Other interaction groups

5-HT3 receptor antagonists

5-HT3 receptor antagonists, antiarrhythmics ---> SmPC of [granisetron] of EMA

5-HT3 receptor antagonists, such as granisetron, may be associated with arrhythmias or ECG abnormalities. This potentially may have clinical significance in patients who are being treated with antiarrhythmics or beta-blockers.

5-HT3 receptor antagonists, betablockers ---> SmPC of [granisetron] of EMA

5-HT3 receptor antagonists, busulfan [2] ---> SmPC of [2] of EMA

No interaction was observed when busulfan was combined with fluconazole (antifungal agent) or 5 HT3 antiemetics such as ondansetron or granisetron.

5-HT3 receptor antagonists, fosaprepitant [2] ---> SmPC of [2] of EMA

There is no evidence of interaction with the use of IVEMEND 150 mg and 5-HT3 antagonists.

5-HT3 receptor antagonists, paracetamol ---> SmPC of [granisetron] of EMA

Co-administration of intravenous 5-HT3 receptor antagonists with oral paracetamol in human subjects has been reported to result in a block in the analgesic effect via a pharmacodynamic mechanism.

5-HT3 receptor antagonists, serotonergic medicines ---> SmPC of [granisetron] of EMA

There have been reports of serotonin syndrome following concomitant use of 5-HT3 antagonists and other serotonergic drugs (including SSRIs and SNRIs).

5-HT3 receptor antagonists, SNRIs ---> SmPC of [granisetron] of EMA

There have been reports of serotonin syndrome following concomitant use of 5-HT3 antagonists and other serotonergic drugs (including SSRIs and SNRIs).

5-HT3 receptor antagonists, SSRI ---> SmPC of [granisetron] of EMA

There have been reports of serotonin syndrome following concomitant use of 5-HT3 antagonists and other serotonergic drugs (including SSRIs and SNRIs).

Aldosterone antagonists

Acetylsalicylic acid, aldosterone antagonists

Decreased effects of aldosterone antagonist

Aldosterone antagonists, aminobenzoate potassium

Increased plasma concentration of potassium

Aldosterone antagonists, drospirenone

The combination may lead to hyperkalemia, particularly in renal failure. Co-administration is not recommended

Aldosterone antagonists, ethinylestradiol/drospirenone [2] ---> SmPC of [2] of eMC

Concomitant use of ethinylestradiol/drospirenone with aldosterone antagonists or potassium-sparing diuretics has not been studied. In this case, serum potassium should be tested during the first treatment cycle.

Aldosterone antagonists, ivabradine [2] ---> SmPC of [2] of EMA

In pivotal phase III clinical trials anti-aldosterone agents were routinely combined with ivabradine with no evidence of safety concerns

Aldosterone antagonists, potassium

The combination may lead to hyperkalemia, particularly in renal failure. Co-administration is not recommended

Aldosterone antagonists, potassium chloride [2] ---> SmPC of [2] of eMC

The combination may lead to hyperkalemia, particularly in renal failure. Co-administration is not recommended

Aldosterone antagonists, potassium sodium hydrogen citrate

The aldosterone antagonist decreases the renal elimination of potassium

Aldosterone antagonists, spironolactone

The combination may lead to hyperkalemia, particularly in renal failure. Co-administration is not recommended

Aldosterone antagonists, triamterene

Increased risk of severe hyperkalaemia when given aldosterone antagonists with triamterene

Alfa-adrenergic receptor blockers

Adrenaline [1], alfa-adrenergic receptor blockers ---> SmPC of [1] of eMC

Alpha blockers increase the risk of hypotension and tachycardia.

Alfa-adrenergic agonists, alfa-adrenergic receptor blockers

The alfa-adrenergic receptor blocker may decrease or abolish the alfa-adrenergic agonist effect

Alfa-adrenergic receptor blockers, amlodipine/valsartan [2] ---> SmPC of [2] of EMA

The combination may increase the antihypertensive effect

Alfa-adrenergic receptor blockers, atenolol/nifedipine

Atenolol/nifedipine may increase the blood pressure lowering and heart rate modulating effects of concomitant applied antihypertensives (alfa-adrenergic blocking agents)

Alfa-adrenergic receptor blockers, betablockers

When combined with beta-blockers, drugs that decrease arterial pressure can cause or increase hypotension, notably orthostatic.

Alfa-adrenergic receptor blockers, brinzolamide/brimonidine [2] ---> SmPC of [2] of EMA

Caution is advised when initiating (or changing the dose of) a concomitant systemic medicinal products (irrespective of pharmaceutical form) which may interact with alfa-adrenergic agonists or interfere with their activity

Alfa-adrenergic receptor blockers, captopril [2] ---> SmPC 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.

Alfa-adrenergic receptor blockers, carteolol

Increased antihypertensive effect, increased risk of orthostatic hypotension

Alfa-adrenergic receptor blockers, clonazepam

The co-administration may enhance the hypotensive and sedative effects

Alfa-adrenergic receptor blockers, dapoxetine [2] ---> SmPC of [2] of eMC

Dapoxetine should be prescribed with caution in patients taking medicinal products with vasodilatation properties (such as alpha adrenergic receptor antagonists and nitrates) due to possible reduced orthostatic tolerance

Alfa-adrenergic receptor blockers, diazepam

Enhanced hypotensive and sedative effect

Alfa-adrenergic receptor blockers, diltiazem [2] ---> SmPC of [2] of eMC

Concomitant treatment of diltiazem with alpha-antagonists may produce or aggravate hypotension. The combination of diltiazem with an alpha-antagonist should be considered only with the strict monitoring of the blood pressure.

Alfa-adrenergic receptor blockers, dopamine [2] ---> SmPC of [2] of eMC

The peripheral vasoconstriction caused by high doses of dopamine is antagonised by alfa-adrenergic blocking agents.

Alfa-adrenergic receptor blockers, doubutamine [2] ---> SmPC of [2] of eMC

Potential for hypotension and tachycardia to occur with concomitant administration of sympathomimetics and alpha-blockers such as phenoxybenzamine

Alfa-adrenergic receptor blockers, doxazosin [2] ---> SmPC of [2] of eMC

Doxazosin potentiates the blood pressure lowering activity of other alpha-blockers

Alfa-adrenergic receptor blockers, epinephrine [2] ---> SmPC of [2] of eMC

Alpha blockers increase the risk of hypotension and tachycardia.

Alfa-adrenergic receptor blockers, etilefrine

The co-administration may abolish partial or totally the etilefrine effect

Alfa-adrenergic receptor blockers, general anesthetics

Enhanced hypotensive effect when general anaesthetics given with alpha-blockers.

Alfa-adrenergic receptor blockers, labetalol

Possible enhancement of hypotensive effect of labetalol

Alfa-adrenergic receptor blockers, lorazepam [2] ---> SmPC of [2] of eMC

Enhanced hypotensive effect

Alfa-adrenergic receptor blockers, midazolam

Enhanced hypotensive effect

Alfa-adrenergic receptor blockers, midodrine

The alfa-adrenergic receptor blocker may decrease or abolish the midodrine effect.

Alfa-adrenergic receptor blockers, naphazoline

The co-administration may cause complex interactions

Alfa-adrenergic receptor blockers, neuroleptics

Antipsychotics may enhance the hypotensive effect of alfa-adrenergic blocking agents.

Alfa-adrenergic receptor blockers, nifedipine [2] ---> SmPC of [2] of eMC

Nifedipine may be used in combined therapy with other antihypertensive agents including beta-blocker drugs, but the possibility of an additive effect resulting in postural hypotension should be borne in mind.

Alfa-adrenergic receptor blockers, noradrenaline

The co-administration of noradrenaline with alfa-adrenergic antagonists may reverse the adrenaline effect (= hypotension)

Alfa-adrenergic receptor blockers, norepinephrine

The co-administration of noradrenaline with alfa-adrenergic antagonists may reverse the adrenaline effect (= hypotension)

Alfa-adrenergic receptor blockers, olmesartan medoxomil [2] ---> SmPC of [2] of eMC

The blood pressure lowering effect of olmesartan medoxomil can be increased by concomitant use of other antihypertensive medications.

Alfa-adrenergic receptor blockers, olmesartan medoxomil/amlodipine [2] ---> SmPC of [2] of eMC

The blood pressure lowering effect of olmesartan medoxomil/amlodipine can be increased by concomitant use of other antihypertensive medicinal products

Alfa-adrenergic receptor blockers, oxazepam

Enhanced hypotensive and sedative effects

Alfa-adrenergic receptor blockers, pancuronium

Possible enhancement of pancuronium effect and the intensity of neuromuscular block

Alfa-adrenergic receptor blockers, phenylephrine

The interaction of phenylephrine with beta und alfa blocker may be complex

Alfa-adrenergic receptor blockers, propranolol [2] ---> SmPC of [2] of EMA

When combined with beta-blockers, drugs that decrease arterial pressure can cause or increase hypotension, notably orthostatic.

Alfa-adrenergic receptor blockers, sildenafil [2] ---> SmPC of [2] of EMA

Concomitant administration of sildenafil to patients taking alpha-blocker therapy may lead to symptomatic hypotension in a few susceptible individuals.

Alfa-adrenergic receptor blockers, silodosin [2] ---> SmPC of [2] of EMA

The concomitant use of other alfa-adrenoreceptor antagonists is not recommended

Alfa-adrenergic receptor blockers, tenoxicam

Tenoxicam may decrease the activity of alfa-adrenergic receptor blockers and ACE inhibitors

Alfa-adrenergic receptor blockers, thiopental

Enhanced hypotensive effect when general anaesthetics given with alpha-blockers.

Alfa-adrenergic receptor blockers, triamterene [2] ---> SmPC of [2] of eMC

The co-administration of triamterene and alpha-blockers may enhance the hypotensive effect

Alfa-adrenergic receptor blockers, urapidil

The antihypertensive effect of urapidil may be enhanced with the concomitant use of alfa-receptor antagonists

Alfa-adrenergic receptor blockers, valsartan

The combination may increase the antihypertensive effect

Alfa-adrenergic receptor blockers, xipamide

Increased hypotensive effect. Risk of orthostatic hypotension

Alfa-adrenergic receptor blockers, zofenopril

Additive or enhanced hypotension may occur

Alkalinizing agents

Acetylsalicylic acid [1], urinary alkalinizing agents ---> SmPC of [1] of eMC

The urinary alkalinizing agent increases the pH of renal tubular urine and the urinary excretion of acetylsalicylic acid

Alkalinizing agents [1], cefuroxime axetil ---> SmPC 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.

Alkalinizing agents, dopamine

The addition of alkalizing agents may inactivate dopamine

Alkalinizing agents, methenamine

The alkalizing agent decreases the effect of methenamine (urinary acidifying). The co-administration should be avoided.

Alkalisation of urine, memantin [2] ---> SmPC of [2] of EMA

Possible increased levels of memantine. Alkalisation of urine may result from drastic changes in diet, e.g. from a carnivore to a vegetarian diet, or from the massive ingestion of alkalising gastric buffers.

Amphetamine [1], urinary alkalinizing agents ---> SmPC of [1] of EMA

The urinary alkalinizing agent alkalizes the urine and decreases urinary excretion and extends the half-life of amfetamine.

Atropine, urinary alkalinizing agents

The urinary alkalinizing agent decreases the renal elimination of atropine

Chloroquine, urinary alkalinizing agents [2] ---> SmPC of [2] of eMC

Care should be taken when alkalinization of urine occurs as this may reduce chloroquine renal excretion.

Chlorpropamide, urinary alkalinizing agents

The urinary alkalinizing agent increases the pH of renal tubular urine and the urinary excretion of chlorpropamide

Cotrimoxazole, urinary alkalinizing agents

Urinary alkalinizing agents increase renal elimination of co-trimoxazole

Ephedrine, urinary alkalinizing agents

The urinary alkalinizing agent, increases the pH of renal tubular urine and decreases the urinary excretion of ephedrine

Flecainide, urinary alkalinizing agents

The urinary alkalinizing agent, increases the pH of renal tubular urine and decreases the urinary excretion of flecainide

Hydroquinidine, urinary alkalinizing agents

The urinary alkalinizing agent alkalizes the urine and decreases urinary excretion of hydroquinidine and increases plasma levels and overdose risk of hydroquinidine

Lisdexamfetamine [1], urinary alkalinizing agents ---> SmPC of [1] of eMC

The urinary alkalinizing agent alkalizes the urine and decreases urinary excretion and extends the half-life of amfetamine.

Lithium carbonate [1], urinary alkalinizing agents ---> SmPC of [1] of eMC

Serum lithium levels may be decreased due to an increase in lithium renal clearance

Lithium, urinary alkalinizing agents

The combination may decrease serum lithium levels due to an increase in lithium renal clearance

Methadone, urinary alkalinizing agents

The urinary alkalinizing agent decreases the clearance of methadone

Methotrexate, urinary alkalinizing agents

The urinary alkalinizing agent increases the pH of renal tubular urine and the urinary excretion of methotrexate

Mexiletine, urinary alkalinizing agents

The urinary alkalinizing agent, increases the pH of renal tubular urine and decreases the urinary excretion of mexiletine

Nitrofurantoin, urinary alkalinizing agents

Decreased anti-bacterial activity by carbonic anhydrase inhibitors and urine alkalisation.

