided. If the combination is needed, then close clinical monitoring should be exercised.
Crizotinib [1], sotalol ---> SmPC of [1] of EMA
Concomitant use of crizotinib (prolongs QT interval) with medicinal products known to prolong QT interval or medicinal products able to induce Torsades de pointes should be carefully considered.
Crizotinib [1], St. John's wort ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inducers may decrease crizotinib plasma concentrations. The concurrent use of strong CYP3A inducers should be avoided
Crizotinib [1], strong CYP3A4 inductors ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inducers may decrease crizotinib plasma concentrations. The concurrent use of strong and moderate CYP3A inducers should be avoided
Crizotinib [1], strong CYP3A4 inhibitors ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Crizotinib [1], telithromycin ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Crizotinib [1], torsades de pointes inducing drugs ---> SmPC of [1] of EMA
Concomitant use of crizotinib (prolongs QT interval) with medicinal products known to prolong QT interval or medicinal products able to induce Torsades de pointes should be carefully considered.
Crizotinib [1], troleandomycin ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Crizotinib [1], verapamil ---> SmPC of [1] of EMA
Bradycardia has been reported during clinical studies; therefore, use crizotinib with caution due to the risk of excessive bradycardia when used in combination with other bradycardic agents
Crizotinib [1], voriconazole ---> SmPC of [1] of EMA
Coadministration of crizotinib with strong CYP3A inhibitors may increase crizotinib plasma concentrations. Therefore, the concomitant use of strong CYP3A inhibitors should be avoided.
Crizotinib [1], women of childbearing potential ---> SmPC of [1] of EMA
Women of childbearing potential should be advised to avoid becoming pregnant while receiving XALKORI.
Crizotinib, duvelisib [2] ---> SmPC of [2] of EMA
Dose reduction of duvelisib is not necessary when co-administered with moderate CYP3A4 inhibitors
Crizotinib, elacestrant [2] ---> SmPC of [2] of EMA
Concomitant administration of ORSERDU with moderate CYP3A4 inhibitors should be avoided which may increase the risk of adverse reactions
Crizotinib, empagliflozin/metformin [2] ---> SmPC of [2] of EMA
Co-administration of metformin with Inhibitors of both OCT1 and OCT2 (such as crizotinib, olaparib) may alter efficacy and renal elimination of metformin.
Crizotinib, ertugliflozin/metformin [2] ---> SmPC of [2] of EMA
Inhibitors of both OCT1 and OCT2 (such as crizotinib, olaparib) may alter efficacy and renal elimination of metformin.
Crizotinib, glecaprevir/pibrentasvir [2] ---> SmPC of [2] of EMA
Co-administration of Maviret with medicinal products that are moderate inducers P-gp/CYP3A may decrease glecaprevir and pibrentasvir plasma concentrations. Co-administration of moderate inducers is not recommended
Crizotinib, ibrutinib [2] ---> SmPC of [2] of EMA
Concomitant use of IMBRUVICA and medicinal products that strongly or moderately inhibit CYP3A4 can increase ibrutinib exposure and strong CYP3A4 inhibitors should be avoided.
Crizotinib, ketoconazole [2] ---> SmPC of [2] of EMA
Not recommended due to the risk of QT interval prolongation and serious hepatic adverse reactions. Monitoring of QT-prolongation if used concomitantly.
Crizotinib, linagliptin/metformin [2] ---> SmPC of [2] of EMA
Inhibitors of both OCT1 and OCT2 (such as crizotinib, olaparib) may alter efficacy and renal elimination of metformin.
Crizotinib, metformin/saxagliptin/dapagliflozin [2] ---> SmPC of [2] of EMA
Co-administration of metformin with inhibitors of both OCT1 and OCT2 (such as crizotinib, olaparib) may alter efficacy and renal elimination of metformin and may increase metformin plasma concentration
Crizotinib, pralsetinib [2] ---> SmPC of [2] of EMA
Co-administration of pralsetinib with P-gp and/or strong or moderate CYP3A4 inhibitors may increase pralsetinib plasma concentrations, which may increase the risk of adverse reactions of pralsetinib. The coadministration should be avoided
Crizotinib, tacrolimus [2] ---> SmPC of [2] of EMA
May increase tacrolimus whole blood trough concentrations and increase the risk of serious adverse reactions (e.g., neurotoxicity, QT prolongation). A rapid increase in tacrolimus level may occur. Monitor tacrolimus whole blood trough levels frequently,
CONTRAINDICATIONS of Crizotinib (Xalkori)
- Hypersensitivity to crizotinib or to any of the excipients listed in section 6.1.
https://www.ema.europa.eu/en/documents/product-information/xalkori-epar-product-information_en.pdf 25/11/2024
Crovalimab (Piasky)
Breast-feeding, crovalimab [2] ---> SmPC of [2] of EMA
A decision must be made whether to discontinue breast-feeding or to discontinue from Piasky therapy taking into account the benefit of breast-feeding for the infant and the benefit of therapy for the mother.
Crovalimab [1], cytochrome P450 ---> SmPC of [1] of EMA
Crovalimab is not expected to show pharmacokinetic interactions with other medicinal products interfering with the metabolising cytochrome P450 (CYP) enzymes
Crovalimab [1], fertility ---> SmPC of [1] of EMA
No clinical data are available on the effect of crovalimab on human fertility. Animal data from repeated-dose toxicity studies showed no effect on male or female reproductive organs (see section 5.3).
Crovalimab [1], pregnancy ---> SmPC of [1] of EMA
Therefore, the use of Piasky may be considered in pregnant women if the clinical condition of the woman requires treatment with crovalimab.
CONTRAINDICATIONS of Crovalimab (Piasky)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Patients with unresolved Neisseria meningitidis infection.
- Patients who are not currently vaccinated against Neisseria meningitidis unless they receive prophylactic treatment with appropriate antibiotics until 2 weeks after vaccination (see section 4.4).
https://www.ema.europa.eu/en/documents/product-information/piasky-epar-product-information_en.pdf 21/10/2025
Cyanocobalamin
Ascorbic acid, cyanocobalamin
Large doses of ascorbic acid may reduce the available quantities of cyanocobalamin (vitamin B12) in plasma and the reserves. It is recommended to administer ascorbic acid at least 2 hours after eating
Biguanides, cyanocobalamin ---> SPC of [2] of eMC
Reduced absorption of vitamin B12
Chloramphenicol, cyanocobalamin [2] ---> SPC of [2] of eMC
Patients treated with chloramphenicol may respond poorly to this medicine.
Cholestyramine, cyanocobalamin ---> SPC of [1] of eMC
Reduced absorption of vitamin B12
Cimetidine, cyanocobalamin ---> SPC of [1] of eMC
Reduced absorption of vitamin B12
Colchicine [1], cyanocobalamin ---> SPC of [1] of eMC
The absorption of Vitamin B 12 may be impaired by chronic administration or high doses of colchicine; requirement may be increased.
Cyanocobalamin [1], neomycin ---> SPC of [1] of eMC
Reduced absorption of vitamin B12
Cyanocobalamin [1], oral contraceptives ---> SPC of [1] of eMC
Serum levels of cyanocobalamin may be lowered by oral contraceptives.
Cyanocobalamin [1], para-aminosalicylic acid ---> SPC of [1] of eMC
Reduced absorption of vitamin B12
Cyanocobalamin [1], pregnancy ---> SPC of [1] of eMC
This medicine should not be used to treat of megaloblastic anaemia of pregnancy because this is due to folate
Cyanocobalamin, H2 antagonists
Reduced absorption of vitamin B12
Cyanocobalamin, methyldopa ---> SPC of [1] of eMC
Reduced absorption of vitamin B12
Cyanocobalamin, omeprazole [2] ---> SPC of [2] of eMC
The inhibition of acid secretion may decrease the absorption of cyanocobalamin (vitamin B12) due to hypochlorhydria or achlorhydria
Cyanocobalamin, potassium chloride ---> SPC of [1] of eMC
Reduced absorption of vitamin B12
Cyanocobalamin, proton pump inhibitors ---> SPC of [omeprazole] of eMC
The inhibition of acid secretion may decrease the absorption of cyanocobalamin (vitamin B12) due to hypochlorhydria or achlorhydria
CONTRAINDICATIONS of Cyanocobalamin
- Hypersensitivity to the product.
http://www.medicines.org.uk/emc/
Cyclosporine
ACE inhibitors, cyclosporine [2] ---> SPC of [2] of eMC
Caution is required with concomitant use of ciclosporin with potassium-sparing medicinal products or potassium-containing medicinal products since they may lead to significant increases in serum potassium
Aceclofenac [1], cyclosporine ---> SPC of [1] of eMC
Administration of NSAID drugs together with cyclosporin is thought to increase the risk of nephrotoxicity due to decreased synthesis of prostacyclin in the kidney. During combination therapy it is therefore important to carefully monitor renal function.
Acemetacine, cyclosporine
Increased risk of nephrotoxicity. Renal function should be monitored
Acetazolamide, cyclosporine
Acetazolamide may increase the ciclosporin levels.
Acetylsalicylic acid [1], cyclosporine ---> SPC of [1] of eMC
Concomitant use of NSAIDs and ciclosporin may increase the nephrotoxic effect of ciclosporin. The renal function should be monitored in case of concomitant use
Aciclovir, cyclosporine
Increased risk of nephrotoxicity. Caution should be exercised
Adefovir dipivoxil [1], cyclosporine ---> SPC of [1] of EMA
Co-administration of adefovir dipivoxil with other medicinal products that are eliminated by tubular secretion or alter tubular function may increase serum concentrations of either adefovir or the co-administered medicinal product
Afatinib [1], cyclosporine ---> SPC of [1] of EMA
Increased exposure to afatinib. It is recommended to administer strong P-gp inhibitors using staggered dosing, preferably 6 hours or 12 hours apart from afatinib
AIIRA, cyclosporine [2] ---> SPC of [2] of eMC
Caution is required with concomitant use of ciclosporin with potassium-sparing medicinal products or potassium-containing medicinal products since they may lead to significant increases in serum potassium
Aliskiren [1], cyclosporine ---> SPC of [1] of EMA
The concomitant use of aliskiren with ciclosporin and itraconazole, two highly potent P-gp inhibitors, and other potent P-gp inhibitors (e.g. quinidine), is contraindicated
Aliskiren/amlodipine, cyclosporine ---> SPC of [aliskiren] of EMA
The concomitant use of aliskiren with ciclosporin and itraconazole, two highly potent P-gp inhibitors, and other potent P-gp inhibitors (e.g. quinidine), is contraindicated
Aliskiren/amlodipine/hydrochlorothiazide, cyclosporine ---> SPC of [aliskiren] of EMA
The concomitant use of aliskiren with ciclosporin and itraconazole, two highly potent P-gp inhibitors, and other potent P-gp inhibitors (e.g. quinidine), is contraindicated
Aliskiren/hydrochlorothiazide [1], cyclosporine ---> SPC of [1] of EMA
The concomitant use of aliskiren with ciclosporin and itraconazole, two highly potent P-gp inhibitors, and other potent P-gp inhibitors (e.g. quinidine), is contraindicated
Alitretinoin [1], cyclosporine ---> SPC of [1] of eMC
No pharmacokinetic interactions were observed when alitretinoin was co-administered with cyclosporine
Allopurinol [1], cyclosporine ---> SPC of [1] of eMC
Reports suggest that the plasma concentration of ciclosporin may be increased during concomitant treatment with allopurinol. The possibility of enhanced ciclosporin toxicity should be considered if the drugs are co-administered.
Allopurinol/lesinurad [1], cyclosporine ---> SPC of [1] of EMA
Allopurinol can increase the plasma concentration of ciclosporin when concomitantly administered. The possibility of an increased occurrence of ciclosporin-specific adverse reactions is to be considered.
Ambrisentan [1], cyclosporine ---> SPC of [1] of EMA
Steady-state co-administration of ambrisentan and cyclosporine A resulted in a 2-fold increase in ambrisentan exposure in healthy volunteers.