Potassium citrate/potassium hydrogen carbonate [1], urinary alkalinizing agents ---> SmPC of [1] of EMA

As Sibnayal may further increase urine pH to a small extent, the interaction of alkaline urine with these medications may be enhanced.

Procainamide, urinary alkalinizing agents

The urinary alkalinizing agent, increases the pH of renal tubular urine and decreases the urinary excretion of procainamide

Pseudoephedrine, urinary alkalinizing agents

The urinary alkalinizing agent increases the pH of renal tubular urine and decreases the urinary excretion of pseudoephedrine

Quinidine, urinary alkalinizing agents

The urinary alkalinizing agent, increases the pH of renal tubular urine and decreases the urinary excretion of quinidine

Quinine, urinary alkalinizing agents

The urinary alkalinizing agent, increases the pH of renal tubular urine and decreases the urinary excretion of quinine

Salicylates, urinary alkalinizing agents

The urinary alkalinizing agent increases the pH of renal tubular urine and the urinary excretion of salicylate

Tetracyclines, urinary alkalinizing agents

The urinary alkalinizing agent increases the pH of renal tubular urine and the urinary excretion of tetracycline

Tricyclic antidepressant, urinary alkalinizing agents

The urinary alkalinizing agent, increases the pH of renal tubular urine and decreases the urinary excretion of tricyclic antidepressant

Ability to drive, vinca alkaloids

Changes in the ability to react

Azole antifungals, vinca alkaloids

The strong CYP3A4 inhibition may increase the plasma concentrations of vinca alkaloid

Bexarotene [1], vinca alkaloids ---> SmPC of [1] of EMA

Caution is advised in case of combination of bexarotene with CYP3A4-metabolised cytotoxics

Bleomycin [1], vinca alkaloids ---> SmPC of [1] of eMC

In patients treated for testicular cancer with a combination of bleomycin and vinca alkaloids a syndrome has been reported corresponding to morbus Raynaud

CYP3A4 inhibitors, vinca alkaloids

The CYP3A4 inhibition may increase the plasma concentrations of the vinca alkaloid

Delamanid [1], vinca alkaloids ---> SmPC of [1] 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.

Desloratadine/pseudoephedrine [1], veratrum alkaloids ---> SmPC of [1] of EMA

Sympathomimetic medicines reduce the antihypertensive effect of veratrum alkaloids

Fluconazole [1], vinca alkaloids ---> SmPC of [1] of eMC

Fluconazole may increase the plasma levels of the vinca alkaloids and lead to neurotoxicity, which is possibly due to an inhibitory effect on CYP3A4.

Itraconazol [1], vinca alkaloids ---> SmPC of [1] of eMC

Itraconazole may increase the plasma concentrations of vinca alkaloids

Ketoconazole, vinca alkaloids ---> SmPC of [vincristine] of eMC

The metabolism of vinca alkaloids has been shown to be mediated by hepatic cytochrome P450 isoenzymes in the CYP3A subfamily. This metabolic pathway may be impaired in patients who are taking concomitant potent inhibitors of these isoenzymes

Mytomicin [1], vinca alkaloids ---> SmPC of [1] of eMC

Acute shortness of breath and severe bronchospasm have been reported following the administration of the vinca alkaloids in combination with mitomycin-C

Ototoxic agents, vinca alkaloids

The co-administration may cause damage of the eighth cranial nerve, equilibrium organ and organ of hearing. Special caution is recommended

Piperaquine, vinca alkaloids ---> SmPC 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

Piperaquine/artenimol [1], vinca alkaloids ---> SmPC of [1] 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

Piroxicam, vinca alkaloids

The co-administration may increase the toxicity of vinca alkaloid

Platinum compounds, vinca alkaloids

The co-administration may cause damage of the eighth cranial nerve, equilibrium organ and organ of hearing. Special caution is recommended

Posaconazole [1], vinca alkaloids ---> SmPC of [1] of EMA

Most of the vinca alkaloids (e.g. vincristine and vinblastine) are substrates of CYP3A4. Posaconazole may increase the plasma concentrations of vinca alkaloids which may lead to neurotoxicity and other serious adverse reactions.

Strong CYP3A4 inhibitors, vinca alkaloids

The strong CYP3A4 inhibition may increase the plasma concentrations of the vinca alkaloid. The dosage should be reduced if necessary

Strong P-gp inhibitors, vinca alkaloids

As vinca-alkaloids are known as substrates for P-glycoprotein, caution should be exercised when combining vinorelbine with strong modulators of this membrane transporter.

Sympathomimetics, veratrum alkaloids

Sympathomimetic medicines reduce the antihypertensive effect of veratrum alkaloids

Vinca alkaloids, voriconazole [2] ---> SmPC of [2] of EMA

Voriconazole is likely to increase the plasma concentrations of vinca alkaloids and lead to neurotoxicity.

Amphetamine

Acetazolamide, amphetamine

Acetazolamide, urinary alkalinizing agent, increases the pH of renal tubular urine and decreases the urinary excretion of amphetamine

Amphetamine [1], bicarbonate ---> SmPC of [1] of eMC

Bicarbonate alkalizes the urine and decreases urinary excretion and extends the half-life of amfetamine.

Amphetamine [1], IMAOs ---> SmPC of [1] of eMC

Amfetamine should not be administered during or within 14 days following the administration of monoamine oxidase inhibitors (MAOI) because it can increase the release of norepinephrine and other monoamines.

Amphetamine [1], urinary alkalinizing agents ---> SmPC of [1] of eMC

The urinary alkalinizing agent alkalizes the urine and decreases urinary excretion and extends the half-life of amfetamine.

Amphetamine, antihypertensives

Amfetamines may decrease the effectiveness of antihypertensive medications.

Amphetamine, bromperidol

The co-administration may decrease the stimulatory effect of amphetamine and the antipsychotic effect of bromperidol

Amphetamine, carbonic anhydrase inhibitors

The carbonic anhydrase inhibitor, urinary alkalinizing agent, increases the pH of renal tubular urine and decreases the urinary excretion of amphetamine (basic/cationic agent)

Amphetamine, chlorpromazine ---> SmPC of [lisdexamfetamine] of eMC

Chlorpromazine blocks dopamine and norepinephrine receptors, thus inhibiting the central stimulant effects of amfetamines.

Amphetamine, chlorprothixene

Decreased stimulant effect of amphetamine, the antipsychotic effect of chlorprothixene may be decreased due to effect on the dopamine receptors

Amphetamine, corticosteroids

Amfetamines can cause a significant elevation in plasma corticosteroid levels. This increase is greatest in the evening.

Amphetamine, desloratadine/pseudoephedrine [2] ---> SmPC of [2] of EMA

The combination may result in critical hypertension reactions

Amphetamine, dextropropoxyphene

Possible enhancement of stimulant effect on the CNS of amphetamine

Amphetamine, disulfiram

Disulfiram inhibits the metabolism of many drugs which are converted in the liver and thereby enhances efficacy.

Amphetamine, esketamine [2] ---> SmPC of [2] of EMA

Blood pressure should be closely monitored when Spravato is used concomitantly with psychostimulants or other medicinal products that may increase blood pressure

Amphetamine, fluphenazine [2] ---> SmPC of [2] of eMC

Concurrent use of phenothiazines and amfetamine/anorectic agents may produce antagonistic pharmacological effects.

Amphetamine, fluspirilene

Mutual decrease in effects

Amphetamine, guanethidine

Amfetamines may decrease the effectiveness of antihypertensive medications.

Amphetamine, haloperidol ---> SmPC of [lisdexamfetamine] of eMC

Haloperidol blocks dopamine receptors, thus inhibiting the central stimulant effects of amfetamines.

Amphetamine, ioflupane [2] ---> SmPC of [2] of EMA

Ioflupane binds to the dopamine transporter. Medicines that bind to the dopamine transporter with high affinity may therefore interfere with ioflupane diagnosis.

Amphetamine, irreversible non-selective MAO-inhibitors

Amphetamine, irreversible selective MAO-A inhibitors

Amphetamine should not be administered during or within 14 days following the administration of monoamine oxidase inhibitors (MAOI) because it can increase the release of norepinephrine and other monoamines.

Amphetamine, irreversible selective MAO-B inhibitors

Amphetamine, isocarboxazid

Patients being treated with a monoamine oxidase inhibitor should not receive indirectly-acting sympathomimetic. In extreme cases interactions may result in severe hypertensive episodes.

Amphetamine, isoflurane [2] ---> SmPC of [2] of eMC

Beta-sympathomimetic agents should be used with caution during isoflurane narcosis, due to a potential risk of ventricular arrhythmia.

Amphetamine, levodopa/benserazide [2] ---> SmPC of [2] of eMC

Sympathomimetics may increase the cardiovascular side-effects of levodopa.

Amphetamine, lithium carbonate ---> SmPC of [lisdexamfetamine] of eMC

The anorectic and stimulatory effects of amfetamines may be inhibited by lithium carbonate.

Amphetamine, magnesium hydroxide

The magnesium hydroxide, urinary alkalinizing agent, increases the pH of renal tubular urine and decreases the urinary excretion of amphetamine

Amphetamine, non-selective MAO-inhibitors

Amphetamine, opioid analgesics

Amfetamines potentiate the analgesic effect of narcotic analgesics.

Amphetamine, phenelzine [2] ---> SmPC of [2] of eMC

Phenelzine may potentiate the action of amphetamines

Amphetamine, phenothiazines

Concurrent use of phenothiazines and amfetamine/anorectic agents may produce antagonistic pharmacological effects.

Amphetamine, promazine

Concurrent use of phenothiazines and amfetamine/anorectic agents may produce antagonistic pharmacological effects.

Amphetamine, pseudoephedrine [2] ---> SmPC of [2] of eMC

Caution should be exercised with patients receiving other sympathomimetic agents (e.g. avoid use with apraclonidine), appetite suppressants or other amphetamine-like psychostimulants, as there is a risk of hypertension.

Amphetamine, reversible non-selective MAO-inhibitors

Amphetamine, reversible selective MAO-A inhibitors

Amphetamine, reversible selective MAO-B inhibitors

Amphetamine, ritonavir [2] ---> SmPC of [2] of EMA

Ritonavir dosed as an antiretroviral agent is likely to inhibit CYP2D6 and as a result is expected to increase concentrations of amphetamine and its derivatives.

Amphetamine, sevoflurane [2] ---> SmPC of [2] of eMC

There is a risk of acute hypertensive episode with the concomitant use of sevoflurane and indirect-acting sympathomimetics products

Amphetamine, sympathomimetics

The combination may cause critical hypertension reactions

Amphetamine, thiazides

The thiazide alkalizes the urine and decreases urinary excretion and extends the half-life of amfetamine.

Amphetamine, tranylcypromine

Tranylcypromine may potentiate the action of amphetamines

Amphetamine, trimipramine

The co-administration may cause hypertensive crisis

Amphetamine, tryptophan

The co-administration can cause serotoninergic syndrome. The combination is contraindicated

Amphetamine, urinary acidifying agents

The urinary acidifying agent acidifies the urine and increases urinary excretion and decreases the half-life of amfetamine (basic medicinal product)

Amphetamine, yohimbine

Possible enhancement of effects. The use concomitant is not recommended

Ascorbic acid, lisdexamfetamine [2] ---> SmPC of [2] of eMC

Ascorbic acid acidifies the urine and increases urinary excretion and decreases the half-life of amfetamine (basic medicinal product)

Lisdexamfetamine [1], sympathomimetics ---> SmPC of [1] of eMC

Lisdexamfetamine should be used with caution in patients who use other sympathomimetic drugs

Lisdexamfetamine [1], thiazides ---> SmPC of [1] of eMC

The thiazide alkalizes the urine and decreases urinary excretion and extends the half-life of amfetamine.

Anabolic steroids

Anabolic steroids [1], phenindione ---> SmPC of [1] of eMC

Anabolic steroids potentiate the effect of phenindione

Anabolic steroids, glibenclamide [2] ---> SmPC of [2] of EMA

The co-administration may enhance the hypoglycemic effect

Anabolic steroids, glimepiride [2] ---> SmPC of [2] of eMC

Potentiation of the blood-sugar-lowering effect and possible hypoglycaemia

Anabolic steroids, glimepiride [2] ---> SmPC of [2] of eMC

The co-administration may enhance the hypoglycemic effect

Anabolic steroids, gliquidone

Hypoglycemic reactions may occur as expression of enhancement effect of gliquidone with gliquidone is co-administered with anabolic steroids.

Anabolic steroids, insulin

Anabolic steroids may improve glucose tolerance and decrease the need for insulin or other anti-diabetic drugs in diabetics.

Anabolic steroids, insulin

The anabolic steroid may improve glucose tolerance and decrease the need for insulin

Anabolic steroids, insulin aspart [2] ---> SmPC of [2] of EMA

Possible reduction of the insulin requirements

Anabolic steroids, insulin degludec [2] ---> SmPC of [2] of EMA

Possible reduction of the insulin requirements

Anabolic steroids, insulin degludec/insulin aspart [2] ---> SmPC of [2] of EMA

Possible reduction of the insulin requirements

Anabolic steroids, insulin degludec/liraglutide [2] ---> SmPC of [2] of EMA

Possible reduction of the Xultophy requirements

Anabolic steroids, insulin detemir [2] ---> SmPC of [2] of EMA

Possible reduction of the insulin requirements

Anabolic steroids, insulin glargin [2] ---> SmPC of [2] of EMA

Possible reduction of the insulin requirements

Anabolic steroids, kebuzone

Enhanced effect of kebuzone

Anabolic steroids, nateglinide [2] ---> SmPC of [2] of EMA

Anabolic hormones may enhance the hypoglycaemic effect of nateglinide

Anabolic steroids, oral anticoagulants

Anabolic steroids have been reported to increase the activity of oral anticoagulants.

Anabolic steroids, oral antidiabetics

Anabolic steroids may improve glucose tolerance and decrease the need for insulin or other anti-diabetic drugs in diabetics.

Anabolic steroids, phenprocoumon

Enhancement of phenprocoumon effect and increased bleeding risk with the concomitant administration of anabolic steroid

Anabolic steroids, phenylbutazone

The co-administration may increase the effect of phenylbutazone

Anabolic steroids, pioglitazone/glimepiride [2] ---> SmPC of [2] of EMA

Potentiation of the blood-glucose-lowering effect and, thus, in some instances hypoglycaemia may occur

Anabolic steroids, probenecide

Probenecid inhibits the renal elimination of anabolic agents

Anabolic steroids, repaglinide [2] ---> SmPC of [2] of EMA

Anabolic steroids may enhance and/or prolong the hypoglycaemic effect of repaglinide.

Anabolic steroids, somatropin

The co-administration may have an additive effect on bone maturation

Anabolic steroids, sulfonylureas

Potentiation of the blood-glucose-lowering effect and, thus, in some instances hypoglycaemia

Analogues

Abacavir/lamivudine [1], cytidine analogues ---> SmPC of [1] of EMA

Due to similarities, abacavir/lamivudine should not be administered concomitantly with other cytidine analogues

Anticoagulants, prostacyclin analogues

Use the anticoagulant with caution with medicinal products which affect platelet function

Benzodiazepine analogues, breast-feeding

The benzodiazepine analog passes into the breast milk. Contraindicated

Benzodiazepine analogues, enzyme inhibitors

The enzymatic inhibition may enhance the benzodiazepine analog activity

Benzodiazepine analogues, flumazenil [2] ---> SmPC of [2] of eMC

Flumazenil antagonizes the central effects of benzodiazepine analog by competitive interaction at the receptor

Benzodiazepine analogues, melatonin [2] ---> SmPC of [2] of EMA

Melatonin may enhance the sedative properties of benzodiazepines and non-benzodiazepine hypnotics

Betaine anhydrous [1], GABA analogues ---> SmPC of [1] of EMA

To minimise the risk of potential drug interactions, it is advisable to leave 30 minutes between the intake of betaine anhydrous and amino acids mixtures and/or medicinal products containing vigabatrin and GABA analogues

Bimatoprost [1], prostaglandin analogues ---> SmPC of [1] of EMA

There is a potential for the IOP-lowering effect of bimatoprost to be reduced in patients with glaucoma or ocular hypertension when used with other prostaglandin analogues

Bromocriptine, somatostatin analogues ---> SmPC of [lanreotide] of eMC

Limited published data indicate that concomitant administration of somatostatin analogues and bromocriptine may increase the availability of bromocriptine.

Capecitabine, nucleoside analogues

The co-administration may increase the effect and toxicity of the fluoropyrimidine

Cidofovir, cytidine analogues

Cidofovir should not be co-administered with other cytidine analogues

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.

Cytidine analogues, cytidine analogues

Cytidine analogues should not be administered concomitantly

Cytidine analogues, emtricitabine [2] ---> SmPC of [2] of EMA

There is no clinical experience as yet on the co-administration of cytidine analogues. Consequently, the use of emtricitabine in combination with lamivudine or zalcitabine for the treatment of HIV infection cannot be recommended at this time.

Cytidine analogues, emtricitabine/rilpivirine/tenofovir disoproxil [2] ---> SmPC of [2] of EMA

Due to similarities with emtricitabine, the fixed combination should not be administered concomitantly with other cytidine analogues

Cytidine analogues, emtricitabine/tenofovir disoproxil [2] ---> SmPC of [2] of EMA

Emtricitabine should not be administered concomitantly with other cytidine analogues

Cytidine analogues, lamivudine [2] ---> SmPC of [2] of EMA

Due to similarities, lamivudine should not be administered concomitantly with other cytidine analogues, such as emtricitabine. Moreover, lamivudine should not be taken with any other medicinal products containing lamivudine

Cytidine analogues, zalcitabine

Zalcitabine should not be administered concomitantly with other cytidine analogues

Drotrecogin alfa [1], prostacyclin analogues ---> SmPC of [1] of EMA

Caution should be employed when using drotrecogin alfa with other drugs that affect haemostasis

Drugs primarily metabolised by CYP1A2, somatostatin analogues

The limited published data available indicate that somatostatin analogues may decrease the metabolic clearance of compounds known to be metabolised by Cytochrome P450 enzymes, which may be due to the suppression of growth hormone.

Drugs primarily metabolised by CYP2C19, somatostatin analogues

Drugs primarily metabolised by CYP2C8, somatostatin analogues

Drugs primarily metabolised by CYP2C9, somatostatin analogues

Drugs primarily metabolised by CYP2D6, somatostatin analogues

Drugs primarily metabolised by CYP3A4, somatostatin analogues

Edotreotide [1], somatostatin analogues ---> SmPC of [1] of EMA

When treating patients with somatostatin analogues, it is preferable to perform imaging with gallium (68Ga) edotreotide the day(s) preceding the next administration of a somatostatin analogue.

Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide [1], nucleoside analogues ---> SmPC of [1] of EMA

Nucleoside and nucleotide analogues have been demonstrated to cause a variable degree of mitochondrial damage. There have been reports of mitochondrial dysfunction in HIV negative infants exposed in utero and/or postnatally to nucleoside analogues.

Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide [1], nucleotide analogues ---> SmPC of [1] of EMA

Emtricitabine/rilpivirine/tenofovir alafenamide [1], nucleoside analogues ---> SmPC of [1] of EMA

Nucleos(t)ide analogues may impact mitochondrial function to a variable degree, which is most pronounced with stavudine, didanosine and zidovudine.

Emtricitabine/rilpivirine/tenofovir alafenamide [1], nucleotide analogues ---> SmPC of [1] of EMA

Nucleos(t)ide analogues may impact mitochondrial function to a variable degree, which is most pronounced with stavudine, didanosine and zidovudine.

Floxuridine, nucleoside analogues

The co-administration may increase the effect and toxicity of the fluoropyrimidine

Flucytosine, nucleoside analogues

The co-administration may increase the effect and toxicity of the fluoropyrimidine

Fluoropyrimidines, nucleoside analogues

The co-administration may increase the effect and toxicity of the fluoropyrimidine

Fluorouracil [1], nucleoside analogues ---> SmPC of [1] of eMC

In the case of accidental administration of nucleoside analogues to patients treated with fluorouracil, effective measures should be taken to reduce fluorouracil toxicity. Immediate hospitalisation is recommended.

Ganciclovir [1], nucleoside analogues ---> SmPC of [1] 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

Hydralazine [1], prostacyclin analogues ---> SmPC of [1] of eMC

Concurrent treatment of hydralazine with other antihypertensives may potentate the effects

Lanreotide [1], somatostatin analogues ---> SmPC of [1] of eMC

Latanoprost [1], prostaglandin analogues ---> SmPC of [1] of eMC

There have been reports of paradoxical elevations in intraocular pressure following the concomitant ophthalmic administration of two prostaglandin analogues. Therefore, the concomitant use is not recommended.

Latanoprost/netarsudil [1], prostaglandin analogues ---> SmPC of [1] of EMA

There have been reports of paradoxical elevations in IOP following the ophthalmic coadministration of 2 prostaglandin analogues. Therefore, the use of two or more prostaglandins, prostaglandin analogues or prostaglandin derivatives is not recommended.

Latanoprost/timolol [1], prostaglandin analogues ---> SmPC of [1] of eMC

There have been reports of paradoxical elevations in intraocular pressure following ophthalmic coadministration of 2 prostaglandin analogues. The use of 2 or more prostaglandins, prostaglandin analogues, or prostaglandin derivatives is not recommended.

Lutetium (177Lu) oxodotreotide [1], somatostatin analogues ---> SmPC of [1] of EMA

Somatostatin and its analogues competitively bind to somatostatin receptors. Therefore, administration of long acting somatostatin analogues should be avoided within 30 days prior to the administration of this medicinal product.

Mitochondrial dysfunction following exposure in utero, nucleoside analogues

Nucleos(t)ide analogues may impact mitochondrial function to a variable degree, which is most pronounced with stavudine, didanosine and zidovudine.

Mitochondrial dysfunction following exposure in utero, nucleoside analogues

Nucleos(t)ide analogues may impact mitochondrial function to a variable degree, which is most pronounced with stavudine, didanosine and zidovudine.

Mitochondrial dysfunction following exposure in utero, nucleoside analogues ---> SmPC of [abacavir/lamivudine] of

Nucleoside and nucleotide analogues have been demonstrated to cause a variable degree of mitochondrial damage. There have been reports of mitochondrial dysfunction in HIV-negative infants exposed in utero and/or post-natally to nucleoside analogues

Mitochondrial dysfunction following exposure in utero, nucleotide analogues

Nucleos(t)ide analogues may impact mitochondrial function to a variable degree, which is most pronounced with stavudine, didanosine and zidovudine.

Mitochondrial dysfunction following exposure in utero, nucleotide analogues

Nucleos(t)ide analogues may impact mitochondrial function to a variable degree, which is most pronounced with stavudine, didanosine and zidovudine.

Mitochondrial dysfunction following exposure in utero, nucleotide analogues ---> SmPC of [abacavir/lamivudine] of

Mitochondrial dysfunction, nucleoside analogues

Nucleoside a. nucleotide analogues have been demonstrated in vitro a. in vivo to cause a variable degree of mitochondrial damage. There have been reports of mitochondrial dysfunction in infants exposed in utero a./o. post-natally to nucleoside analogues.

Mitochondrial dysfunction, nucleoside analogues

Mitochondrial dysfunction, nucleoside analogues ---> SmPC of [emtricitabine/tenofovir alafenamide] of EMA

Mitochondrial dysfunction, nucleotide analogues

Mitochondrial dysfunction, nucleotide analogues ---> SmPC of [emtricitabine/tenofovir alafenamide] of EMA

Nateglinide [1], somatostatin analogues ---> SmPC of [1] of EMA

Somatostatin analogues may reduce the hypoglycaemic effect of nateglinide

Nepafenac [1], prostaglandin analogues ---> SmPC of [1] of EMA

Considering their mechanism of action, the concomitant use of prostaglandin analogues and nepafenac is not recommended.

Nucleoside analogues, peginterferon alfa-2b [2] ---> SmPC of [2] of EMA

Use of nucleoside analogs, alone or in combination with other nucleosides, has resulted in lactic acidosis.

Nucleoside analogues, tegafur

The inhibition of dihydropyrimidine dehydrogenase increases the plasma levels of tegafur. Contraindicated. A period of at least 4 weeks should elapse between them.

Nucleoside analogues, valganciclovir [2] ---> SmPC of [2] of eMC

Toxicity may be enhanced when valganciclovir is co-administered with, or is given immediately before or after, other drugs that inhibit replication of rapidly dividing cell populations such as occur in the bone marrow

Prostaglandin analogues, prostaglandin analogues

Paradoxical elevation in intraocular pressure

Prostaglandin analogues, prostaglandins

Paradoxical elevation in intraocular pressure

Prostaglandin analogues, tissue-type plasminogen activator

The prostaglandin analogue may reduce the thrombolytic efficacy of tissue plasminogen activator (t-PA) by increasing hepatic clearance of t-PA

Quinidine, somatostatin analogues

Somatorelin [1], somatostatin analogues ---> SmPC of [1] of eMC

Concomitant use of somatorelin and substances influencing the release of growth hormone should be avoided.

Somatostatin analogues, terfenadine

Anionic drugs

Almasilate, anionic drugs

Almasilate, urinary alkalinizing agent, increases the urinary excretion of anionic drug

Ammonium chloride, anionic drugs

The ammonium chloride, urinary acidifying agent, decreases the elimination of the acidic (anionic) medicinal product

Anionic drugs, ascorbic acid

Ascorbic acid, urinary acidifying agent, decreases the elimination of the acidic (anionic) medicinal product

Anionic drugs, atracurium

Do not mix atracurium with alkalizing solutions due to atracurium can be inactivated

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.