Amikacine [1], cyclosporine ---> SPC of [1] of eMC
Concurrent or serial use of amikacin with other neurotoxic, ototoxic or nephrotoxic agents should be avoided either systemically or topically because of the potential for additive effects.
Amiloride, cyclosporine
When amiloride hydrochloride is administered concomitantly with ciclosporin the risk of hyperkalaemia may be increased.
Amiloride/hydrochlorothiazide [1], cyclosporine ---> SPC of [1] of eMC
When amiloride hydrochloride is administered concomitantly with ciclosporin the risk of hyperkalaemia may be increased.
Aminoglycoside antibiotics, cyclosporine [2] ---> SPC of [2] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Amiodarone, cyclosporine [2] ---> SPC of [2] of eMC
Amiodarone, CYP3A4 inhibitor, may increase the plasma concentrations of cyclosporine
Amlodipine/valsartan [1], cyclosporine ---> SPC of [1] of EMA
The results of an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic efflux transporter MRP2. Co-administration of inhibitors of the MRP2 may increase the systemic exposure to valsartan.
Amlodipine/valsartan, cyclosporine ---> SPC of [amlodipine/valsartan/hydrochlorothiazide] of EMA
The results of an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1. Co-administration of inhibitors of OATP1B1 may increase the systemic exposure to valsartan.
Amlodipine/valsartan/hydrochlorothiazide [1], cyclosporine ---> SPC of [1] of EMA
Ciclosporin, OATP1B1 inhibitor, may increase the systemic exposure to valsartan. Concomitant treatment of hydrochlorothiazide with ciclosporin may increase the risk of hyperuricaemia and gout-type complications.
Amphotericin B, cyclosporine [2] ---> SPC of [2] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Amprenavir [1], cyclosporine ---> SPC of [1] of EMA
Frequent therapeutic concentration monitoring of immunosuppressant levels is recommended until levels have stabilised as plasma concentrations of immunosuppressant may be increased when co-administered with amprenavir
Anthracyclines, cyclosporine [2] ---> SPC of [2] of eMC
A significantly increased exposure to anthracycline antibiotics was observed in oncology patients with the intravenous co-administration of anthracycline antibiotics and very high doses of ciclosporin.
Aprepitant [1], cyclosporine ---> SPC of [1] of EMA
Caution is advised during concomitant administration of aprepitant and orally administered active substances that are metabolised primarily through CYP3A4 and with a narrow therapeutic range
Ascorbic acid, cyclosporine
Ascorbic acid could decrease plasma levels of ciclosporin
Ataluren [1], cyclosporine ---> SPC of [1] of EMA
Caution should be exercised when ataluren is co-administered with medicinal products that are inhibitors of BCRP (e.g. cyclosporine).
Atazanavir [1], cyclosporine ---> SPC of [1] of EMA
Concentrations of the immunosuppressant may be increased when co-administered with REYATAZ due to CYP3A4 inhibition.
Atazanavir/cobicistat [1], cyclosporine ---> SPC of [1] of EMA
Concentrations of the immunosuppressant may be increased when co-administered with EVOTAZ. The mechanism of interaction is inhibition of CYP3A4 by atazanavir and cobicistat.
Atorvastatin [1], cyclosporine ---> SPC of [1] of eMC
Risk of rhabdomyolysis is increased when atorvastatin is administered concomitantly with certain medicinal products that may increase the plasma concentration of atorvastatin such as potent inhibitors of CYP3A4 or transport proteins
Azathioprine, cyclosporine
The co-administration may increase the risk of an excessive immunsuppression
Azithromycin, cyclosporine
Caution should be used when administering azithromycin with medicines mainly metabolised by CYP3A4 and narrow therapeutic window
Azole antifungals, cyclosporine [2] ---> SPC of [2] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Barbiturates, cyclosporine [2] ---> SPC of [2] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Barnidipine, cyclosporine
The strong CYP3A4 inhibition may increase the plasma concentrations of barnidipine. Barnidipine should not be concomitantly prescribed with strong CYP3A4 inhibitors.
Benazepril, cyclosporine
Potassium-sparing diuretics potassium supplements or potassium-containing salt substitutes have been shown to increase the risk of hyperkalaemia when used concomitantly with ACE inhibitors.
Bendamustine [1], cyclosporine ---> SPC of [1] of eMC
Combination of bendamustine with cyclosporine may result in excessive immunosuppression with risk of lymphoproliferation.
Bexarotene [1], cyclosporine ---> SPC of [1] of EMA
Caution is advised in case of combination of bexarotene with CYP3A4 substrates having a narrow therapeutic margin
Bezafibrate, cyclosporine [2] ---> SPC of [2] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Bictegravir/emtricitabine/tenofovir alafenamide [1], cyclosporine ---> SPC of [1] of EMA
Co-administration of ciclosporin (IV or oral use) is not recommended. If the combination is needed, clinical and biological monitoring, notably renal function, is recommended.
Bilastine [1], cyclosporine ---> SPC of [1] of eMC
Concomitant intake of bilastine, substrate for P-gp, may likewise have the potential to increase plasma concentrations of bilastine.
Bleomycin, cyclosporine
Exaggerated immunosuppression with risk of lymphoproliferation
Blinatumomab [1], cyclosporine ---> SPC of [1] of EMA
Patients who are receiving medicinal products that are CYP450 and transporter substrates with a narrow therapeutic index should be monitored for adverse effects (e.g. warfarin) or drug concentrations (e.g. cyclosporine) during this time.
Boceprevir [1], cyclosporine ---> SPC of [1] of EMA
The CYP3A4 inhibition by boceprevir increases the plasma levels of cyclosporine. Dose adjustments of cyclosporine should be anticipated when coadministered
Bosentan [1], cyclosporine ---> SPC of [1] of EMA
Decreased cyclosporine plasma concentrations and increased levels of bosentan. The coadministration is contra-indicated
Breast-feeding, cyclosporine [2] ---> SPC of [2] of eMC
Ciclosporin passes into breast milk. A decision should be made whether to abstain from breast-feeding or to abstain from using the medicinal drug
Bromocriptine, cyclosporine
The inhibition of P-glycoprotein may lead to increased bioavailability of oral cyclosporine
Budesonide, cyclosporine ---> SPC of [budesonide/formoterol] of EMA
Potent inhibitors of CYP3A4 are likely to markedly increase plasma levels of budesonide and concomitant use should be avoided.
Bupropion, cyclosporine
Bupropion may decrease the therapeutic effect of cyclosporine.
Cabozantinib [1], cyclosporine ---> SPC of [1] of EMA
In vitro data demonstrate that cabozantinib is a substrate of MRP2. Therefore, administration of MRP2 inhibitors may result in increases in cabozantinib plasma concentrations.
Calcineurin inhibitors, cyclosporine [2] ---> SPC of [2] of eMC
Patients receiving calcineurin inhibitor (CNI) therapies, including ciclosporin and ciclosporin-containing regimens, are at increased risk of acute or chronic nephrotoxicity.
Calcium antagonists, cyclosporine
The co-administration may increase the cyclosporine plasma levels. Possible renal impairment
Carbamazepine, cyclosporine [2] ---> SPC of [2] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Carboplatin, cyclosporine
The co-administration of carboplatin with ciclosporin may cause an excessive immunosuppression with risk of lymphoproliferation
Carvedilol [1], cyclosporine ---> SPC of [1] of eMC
Modest increases in mean trough cyclosporine concentrations were observed following the initiation of carvedilol treatment in 21 renal transplant patients suffering from chronic vascular rejection.
Caspofungin [1], cyclosporine ---> SPC of [1] of EMA
Caspofungin can be used in patients receiving cyclosporin when the potential benefit outweighs the potential risk. Close monitoring of liver enzymes should be considered if caspofungin and cyclosporin are used concomitantly.
Celecoxib [1], cyclosporine ---> SPC of [1] of EMA
The combination may increase the risk of nephrotoxicity. Renal function must be closely monitored.
Ceritinib [1], cyclosporine ---> SPC of [1] of EMA
Co-administration of ceritinib with CYP3A substrates known to have narrow therapeutic indices should be avoided.
Chenodeoxycholic acid [1], cyclosporine ---> SPC of [1] of EMA
If administration of ciclosporin or sirolimus is considered necessary, serum and urine bile alcohol levels should be closely monitored and the chenodeoxycholic acid dose adjusted accordingly.
Chloroquine [1], cyclosporine ---> SPC of [1] of eMC
If the patient is taking ciclosporin then chloroquine may cause an increase in ciclosporin levels.
Chlortalidone, cyclosporine
Concomitant treatment of chlortalidone with ciclosporin may increase the risk of hyperuricaemia and gout-type complications.
Cholic acid derivates, cyclosporine
Increased cyclosporine plasma levels
Cholic acid [1], cyclosporine ---> SPC of [1] of EMA
Ciclosporin inhibits the hepatic uptake and hepatobiliary secretion of bile acids. The co-administration should be avoided
Cimetidine, cyclosporine [2] ---> SPC of [2] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Ciprofloxacin, cyclosporine [2] ---> SPC of [2] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cisplatin, cyclosporine
The co-administration may cause an excessive immunosuppression with risk of lymphoproliferation
Clarithromycin, cyclosporine [2] ---> SPC of [2] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Clofarabine [1], cyclosporine ---> SPC of [1] of EMA
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Cloprednol, cyclosporine
Increased plasma concentration of cyclosporine and the risk of cerebral seizures
Cobicistat [1], cyclosporine ---> SPC of [1] of EMA
The co-administration may increase the plasma levels of immunosuppressive
Cobimetinib [1], cyclosporine ---> SPC of [1] of EMA
Cobimetinib is a substrate of P-glycoprotein (P-gp). Concomitant administration of P-gp inhibitors such as ciclosporin and verapamil may have the potential to increase plasma concentrations of cobimetinib.
Colchicine [1], cyclosporine ---> SPC of [1] of eMC
Colchicine should be used with caution with ciclosporin due to the possible increased risk of nephrotoxicity and myotoxicity.
Colesevelam [1], cyclosporine ---> SPC of [1] of EMA
The bile-acid sequestrant may decrease the bioavailability of cyclosporine. Administer colesevelam 4 hours after the cyclosporine
Corticosteroids, cyclosporine
Monitor for evidence of increased toxicity of cyclosporine when the two are used concurrently.
Cotrimoxazole [1], cyclosporine ---> SPC of [1] of eMC
Reversible deterioration in renal function has been observed in patients treated with co-trimoxazole and ciclosporin following renal transplantation.
Crizotinib [1], cyclosporine ---> SPC of [1] of EMA
Coadministration of crizotinib (moderate inhibitor of CYP3A) with CYP3A substrates with narrow therapeutic indices should be avoided. If the combination is needed, then close clinical monitoring should be exercised.
Cyclophosphamide, cyclosporine
The co-administration may decrease the plasma levels of cyclosporine
Cyclosporine [1], CYP3A4 and P-glycoprotein-inhibitors ---> SPC of [1] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Cyclosporine [1], danazol ---> SPC of [1] of eMC
Danazol can increase the plasma level of ciclosporin, leading to an increase of the renal toxicity
Cyclosporine [1], daunorubicin ---> SPC of [1] of eMC
A significantly increased exposure to anthracycline antibiotics was observed in oncology patients with the intravenous co-administration of anthracycline antibiotics and very high doses of ciclosporin.
Cyclosporine [1], diclofenac ---> SPC of [1] of eMC
lncreased risk of nephrotoxicity.
Cyclosporine [1], digoxin ---> SPC of [1] of eMC
Ciclosporin may reduce the clearance of digoxin
Cyclosporine [1], diltiazem ---> SPC of [1] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Cyclosporine [1], drugs metabolised by CYP3A4 ---> SPC of [1] of eMC
Ciclosporin is an inhibitor of CYP3A4, the multidrug efflux transporter P-glycoprotein and organic anion transporter proteins (OATP) and may increase plasma levels of co-medications that are substrates of this enzyme and/or transporter.
Cyclosporine [1], drugs primarily metabolised by CYP3A4 ---> SPC of [1] of eMC
Ciclosporin is an inhibitor of CYP3A4, the multidrug efflux transporter P-glycoprotein and organic anion transporter proteins (OATP) and may increase plasma levels of co-medications that are substrates of this enzyme and/or transporter.
Cyclosporine [1], erythromycin ---> SPC of [1] of eMC
Oral erythromycin, which is known to have the potential to increase the blood concentration of ciclosporin, should be avoided.
Cyclosporine [1], fenofibrate ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], fibrates ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], gentamicin ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], grapefruit juice ---> SPC of [1] of eMC
The concomitant intake of grapefruit and grapefruit juice has been reported to increase the bioavailability of ciclosporin.
Cyclosporine [1], H2 antagonists ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], hyperkalemia ---> SPC of [1] of eMC
Caution is required with concomitant use of ciclosporin with potassium-sparing medicinal products or potassium-containing medicinal products since they may lead to significant increases in serum potassium
Cyclosporine [1], itraconazol ---> SPC of [1] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Cyclosporine [1], josamycin ---> SPC of [1] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Cyclosporine [1], lercanidipine ---> SPC of [1] of eMC
The co-administration of lercanidipine with ciclosporin has caused a 3-fold increase of the plasma levels of lercanidipine and a 21% increase of the ciclosporin AUC. Ciclosporin and lercanidipine should not be administered together.
Cyclosporine [1], macrolide antibiotics ---> SPC of [1] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Cyclosporine [1], meloxicam ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], melphalan ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], methotrexate ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], mitoxantrone ---> SPC of [1] of eMC
A significantly increased exposure to anthracycline antibiotics was observed in oncology patients with the intravenous co-administration of anthracycline antibiotics and very high doses of ciclosporin.
Cyclosporine [1], nafcillin ---> SPC of [1] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Cyclosporine [1], naproxen ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], nefazodone ---> SPC of [1] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Cyclosporine [1], neomycin ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], nephrotoxic substances ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], nicardipine ---> SPC of [1] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Cyclosporine [1], nifedipine ---> SPC of [1] of eMC
The concurrent administration of nifedipine with ciclosporin may result in an increased rate of gingival hyperplasia compared with that observed when ciclosporin is given alone.
Cyclosporine [1], NSAID ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], OATP1B1 substrates ---> SPC of [1] of eMC
Ciclosporin is an inhibitor of CYP3A4, the multidrug efflux transporter P-glycoprotein and organic anion transporter proteins (OATP) and may increase plasma levels of co-medications that are substrates of this enzyme and/or transporter.
Cyclosporine [1], octreotide ---> SPC of [1] of eMC
Octreotide has been reported to reduce the intestinal absorption of ciclosporin.
Cyclosporine [1], P-glycoprotein and CYP3A4 inhibitors ---> SPC of [1] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Cyclosporine [1], P-glycoprotein substrates ---> SPC of [1] of eMC
Ciclosporin is an inhibitor of CYP3A4, the multidrug efflux transporter P-glycoprotein and organic anion transporter proteins (OATP) and may increase plasma levels of co-medications that are substrates of this enzyme and/or transporter.
Cyclosporine [1], P-gp inhibitors ---> SPC of [1] of eMC
All inhibitors of CYP3A4 and/or P-glycoprotein may lead to increased levels of cyclosporine.
Cyclosporine [1], phenobarbital ---> SPC of [1] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Cyclosporine [1], phenytoin ---> SPC of [1] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Cyclosporine [1], potassium ---> SPC of [1] of eMC
Caution is required with concomitant use of ciclosporin with potassium-sparing medicinal products or potassium-containing medicinal products since they may lead to significant increases in serum potassium
Cyclosporine [1], potassium chloride ---> SPC of [1] of eMC
Caution is required with concomitant use of ciclosporin with potassium-sparing medicinal products or potassium-containing medicinal products since they may lead to significant increases in serum potassium
Cyclosporine [1], potassium-sparing diuretics ---> SPC of [1] of eMC
Caution is required with concomitant use of ciclosporin with potassium-sparing medicinal products or potassium-containing medicinal products since they may lead to significant increases in serum potassium
Cyclosporine [1], pregnancy ---> SPC of [1] of eMC
Ciclosporin should not be used during pregnancy unless the potential benefit to the mother justifies the potential risk to the foetus.
Cyclosporine [1], probucol ---> SPC of [1] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Cyclosporine [1], protease inhibitors ---> SPC of [1] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Cyclosporine [1], ranitidine ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], rifampicin ---> SPC of [1] of eMC
Rifampicin induces ciclosporin intestinal and liver metabolism. Ciclosporin doses may need to be increased 3- to 5-fold during co-administration.
Cyclosporine [1], spironolactone ---> SPC of [1] of eMC
Caution is required with concomitant use of ciclosporin with potassium-sparing medicinal products or potassium-containing medicinal products since they may lead to significant increases in serum potassium
Cyclosporine [1], St. John's wort ---> SPC of [1] of eMC
Decreased cyclosporine plasma levels. The co-administration is contraindicated
Cyclosporine [1], strong CYP3A4 and P-glycoprotein inductors ---> SPC of [1] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Cyclosporine [1], strong CYP3A4 and P-glycoprotein inductors ---> SPC of [1] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Cyclosporine [1], strong CYP3A4 and P-glycoprotein-inhibitors ---> SPC of [1] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Cyclosporine [1], strong CYP3A4 inductors ---> SPC of [1] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Cyclosporine [1], strong CYP3A4 inhibitors ---> SPC of [1] of eMC
All inhibitors of CYP3A4 and/or P-glycoprotein may lead to increased levels of cyclosporine.
Cyclosporine [1], strong P-gp inductors ---> SPC of [1] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Cyclosporine [1], strong P-gp inhibitors ---> SPC of [1] of eMC
All inhibitors of CYP3A4 and/or P-glycoprotein may lead to increased levels of cyclosporine.
Cyclosporine [1], sulfadiazine ---> SPC of [1] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Cyclosporine [1], sulfadimidine ---> SPC of [1] of eMC
Decreased cyclosporine plasma levels with i.v. sulfadimidine
Cyclosporine [1], sulfinpyrazone ---> SPC of [1] of eMC
All inducers of CYP3A4 and/or P-glycoprotein are expected to decrease ciclosporin levels.
Cyclosporine [1], sulindac ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], sun ---> SPC of [1] of eMC
Patients should be warned to avoid excess unprotected sun exposure and should not receive concomitant ultraviolet B irradiation or PUVA photochemotherapy.
Cyclosporine [1], ticlopidine ---> SPC of [1] of eMC
Decreased cyclosporine plasma levels.
Cyclosporine [1], tobramycin ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], trimethoprim ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], trimethoprim/sulfamethoxazol ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], vaccinations ---> SPC of [1] of eMC
During treatment with ciclosporin, vaccination may be less effective and the use of live attenuated vaccines should be avoided.
Cyclosporine [1], vancomycin ---> SPC of [1] of eMC
Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy
Cyclosporine [1], verapamil ---> SPC of [1] of eMC
Inhibitors of CYP3A4 may lead to increased levels of cyclosporine.
Cyclosporine, cytostatics
The co-administration may cause an excessive immunosuppression with risk of lymphoproliferation
Cyclosporine, dabigatran etexilate [2] ---> SPC of [2] of EMA
Dabigatran is a substrate for the efflux transporter P-gp. Concomitant administration of strong P-gp inhibitors is expected to result in increased dabigatran plasma concentrations. The coadministration with cyclosporine is contraindicated
Cyclosporine, dabrafenib [2] ---> SPC of [2] of EMA
Interactions with many medicinal products eliminated through metabolism or active transport is expected. These medicinal products are to be avoided or used with caution.
Cyclosporine, dacarbazine
The co-administration of dacarbazine with cyclosporine (and by extrapolation tacrolimus) is only to be used after carefully weighing because it may result in excessive immunosuppression with risk of lymphoproliferation.
Cyclosporine, daclatasvir [2] ---> SPC of [2] of EMA
No dose adjustment of either medicinal product is required when daclatasvir is coadministered with cyclosporine
Cyclosporine, dalbavancin [2] ---> SPC of [2] of EMA
It is not known if dalbavancin is a substrate for hepatic uptake and efflux transporters. Co-administration with inhibitors of these transporters may increase the exposure to dalbavancin.
Cyclosporine, darbepoetin alfa [2] ---> SPC of [2] of EMA
There is potential for an interaction with substances that are highly bound to red blood cells e.g. cyclosporin, tacrolimus. Blood levels of these substances should be monitored and the dosage adjusted as the haemoglobin rises.
Cyclosporine, darifenacin [2] ---> SPC of [2] of EMA
Concomitant treatment of darifenacin with potent P-glycoprotein inhibitors should be avoided.
Cyclosporine, darunavir/cobicistat [2] ---> SPC of [2] of EMA
Based on theoretical considerations darunavir/cobicistat (CYP3A inhibition) is expected to increase the immunosuppressant plasma concentrations.
Cyclosporine, darunavir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Based on theoretical considerations DRV/COBI is expected to increase these immunosuppressant plasma concentrations. CYP3A inhibition. Co-administration of ciclosporin is expected to increase plasma concentrations of tenofovir alafenamide. P-gp inhibition
Cyclosporine, darunavir/ritonavir ---> SPC of [darunavir] of EMA
Exposure to the immunosuppressant will be increased when co-administered with boosted darunavir. (CYP3A inhibition)
Cyclosporine, dasabuvir with ombitasvir/paritaprevir/ritonavir ---> SPC of [dasabuvir] of EMA
Effect on ciclosporin is due to CYP3A4 inhibition by ritonavir and increase in paritaprevir exposures may be due to OATP/BCRP/P-gp inhibition by ciclosporin.
Cyclosporine, deferasirox [2] ---> SPC of [2] of EMA
Due to a possible decrease in efficacy, caution should be exercised when deferasirox is combined with substances metabolised through CYP3A4
Cyclosporine, deflazacort
Increased plasma concentration of cyclosporine and the risk of cerebral seizures
Cyclosporine, dexibuprofen [2] ---> SPC of [2] of eMC
As with other NSAIDs, concomitant treatment with drugs increasing potassium plasma levels, may be associated with increased serum potassium levels and may increase the risk of renal failure
Cyclosporine, dexketoprofen [2] ---> SPC of [2] of eMC
Nephrotoxicity may be enhanced by NSAIDs via renal prostaglandin mediated effects. During combination therapy, renal function has to be measured.
Cyclosporine, dexrazoxane [2] ---> SPC of [2] of EMA
Excessive immunosuppression with risk of lymphoproliferative disease
Cyclosporine, dihydropyridines
The co-administration may increase the plasma levels of cyclosporine
Cyclosporine, disopyramide [2] ---> SPC of [2] of eMC
When prescribing a drug metabolised by CYP3A it should be kept in mind that disopyramide is probably also a substrate of this isozyme and thus competitive inhibition of metabolism might occur, possibly increasing serum levels of these drugs.
Cyclosporine, docetaxel [2] ---> SPC of [2] of EMA
Cyclosporine may inhibit competitively the CYP3A and there is a potential for a significant interaction
Cyclosporine, doxorubicine [2] ---> SPC of [2] of eMC
Ciclosporin, an inhibitor of CYP3A4 and Pgp, increased the AUC of doxorubicin and doxorubicinol by 55% and 350%, respectively. A 40% dose reduction of doxorubicin is proposed for this combination.
Cyclosporine, doxycycline ---> SPC of [2] of eMC
Doxycycline may increase the plasma concentration of ciclosporin. Co-administration should only be undertaken with appropriate monitoring.
Cyclosporine, dronedarone [2] ---> SPC of [2] of EMA
Dronedarone could increase the cyclosporine plasma levels. Monitoring of the plasma concentrations and appropriate dose adjustment is recommended in case of combination
Cyclosporine, edoxaban [2] ---> SPC of [2] of EMA
Edoxaban is a substrate for the efflux transporter P-gp. In pharmacokinetic (PK) studies, concomitant administration of edoxaban with the P-gp inhibitor resulted in increased plasma concentrations of edoxaban.