Anionic drugs, hydrotalcite

Hydrotalcite, urinary alkalinizing agent, may increase the renal elimination of the acid (anionic) medicinal products (e.g. salicylates)

Anionic drugs, magnesium hydroxide

The magnesium hydroxide, urinary alkalinizing agent, increases the renal elimination of the acidic (anionic) medicinal product

Anionic drugs, nitrofurantoin

Urinary acidifying agents increase the effect of nitrofurantoine

Anionic drugs, trometamol

The urinary alkalinizing agent (trometamol) increases the renal elimination of the acidic (anionic) medicinal product

Anorexics

Anorexics, fenproporex

Fenproporex should not be used with other anorexiant

Anorexics, fluphenazine [2] ---> SmPC of [2] of eMC

Concurrent use of phenothiazines and amfetamine/anorectic agents may produce antagonistic pharmacological effects.

Anorexics, IMAOs

The anorexiant should not be used with a MAOI

Anorexics, isoflurane [2] ---> SmPC of [2] of eMC

Beta-sympathomimetic agents should be used with caution during isoflurane narcosis, due to a potential risk of ventricular arrhythmia.

Anorexics, methocarbamol

Methocarbamol may potentiate the effects of other central nervous system depressants and stimulants

Anorexics, phenothiazines

Concurrent use of phenothiazines and amfetamine/anorectic agents may produce antagonistic pharmacological effects.

Anorexics, pseudoephedrine [2] ---> SmPC of [2] of eMC

Anorexics, trimipramine

The co-administration may cause hypertensive crisis

H2 antagonists

Acalabrutinib [1], H2 antagonists ---> SmPC of [1] of EMA

For H2-receptor antagonists, take Calquence should be taken 2 hours before (or 10 hours after) taking the H2-receptor antagonist.

Alectinib [1], H2 antagonists ---> SmPC of [1] of EMA

Therefore, no dose adjustments are required when Alecensa is co-administered with proton pump inhibitors or other medicinal products which raise gastric pH (e.g. H2 receptor antagonists or antacids).

Algeldrate/magnesium hydroxide, H2 antagonists

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, H2 antagonists

There are studies which describe an absorption reduction of the active principle co-administered with almasilate

Alpelisib [1], H2 antagonists ---> SmPC of [1] of EMA

Alpelisib can be co-administered with acid-reducing agents, provided alpelisib is taken immediately after food

Aluminium hydroxide, H2 antagonists

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, H2 antagonists

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

Atazanavir/cobicistat [1], H2 antagonists ---> SmPC of [1] of EMA

The mechanism of interaction is decreased solubility of atazanavir as intra-gastric pH increases with H2 blockers. It is not recommended to co-administer EVOTAZ with an H2-receptor antagonist.

Atazanavir/ritonavir, H2 antagonists ---> SmPC of [atazanavir] of EMA

The mechanism of interaction is decreased solubility of atazanavir as intra-gastric pH increases with H2 blockers.

Atazanavir/ritonavir/tenofovir, H2 antagonists ---> SmPC of [atazanavir] of EMA

The mechanism of interaction is decreased solubility of atazanavir as intra-gastric pH increases with H2 blockers. Co-administration of atazanavir/ritonavir in combination with tenofovir and an H2-receptor antagonist should be avoided

Bisacodyl [1], H2 antagonists ---> SmPC of [1] of eMC

The concomitant use of antacids may reduce the resistance of the coating of the tablets and result in dyspepsia and gastric irritation.

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

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

Carbaldrate, H2 antagonists

The aluminium salt decreases the absorption of the co-administered active principle. Separate administration by at least 2 hours

Cefpodoxime [1], H2 antagonists ---> SmPC of [1] of eMC

The bioavailability is decreased by approximately 30% when cefpodoxime is administered with drugs which neutralize gastric pH or inhibit acid secretions. Therefore, such drugs should be taken 2 to 3 hours after cefpodoxime administration.

Cefuroxime [1], H2 antagonists ---> SmPC 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.

Ceritinib [1], H2 antagonists ---> SmPC of [1] of EMA

Gastric acid-reducing agents may alter the solubility of ceritinib and reduce its bioavailability as ceritinib demonstrates pH-dependent solubility and becomes poorly soluble as pH increases in vitro.

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

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.

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

Cyanocobalamin, H2 antagonists

Reduced absorption of vitamin B12

Cyclosporine [1], H2 antagonists ---> SmPC of [1] of eMC

Care should be taken when using ciclosporin together with other active substances that exhibit nephrotoxic synergy

Dabrafenib [1], H2 antagonists ---> SmPC of [1] of EMA

Due to the theoretical risk that pH-elevating agents may decrease oral bioavailability and exposure to dabrafenib, these medicinal products that increase gastric pH should, if possible, be avoided during treatment with dabrafenib.

Dacomitinib [1], H2 antagonists ---> SmPC of [1] of EMA

H2 receptor antagonists may be used if needed. Dacomitinib should be administered 2 hours before or at least 10 hours after taking H2 receptor antagonists.

Darunavir/cobicistat [1], H2 antagonists ---> SmPC of [1] of EMA

Based on theoretical considerations, no mechanistic interaction is expected. Darunavir/cobicistat can be co-administered with H2-receptor antagonists without dose adjustments.

Darunavir/ritonavir, H2 antagonists ---> SmPC of [darunavir] of EMA

Darunavir co-administered with low dose ritonavir can be co-administered with H2-receptor antagonists without dose adjustments.

Dasatinib [1], H2 antagonists ---> SmPC of [1] of EMA

Long-term suppression of gastric acid secretion by H2 antagonists or proton pump inhibitors (e.g. famotidine and omeprazole) is likely to reduce dasatinib exposure.

Diltiazem [1], H2 antagonists ---> SmPC of [1] 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.

Dipotassium clorazepate, H2 antagonists

The co-administration may decrease the bioavailibility of clorazepate

Dolutegravir/lamivudine [1], H2 antagonists ---> SmPC of [1] of EMA

No dose adjustment is necessary.

Dolutegravir/rilpivirine [1], H2 antagonists ---> SmPC of [1] of EMA

Juluca should not be co-administered at the same time as H2-receptor antagonists. These medicinal products are recommended to be administered 12 hours before or 4 hours after Juluca.

Efavirenz [1], H2 antagonists ---> SmPC of [1] of EMA

Co-administration of efavirenz with medicinal products that alter gastric pH would not be expected to affect efavirenz absorption.

Elbasvir/grazoprevir [1], H2 antagonists ---> SmPC of [1] of EMA

No dose adjustment is required.

Emtricitabine/rilpivirine/tenofovir alafenamide [1], H2 antagonists ---> SmPC of [1] of EMA

Only H2-receptor antagonists that can be dosed once daily should be used. A strict dosing schedule with intake of the H2-receptor antagonists at least 12 hours before or at least 4 hours after Odefsey should be used.

Emtricitabine/rilpivirine/tenofovir disoproxil [1], H2 antagonists ---> SmPC of [1] 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

Entrectinib [1], H2 antagonists ---> SmPC of [1] of EMA

No dose adjustments are required when entrectinib is co-administered with PPIs or other drugs that raise gastric pH (e.g., H2 receptor antagonists or antacids).

Erlotinib [1], H2 antagonists ---> SmPC of [1] of EMA

Erlotinib is characterised by a decrease in solubility at pH above 5. Medicinal products that alter the pH of the upper Gastro-Intestinal (GI) tract may alter the solubility of erlotinib and hence its bioavailability.

Esomeprazole [1], H2 antagonists ---> SmPC of [1] of EMA

Patients should not take another PPI or H2 antagonist concomitantly.

Etravirine [1], H2 antagonists ---> SmPC of [1] of EMA

Etravirine can be co-administered with H2-receptor antagonists without dose adjustments.

Fosamprenavir/ritonavir, H2 antagonists ---> SmPC of [fosamprenavir] of EMA

The increase in gastric pH decreases the fosamprenavir absorption. No dosage adjustment necessary

Fosphenytoin, H2 antagonists ---> SmPC of [phenytoin] of eMC

H2-antagonists may increase phenytoin serum levels

Fostemsavir [1], H2 antagonists ---> SmPC of [1] of EMA

No dose adjustment is necessary when combined with medicinal products that increase gastric pH.

Gefitinib [1], H2 antagonists ---> SmPC of [1] of EMA

Substances that cause significant sustained elevation in gastric pH may reduce gefitinib plasma concentrations and thereby reduce the efficacy of gefitinib.

Glasdegib [1], H2 antagonists ---> SmPC of [1] of EMA

Concomitant administration of glasdegib with acid-reducing agents (including PPIs, H2-receptor antagonists, and locally acting antacids) is permitted.

Glibenclamide [1], H2 antagonists ---> SmPC of [1] of EMA

Potentiation or weakening of the blood- glucose lowering effect

Gliclazide [1], H2 antagonists ---> SmPC of [1] of eMC

Potentiation of the blood glucose lowering effect and thus, in some instances, hypoglycaemia may occur when H2-receptor antagonists are taken

Glimepiride [1], H2 antagonists ---> SmPC of [1] of eMC

The combination may lead to either potentiation or weakening of the blood glucose lowering effect

Gliquidone, H2 antagonists

H2-antagonists may increase or decrease the hypoglycemic effect of gliquidone

H2 antagonists, histamine

Possible decrease of histamine dihydrochloride efficacy

H2 antagonists, histamine dihydrochloride [2] ---> SmPC of [2] of EMA

H2 receptor antagonists with imidazole structures similar to histamine must not be used during treatment with histamine dihydrochloride

H2 antagonists, hydrocodone

The co-administration may enhance the hydrocodone effects and increase the respiratory depression

H2 antagonists, ibandronic acid [2] ---> SmPC of [2] of EMA

No dosage adjustment is required when ibandronic acid is administered with H2-antagonists or medicinal products that increase gastric pH.

H2 antagonists, ibrutinib [2] ---> SmPC of [2] of EMA

As ibrutinib solubility is pH dependent, there is a theoretical risk that medicinal products increasing stomach pH may decrease ibrutinib exposure. This interaction has not been studied in vivo.

H2 antagonists, itraconazol [2] ---> SmPC of [2] of eMC

Acid secretion suppressors impair the absorption of itraconazole. It is recommended that itraconazole be administered with an acidic beverage (such as non-diet cola)

H2 antagonists, ketoconazole [2] ---> SmPC of [2] of EMA

Acid-neutralising medicines should not be administered for at least 2 hours after the intake of ketoconazole. It is advised to administer ketoconazole with an acidic beverage eg cola beverage, orange juice.

H2 antagonists, lamivudine/raltegravir [2] ---> SmPC of [2] of EMA

Co-administration of lamivudine/raltegravir with other agents that increase gastric pH may increase the rate of raltegravir absorption and result in increased plasma levels of raltegravir. No dose adjustment is required

H2 antagonists, lapatinib [2] ---> SmPC of [2] of EMA

The solubility of lapatinib is pH-dependent. Concomitant treatment with substances that increase gastric pH should be avoided, as lapatinib solubility and absorption may decrease.

H2 antagonists, ledipasvir/sofosbuvir [2] ---> SmPC 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

H2 antagonists, magnesium hydroxide

The magnesium hydroxide may decrease the absorption of H2 antagonist. Separate administration by 2-3 hours

H2 antagonists, metformin

Increased or decreased hypoglycemic effect of metformin

H2 antagonists, methadone

The H2 antagonist may increase the plasma levels of methadone due to displacement of methadone from its plasma protein binding

H2 antagonists, metoclopramide

The co-administration may accelerate the intestinal transit and decrease the absorption and plasma levels of H2 antagonist

H2 antagonists, minocycline

Medicinal products which increase gastric pH may reduce the absorption of minocycline, and should be taken at least 2 hours after minocycline

H2 antagonists, neratinib [2] ---> SmPC of [2] of EMA

Co-administration with proton pump inhibitors (PPIs) and H2-receptor antagonists are not recommended.

H2 antagonists, nicotine [2] ---> SmPC of [2] of eMC

Smoking may lead to reduced responder rates in ulcer healing with H2-antagonists.

H2 antagonists, nilotinib [2] ---> SmPC of [2] of EMA

When the concurrent use of a H2 blocker is necessary, it may be administered approximately 10 hours before and approximately 2 hours after the dose of Tasigna.

H2 antagonists, palbociclib [2] ---> SmPC of [2] of EMA

Given the reduced effect on gastric pH of H2-receptor antagonists and local antacids compared to PPIs, no clinically relevant effect of H2-receptor antagonists or local antacids on palbociclib exposure is expected when palbociclib is taken with food.

H2 antagonists, pazopanib [2] ---> SmPC of [2] of EMA

Co-administration of pazopanib with medicines that increase gastric pH should be avoided.

H2 antagonists, phenytoin [2] ---> SmPC of [2] of eMC

H2-antagonists may increase phenytoin serum levels

H2 antagonists, pioglitazone/glimepiride [2] ---> SmPC of [2] of EMA

H2 antagonists may lead to either potentiation or weakening of the blood glucose lowering effect.

H2 antagonists, pirenzepine

The co-administration of pirenzepine and histamine H2 receptor antagonists may enhance the effect of acid secretion inhibitor

H2 antagonists, posaconazole [2] ---> SmPC of [2] of EMA

Co-administration of posaconazole with H2 receptor antagonists or with proton pump inhibitors should be avoided if possible.