Cyclosporine, efavirenz [2] ---> SPC of [2] of EMA
Decreased exposure of the immunosuppressant may be expected (CYP3A4 induction). This immunosuppressant is not anticipated to affect exposure of efavirenz.
Cyclosporine, efavirenz/emtricitabine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
Decreased exposure of the immunosuppressant may be expected (CYP3A4 induction). The immunosuppressant is not anticipated to impact exposure of efavirenz. Dose adjustments of the immunosuppressant may be required.
Cyclosporine, elbasvir/grazoprevir [2] ---> SPC of [2] of EMA
Due in part to OATP1B and CYP3A inhibition. Co-administration is contraindicated.
Cyclosporine, eltrombopag [2] ---> SPC of [2] of EMA
A decrease in eltrombopag exposure was observed with co-administration of 200 mg and 600 mg ciclosporin (a BCRP inhibitor)
Cyclosporine, eluxadoline [2] ---> SPC of [2] of EMA
Co-administration of OATP1B1 inhibitors with eluxadoline may increase exposure to eluxadoline. Eluxadoline should not be administered concomitantly with such medicinal products
Cyclosporine, elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Concentrations of this immunosuppressant agent may be increased when administered with cobicistat. Therapeutic monitoring is recommended upon co-administration with Genvoya.
Cyclosporine, elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil [2] ---> SPC of [2] of EMA
The co-administration may increase the plasma levels of immunosuppressive
Cyclosporine, emtricitabine/rilpivirine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Co-administration of ciclosporin is expected to increase plasma concentrations of rilpivirine (inhibition of CYP3A) and tenofovir alafenamide (inhibition of P-gp). Co-administration is not recommended.
Cyclosporine, emtricitabine/tenofovir alafenamide [2] ---> SPC of [2] of EMA
Co-administration of Descovy with other medicinal products that inhibit P-gp (e.g., cobicistat, ritonavir, ciclosporin) are expected to increase the absorption and plasma concentration of tenofovir alafenamide.
Cyclosporine, eplerenone [2] ---> SPC of [2] of eMC
Cyclosporin may lead to impaired renal function and increase the risk of hyperkalaemia. The concomitant use of eplerenone and cyclosporin should be avoided.
Cyclosporine, epoetin alfa [2] ---> SPC of [2] of EMA
Since cyclosporin is bound by red blood cells (RBCs) there is potential for a medicinal product interaction. Blood levels of cyclosporin should be monitored and the dose of cyclosporin adjusted as the haematocrit rises.
Cyclosporine, epoetin zeta [2] ---> SPC of [2] of EMA
If erythropoietin is given concomitantly with ciclosporin, blood levels of ciclosporin should be monitored and the dose of ciclosporin adjusted as the haematocrit rises.
Cyclosporine, eravacycline [2] ---> SPC of [2] of EMA
A drug-drug interaction in vivo cannot be excluded and co-administration of eravacycline and other medicinal products that inhibit gp-P, OATP1B1 y OATP1B3 transporters may increase the eravacycline plasma concentration.
Cyclosporine, eribulin [2] ---> SPC of [2] of EMA
Caution and monitoring for adverse effects is recommended with concomitant use of substances that have a narrow therapeutic window and that are eliminated mainly via CYP3A4-mediated metabolism
Cyclosporine, erlotinib [2] ---> SPC of [2] of EMA
Erlotinib is a substrate for the P-glycoprotein active substance transporter. Concomitant administration of inhibitors of Pgp may lead to altered distribution and/or altered elimination of erlotinib.
Cyclosporine, erythropoietin
Blood levels of cyclosporine should be monitored and the dosage adjusted as the hematocrit rises
Cyclosporine, estradiol/norethisterone [2] ---> SPC of [2] of eMC
Concomitant administration of cyclosporine may cause increased blood levels of cyclosporine, creatinine and transaminases due to decreased metabolism of cyclosporine in the liver.
Cyclosporine, estrogens
The plasma and tissue levels of cyclosporine may increase up to toxic levels
Cyclosporine, ethinyl estradiol
The plasma and tissue levels of cyclosporine may increase up to toxic levels
Cyclosporine, ethinylestradiol/chlormadinone
Ethinylestradiol may inhibit the hepatic microsomal enzymes and increase plasma concentrations of ciclosporin
Cyclosporine, ethinylestradiol/desogestrel [2] ---> SPC of [2] of eMC
Oral contraceptives may interfere with the metabolism of other drugs. Accordingly, plasma and tissue concentrations may be increased (e.g., ciclosporin)
Cyclosporine, ethinylestradiol/drospirenone [2] ---> SPC of [2] of eMC
Oral contraceptives may affect the metabolism of certain other active substances. Accordingly, plasma and tissue concentrations of ciclosporin may increase
Cyclosporine, ethinylestradiol/etonogestrel [2] ---> SPC of [2] of eMC
Hormonal contraceptives may interfere with the metabolism of other drugs. Accordingly, plasma and tissue concentrations may either increase (e.g. ciclosporin) or decrease (e.g. lamotrigine).
Cyclosporine, ethinylestradiol/norgestimate [2] ---> SPC of [2] of eMC
Combination hormonal contraceptives with ciclosporin may increase plasma levels (due to CYP inhibition) of ciclosporin
Cyclosporine, etonogestrel [2] ---> SPC of [2] of eMC
Oral contraceptives may affect the metabolism of certain other active substances. Accordingly, plasma and tissue concentrations of ciclosporin may increase
Cyclosporine, etoposide
Ciclosporin may reduce the clearance of etoposide
Cyclosporine, etoricoxib [2] ---> SPC of [2] of eMC
Although this interaction has not been studied with etoricoxib, coadministration of ciclosporin or tacrolimus with any NSAID may increase the nephrotoxic effect of ciclosporin or tacrolimus.
Cyclosporine, etravirine [2] ---> SPC of [2] of EMA
Etravirine may decrease the plasma concentrations of cyclosporine
Cyclosporine, everolimus [2] ---> SPC of [2] of EMA
Increase in everolimus concentration is expected. Use caution when co-administration of moderate CYP3A4 inhibitors or PgP inhibitors cannot be avoided.
Cyclosporine, ezetimibe [2] ---> SPC of [2] of eMC
Caution should be exercised when initiating ezetimibe in the setting of ciclosporin. Ciclosporin concentrations should be monitored in patients receiving ezetimibe and ciclosporin
Cyclosporine, ezetimibe/atorvastatin [2] ---> SPC of [2] of eMC
Potent CYP3A4 inhibitors have been shown to lead to markedly increased concentrations of atorvastatin. Coadministration of potent CYP3A4 inhibitors should be avoided if possible.
Cyclosporine, ezetimibe/simvastatine [2] ---> SPC of [2] of eMC
Caution should be exercised when initiating ezetimibe in the setting of ciclosporin. The risk of myopathy/rhabdomyolysis is increased by concomitant administration, use with ciclosporin is contraindicated
Cyclosporine, felodipine [2] ---> SPC of [2] of eMC
Felodipine does not affect plasma concentrations of cyclosporine.
Cyclosporine, felodipine/metoprolol [2] ---> SPC of [2] of eMC
Felodipine does not affect plasma concentrations of cyclosporine.
Cyclosporine, fenofibrate/pravastatine [2] ---> SPC of [2] of EMA
Concomitant administration of pravastatin and ciclosporin leads to an approximately 4 fold increase in pravastatin systemic exposure.
Cyclosporine, fenofibrate/simvastatin [2] ---> SPC of [2] of EMA
The risk of myopathy and rhabdomyolysis is increased by concomitant administration of ciclosporin and simvastatin. The co-administration is contraindicated
Cyclosporine, fidaxomicin [2] ---> SPC of [2] of EMA
Fidaxomicin is a substrate of P-gp. Co-administration of potent inhibitors of P-gp increases fidaxomicin exposure. Co-administration of potent inhibitors of P-gp is not recommended.
Cyclosporine, fingolimod [2] ---> SPC of [2] of EMA
Co-administration of fingolimod with ciclosporin did not elicit any change in the ciclosporin or fingolimod exposure. Therefore, fingolimod is not expected to alter the pharmacokinetics of medicinal products that are CYP3A4 substrates.
Cyclosporine, fluconazole [2] ---> SPC of [2] of eMC
Fluconazole significantly increases the concentration and AUC of ciclosporin. This combination may be used by reducing the dose of ciclosporin depending on ciclosporin concentration.
Cyclosporine, fludrocortisone ---> SPC of [1] of eMC
Possible increased toxicity of cyclosporin when the two are used concurrently.
Cyclosporine, flurbiprofen [2] ---> SPC of [2] of eMC
Increased risk of nephrotoxicity.
Cyclosporine, fluvastatin [2] ---> SPC of [2] of eMC
Isolated cases of myopathy have been reported post-marketing for concomitant administration of fluvastatin with ciclosporin
Cyclosporine, fluvoxamine [2] ---> SPC of [2] of eMC
Patients co-administered fluvoxamine and CYP3A4 metabolised drugs with a narrow therapeutic index should be carefully monitored and, if necessary, dose adjustment of these drugs is recommended.
Cyclosporine, foods
Fatty foods and the grapefruit juice increase absorption of ciclosporin
Cyclosporine, fosamprenavir/ritonavir ---> SPC of [fosamprenavir] of EMA
Frequent therapeutic concentration monitoring of immunosuppressant levels is recommended until levels have stabilised as plasma concentrations of immunosuppressant may be increased when co-administered with amprenavir
Cyclosporine, fosaprepitant [2] ---> SPC of [2] of EMA
Caution is advised during co-administration of fosaprepitant and orally administered active principles metabolised primarily through CYP3A4 and with a narrow therapeutic range
Cyclosporine, foscarnet [2] ---> SPC of [2] of eMC
Since foscarnet can impair renal function, additive toxicity may occur when used in combination with other nephrotoxic drugs
Cyclosporine, fosphenytoin [2] ---> SPC of [2] of eMC
Blood levels and/or effects of ciclosporin may be altered by phenytoin (CYP3A4 induction)
Cyclosporine, furosemide
The co-administration is associated with increased risk of gouty arthritis.
Cyclosporine, fusidic acid
Co-administration with fusidic acid systemically may cause increased plasma concentration of ciclosporin
Cyclosporine, gallopamil
Increased plasma levels of cyclosporine
Cyclosporine, glecaprevir/pibrentasvir [2] ---> SPC of [2] of EMA
Maviret is not recommended for use in patients requiring stable ciclosporin doses > 100 mg per day.
Cyclosporine, glibenclamide [2] ---> SPC of [2] of EMA
Glibenclamide may increase ciclosporin plasma concentration and potentially lead to its increased toxicity.
Cyclosporine, glucocorticoids
Increased plasma concentration of cyclosporine and the risk of cerebral seizures
Cyclosporine, griseofulvin
Decreased cyclosporine plasma levels.
Cyclosporine, hydrochlorothiazide ---> SPC of [amlodipine/valsartan/hydrochlorothiazide] of EMA
Concomitant treatment of hydrochlorothiazide with ciclosporin may increase the risk of hyperuricaemia and gout-type complications.
Cyclosporine, hydrocortisone
Increased plasma concentration of cyclosporine and the risk of cerebral seizures
Cyclosporine, ibrutinib [2] ---> SPC of [2] of EMA
Caution should be exercised if co-administering ibrutinib with CYP3A4 substrates administered orally with narrow therapeutic range (such as dihydroergotamine, ergotamine, fentanyl, cyclosporine, sirolimus and tacrolimus).
Cyclosporine, ibuprofen
The co-administration may increase the risk of nephrotoxicity due to reduced synthesis of renal prostaglandins. Renal function must be closely monitored
Cyclosporine, idarubicin [2] ---> SPC of [2] of eMC
The coadministration of cyclosporine A as a single chemosensitizer significantly increased idarubicin AUC (1.78-fold) and idarubicinol AUC (2.46-fold) in patients with acute leukaemia.
Cyclosporine, idebenone [2] ---> SPC of [2] of EMA
CYP3A4 substrates known to have a narrow therapeutic index should be administered with caution in patients receiving idebenone.