H2 antagonists, protease inhibitors ---> SmPC of [ritonavir] of EMA

Proton pump inhibitors and H2-receptor antagonists (e.g. omeprazole or ranitidine) may reduce concentrations for co-administered protease inhibitors.

H2 antagonists, raltegravir [2] ---> SmPC of [2] of EMA

The co-administration may increase the rate of raltegravir absorption. No dosage adjustment necessary.

H2 antagonists, rilpivirine [2] ---> SmPC 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

H2 antagonists, scopolamine

With the concomitant use of scopolamine and H2 antagonists is possible an additive effect in relation to inhibition of gastric acid secretion

H2 antagonists, simeprevir [2] ---> SmPC of [2] of EMA

No clinically relevant drug-drug interaction is expected. No dose adjustment is required

H2 antagonists, sofosbuvir/velpatasvir [2] ---> SmPC 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.

H2 antagonists, sofosbuvir/velpatasvir/voxilaprevir [2] ---> SmPC 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.

H2 antagonists, sonidegib [2] ---> SmPC of [2] of EMA

H2 receptor antagonists were estimated to have no significant effect on bioavailability

H2 antagonists, sucralfate [2] ---> SmPC of [2] of eMC

Concomitant administration of sucralfate may reduce the bioavailability of H2 antagonists. The bioavailability may be restored by separating the administration from sucralfate by 2 hours.

H2 antagonists, sulfonylureas

May lead to either potentiation or weakening of the blood glucose lowering effect.

H2 antagonists, tetracyclines

Medicinal products which increase gastric pH may reduce the absorption of tetracycline, and should be taken at least 2 hours after tetracycline

H2 antagonists, tipranavir/ritonavir ---> SmPC of [tipranavir] of EMA

An increase in gastric pH that may result from H2-receptor antagonist therapy is not expected to have an impact on tipranavir plasma concentrations.

H2 antagonists, ulipristal [2] ---> SmPC of [2] of EMA

The effect of medicinal products that increase gastric pH is not expected to be of clinical relevance for daily administration of ulipristal acetate tablets.

H2 antagonists, venetoclax [2] ---> SmPC of [2] of EMA

Based on population pharmacokinetic analysis, gastric acid reducing agents (e.g., proton pump inhibitors, H2-receptor antagonists, antacids) do not affect venetoclax bioavailability.

Anthracyclines

Anthracyclines, arsenic trioxide [2] ---> SmPC of [2] of EMA

The pretreatment with an anthracycline increases the risk of QT interval prolonging

Anthracyclines, breast-feeding

Contraindicated

Anthracyclines, collagenase clostridium histolyticum [2] ---> SmPC of [2] of EMA

Such derivatives have been shown to inhibit matrix metalloproteinase-mediated collagen degradation at pharmacologically relevant concentrations in vitro.

Anthracyclines, cyclophosphamide

Anthracyclines may enhance the potential cardiotoxicity of cyclophosphamide

Anthracyclines, cyclosporine [2] ---> SmPC 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.

Anthracyclines, cytostatics

Increased toxicity of cytostatic drugs

Anthracyclines, daunorubicin

Increased cardiotoxic effect

Anthracyclines, doxorubicine [2] ---> SmPC of [2] of eMC

Doxorubicin cardiotoxicity is enhanced by previous or concurrent use of other anthracyclines. When doxorubicin is used together, cardiac function must be followed carefully.

Anthracyclines, etoposide

Possible cross resistance

Anthracyclines, fluorouracil [2] ---> SmPC of [2] of eMC

The cardiotoxicity of anthracyclines may be increased.

Anthracyclines, hepatotoxic drugs

Increased hepatotoxic effect

Anthracyclines, medicines with cardiotoxic effects ---> SmPC of [epirubicin] of eMC

Anthracyclines should not be administered in combination with other cardiotoxic agents unless the patient's cardiac function is closely monitored.

Anthracyclines, mitoxantrone [2] ---> SmPC of [2] of eMC

Combining mitoxantrone with potentially cardiotoxic drugs (anthracyclines) increases the risk of cardiac toxicity.

Anthracyclines, ondansetron [2] ---> SmPC of [2] of eMC

Concomitant use of ondansetron with cardiotoxic drugs (e.g. anthracyclines) may increase the risk of arrhythmias.

Anthracyclines, pertuzumab [2] ---> SmPC of [2] of EMA

Based on the pharmacological actions of pertuzumab and anthracyclines an increased risk of cardiac toxicity might be expected from concomitant use of these agents compared with sequential use, although not seen in the TRYPHAENA study.

Anthracyclines, pregnancy

Contraindicated

Anthracyclines, sulphamides

Increased hyperuricemia

Anthracyclines, sulphonamides

Increased hyperuricemia

Anthracyclines, tasonermin [2] ---> SmPC of [2] of EMA

Combinations of tasonermin with cardiotoxic substances (e.g. anthracyclines) should be avoided because it is possible that tasonermin could enhance cardiotoxicity

Anthracyclines, trastuzumab ---> SmPC of [doxorubicine] of eMC

The use of trastuzumab in combination with anthracyclines is associated with a high cardiotoxic risk. Careful monitoring of the cardiac function is imperative.

Adenosine [1], antiadrenergics ---> SmPC of [1] of eMC

Adenosine may interact with drugs tending to impair cardiac conduction.

Adrenaline [1], antiadrenergics ---> SmPC of [1] of eMC

Adrenaline specifically reverses the antihypertensive effects of adrenergic neurone blockers such as guanethidine with the risk of severe hypertension.

Alfa1-adrenergic receptor blockers, antiadrenergics

Increased hypotensive effect

Antiadrenergics, aripiprazole

Increased hypotensive effect

Antiadrenergics, atenolol/nifedipine

Atenolol/nifedipine may increase the blood pressure lowering and heart rate modulating effects of concomitant applied antihypertensives (anti-sympathomimetics)

Antiadrenergics, epinephrine [2] ---> SmPC of [2] of eMC

Adrenaline specifically reverses the antihypertensive effects of adrenergic neurone blockers such as guanethidine with the risk of severe hypertension.

Antiadrenergics, gadoteric acid

Decreased efficacy of cardiovascular compensation mechanisms that occur in blood pressure disorder

Antiadrenergics, general anesthetics

Enhanced hypotensive effect when general anaesthetics given with adrenergic neurone blockers.

Antiadrenergics, glibenclamide

The co-administration may enhance the hypoglycemic effect

Antiadrenergics, glimepiride [2] ---> SmPC of [2] of eMC

Potentiation of the blood-sugar-lowering effect and possible hypoglycaemia

Antiadrenergics, gliquidone

The co-administration may enhance the hypoglycemic effect of gliquidone and also mask the symptoms of a hypoglycemia

Antiadrenergics, haloperidol [2] ---> SmPC of [2] of eMC

Haloperidol may reverse the blood-pressure-lowering effects of adrenergic-blocking agents

Antiadrenergics, imipramine

Imipramine may diminish or abolish the antihypertensive effects of adrenergic blocker

Antiadrenergics, insulin glargine/lixisenatide [2] ---> SmPC of [2] of EMA

Under the influence of sympatholytic medicinal products such as beta-blockers, clonidine, guanethidine and reserpine, the signs of adrenergic counter-regulation may be reduced or absent

Antiadrenergics, insulin glulisin [2] ---> SmPC of [2] of EMA

The signs of adrenergic counter-regulation may be reduced or absent.

Antiadrenergics, latanoprost/timolol [2] ---> SmPC 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-blocking agents

Antiadrenergics, lofepramine

Lofepramine may decrease the antihypertensive effect of adrenergic neurone-blocking drugs

Antiadrenergics, maprotiline

Maprotiline may decrease or abolish the antihypertensive effects of the antiadrenergic agents

Antiadrenergics, midazolam

Enhanced hypotensive effect

Antiadrenergics, nicotinic acid

Nicotinic acid may potentiate the blood-pressure lowering effect

Antiadrenergics, nimodipine [2] ---> SmPC of [2] of eMC

Nimodipine may increase the blood pressure lowering effect of concomitant antihypertensives

Antiadrenergics, nisoldipine

The co-administration may potentiate the hypotensive effect

Antiadrenergics, nitrendipine

The co-administration may potentiate the hypotensive effect

Antiadrenergics, norfenefrine

Antagonism. The co-administration should be avoided

Antiadrenergics, opipramol

Opipramol may diminish or abolish the antihypertensive effects of adrenergic blocker

Antiadrenergics, pioglitazone/glimepiride [2] ---> SmPC of [2] of EMA

Potentiation of the blood-glucose-lowering effect and, thus, in some instances hypoglycaemia may occur

Antiadrenergics, pizotifen

Pizotifen antagonizes the hypotensive effect of adrenergic neurone blockers.

Antiadrenergics, sulfonylureas

Potentiation of the blood-sugar-lowering effect and possible hypoglycaemia

Antiadrenergics, thiopental

Enhanced hypotensive effect when general anaesthetics given with adrenergic neurone blockers.

Antiadrenergics, trandolapril [2] ---> SmPC of [2] of eMC

Adrenergic-blocking drugs should only be combined with trandolapril under careful supervision.

Antiadrenergics, triamterene

The combination likely enhances the hypotensive effect

Antiadrenergics, tricyclic antidepressant

The tricyclic antidepressant may diminish or abolish the antihypertensive effects of adrenergic blocker

Antiadrenergics, trifluoperazine

Trifluoperazine may reverse the hypotensive effect of antiadrenergic agent

Antiadrenergics, vasoconstrictors

Decreased hypertensive effect of vasoconstrictor

Betablockers, centrally-acting antihypertensives

The co-administration may enhance the hypotensive effect and further decrease the central sympathetic tonus

Betaxolol, centrally-acting antihypertensives

The co-administration may enhance the hypotensive effect and further decrease the central sympathetic tonus

Centrally-acting antihypertensives, propranolol [2] ---> SmPC of [2] of EMA

Beta-blockers may exacerbate the rebound hypertension after clonidine abrupt withdrawal, and propranolol should be stopped several days before discontinuing clonidine.

Furosemide, peripheral antiadrenergic agent

Furosemide may enhance the effect of peripheral antiadrenergic agent

Periciazine, peripheral antiadrenergic agent

Possible weakening of the hypotensive effect

Anticholinesterase

Acetylcholine, anticholinesterase

Enhanced and prolonged parasympathomimetic effects

Amifampridine [1], anticholinesterase ---> SmPC of [1] of EMA

The concomitant use of amifampridine and medicinal products with cholinergic effects may lead to an increased effect of both products and should be taken into consideration.

Aminoglycoside antibiotics, anticholinesterase

Neuromuscular effects

Anticholinergics, anticholinesterase

The therapeutic effects may be reduced due to antagonism.

Anticholinesterase, atracurium [2] ---> SmPC of [2] of eMC

Treatment with anticholinesterases, commonly used in the treatment of Alzheimer's disease e.g. donepezil, may shorten the duration and diminish the magnitude of neuromuscular blockade with atracurium.

Anticholinesterase, atropine

The co-administration may decrease the antiglaucomatous effect

Anticholinesterase, benzocaine

Cholinesterase inhibitors inhibit benzocaine metabolism

Anticholinesterase, bethanechol

The co-administration of bethanechol with cholinergic drugs may have an additive effect particularly cholinesterase inhibitors.

Anticholinesterase, carteolol

Risk of excessive bradycardia (addition of bradycardic effects)

Anticholinesterase, cisatracurium [2] ---> SmPC of [2] of eMC

Treatment with anticholinesterases may shorten the duration and diminish the magnitude of neuromuscular blockade with cisatracurium.

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

Anticholinesterase, deflazacort

Anticholinesterase drugs may interact with glucocorticoids and cause severe muscle weakness in patients with myasthenia gravis

Anticholinesterase, depolarizing muscle relaxants

The drug with anticholinesterase activity may prolong the neuromuscular blocking effects of depolarizing muscle relaxant

Anticholinesterase, dipyridamole [2] ---> SmPC of [2] of eMC

Dipyridamole may counteract the anticholinesterase effect of cholinesterase inhibitors thereby potentially aggravating myasthenia gravis.

Anticholinesterase, eserine

The co-administration may enhance the effect of other anticholinesterase agents

Anticholinesterase, fingolimod [2] ---> SmPC of [2] of EMA

Treatment with Gilenya should not be initiated in patients receiving beta blockers, or other substances which may decrease heart rate because of the potential additive effects on heart rate

Anticholinesterase, fludrocortisone

Effects of anticholinesterase agents may be antogonised.

Anticholinesterase, glucocorticoids ---> SmPC of [deflazacort] of eMC

Anticholinesterase drugs may interact with glucocorticoids and cause severe muscle weakness in patients with myasthenia gravis

Anticholinesterase, homatropine

The co-administration may decrease the antiglaucomatous effect of homatropine

Anticholinesterase, hydroquinidine

Risk excessive bradycardia due to the bradycardic effects of both active ingredients may be additive

Anticholinesterase, hydroxyzine [2] ---> SmPC of [2] of eMC

Hydroxyzine may antagonise the effects of anticholinesterase drugs

Anticholinesterase, irinotecan [2] ---> SmPC of [2] of eMC

Since irinotecan has anticholinesterase activity, drugs with anticholinesterase activity may prolong the neuromuscular blocking effects of suxamethonium and the neuromuscular blockade of non-depolarising drugs may be antagonised.

Anticholinesterase, midazolam

The acetylcholinesterase inhibitor may abolish the hypnotic effects of midazolam

Anticholinesterase, mivacurium

Drugs that may reduce plasma cholinesterase activity may also prolong the neuromuscular blocking action of mivacurium.

Anticholinesterase, muscle relaxants (non-depolarizing)

The drug with anticholinesterase activity may antagonize the neuromuscular blockade of non-depolarising drugs

Anticholinesterase, para-aminobenzoic acid ester

The anticholinesterase may inhibit the metabolism of ester-type local anaesthetic agent and increase the risk of systemic toxicity

Anticholinesterase, pasireotide [2] ---> SmPC 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

Anticholinesterase, physostigmine

The co-administration may enhance the effect of other anticholinesterase agents

Anticholinesterase, procaine

The co-administration may inhibit the procaine metabolism and enhance its effect

Anticholinesterase, proxymetacaine

The anticholinesterase may inhibit the metabolism of ester-type local anaesthetic agent and increase the risk of systemic toxicity

Anticholinesterase, rocuronium [2] ---> SmPC of [2] of eMC

Reversal of the block with acetylcholinesterase inhibitors could be inhibited.

Anticholinesterase, scopolamine

The therapeutic effects may be reduced due to antagonism.

Anticholinesterase, sotalol

Bradycardia-inducing medicinal products enhance the risk of torsades de pointes

Anticholinesterase, succinylcholine [2] ---> SmPC of [2] of eMC

The decrease in the normal plasma cholinesterase activity may prolong the neuromuscular blocking effects of suxamethonium

Anticholinesterase, suxamethonium [2] ---> SmPC of [2] of eMC

The decrease in the normal plasma cholinesterase activity may prolong the neuromuscular blocking effects of suxamethonium

Anticholinesterase, tetracaine

The anticholinesterase may inhibit the metabolism of ester-type local anaesthetic agent and increase the risk of systemic toxicity

Anticholinesterase, thalidomide [2] ---> SmPC of [2] of EMA

Due to thalidomide 's potential to induce bradycardia, caution should be exercised with medicinal products having the same pharmacodynamic effect

Anticholinesterase, tiapride

Bradycardia-inducing medicinal products increase the risk of ventricular arrhythmias, particularly torsades de pointes. Clinical and electrocardiographic monitoring

Anticholinesterase, tobramycin [2] ---> SmPC of [2] of EMA

Neuromuscular effects

Anticholinesterase, triamcinolone acetonide

Effects of anticholinesterase agent may be antagonized.

Anticholinesterase, triamcinolone [2] ---> SmPC of [2] of eMC

Effects of anticholinesterase agent may be antagonized.

Antiepileptics

Alcohol, antiepileptics

Alcohol may decrease or abolish the antiepileptic effect

Alendronic acid/colecalciferol [1], antiepileptics ---> SmPC of [1] of EMA

Anticonvulsants, cimetidine and thiazides may increase the catabolism of vitamin D.

Alprazolam [1], antiepileptics ---> SmPC of [1] of eMC

Enhancement of the central depressive effect may occur in case of concomitant use of alprazolam with other CNS depressants

Amfepramone, antiepileptics

Decreased anticonvulsivant metabolism

Amitriptyline [1], antiepileptics ---> SmPC of [1] of eMC

Concomitant use of amitriptyline and antiepileptics may lower the convulsive threshold.

Antiepileptics [1], flupentixol ---> SmPC of [1] of eMC

In common with other antipsychotics, flupentixol enhances the response to other CNS depressants.

Antiepileptics [1], somapacitan ---> SmPC of [1] of EMA

The clearance of compounds metabolised by cytochrome P450 (e.g. sex steroids, corticosteroids, anticonvulsants and cyclosporine) may be especially increased resulting in lower plasma levels of these compounds.

Antiepileptics, antimalarial agents ---> SmPC of [ethosuximide] of eMC

Concomitant use of antiepileptic and antimalarial agents may increase the risk of seizures

Antiepileptics, antineoplastics

Co-administration of antiepileptic drugs and chemotherapeutic drugs including lomustine can lead to complications secondary to pharmacokinetic interactions between the drugs.

Antiepileptics, atracurium [2] ---> SmPC of [2] 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).

Antiepileptics, benperidol [2] ---> SmPC of [2] of eMC

The dosage of anti-convulsants may need to be increased to take account of the lowered seizure threshold.

Antiepileptics, benzodiazepines

Enhancement of the central depressive effect may occur if benzodiazepines are combined with centrally-acting drugs

Antiepileptics, biotin

Decreased absorption of biotin and decreased effect of antiepileptic medicine

Antiepileptics, bisacodyl

The co-administration may decrease the absorption of the antiepileptic agent

Antiepileptics, bromazepam

Enhancement of the depressor effect on the central nervous system

Antiepileptics, brotizolam

The co-administration of brotizolam with other central nervous system depressants may enhance the central nervous depressant effect

Antiepileptics, calcium folinate

Folic acid in large amounts may counteract the effect of antiepileptic drugs and increase the frequency of seizures.

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.

Antiepileptics, carmustine [2] ---> SmPC of [2] of EMA

In combination with chemotherapeutic medicinal products reduced activity of antiepileptic medicinal products must be anticipated.

Antiepileptics, celiprolol

Additive effect

Antiepileptics, chemotherapeutic agents ---> SmPC of [carmustine] of EMA

In combination with chemotherapeutic medicinal products reduced activity of antiepileptic medicinal products must be anticipated.

Antiepileptics, chlordiazepoxide [2] ---> SmPC of [2] of eMC

Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs.

Antiepileptics, cholecalciferol ---> SmPC of [alendronic acid/colecalciferol] of EMA

Anticonvulsants, cimetidine and thiazides may increase the catabolism of vitamin D.

Antiepileptics, cimetidine

Cimetidine delays the elimination of antiepileptic agent and enhances or prolongs its effects and adverse effects (dose adjustment may be necessary)

Antiepileptics, cisplatin [2] ---> SmPC of [2] of eMC

Serum concentrations of anticonvulsive medicines may remain at subtherapeutic levels during treatment with cisplatin.

Antiepileptics, clobazam [2] ---> SmPC 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, clomipramine

The enzymatic induction may decrease the plasma levels of the tricyclic antidepressant

Antiepileptics, clonazepam [2] ---> SmPC 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

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

Antiepileptics, conjugated oestrogens/bazedoxifene [2] ---> SmPC 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

Antiepileptics, cytostatics

The cytostatic agent may decrease the plasma levels of anticonvulsant

Antiepileptics, cytotoxic agents

It is possible that the levels of anti-epileptic medicinal products may be altered by cytotoxic agents. Serum antiepileptic levels should be closely monitored during treatment

Antiepileptics, dantrolene

The co-administration of dantrolene and CNS depressants should be avoided due to the adverse reactions of dantrolene may be enhanced (specially the CNS depressant effect and muscle weakness)

Antiepileptics, dapoxetine [2] ---> SmPC of [2] of eMC

Caution is advised if the concomitant administration of dapoxetine and CNS active medicinal products is required

Antiepileptics, diazepam [2] ---> SmPC of [2] of eMC

Enhancement of the central depressive effect may occur

Antiepileptics, dimethindene

The sedative effect of CNS depressant drugs may be enhanced

Antiepileptics, dipotassium clorazepate

The combination of CNS depressors may mutually potentiate the depressor effect on the CNS

Antiepileptics, disodium folinate

The co-administration may decrease the antiepileptic effect

Antiepileptics, diuretics ---> SmPC of [amlodipine/valsartan/hydrochlorothiazide] of EMA

The hyponatraemic effect of diuretics may be intensified by concomitant administration of antiepileptics. Caution is indicated in long-term administration of these medicinal products.

Antiepileptics, doxepin

The co-administration may enhance the central sedative effect

Antiepileptics, doxorubicine [2] ---> SmPC of [2] of eMC

The absorption of anticonvulsants (e.g. carbamazepine, phenytoin, valproate) is decreased when administered in combination with doxorubicin.

Antiepileptics, doxylamine

Antihistaminic agents have additive effects with other CNS depressants

Antiepileptics, estradiol [2] ---> SmPC 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

Antiepileptics, estrogens ---> SmPC of [estradiol] of eMC

The metabolism of estrogens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes

Antiepileptics, ethinyl estradiol

Interactions can occur with drugs that induce hepatic enzymes which can result in increased clearance of sex hormones

Antiepileptics, ethosuximide

Periodic serum level determinations of these drugs may be necessary

Antiepileptics, flunarizine

Concomitant use of anticonvulsivant drugs may accelerate the metabolism of flunarizine

Antiepileptics, flunitrazepam

The co-administration may cause a mutual potentiation of effects

Antiepileptics, fluphenazine [2] ---> SmPC of [2] of eMC

Phenothiazines may impair the action of anti-convulsants.

Antiepileptics, flurazepam [2] ---> SmPC of [2] of eMC

When flurazepam is used in conjunction with anti-epileptic drugs, side-effects and toxicity may be more evident, particularly with hydantoins or barbiturates

Antiepileptics, folic acid

Drugs that may adversely affect the absorption or metabolism of folic acid may cause statuses of folate deficiency

Antiepileptics, folinic acid

Folic acid in large amounts may counteract the effect of antiepileptic drugs and increase the frequency of seizures.

Antiepileptics, fossil tree ---> SmPC of [ethosuximide] of eMC

Concomitant use of ginkgo and anticonvulsant agents may decrease the anticonvulsant efficacy

Antiepileptics, gestagens ---> SmPC of [estradiol] of eMC

The metabolism of estrogens may be increased by concomitant use of substances known to induce drug-metabolising enzymes, specifically cytochrome P450 enzymes

Antiepileptics, gestrinone

The enzymatic inductor may increase the metabolism of gestrinone and decrease its plasma levels and effect

Antiepileptics, IMAOs ---> SmPC of [ethosuximide] of eMC

The anticonvulsant effect of antiepileptic agents may be antagonized by MAO inhibitors (convulsive threshold lowered)

Antiepileptics, indocyanine green

Extinction attenuation

Antiepileptics, interferon beta-1b [2] ---> SmPC of [2] of EMA

Caution should be exercised when interferon beta-1b is administered with drugs that have a narrow therapeutic index and are largely dependent on the P450 for clearance

Antiepileptics, isradipine

Isradipine doesn't bind specifically to proteins; however, caution is recommended in combination with anticoagulants and anticonvulsants

Antiepileptics, lacosamide [2] ---> SmPC of [2] of EMA

A population PK analysis estimated that concomitant treatment with other antiepileptics known to be enzyme inducers (carbamazepine, phenytoin, phenobarbital, in various doses) decreased the overall systemic exposure of lacosamide by 25%.

Antiepileptics, lidocaine

Adjustment of lidocaine dose may be required after long-term administration of antiepileptics

Antiepileptics, lofepramine

Co-medication of lofepramine with anti-epileptic agents may result in a lowered convulsion threshold and seizures.

Antiepileptics, loprazolam [2] ---> SmPC of [2] of eMC

Combination with CNS depressants causes enhancement of the central depressive effects of loprazolam.

Antiepileptics, lorazepam [2] ---> SmPC of [2] of eMC

Enhancement of the central depressive effect may occur if lorazepam is combined with other CNS depressants

Antiepileptics, lormetazepam

The benzodiazepines, including lormetazepam produce additive CNS depressant effects when co-administered with other medications which themselves produce CNS depression

Antiepileptics, medazepam

The co-administration of medazepam with other central nervous system depressants may enhance the central nervous depressant effect.

Antiepileptics, mefloquine

Patients taking mefloquine while on concomitant treatment with anticonvulsants had loss of seizure control and lower than expected anticonvulsants blood level

Antiepileptics, mepivacaine

Long-term or permanent therapy with anticonvulsants may decrease the sensitivity to local anaesthetics

Antiepileptics, mercaptopurine [2] ---> SmPC of [2] of EMA

Serum antiepileptic levels should be closely monitored

Antiepileptics, methionine

Medicinal product which increase homocysteine levels must not be co-administered with methionine

Antiepileptics, methotrexate [2] ---> SmPC of [2] of EMA

One should be aware of pharmacokinetic interactions between methotrexate, anticonvulsant medicinal products (reduced methotrexate blood levels), and 5-fluorouracil (increased t½ of 5-fluorouracil).

Antiepileptics, midazolam [2] ---> SmPC of [2] of EMA

Co-administration of antiepileptics with midazolam may cause enhanced sedation or respiratory or cardiovascular depression.