Cyclosporine, idelalisib [2] ---> SPC of [2] of EMA
The co-administration of idelalisib with cyclosporine may increase the serum concentrations of cyclosporine. Therapeutic monitoring is recommended.
Cyclosporine, imatinib [2] ---> SPC of [2] of EMA
Imatinib inhibits CYP3A4 and may increase plasma concentration of other CYP3A4 metabolised drugs. Caution is recommended when administering imatinib with CYP3A4 substrates with a narrow therapeutic window
Cyclosporine, imipenem
Increased cyclosporine plasma levels
Cyclosporine, immunosuppressives
The combination with other immunosupressive agents may increase the susceptibility to infections and develop malignant lymphomas (e. g. no-Hodgkin and reticulum cell sarcoma)
Cyclosporine, indapamide [2] ---> SPC of [2] of eMC
Risk of increased plasma creatinine without any change in circulating cyclosporin levels, even in the absence of water/sodium depletion.
Cyclosporine, indinavir [2] ---> SPC of [2] of EMA
Cyclosporine A (CsA) levels markedly increase in patients on PIs, including indinavir. CsA levels require progressive dose adjustment using therapeutic medicinal product monitoring.
Cyclosporine, indinavir/ritonavir ---> SPC of [indinavir] of EMA
Is expected to increase the plasma concentrations of cyclosporine. Careful monitoring of therapeutic and adverse effects is recommended
Cyclosporine, indometacin ---> SPC of [2] of eMC
Administration of non-steroidal anti-inflammatory drugs concomitantly with cyclosporin has been associated with an increase in cyclosporin-induced toxicity, possibly due to decreased synthesis of renal prostacyclin.
Cyclosporine, interferon
Caution should be used when administering interferon with medicines mainly metabolised by hepatic cytochrome P450 and have a narrow therapeutic window
Cyclosporine, isavuconazole [2] ---> SPC of [2] of EMA
No CRESEMBA dose adjustment necessary. Ciclosporin, sirolimus, tacrolimus: monitoring of plasma levels and appropriate dose adjustment if required. No CRESEMBA dose adjustment
Cyclosporine, isradipine
The co-administration may increase the cyclosporine plasma levels. Possible renal impairment
Cyclosporine, ivacaftor [2] ---> SPC of [2] of EMA
Administration of ivacaftor may increase systemic exposure of medicinal products which are substrates of P-gp, which may increase or prolong their therapeutic effect and adverse reactions.
Cyclosporine, ketoconazole [2] ---> SPC of [2] of EMA
Increased in plasma concentrations of Ciclosporin have been observed. Not recommended unless necessary. Careful monitoring and dose adjustment of this drug may be required
Cyclosporine, ketoprofen ---> SPC of [piroxicam] of eMC
Possible increased risk of nephrotoxicity when NSAIDs are given with ciclosporin
Cyclosporine, ketorolac ---> SPC of [piroxicam] of eMC
Possible increased risk of nephrotoxicity when NSAIDs are given with ciclosporin
Cyclosporine, lacidipine [2] ---> SPC of [2] of eMC
In clinical studies in patients with a renal transplant treated with cyclosporin, lacidipine reversed the decrease in renal plasma flow and glomerular filtration rate induced by cyclosporin.
Cyclosporine, lamivudine [2] ---> SPC of [2] of EMA
There were no observed clinically significant adverse interactions in patients taking lamivudine concurrently with commonly used immunosuppressant medicinal products (e.g. cyclosporin A). However, formal interaction studies have not been performed.
Cyclosporine, lanreotide [2] ---> SPC of [2] of eMC
Concomitant administration of ciclosporin with lanreotide may decrease the relative bioavailability of ciclosporin and therefore may necessitate the adjustment of ciclosporin dose to maintain therapeutic levels.
Cyclosporine, lapatinib [2] ---> SPC of [2] of EMA
The CYP3A4 and P-glycoprotein inhibition may increase the systemic exposure of lapatinib. Concomitant use should be avoided
Cyclosporine, ledipasvir/sofosbuvir [2] ---> SPC of [2] of EMA
No dosage adjustment necessary.
Cyclosporine, letermovir [2] ---> SPC of [2] of EMA
For oral letermovir with cyclosporine, or intravenous letermovir with or without cyclosporine: Strong inducers may give rise to subtherapeutic letermovir exposure.
Cyclosporine, levofloxacin [2] ---> SPC of [2] of EMA
The half-life of ciclosporin was increased by 33% when coadministered with levofloxacin
Cyclosporine, levonorgestrel [2] ---> SPC of [2] of eMC
Medicines containing levonorgestrel may increase the risk of cyclosporin toxicity due to possible inhibition of cyclosporin metabolism.
Cyclosporine, levonorgestrel/ethinylestradiol [2] ---> SPC of [2] of eMC
Oral contraceptives may affect the metabolism of certain other drugs. Accordingly, plasma and tissue concentrations may either increase (e.g. cyclosporin) or decrease (e.g. lamotrigine).
Cyclosporine, liposome-encapsulated doxorubicin-citrate complex [2] ---> SPC of [2] of EMA
Plasma levels of doxorubicin and its metabolite, doxorubicinol, may be increased when doxorubicin is administered with cyclosporine, verapamil, paclitaxel or other agents that inhibit P-glycoprotein (P-Gp).
Cyclosporine, lisinopril
The concomitant use of ciclosporin and ACE inhibitors increases the risk of renal impairment and hypercaliemia
Cyclosporine, lomitapide [2] ---> SPC of [2] of EMA
Weak CYP3A4 inhibitors are expected to increase the exposure of lomitapide when taken simultaneously. Separate the dose of the medications by 12 hours OR decrease the dose of Lojuxta by half.
Cyclosporine, lopinavir/ritonavir [2] ---> SPC of [2] of EMA
Lopinavir/ritonavir, CYP3A4 inhibitors, may increase the plasma concentrations of cyclosporine. Monitoring is recommended
Cyclosporine, lornoxicam
Increased plasma levels of ciclosporin. The nephrotoxicity of ciclosporin can be increased by mediation of renal prostaglandin
Cyclosporine, losartan/hydrochlorothiazide [2] ---> SPC of [2] of eMC
Concomitant treatment of hydrochlorothiazide with ciclosporin may increase the risk of hyperuricaemia and gout-type complications.
Cyclosporine, lovastatine
The risk of myopathy and rhabdomyolysis increases with the co-administration of ciclosporin, particularly with high dose of lovastatine
Cyclosporine, lumacaftor/ivacaftor [2] ---> SPC of [2] of EMA
Concomitant use of lumacaftor/ivacaftor with this immunosuppressant is not recommended. Lumacaftor/ivacaftor will decrease the exposure of the immunosuppressant, which may reduce the efficacy of the immunosuppressant.
Cyclosporine, lumiracoxib
The co-administration may increase the risk of nephrotoxicity due to reduced synthesis of renal prostaglandins. Renal function must be closely monitored
Cyclosporine, macitentan [2] ---> SPC of [2] of EMA
The combination did not alter the steady-state exposure to macitentan and its active metabolite to a clinically relevant extent.
Cyclosporine, medroxyprogesterone
Concurrent administration of ciclosporin and medroxyprogesterone has been reported to lead to increased plasma ciclosporin levels and/or decreased plasma medroxyprogesterone levels.
Cyclosporine, meglumine and sodium ioxitalamate
The co-administration with other medicinal products with nephrotoxic potential may decrease the renal function and cause a permanent damage
Cyclosporine, melagatran
The strong inhibition of P-glycoprotein may increase the plasma concentrations of melagatran
Cyclosporine, mesuximide
Mesuximide may decrease the plasma levels of cyclosporine
Cyclosporine, metamizole
Decreased cyclosporine plasma levels.
Cyclosporine, methylphenidate
Methylphenidate increases the effect and toxicity of cyclosporine
Cyclosporine, methylprednisolone [2] ---> SPC of [2] of eMC
Mutual inhibition of metabolism occurs with concurrent use of cyclosporine and methylprednisolone, which may increase the plasma concentrations of either or both drugs.
Cyclosporine, metildigoxin
Increased plasma levels of metildigoxin
Cyclosporine, metoclopramide [2] ---> SPC of [2] of eMC
Concomitant use of metoclopramide with ciclosporin may increase plasma levels of ciclosporin
Cyclosporine, metreleptin [2] ---> SPC of [2] of EMA
The effect of metreleptin on CYP450 enzymes may be clinically relevant for CYP450 substrates with narrow therapeutic index, where the dose is individually adjusted.
Cyclosporine, metronidazole [2] ---> SPC of [2] of eMC
Patients receiving ciclosporin are at risk of elevated ciclosporin serum levels. Serum ciclosporin and serum creatinine should be closely monitored when coadministration is necessary.
Cyclosporine, mibefradil
Increased cyclosporine plasma levels. Possible renal impairment
Cyclosporine, midecamycin
Midecamycin may increase the ciclosporin plasma concentrations
Cyclosporine, mifamurtide [2] ---> SPC of [2] of EMA
The use of mifamurtide concurrently with ciclosporin or other calcineurin inhibitors is contraindicated due to their hypothesised effect on splenic macrophages and mononuclear phagocytic function
Cyclosporine, minocycline
Increased cyclosporine toxicity
Cyclosporine, mizolastine [2] ---> SPC of [2] of eMC
Concurrent use of other potent inhibitors or substrates of hepatic oxidation (cytochrome P450 3A4) with mizolastine should be approached with caution.
Cyclosporine, modafinil [2] ---> SPC of [2] of eMC
Modafinil, CYP3A4 inductor, may decrease the plasma concentrations of ciclosporin
Cyclosporine, mycophenolate ---> SPC of [mycophenolate mofetil] of EMA
Ciclosporin A (CsA) pharmacokinetics are unaffected by mycophenolate mofetil. In contrast, if concomitant ciclosporin treatment is stopped, an increase in MPA AUC of around 30% should be expected.
Cyclosporine, mycophenolate mofetil [2] ---> SPC of [2] of EMA
Ciclosporin A (CsA) pharmacokinetics are unaffected by mycophenolate mofetil. In contrast, if concomitant ciclosporin treatment is stopped, an increase in MPA AUC of around 30% should be expected.
Cyclosporine, mycophenolic acid [2] ---> SPC of [2] of eMC
In case of interruption or discontinuation of ciclosporin, mycophenolic acid dosage should be re-evaluated depending on the immunosuppressive regimen.
Cyclosporine, mytomicin
The long-term co-administration may cause a hemolytic uremic syndrome
Cyclosporine, nabumetone ---> SPC of [2] of eMC
Increased risk of nephrotoxicity.
Cyclosporine, naproxen/esomeprazole [2] ---> SPC of [2] of eMC
As with all NSAIDs, caution is advised when ciclosporin is co-administered because of the increased risk of nephrotoxicity.
Cyclosporine, netilmicin
The administration concurrent or sequential of netilmicin with other potentially nephrotoxic or neurotoxic drugs may increase the nephrotoxicity and/or neurotoxicity
Cyclosporine, netupitant/palonosetron [2] ---> SPC of [2] of EMA
Netupitant/palonosetron should be used with caution in patients receiving concomitant orally administered active substances that are metabolised primarily through CYP3A4 and with a narrow therapeutic range
Cyclosporine, nilotinib [2] ---> SPC of [2] of EMA
Nilotinib is a moderate CYP3A4 inhibitor. Appropriate monitoring and dose adjustment may be necessary for drugs that are CYP3A4 substrates and have a narrow therapeutic index when co-administered with nilotinib.
Cyclosporine, nimesulide
Prostaglandin synthetase inhibitors like nimesulide may increase the nephrotoxicity of cyclosporine
Cyclosporine, niraparib [2] ---> SPC of [2] of EMA
Caution is recommended when niraparib is combined with principles the metabolism of which is CYP3A4-dependent and, notably, those having a narrow therapeutic range (e.g. ciclosporin, tacrolimus, alfentanil, ergotamine, pimozide, quetiapine, and halofantrine
Cyclosporine, norelgestromin/ethinylestradiol [2] ---> SPC of [2] of EMA
The plasma and tissue levels of cyclosporine may increase up to toxic levels
Cyclosporine, norfloxacin
The co-administration may increase the plasma levels of cyclosporine.