Antiepileptics, neuroleptics

The co-administration may cause a mutual potentiation of effects

Antiepileptics, nitrazepam

Enhancement of the central depressive effect may occur if benzodiazepines are combined with centrally-acting drugs

Antiepileptics, nortriptyline

Nortriptyline decreases the effects of anticonvulsivant drugs

Antiepileptics, orlistat [2] ---> SmPC of [2] of EMA

Orlistat may unbalance anticonvulsivant treatment by decreasing the absorption of antiepileptic drugs, leading to convulsions

Antiepileptics, oxazepam

Enhancement of other CNS depressant drugs

Antiepileptics, perazine

The co-administration of anticonvulsivant drugs may increase the metabolism of phenothiazines

Antiepileptics, phenobarbital

Phenobarbital, enzymatic inductor, may increase the metabolism of antiepileptic agent and decrease its plasma levels and effect

Antiepileptics, phenothiazines

Phenothiazines may decrease the seizure threshold

Antiepileptics, prazepam

Concomitant use of prazepam and other CNS depressant drugs can mutually enhance the effects

Antiepileptics, promazine

Promazine may impair the effects of anticonvulsants.

Antiepileptics, promethazine

The co-administration of promethazine and anticonvulsivant drugs may increase the phenothiazine metabolism

Antiepileptics, quazepam

The co-administration may cause a mutual potentiation of the depressor effect on the CNS

Antiepileptics, retigabine [2] ---> SmPC of [2] of EMA

In vitro data indicated a low potential for interaction of retigabine with other antiepileptic drugs

Antiepileptics, rifabutin

Rifabutin has a similar structure as rifampicin. Concomitant use of rifabutin and anticonvulsants may decrease anticonvulsant effects

Antiepileptics, sevelamer

Caution should be exercised when prescribing sevelamer to patients also taking anti-seizure medications

Antiepileptics, sevelamer carbonate [2] ---> SmPC of [2] of EMA

Patients taking anti-arrhythmic medicinal products for the control of arrhythmias and anti-seizure medicinal products for the control of seizure disorders were excluded from clinical trials.

Antiepileptics, sevelamer hydrochloride [2] ---> SmPC of [2] of EMA

Caution should be exercised when prescribing sevelamer hydrochloride to patients also taking anti-seizure medicinal products.

Antiepileptics, SSRI ---> SmPC of [ethosuximide] of eMC

The anticonvulsant effect of antiepileptic agents may be antagonized by SSRIs (convulsive threshold lowered)

Antiepileptics, St. John's wort

St. John's wort, enzymatic inductor, may decrease the plasma concentrations of antiepileptic agent (with risk of seizures). St. John's Wort should be avoided

Antiepileptics, temazepam

Concomitant use of antiepileptics and other CNS depressant drugs can mutually enhance the CNS depressant effects

Antiepileptics, teniposide

Increased elimination of teniposide

Antiepileptics, tetracosactide

Concurrent use of tetracosactide and other anticonvulsants may increase the risk of liver damage

Antiepileptics, tetracyclic antidepressant

The enzymatic induction may decrease the plasma levels of the tetracyclic antidepressant

Antiepileptics, thioridazine

Phenothiazines may decrease the seizure threshold

Antiepileptics, tranylcypromine

The co-administration should be avoided, since the MAOI possibly antagonizes anticonvulsant effects of antiepileptics (convulsive threshold lowered)

Antiepileptics, triazolam

Increased CNS depressant effect with the co-administration of triazolam and antiepileptics may occur

Antiepileptics, tricyclic antidepressant ---> SmPC of [ethosuximide] of eMC

The anticonvulsant effect of antiepileptic agents may be antagonized by tricyclic antidepressants (convulsive threshold lowered)

Antiepileptics, trifluoperazine

Phenothiazines may decrease the seizure threshold

Antiepileptics, trimipramine

Risk of generalized convulsive seizures

Antiepileptics, vinblastine

Vinblastine may decrease the plasma levels of anticonvulsant

Antiepileptics, vitamin D

The enzymatic induction may decrease the levels of D vitamin.

Antiepileptics, zaleplon [2] ---> SmPC of [2] of EMA

Combination of zaleplon with other CNS-acting compounds may enhance the central sedation

Antiepileptics, zolpidem [2] ---> SmPC of [2] of eMC

Enhancement of the central depressive effect may occur in case of concomitant use of zolpidem with other central nervous system depressants

Antiepileptics, zonisamide [2] ---> SmPC of [2] of EMA

In epileptic patients, steady-state dosing with Zonegran resulted in no clinically relevant pharmacokinetic effects on carbamazepine, lamotrigine, phenytoin, or sodium valproate

Antiepileptics, zopiclone [2] ---> SmPC of [2] of eMC

The combination with CNS depressants an enhancement of the central depressive effect may occur.

Brivaracetam [1], strong enzyme inducing antiepileptic drugs ---> SmPC 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

Antiestrogens

Antiestrogens [1], warfarin ---> SmPC of [1] of EMA

There is a known interaction between anti-estrogens and warfarin-type anticoagulants leading to a seriously increased bleeding time. Therefore, the concomitant use of toremifene with such drugs should be avoided.

Antiestrogens, coumarin anticoagulants ---> SmPC of [toremifene] of EMA

There is a known interaction between anti-estrogens and warfarin-type anticoagulants leading to a seriously increased bleeding time. Therefore, the concomitant should be avoided.

Antiestrogens, estrogens

Association not recommended

Antiestrogens, letrozole

Co-administration of letrozole with other anti-oestrogens should be avoided as it may diminish the pharmacological action of letrozole

Antifibrinolytics

Anticoagulants, antifibrinolytics

The co-administration may weaken the effect of antifibrinolytic agent

Antifibrinolytics, coumarin anticoagulants

The co-administration may weaken the effect of antifibrinolytic agent

Antifibrinolytics, eptacog alfa (activated) [2] ---> SmPC of [2] of EMA

Anti-fibrinolytics have been reported to reduce blood loss in association with surgery in haemophilia patients, especially in orthopaedic surgery and surgery in regions rich in fibrinolytic activity, such as the oral cavity.

Antifibrinolytics, heparin

The co-administration may weaken the effect of antifibrinolytic agent

Antifibrinolytics, platelet aggregation inhibitors

The co-administration may weaken the effect of antifibrinolytic agent

Antifibrinolytics, salicylates

The co-administration may weaken the effect of antifibrinolytic agent

Antifibrinolytics, streptokinase [2] ---> SmPC of [2] of eMC

There is an increased risk of haemorrhage in patients who are receiving or who have recently been treated with anticoagulants or drugs which inhibit platelet formation or function

Antifibrinolytics, streptokinase/streptodornase

There is an increased risk of haemorrhage in patients who are receiving or who have recently been treated with anticoagulants or drugs which inhibit platelet formation or function

Antifibrinolytics, ticagrelor [2] ---> SmPC of [2] of EMA

Antifibrinolytic therapy and/or recombinant factor VIIa may increase haemostasis. Ticagrelor may be resumed after the cause of bleeding has been identified and controlled.

Antifibrinolytics, tretinoin [2] ---> SmPC of [2] of eMC

There is a risk of thrombosis (both venous and arterial) which may involve any organ system, during the first month of treatment. Therefore, caution should be exercised when treating patients with the combination of tretinoin and anti-fibrinolytic agents

Antifibrinolytics, urokinase

Effect inhibition of urokinase

Antigout preparations

Aliskiren/amlodipine/hydrochlorothiazide [1], antigout preparations ---> SmPC of [1] of EMA

Possible increase of the level of serum uric acid. Dosage adjustment of the antigout medicinal product may be necessary

Amiloride/hydrochlorothiazide, antigout preparations

The effect of uric acid lowering agents can be weaken with the concomitant administration of amiloride/hydrochlorothiazide

Antigout preparations, atenolol/chlortalidone

Decreased uric acid lowering effect

Antigout preparations, chlortalidone

Decreased uric acid lowering effect

Antigout preparations, doxorubicine [2] ---> SmPC of [2] of eMC

Doxorubicin therapy may lead to increased serum uric acid; therefore dose adjustment of uric acid lowering agents may be necessary.

Antigout preparations, hydrochlorothiazide

Possible increase of the level of serum uric acid. Dosage adjustment of the antigout medicinal product may be necessary

Antigout preparations, pindolol/clopamide

Concomitant use of pindolol/clopamide and urate lowering agents may decrease the antigout effect

Antigout preparations, piretanide

The effect of uric acid lowering may be diminished by the co-administration of piretanide

Antigout preparations, pyrazinamide

Pyrazinamide antagonizes the effect of uricosuric agents

Antigout preparations, salicylates

Decreased uricosuric effect (competition of renal tubular uric acid elimination).

Antigout preparations, thioguanine

Tioguanine may increase plasma levels of uric acid. Dosage adjustment of the antigout medicinal product may be necessary

Antigout preparations, triamterene/hydrochlorothiazide

The co-administration of triamterene/hydrochlorothiazide may weaken the effect of antiuricemic agents

Antigout preparations, xipamide

The co-administration may weaken the uric acid lowering effect

Antimalarial agents

Antiepileptics, antimalarial agents ---> SmPC of [ethosuximide] of eMC

Concomitant use of antiepileptic and antimalarial agents may increase the risk of seizures

Antimalarial agents, artemether/lumefantrine [2] ---> SmPC of [2] of eMC

Due to some antimalarial agents may prolong the QTc interval, caution is advised when administering artemether/lumefantrine to patients in whom there may still be detectable concentrations of these drugs in the plasma.

Antimalarial agents, bupropion [2] ---> SmPC of [2] of eMC

There is an increased risk of seizures occurring with the use of bupropion in the presence of predisposing risk factors which lower the seizure threshold.

Antimalarial agents, chlorprothixene

The concurrent use of chlorprothixene and drugs that also prolong the QT interval should be avoided

Antimalarial agents, citalopram [2] ---> SmPC of [2] of eMC

Co-administration of citalopram with medicinal products that prolong the QT interval is contraindicated

Antimalarial agents, clomipramine [2] ---> SmPC 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

Antimalarial agents, dapsone

The methemoglobin reductase inhibition may increase the formation of methemoglobin

Antimalarial agents, dimenhydrinate

The concurrent use of dimenhydrinate and drugs that also prolong the QT interval should be avoided

Antimalarial agents, diphenhydramine

The co-administration is contraindicated

Antimalarial agents, doxepin

The co-administration of doxepin with drugs that can prolong the QT interval should be avoided

Antimalarial agents, droperidol [2] ---> SmPC of [2] of eMC

Medicinal products known to prolong the QTc interval should not be concomitantly administered with droperidol.

Antimalarial agents, escitalopram [2] ---> SmPC of [2] of eMC

Co-administration of escitalopram with medicinal products that prolong the QT-interval is contraindicated.

Antimalarial agents, folic acid

Drugs that may adversely affect the absorption or metabolism of folic acid may cause statuses of folate deficiency

Antimalarial agents, histamine dihydrochloride [2] ---> SmPC of [2] of EMA

Monoamine oxidase inhibitors, anti-malarial, and anti-trypanosomal active substances may alter the metabolism of histamine dihydrochloride and should be avoided

Antimalarial agents, lofepramine

There is an increased risk of ventricular arrhythmias if lofepramine is given with drugs which prolong the Q-T interval.

Antimalarial agents, methemoglobin reductase inhibitors

The methemoglobin reductase inhibition may increase the formation of methemoglobin

Antimalarial agents, moxifloxacin [2] ---> SmPC 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.

Antimalarial agents, naltrexone/bupropion [2] ---> SmPC of [2] of EMA

Caution should be used when prescribing naltrexone/bupropion to patients with predisposing factors that may increase the risk of seizure

Antimalarial agents, nortriptyline

Concomitant use of nortriptyline with drugs known to prolong the QT interval should be avoided

Antimalarial agents, opipramol

The co-administration may prolong the QT interval. Concomitant use should be avoided

Antimalarial agents, pasireotide [2] ---> SmPC of [2] of EMA

Pasireotide should be used with caution in patients who are concomitantly receiving medicinal products that prolong the QT interval

Antimalarial agents, penicillamine

Concomitant use is not recommended

Antimalarial agents, perazine

The effect of perazine on the QT interval is likely to be potentiated by concurrent use of other drugs that also prolong the QT interval. Therefore, concurrent use of these drugs should be avoided

Antimalarial agents, perphenazine

Concomitant use of perphenazine with QT prolonging drugs is not recommended.

Antimalarial agents, pipamperone

The co-administration of drugs that can prolong the QT interval should be avoided

Antimalarial agents, prednisolone

Increased risk of myopathies and cardiomyopathies

Antimalarial agents, prilocaine [2] ---> SmPC of [2] of eMC

Drugs which may predispose to methaemoglobin formation could potentiate this adverse effect of prilocaine.

Antimalarial agents, promethazine

The co-administration of promethazine with drugs that also prolong the QT interval should be avoided

Antimalarial agents, prothipendyl

Concomitant use of prothipendyl with drugs known to prolong the QT interval should be avoided

Antimalarial agents, pyrimethamine

Seizures have occasionally been reported when pyrimethamine was used in combination with other antimalarial drugs.

Antimalarial agents, quinine

The co-administration of quinine with medicinal products that significant prolong the QT interval is contraindicated

Antimalarial agents, toremifene [2] ---> SmPC 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

Antimalarial agents, trazodone [2] ---> SmPC of [2] of eMC

Concomitant use of trazodone with drugs known to prolong the QT interval may increase the risk of ventricular arrhythmias, including torsade de pointes. Caution should be used when these drugs are coadministered with trazodone.