Cyclosporine, olaparib [2] ---> SPC of [2] of EMA
Olaparib inhibits CYP3A4 in vitro and is predicted to be a mild CYP3A inhibitor in vivo. Therefore, caution should be exercised when sensitive CYP3A substrates or substrates with a narrow therapeutic margin are combined with olaparib.
Cyclosporine, olmesartan medoxomil [2] ---> SPC of [2] of eMC
Ciclosporin may provoke a hyperkalaemia
Cyclosporine, ombitasvir/paritaprevir/ritonavir [2] ---> SPC of [2] of EMA
CYP3A4 substrates may require dose adjustment and/or clinical monitoring
Cyclosporine, oral contraceptives ---> SPC of [norethisterone] of eMC
Oral contraceptives may affect the metabolism of certain other active substances. Accordingly, plasma and tissue concentrations of ciclosporin may increase
Cyclosporine, orlistat [2] ---> SPC of [2] of EMA
Decrease of the cyclosporine plasma levels. Co-administration of orlistat with ciclosporin is not recommended
Cyclosporine, oxaprozin
The co-administration may increase the risk of nephrotoxicity due to reduced synthesis of renal prostaglandins. Renal function must be closely monitored
Cyclosporine, oxcarbazepine [2] ---> SPC of [2] of eMC
Oxcarbazepine and its pharmacologically active metabolite (the monohydroxy derivative, MHD) are weak inducers of the cytochrome P450 enzymes CYP3A4 and CYP3A5, resulting in a lower plasma levels of drug coadministered with oxcarbazepine
Cyclosporine, palbociclib [2] ---> SPC of [2] of EMA
The dose of sensitive CYP3A substrates with a narrow therapeutic index may need to be reduced when coadministered with IBRANCE as IBRANCE may increase their exposure.
Cyclosporine, parecoxib [2] ---> SPC of [2] of EMA
Co-administration of NSAIDs and cyclosporin has been suggested to increase the nephrotoxic effect of cyclosporin. Renal function should be monitored when these medicinal products are co-administered.
Cyclosporine, pasireotide [2] ---> SPC of [2] of EMA
Pasireotide may decrease the relative bioavailability of ciclosporin. Concomitant administration of pasireotide and ciclosporin may require adjustment of the ciclosporin dose to maintain therapeutic levels.
Cyclosporine, pazopanib [2] ---> SPC of [2] of EMA
The possible strong inhibition of CYP3A4, BCRP and P-glycoprotein may increase the plasma concentrations of pazopanib. The combination should be avoided
Cyclosporine, pemetrexed [2] ---> SPC of [2] of EMA
Concomitant administration of nephrotoxic can potentially delay the clearance of pemetrexed. The combination should be used with caution
Cyclosporine, perindopril [2] ---> SPC of [2] of eMC
The combination of these drugs increases the risk of hyperkalaemia.
Cyclosporine, phenylalkylamines
Increased plasma levels of cyclosporine
Cyclosporine, pioglitazone ---> SPC of [pioglitazone/metformin] of EMA
Interactions with substances metabolised by these enzymes (see cytochrome P450), e.g. oral contraceptives, cyclosporin, calcium channel blockers, and HMGCoA reductase inhibitors are not to be expected.
Cyclosporine, pioglitazone/metformin [2] ---> SPC of [2] of EMA
Interactions with substances metabolised by these enzymes (see cytochrome P450), e.g. oral contraceptives, cyclosporin, calcium channel blockers, and HMGCoA reductase inhibitors are not to be expected.
Cyclosporine, piperaquine/artenimol [2] ---> SPC of [2] of EMA
Piperaquine is metabolised by, and is an inhibitor of CYP3A4. Particular attention should be paid when medicinal products that have a narrow therapeutic index (e.g. antiretroviral medicinal products and cyclosporine) are co-administered with Eurartesim.
Cyclosporine, piroxicam [2] ---> SPC of [2] of eMC
Possible increased risk of nephrotoxicity when NSAIDs are given with ciclosporin
Cyclosporine, pitavastatin
The co-administration may increase the AUC of pravastatine. The co-administration is contraindicated
Cyclosporine, pixantrone [2] ---> SPC of [2] of EMA
Based on in vitro studies, pixantrone was found to be a substrate for the membrane transport proteins P-gp/BCRP and OCT1 and agents which inhibit these transporters have the potential to decrease hepatic uptake and excretion efficiency of pixantrone.
Cyclosporine, posaconazole [2] ---> SPC of [2] of EMA
Cases of elevated ciclosporin levels resulting in serious adverse reactions, including nephrotoxicity and one fatal case of leukoencephalopathy, were reported in clinical efficacy studies.
Cyclosporine, pravastatine ---> SPC of [fenofibrate/pravastatine] of EMA
Concomitant administration of pravastatin and ciclosporin leads to an approximately 4 fold increase in pravastatin systemic exposure.
Cyclosporine, prednisolone ---> SPC of [2] of eMC
Ciclosporin increases the plasma concentration of prednisolone.
Cyclosporine, prednisone [2] ---> SPC of [2] of eMC
The blood levels of cyclosporine are increased. There is an increased risk of seizures.
Cyclosporine, primidone
The effect of ciclosporin may decrease due to metabolism acceleration
Cyclosporine, pristinamycin
The increased oral absorption of cyclosporine and inhibition of CYP3A4 by macrolide increase the cyclosporine plasma levels (carefully monitor)
Cyclosporine, proglumetacine
The co-administration may increase the risk of nephrotoxicity due to reduced synthesis of renal prostaglandins. Renal function must be closely monitored
Cyclosporine, propafenone [2] ---> SPC of [2] of eMC
Cases of possible interactions with cyclosporin (levels increased with deterioration in renal function) have been reported
Cyclosporine, propofol
Leukoencephalopathy may occur
Cyclosporine, prucalopride [2] ---> SPC of [2] of EMA
The inhibition of P-glycoprotein may increase the systemic exposure to prucalopride. This effect is too small to be clinically relevant.
Cyclosporine, pyrazinamide
Decrease of cyclosporine plasma levels and of its immunosuppresive effect
Cyclosporine, quinine
Quinine can decrease plasma concentrations of ciclosporin
Cyclosporine, ramipril [2] ---> SPC of [2] of eMC
Hyperkalaemia may occur, therefore close monitoring of serum potassium is required. Caution is recommended
Cyclosporine, ranolazine [2] ---> SPC of [2] of EMA
Dose adjustment of CYP3A4 substrates with a narrow therapeutic range may be required as ranolazine may increase plasma concentrations of these drugs.
Cyclosporine, red wine
Increased clearance and decreased plasma levels of cyclosporine. Avoid combination.
Cyclosporine, repaglinide [2] ---> SPC of [2] of EMA
Ciclosporin may enhance and/or prolong the hypoglycaemic effect of repaglinide. Concomitant use should be avoided
Cyclosporine, ribociclib [2] ---> SPC of [2] of EMA
Caution is recommended in case of concomitant use with sensitive CYP3A4 substrates with a narrow therapeutic index (see section 4.4). The dose of a sensitive CYP3A4 substrate with a narrow therapeutic index
Cyclosporine, rifabutin [2] ---> SPC of [2] of eMC
Rifabutin has been shown to induce the enzymes of the cytochrome P450 3A subfamily and therefore may affect the pharmacokinetic behaviour of drugs metabolised by the enzymes belonging to this subfamily.
Cyclosporine, riociguat [2] ---> SPC of [2] of EMA
Drugs strongly inhibiting P-gp/BCRP such as the immuno-suppressive cyclosporine A, should be used with caution
Cyclosporine, risperidone [2] ---> SPC of [2] of eMC
The CYP3A4 and P-glycoprotein inhibition may increase the plasma levels of risperidone
Cyclosporine, ritonavir [2] ---> SPC of [2] of EMA
Ritonavir, CYP3A4 inhibitor, may increase the plasma concentrations of cyclosporine. Careful monitoring of therapeutic and adverse effects is recommended
Cyclosporine, rosuvastatin [2] ---> SPC of [2] of eMC
The co-administration increases significantly the plasma levels of rosuvastatin. The co-administration is contraindicated
Cyclosporine, roxithromycin
The co-administration may increase the plasma levels of cyclosporine
Cyclosporine, rucaparib [2] ---> SPC of [2] of EMA
Caution is advised when co-administering medicinal products that CYP3A substrates with a narrow therapeutic index. Dose adjustments may be considered, if clinically indicated based on observed adverse reactions.
Cyclosporine, ruxolitinib [2] ---> SPC of [2] of EMA
Ruxolitinib may inhibit P-glycoprotein and breast cancer resistance protein (BCRP) in the intestine. This may result in increased systemic exposure of substrates of these transporters
Cyclosporine, sacubitril/valsartan [2] ---> SPC of [2] of EMA
Co-administration of Entresto with inhibitors of OATP1B1, OATP1B3, OAT3 (e.g. rifampicin, ciclosporin), OAT1 (e.g. tenofovir, cidofovir) or MRP2 (e.g. ritonavir) may increase the systemic exposure of LBQ657 or valsartan.
Cyclosporine, saquinavir/ritonavir ---> SPC of [saquinavir] of EMA
Careful therapeutic drug monitoring is necessary for immunosuppressants when co-administered with saquinavir/ritonavir.
Cyclosporine, sevelamer carbonate [2] ---> SPC of [2] of EMA
Reduced levels of ciclosporin, mycophenolate mofetil and tacrolimus have been reported in transplant patients when co-administered with sevelamer hydrochloride without any clinical consequences (e.g., graft rejection).
Cyclosporine, sevelamer hydrochloride [2] ---> SPC of [2] of EMA
Reduced levels of ciclosporin have been reported in transplant patients when coadministered with sevelamer hydrochloride without any clinical consequences (i.e graft rejection).
Cyclosporine, sibutramine [2] ---> SPC of [2] of eMC
Caution should be exercised on concomitant administration of sibutramine with drugs which affect CYP3A4 enzyme activity (increased plasma concentrations (AUC) of sibutramine active metabolites)
Cyclosporine, silodosin [2] ---> SPC of [2] of EMA
The strong CYP3A4 inhibition may increase the plasma levels of silodosin. Concomitant use of silodosin with potent CYP3A4 inhibitors is not recommended
Cyclosporine, simeprevir [2] ---> SPC of [2] of EMA
OATP1B1, P-gp and CYP3A inhibition by ciclosporin may increase simeprevir exposition. It is not recommended to co-administer OLYSIO with ciclosporin.
Cyclosporine, simvastatine [2] ---> SPC of [2] of eMC
The risk of myopathy/rhabdomyolysis is increased by concomitant administration of ciclosporin with simvastatin; therefore, use of simvastatin with ciclosporin is contraindicated
Cyclosporine, sirolimus [2] ---> SPC of [2] of EMA
Significant increase in the rate and extent of absorption of sirolimus. It is recommended that sirolimus be administered 4 hours after ciclosporin
Cyclosporine, sitagliptin [2] ---> SPC of [2] of EMA
Meaningful interactions would not be expected with p-glycoprotein inhibitors.
Cyclosporine, sitagliptin/metformin [2] ---> SPC of [2] of EMA
Co-administration of a single 100 mg oral dose of sitagliptin and a single 600 mg oral dose of ciclosporin increased the AUC and Cmax of sitagliptin by approximately 29 % and 68 %, respectively.
Cyclosporine, sitaxentan [2] ---> SPC of [2] of EMA
Co-administration with ciclosporin A, a potent OATP inhibitor, resulted in a 6-fold increase in Cmin and a 67% increase in AUC of sitaxentan therefore the use of sitaxentan in patients receiving systemic ciclosporin A is contraindicated
Cyclosporine, sofosbuvir [2] ---> SPC of [2] of EMA
No dose adjustment of sofosbuvir or ciclosporin is required when sofosbuvir and methadone are used concomitantly.
Cyclosporine, sofosbuvir/velpatasvir [2] ---> SPC of [2] of EMA
No dose adjustment of Epclusa or ciclosporin is required.
Cyclosporine, sofosbuvir/velpatasvir/voxilaprevir [2] ---> SPC of [2] of EMA
Medicinal products that are strong OATP1B inhibitors (e.g. ciclosporin) may substantially increase voxilaprevir plasma levels, the safety of which has not been established. Co-administration of strong OATP1B inhibitors with Vosevi is not recommended
Cyclosporine, somatropin [2] ---> SPC of [2] of EMA
The clearance of compounds metabolised by cytochrome P450 3A4 (e.g. sex steroids, corticosteroids, anticonvulsants and cyclosporine) may be increased resulting in lower plasma levels of these compounds. The clinical significance of this is unknown.
Cyclosporine, statins ---> SPC of [simvastatine] of eMC
Although the mechanism is not fully understood, ciclosporin has been shown to increase the AUC of HMG-CoA reductase inhibitors. The increase in AUC for simvastatin acid is presumably due, in part, to inhibition of CYP3A4 and/or OATP1B1.
Cyclosporine, stiripentol [2] ---> SPC of [2] of EMA
Raised blood levels of immunosuppressant (decreased hepatic metabolism). The combination is to be avoided unless strictly necessary
Cyclosporine, sulfasalazine
The co-administration may decrease the plasma levels of cyclosporine
Cyclosporine, tacrolimus [2] ---> SPC of [2] of EMA
The half-life of ciclosporin is prolonged when tacrolimus is given concomitantly. In addition, synergistic/additive nephrotoxic effects can occur.
Cyclosporine, teicoplanin [2] ---> SPC of [2] of eMC
Teicoplanin should be used with care in conjunction with or sequentially with other medicinal products with known nephrotoxic or ototoxic potential.
Cyclosporine, telaprevir [2] ---> SPC of [2] of EMA
Increased plasma concentrations of cyclosporine and telaprevir. A careful monitoring is recommended
Cyclosporine, telithromycin [2] ---> SPC of [2] of EMA
Due to its CYP3A4 inhibitory potential, telithromycin can increase blood concentrations of the CYP3A4 substrate ciclosporin.
Cyclosporine, telmisartan [2] ---> SPC of [2] of EMA
As with other medicinal products acting on the renin-angiotensin-aldosterone system, telmisartan may provoke hyperkalaemia. The risk may increase in case of treatment combination with other medicinal products that may also provoke hyperkalaemia
Cyclosporine, telmisartan/amlodipine [2] ---> SPC of [2] of EMA
Consideration should be given for monitoring cyclosporine levels in renal transplant patients on amlodipine, and cyclosporine dose reductions should be made as necessary.
Cyclosporine, telmisartan/hydrochlorothiazide [2] ---> SPC of [2] of EMA
Medicinal products that may increase potassium levels or induce hyperkalaemia: Concomitant use of the these medicinal products may lead to increases in serum potassium and is, therefore, not recommended
Cyclosporine, telotristat ethyl [2] ---> SPC of [2] of EMA
Concomitant use of Xermelo may decrease the efficacy of medicinal products that are CYP3A4 substrates (e.g. midazolam, everolimus, sunitinib, simvastatin, ethinyloestradiol, amlodipine, cyclosporine_) by decreasing their systemic exposure
Cyclosporine, tenoxicam ---> SPC of [2] of eMC
As with all NSAIDs caution is advised when cyclosporin is co-administered because of the increased risk of nephrotoxicity.
Cyclosporine, terbinafine [2] ---> SPC of [2] of eMC
Terbinafine increased the clearance of ciclosporin by 15%.
Cyclosporine, thiazides
The co-administration may increase the risk of hyperuricaemia and gout-like symptoms
Cyclosporine, thiotepa [2] ---> SPC of [2] of EMA
Excessive immunosuppression with risk of lymphoproliferation
Cyclosporine, ticagrelor [2] ---> SPC of [2] of EMA
Co-administration of cyclosporine with ticagrelor increased ticagrelor Cmax and AUC. The AUC of the active metabolite was increased and Cmax was decreased. If the association cannot be avoided, their concomitant use should be made with caution
Cyclosporine, tigecycline [2] ---> SPC of [2] of EMA
Coadministration of P-gp inhibitors could affect the pharmacokinetics of tigecycline
Cyclosporine, tipranavir/ritonavir ---> SPC of [tipranavir] of EMA
Concentrations of ciclosporin cannot be predicted when co-administered with tipranavir/ritonavir. More frequent concentration monitoring of these medicinal products is recommended
Cyclosporine, tocilizumab [2] ---> SPC of [2] of EMA
When starting or stopping therapy with tocilizumab, patients taking medicinal products which are individually adjusted and are metabolised via CYP450 3A4, 1A2 or 2C9 should be monitored as doses may need to be increased to maintain therapeutic effect.
Cyclosporine, tocofersolan [2] ---> SPC of [2] of EMA
Due to inhibition of P-Glycoprotein transporter, tocofersolan may also enhance intestinal absorption of highly lipophilic medicinal products. Therefore, monitoring should be performed and, when necessary, doses should be adjusted.
Cyclosporine, tofacitinib [2] ---> SPC of [2] of EMA
Coadministration with tacrolimus (mild CYP3A4 inhibitor) and cyclosporine (moderate CYP3A4 inhibitor) increased XELJANZ AUC
Cyclosporine, trabectedin [2] ---> SPC of [2] of EMA
Preclinical data have demonstrated that trabectedin is a substrate to P-gp. Concomitant administration of inhibitors of P-gp may alter trabectedin distribution and/or elimination.
Cyclosporine, trametinib [2] ---> SPC of [2] of EMA
As it cannot be excluded that strong inhibition of hepatic P-gp may result in increased levels of trametinib, caution is advised when coadministering trametinib with medicinal products that are strong inhibitors of P-gp
Cyclosporine, trandolapril/verapamil [2] ---> SPC of [2] of eMC
Verapamil may increase the plasma concentrations of ciclosporin thus increasing risk of toxicity
Cyclosporine, triamcinolone acetonide [2] ---> SPC of [2] of eMC
Monitor for evidence of increased toxicity of cyclosporine when the two are used concurrently.
Cyclosporine, triamcinolone [2] ---> SPC of [2] of eMC
Monitor for evidence of increased toxicity of cyclosporine when the two are used concurrently.
Cyclosporine, troglitazone
Troglitazone, CYP3A4 inductor, may decrease the plasma concentrations of ciclosporin
Cyclosporine, tubular secretion
The concomitant use of medicinal products eliminated by tubular secretion should be avoided
Cyclosporine, ursodeoxycholic acid [2] ---> SPC of [2] of eMC
Ursodeoxycholic acid can increase the absorption of ciclosporin from the intestine.
Cyclosporine, valaciclovir [2] ---> SPC of [2] of eMC
The combination of valaciclovir with nephrotoxic medicinal products should be made with caution, especially in subjects with impaired renal function, and warrants regular monitoring of renal function.
Cyclosporine, valdecoxib
The co-administration may increase the risk of nephrotoxicity due to reduced synthesis of renal prostaglandins. Renal function must be closely monitored
Cyclosporine, valsartan ---> SPC of [amlodipine/valsartan/hydrochlorothiazide] of EMA
The results of an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1. Co-administration of inhibitors of OATP1B1 may increase the systemic exposure to valsartan.
Cyclosporine, vandetanib
Vandetanib, CYP3A4 inductor, may decrease the plasma levels of cyclosporine. Caution should be exercised
Cyclosporine, vemurafenib [2] ---> SPC of [2] of EMA
In vitro studies have demonstrated that vemurafenib is a substrate of the efflux transporters P-gp and BCRP. It cannot be excluded that vemurafenib pharmacokinetics could be affected by medicines that influence P-gp or BCRP
Cyclosporine, vinblastine
The co-administration may cause an excessive immunosuppression with risk of lymphoproliferation
Cyclosporine, vincristine
The co-administration of vincristine and ciclosporin A may cause neurotoxicity
Cyclosporine, vinflunine
The co-administration may cause an excessive immunosuppression with risk of lymphoproliferation
Cyclosporine, vinorelbine [2] ---> SPC of [2] of eMC
The co-administration may cause an excessive immunosuppression with risk of lymphoproliferation
Cyclosporine, voriconazole [2] ---> SPC of [2] of EMA
The CYP3A4 inhibition by voriconazole may increase the plasma concentrations of ciclosporin. Dose adjustment may be required. Increased ciclosporin levels have been associated with nephrotoxicity.
Cyclosporine, xipamide
Risk of increased creatinine plasma levels without modification of circulating cyclosporine levels, even with normal water and sodium balance
Cyclosporine, zafirlukast
The co-administration may decrease the bioavailability of zafirlukast
Cyclosporine, zofenopril
Increased risk of renal dysfunction when ACE inhibitors are used concurrently with cyclosporin
CONTRAINDICATIONS of Cyclosporine
- Hypersensitivity to the active substance or to any of the excipients
- Combination with products containing Hypericum perforatum (St John´s Wort)
- Combination with medicines that are substrates for the multidrug efflux transporter P-glycoprotein or the organic anion transporter proteins (OATP) and for which elevated plasma concentrations are associated with serious and/or life-threatening events, e.g. bosentan, dabigatran etexilate and aliskiren
http://www.medicines.org.uk/emc/
Cyproterone
Ability to drive, cyproterone [2] ---> SPC of [2] of eMC
Fatigue and lassitude are common - patients should be warned about this and if affected should not drive or operate machinery.
Alcohol, cyproterone
The sexual drive reducing effect of cyproterone can be diminished under the influence of alcohol
Atorvastatin, cyproterone [2] ---> SPC of [2] of eMC
The risk of statin-associated myopathy or rhabdomyolysis may be increased when those statins which are mainly metabolised by CYP3A4 are co-administered with high therapeutic cyproterone doses, since they share the same metabolic pathway.
Breast-feeding, cyproterone [2] ---> SPC of [2] of eMC
Not applicable
Clotrimazole, cyproterone [2] ---> SPC of [2] of eMC
Since cyproterone acetate is metabolised by CYP3A4, it is expected strong inhibitors of CYP3A4 inhibit the metabolism of cyproterone acetate.
Cyproterone [1], insulin ---> SPC of [1] of eMC
The requirement for insulin can change
Cyproterone [1], itraconazol ---> SPC of [1] of eMC
Since cyproterone acetate is metabolised by CYP3A4, it is expected strong inhibitors of CYP3A4 inhibit the metabolism of cyproterone acetate.
Cyproterone [1], ketoconazole ---> SPC of [1] of eMC
Since cyproterone acetate is metabolised by CYP3A4, it is expected strong inhibitors of CYP3A4 inhibit the metabolism of cyproterone acetate.
Cyproterone [1], lovastatine ---> SPC of [1] of eMC
The risk of statin-associated myopathy or rhabdomyolysis may be increased when those statins which are mainly metabolised by CYP3A4 are co-administered with high therapeutic cyproterone doses, since they share the same metabolic pathway.
Cyproterone [1], oral antidiabetics ---> SPC of [1] of eMC
The requirement for oral antidiabetics can change
Cyproterone [1], phenytoin ---> SPC of [1] of eMC
Inducers of CYP3A4 may reduce the levels of cyproterone acetate.
Cyproterone [1], pregnancy ---> SPC of [1] of eMC
Not applicable
Cyproterone [1], rifampicin ---> SPC of [1] of eMC
Inducers of CYP3A4 may reduce the levels of cyproterone acetate.
Cyproterone [1], ritonavir ---> SPC of [1] of eMC
Since cyproterone acetate is metabolised by CYP3A4, it is expected strong inhibitors of CYP3A4 inhibit the metabolism of cyproterone acetate.
Cyproterone [1], simvastatine ---> SPC of [1] of eMC
The risk of statin-associated myopathy or rhabdomyolysis may be increased when those statins which are mainly metabolised by CYP3A4 are co-administered with high therapeutic cyproterone doses, since they share the same metabolic pathway.
Cyproterone [1], St. John's wort ---> SPC of [1] of eMC
Inducers of CYP3A4 may reduce the levels of cyproterone acetate.
Cyproterone [1], statins ---> SPC of [1] of eMC
The risk of statin-associated myopathy or rhabdomyolysis may be increased when those statins which are mainly metabolised by CYP3A4 are co-administered with high therapeutic cyproterone doses, since they share the same metabolic pathway.
Cyproterone [1], strong CYP3A4 inductors ---> SPC of [1] of eMC
Inducers of CYP3A4 may reduce the levels of cyproterone acetate.
Cyproterone [1], strong CYP3A4 inhibitors ---> SPC of [1] of eMC
Since cyproterone acetate is metabolised by CYP3A4, it is expected strong inhibitors of CYP3A4 inhibit the metabolism of cyproterone acetate.
Cyproterone, foods
The tablets are to be taken with some liquid after meals.
CONTRAINDICATIONS of Cyproterone
Cyprostat must not be used in patients with:
- Meningioma or a history of meningioma.
- Liver diseases (including Dubin-Johnson syndrome and Rotor syndrome)
- Malignant tumours (except for carcinoma of the prostate)
- Previous or existing liver tumours (only if these are not due to metastases from carcinoma of the prostate)
- Wasting diseases (with the exception of inoperable carcinoma of the prostate)
- Existing thromboembolic processes
- Hypersensitivity to the active substance or any of the excipients.
http://www.medicines.org.uk/emc/
Cyproterone/ethinylestradiol
Antacids, cyproterone/ethinylestradiol
Antacids may decrease the plasma levels of ethinylestradiol by reduction of intestinal transit and hence may result in breakthrough bleeding and pregnancy.
Antacids, ethinyl estradiol
Antacids may decrease the plasma levels of ethinylestradiol by reduction of intestinal transit and hence may result in breakthrough bleeding and pregnancy.
Ascorbic acid, cyproterone/ethinylestradiol
Increase in plasma hormone levels associated with co-administered drug
Atorvastatin, cyproterone/ethinylestradiol
Atorvastatin may increase plasma concentrations of ethinylestradiol
Barbiturates, cyproterone/ethinylestradiol [2] ---> SPC of [2] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Breast-feeding, cyproterone/ethinylestradiol [2] ---> SPC of [2] of eMC
Mothers who are breast-feeding should be advised not to take cyproterone/ethinylestradiol until the nursing mother has weaned her child off breast milk.
Carbamazepine, cyproterone/ethinylestradiol [2] ---> SPC of [2] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], felbamate ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], griseofulvin ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], hydantoins ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], lansoprazole ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], modafinil ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], nelfinavir ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], nevirapine ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], oral contraceptives ---> SPC of [1] of eMC
Concomitant use of cyproterone/ethinylestradiol with another hormonal contraceptive is contraindicated
Cyproterone/ethinylestradiol [1], oxcarbazepine ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], phenobarbital ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], phenytoin ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], pregnancy ---> SPC of [1] of eMC
Cyproterone/ethinylestradiol is not indicated during pregnancy.
Cyproterone/ethinylestradiol [1], primidone ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], rifabutin ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], rifampicin ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], ritonavir ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol [1], St. John's wort ---> SPC of [1] of eMC
The enzymatic induction by St. John's wort may decrease the plasma levels of ethinylestradiol. St. John's Wort should be avoided
Cyproterone/ethinylestradiol [1], topiramate ---> SPC of [1] of eMC
Drugs which induce hepatic enzymes (especially cytochrome P450 3A4) increase the metabolism of contraceptive steroids and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol, erythromycin
Erythromycin may decrease plasma concentrations of ethinylestradiol
Cyproterone/ethinylestradiol, erythromycin
Erythromycin may decrease plasma concentrations of ethinylestradiol
Cyproterone/ethinylestradiol, insulin
Oral contraceptives may decrease glucose tolerance resulting in hyperglycemia and decreased efficacy of oral antidiabetics and insulin
Cyproterone/ethinylestradiol, laxatives
Laxatives may decrease the plasma levels of ethinylestradiol by reduction of intestinal transit and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol, oral anticoagulants
Oral contraceptives may decrease the effect of oral anticoagulants probably due to an antagonist effect on some coagulation factors
Cyproterone/ethinylestradiol, oral antidiabetics
Oral contraceptives may decrease glucose tolerance resulting in hyperglycemia and decreased efficacy of oral antidiabetics and insulin
Cyproterone/ethinylestradiol, paracetamol
Active principles which inhibit ethinylestradiol sulphonation in the intestinal wall, e. g. paracetamol, may increase plasma concentrations of ethinylestradiol
Cyproterone/ethinylestradiol, penicillins
Penicillins may decrease the plasma levels of ethinylestradiol by reduction of enterohepatic circulation and hence may result in breakthrough bleeding and pregnancy.
Cyproterone/ethinylestradiol, tetracyclines
Tetracyclines may decrease the plasma levels of ethinylestradiol by reduction of enterohepatic circulation and hence may result in breakthrough bleeding and pregnancy.
Oral anticoagulants, oral contraceptives
Oral contraceptives may decrease the effect of oral anticoagulants probably due to an antagonist effect on some coagulation factors
Oral antidiabetics, oral contraceptives
Oral contraceptives may decrease glucose tolerance resulting in hyperglycemia and decreased efficacy of oral antidiabetics and insulin
CONTRAINDICATIONS of Cyproterone/ethinylestradiol
Preparations containing oestrogen/progestogen combinations should not be used in the presence of any of the conditions listed below. Should any of the conditions appear for the first time during their use, the product should be stopped immediately.
- Concomitant use with another hormonal contraceptive
- Venous thrombosis present or in history (deep venous thrombosis, pulmonary embolism)
- Arterial thrombosis present or in history (e.g. myocardial infarction) or prodromal conditions (e.g. angina pectoris and transient ischaemic attack).
- Presence or history of cerebrovascular accident
- The presence of a severe or multiple risk factor(s) for venous or arterial thrombosis (see section 4.4) such as:
- diabetes mellitus with vascular symptoms
- severe hypertension
- severe dyslipoproteinaemia
- Hereditary or acquired predisposition for venous or arterial thrombosis, such as activated protein C (APC) resistance, antithrombin-III-deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinaemia and antiphospholipid antibodies (anticardiolipin-antibodies, lupus anticoagulant)
- History of migraine with focal neurological symptoms.
- Presence or history of severe hepatic disease e.g. active viral hepatitis and severe cirrhosis, as long as liver function values have not returned to normal.
- Presence or history of liver tumours (benign or malignant).
- Current or history of breast cancer.
- Known or suspected pregnancy
- Breast-feeding
- Hypersensitivity to the active substances or to any of the excipients.
Relevant UK clinical guidance on COCs should also be consulted.
Dianette is not for use in men.
http://www.medicines.org.uk/emc/
Cysteamine
Ability to drive, cysteamine [2] ---> SPC of [2] of EMA
Cysteamine may cause drowsiness.
Breast-feeding, cysteamine [2] ---> SPC of [2] of EMA
Breast-feeding is contra-indicated in women taking PROCYSBI
Cysteamine [1], foods ---> SPC of [1] of EMA
Patients should try to consistently avoid meals and dairy products for at least 1 hour before and 1 hour after PROCYSBI dosing.
Cysteamine [1], omeprazole ---> SPC of [1] of EMA
Co-administration of the proton pump inhibitor omeprazole and PROCYSBI in vivo showed no effects on cysteamine bitartrate exposure
Cysteamine [1], pregnancy ---> SPC of [1] of EMA
Mercaptamine should not be used during pregnancy, particularly during the first trimester, unless clearly necessary.
CONTRAINDICATIONS of Cysteamine
- Hypersensitivity to the active substance, any form of cysteamine (mercaptamine), or to any of the excipients listed in section 6.1.
- Hypersensitivity to penicillamine
- Breast-feeding
Cytarabine (DepoCyte)
Ability to drive, cytarabine [2] ---> SmPC of [2] of EMA
On the basis of reported adverse reactions, patients should be advised against driving or using machines during treatment.
Asparaginase [1], cytarabine ---> SmPC of [1] of EMA
The efficacy of high-dose cytarabine is reduced by prior administration of asparaginase. However, when asparaginase was given after cytarabine a synergistic effect was observed.
Benzylpenicillin, cytarabine
Incompatible with benzylpenicillin in solution
Breast-feeding, cytarabine [2] ---> SmPC of [2] of EMA
Because of possible excretion in human milk and because of the potential for serious adverse reactions in nursing infants, the use of DepoCyte is not recommended in breast-feeding women.
Colaspase, cytarabine
The previous/posterior treatment with cytarabine may synergistic/antagonistic increase/weaken the effect of colaspase (asparaginase).
Cyclophosphamide, cytarabine
The co-administration may increase the cardiotoxicity
Cytarabine [1], cytotoxic agents ---> SmPC of [1] of EMA
Intrathecal co-administration of cytarabine with other cytotoxic agents may increase the risk of neurotoxicity.
Cytarabine [1], fertility ---> SmPC of [1] of EMA
Because the systemic exposure to free cytarabine following intrathecal treatment with DepoCyte is negligible, the risk of impaired fertility is likely to be low (see section 5.3).
Cytarabine [1], men ---> SmPC of [1] of EMA
Given that cytarabine has a mutagenic potential which could induce chromosomal damage in the human spermatozoa, males undergoing DepoCyte treatment and their partner should be advised to use a reliable contraceptive method.
Cytarabine [1], pregnancy ---> SmPC of [1] of EMA
Despite the low apparent risk women of childbearing potential should not receive treatment until pregnancy is excluded and should be advised to use a reliable contraceptive method.
Cytarabine [1], women of childbearing potential ---> SmPC of [1] of EMA
Despite the low apparent risk women of childbearing potential should not receive treatment until pregnancy is excluded and should be advised to use a reliable contraceptive method.
Cytarabine, cytostatics
The co-administration may cause myelotoxic interaction
Cytarabine, daunorubicin [2] ---> SmPC of [2] of eMC
If daunorubicin is combined with other cytostatics, the toxic effects of the daunorubicin therapy may be potentiated
Cytarabine, decitabine/cedazuridine [2] ---> SmPC of [2] of EMA
Concomitant administration of Inaqovi with medicinal products metabolised by CDA (i.e., cytarabine, gemcitabine, azacitidine) may result in increased systemic exposure with a potential for increased toxicity of these medicinal products.
Cytarabine, doxorubicine [2] ---> SmPC of [2] of eMC
The toxic effects of a doxorubicin therapy may be increased in a combination with other cytostatics. Necroses of the large intestine with massive haemorrhage and severe infections in connection with combination therapies with cytarabine.
Cytarabine, flucytosine [2] ---> SmPC of [2] of eMC
There is contradictory evidence concerning a drug interaction between flucytosine and cytarabine. Strict monitoring of blood levels is required if the two medicines are given concurrently.
Cytarabine, fluoropyrimidines
The inhibition of dihydropyrimidine dehydrogenase increases the plasma levels of fluoropyrimidine. Contraindicated. A period of at least 4 weeks should elapse between them.
Cytarabine, medicines with myelotoxic effects
The co-administration may cause myelotoxic interaction
Cytarabine, pegaspargase [2] ---> SmPC of [2] of EMA
Methotrexate and cytarabine can interfere differently: prior administration of these substances can increase the action of Oncaspar synergistically. If these substances are given subsequently, the effect of Oncaspar can be weakened antagonistically.
Cytarabine, phenytoin
The co-administration may increase the plasma levels and toxicity of phenytoin
Cytarabine, pyrimethamine [2] ---> SmPC of [2] of eMC
Cases of fatal bone marrow aplasia have been associated with the administration of daunorubicin, cytosine arabinoside and pyrimethamine to individuals suffering from acute myeloid leukaemia.
Cytarabine, radiotherapy
The co-administration may cause myelotoxic interaction
CONTRAINDICATIONS of Cytarabine (DepoCyte)
- Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
- Patients with active meningeal infection.
https://www.ema.europa.eu/en/documents/product-information/depocyte-epar-product-information_en.pdf 03/04/2023 (withdrawn)