Antimalarial agents, trimipramine

Additive QT-prolongation may occur, increasing the risk of serious ventricular arrhythmias. The co-administration should be used with caution

Antimuscarinic agents

Ability to drive, antimuscarinic agents

Dizziness, blurred vision, insomnia and somnolence may occur

Antihistamines, antimuscarinic agents

The use of antimuscarinics will increase the risk of antimuscarinic side effects when used in conjunction with antihistamines.

Antimuscarinic agents, benperidol

The effect of benperidol may be reduced by concomitant antimuscarinic medications.

Antimuscarinic agents, betablockers

Antimuscarinic agents may counteract the bradycardia caused by beta blockers.

Antimuscarinic agents, breast-feeding

Contraindicated

Antimuscarinic agents, darifenacin [2] ---> SmPC of [2] of EMA

As with any other antimuscarinic agents, concomitant use of medicinal products that possess antimuscarinic properties may result in more pronounced therapeutic and side effects.

Antimuscarinic agents, diamorphine

The risk of severe constipation and/or urinary retention is increased by administration of antimuscarinic drugs

Antimuscarinic agents, fesoterodine [2] ---> SmPC of [2] of EMA

Caution should be exercised in coadministration of fesoterodine with other antimuscarinics and medicinal products with anticholinergic properties as this may lead to more pronounced therapeutic-and side-effects

Antimuscarinic agents, glycopyrronium/indacaterol/mometasone [2] ---> SmPC of [2] of EMA

The co-administration of this medicinal product with other medicinal products containing long-acting muscarinic antagonists has not been studied and is not recommended as it may potentiate adverse reactions

Antimuscarinic agents, hydroxyzine [2] ---> SmPC of [2] of eMC

Antimuscarinic side effects (both peripheral and central) may be increased if hydroxyzine is given with antimuscarinics

Antimuscarinic agents, loteprednol

The co-administration may increase the risk of raised intraocular pressure

Antimuscarinic agents, methadone

Opioid analgesics combined with antimuscarinic agents may produce severe constipation or paralytic ileus

Antimuscarinic agents, mirabegron [2] ---> SmPC of [2] of EMA

Mirabegron should be administered with caution to patients taking antimuscarinic medications for the treatment of overactive bladder syndrome.

Antimuscarinic agents, nadolol [2] ---> SmPC of [2] of eMC

Antimuscarinic agents may counteract the bradycardia caused by beta blockers.

Antimuscarinic agents, neostigmine

The antimuscarinic agent antagonizes the effects of neostigmine

Antimuscarinic agents, opioid analgesics ---> SmPC of [methadone] of eMC

Opioid analgesics combined with antimuscarinic agents may produce severe constipation or paralytic ileus

Antimuscarinic agents, organic nitrates ---> SmPC of [nitroglycerine] of eMC

There is a potential for drugs that cause dry mouth to reduce the effectiveness of sublingual nitrates.

Antimuscarinic agents, parasympathomimetics

The antimuscarinic agent antagonizes the effects of the parasympathomimetic agent

Antimuscarinic agents, pethidine [2] ---> SmPC of [2] of eMC

Use of pethidine concomitantly with anticholinergics may result in neurotoxicity in patients with renal failure, cancer, and sickle cell anaemia.

Antimuscarinic agents, phenelzine [2] ---> SmPC of [2] of eMC

Phenelzine may potentiate the action of antimuscarinic drugs

Antimuscarinic agents, piperidolate

The co-administration may increase the risk of adverse effects, e.g. paralytic ileus, retention of urine and blurred vision

Antimuscarinic agents, pregnancy

Strict indication

Antimuscarinic agents, proxymetacaine

Effect enhancement of mydriatic agent

Antimuscarinic agents, tolterodine [2] ---> SmPC of [2] of eMC

Concomitant medication of tolterodine with other drugs that possess antimuscarinic properties may result in more pronounced therapeutic effect and side-effects.

Antineoplastics

Acenocoumarol [1], antineoplastics ---> SmPC of [1] of eMC

The co-administration may decrease the anticoagulant effect

Aldesleukin [1], antineoplastics ---> SmPC of [1] of eMC

Hypersensitivity reactions have been reported in patients receiving combination regimens containing sequential high dose aldesleukin and antineoplastic agents, specifically, dacarbazine, cisplatin, tamoxifen and interferon-alpha.

Amphotericin, antineoplastics

The co-administration of antineoplastics drugs should be avoided

Anticoagulants, antineoplastics

Patients treated with anticoagulant and antineoplastic agents should be monitored more frequently

Antiepileptics, antineoplastics

Co-administration of antiepileptic drugs and chemotherapeutic drugs including lomustine can lead to complications secondary to pharmacokinetic interactions between the drugs.

Antineoplastics, BCG intravesical [2] ---> SmPC of [2] of eMC

The co-administration may interfere with the development of the immune response and thus with the anti-tumor efficacy. The combination is not recommended

Antineoplastics, bevacizumab [2] ---> SmPC of [2] of EMA

No clinically relevant pharmacokinetic interaction of co-administered chemotherapy on Avastin pharmacokinetics has been observed based on the results of a population PK analysis.

Antineoplastics, brivudine

Co-administration of brivudine with chemotherapeutic drugs (particularly 5-FU, including its topic preparations and prodrugs) and other 5-fluoropyrimidines is contraindicated

Antineoplastics, chlortalidone

Decreased renal elimination of antineoplastic agent

Antineoplastics, cimetidine

Cimetidine may potentiate the myelosuppressive effects (e.g. neutropenia, agranulocytosis) of chemotherapeutic agent

Antineoplastics, colchicine

The co-administration may decrease the effect of colchicine and/or increase its toxicity

Antineoplastics, dexrazoxane [2] ---> SmPC of [2] of EMA

Dexrazoxane may add to the toxicity induced by the chemotherapy cycle during which the accident took place, requiring careful monitoring of haematological parameters

Antineoplastics, dimethyl fumarate [2] ---> SmPC of [2] of EMA

Dimethyl fumarate has not been studied in combination with anti-neoplastic therapies and caution should, therefore, be used during concomitant administration.

Antineoplastics, doxorubicine [2] ---> SmPC of [2] of eMC

Doxorubicin may potentiate the toxicity of other anticancer therapies.

Antineoplastics, epirubicin [2] ---> SmPC of [2] of eMC

Epirubicin can be used in combination with other antic-cancer agents but patients should be monitored for additive toxicity, especially myelotoxicity and gastrointestinal toxicity

Antineoplastics, fingolimod [2] ---> SmPC of [2] of EMA

Anti-neoplastic, immunomodulatory or immunosuppressive therapies should not be co-administered due to the risk of additive immune system effects

Antineoplastics, fosphenytoin [2] ---> SmPC of [2] of eMC

Blood levels and/or effects of antineoplastic agents may be altered by phenytoin

Antineoplastics, immunocyanin

The co-administration may decrease the immunostimulants effect. The combination should be avoided

Antineoplastics, interferon alfa

The co-administration may increase the risk of toxicity

Antineoplastics, interferon alfa-2b [2] ---> SmPC of [2] of EMA

Administration of interferon alfa-2b in combination with other chemotherapeutic agents (e.g., Ara-C, cyclophosphamide, doxorubicin, teniposide) may lead to increased risk of toxicity (severity and duration)

Antineoplastics, irinotecan/fluorouracil/leucovorin/panitumumab

High incidence of severe diarrhea. Concomitant use of panitumumab and IFL is not recommended

Antineoplastics, lenograstim [2] ---> SmPC of [2] of eMC

In view of the sensitivity of rapidly dividing myeloid cells to cytotoxic chemotherapy, the use of lenograstim is not recommended from 24 hours before until 24 hours after chemotherapy ends

Antineoplastics, liposome-encapsulated doxorubicin-citrate complex [2] ---> SmPC of [2] of EMA

Doxorubicin may potentiate the toxicity of other antineoplastic agents.

Antineoplastics, macrosalb

Pharmacological interactions may occur

Antineoplastics, mitoxantrone

Topoisomerase II inhibitors, including Mitoxantrone, when used concomitantly with other antineoplastic agents and/or radiotherapy, have been associated with the development of Acute Myeloid Leukaemia (AML) or Myelodysplastic Syndrome (MDS)

Antineoplastics, mytomicin [2] ---> SmPC of [2] of eMC

Mitomycin should be administered with care when it is coadministered with other antineoplastic agents

Antineoplastics, natalizumab [2] ---> SmPC of [2] of EMA

Combination with other immunosuppressive and antineoplastic therapies. Concurrent use of these agents with TYSABRI may increase the risk of infections, including opportunistic infections, and is contraindicated

Antineoplastics, olaparib [2] ---> SmPC of [2] of EMA

The recommended olaparib monotherapy dose is not suitable for combination with other anticancer medicinal products.

Antineoplastics, 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

Antineoplastics, ozanimod [2] ---> SmPC of [2] of EMA

Anti-neoplastic, immunomodulatory or non-corticosteroid immunosuppressive therapies should not be coadministered due to the risk of additive immune system effects

Antineoplastics, paclitaxel [2] ---> SmPC of [2] of EMA

Paclitaxel should not be used in combination with other anticancer agents

Antineoplastics, panitumumab/bevacizumab

Increased toxicity and deaths were seen when panitumumab was combined with bevacizumab and chemotherapy. The combination should be avoided

Antineoplastics, panitumumab/oxaliplatin

The combination is contraindicated for patients with mutant KRAS mCRC or for whom KRAS mCRC status is unknown

Antineoplastics, pegylated liposomal doxorubicin [2] ---> SmPC of [2] of EMA

Doxorubicin hydrochloride preparations may potentiate the toxicity of other anti-cancer therapies.

Antineoplastics, phenytoin ---> SmPC of [fosphenytoin] of eMC

Blood levels and/or effects of antineoplastic agents may be altered by phenytoin

Antineoplastics, radium dichloride [2] ---> SmPC of [2] of EMA

Concomitant chemotherapy with radium dichloride may have additive effects on bone marrow suppression

Antineoplastics, samarium lexidronam pentasodium [2] ---> SmPC of [2] of EMA

Because of the potential for additive effects on bone marrow, the treatment of samario should not be given concurrently with chemotherapy or external beam radiation therapy

Antineoplastics, siponimod [2] ---> SmPC of [2] of EMA

Caution should be exercised during concomitant administration due to the risk of additive immune effects during such therapy and in the weeks after administration of any of these medicinal products is stopped

Antineoplastics, tamoxifen

The co-administration may increase the risk of thromboembolia

Antineoplastics, topoisomerase II inhibitors ---> SmPC of [mitoxantrone] of eMC

Antineoplastics, topotecan [2] ---> SmPC of [2] of EMA

In combining topotecan with other chemotherapy agents, reduction of the doses of each medicinal product may be required to improve tolerability.

Antineoplastics, ziconotide [2] ---> SmPC of [2] of EMA

Ziconotide is contraindicated with intrathecal chemotherapy. Caution should be exercised when ziconotide is administered with systemic chemotherapy

Cytotoxic chemotherapy, febuxostat [2] ---> SmPC of [2] of EMA

Drug interaction studies of febuxostat with cytotoxic chemotherapy have not been conducted. No data is available regarding the safety of febuxostat during cytotoxic therapy.

Cytotoxic chemotherapy, filgrastim [2] ---> SmPC of [2] of EMA

In view of the sensitivity of rapidly dividing myeloid cells to myelosuppressive cytotoxic chemotherapy, the use of filgrastim is not recommended in the period from 24 hours before to 24 hours after chemotherapy.

Cytotoxic chemotherapy, lipegfilgrastim [2] ---> SmPC of [2] of EMA

Lipegfilgrastim should be administered approximately 24 hours after administration of cytotoxic chemotherapy

Cytotoxic chemotherapy, pegfilgrastim [2] ---> SmPC of [2] of EMA

Due to the potential sensitivity of rapidly dividing myeloid cells to cytotoxic chemotherapy, pegfilgrastim should be administered at least 24 hours after administration of cytotoxic chemotherapy.

Doxorubicine [1], hepatotoxic chemotherapeutic agents ---> SmPC of [1] of eMC

The concomitant administration of known hepatotoxic chemotherapeutic agents (e.g. mercaptopurine, methotrexate, streptozocin) could potentially increase the toxicity of doxorubicin as a result of reduced hepatic clearance of the drug.

Emetogenic cancer therapies, granisetron [2] ---> SmPC of [2] of EMA

No clinically relevant drug interactions between SANCUSO and emetogenic cancer chemotherapies have been seen. Furthermore, no interaction has been observed between granisetron and emetogenic cancer therapies.

Idarubicin [1], potentially cardiotoxic drugs ---> SmPC of [1] of eMC

The use of idarubicin in combination chemotherapy with other potentially cardiotoxic drugs requires monitoring of cardiac function throughout treatment.

Antiretroviral CYP3A4 substrates, posaconazole [2] ---> SmPC of [2] of EMA

Frequent monitoring for adverse reactions and toxicity related to antiretroviral agents that are substrates of CYP3A4 is recommended during co- administration with posaconazole.

Antiretrovirals [1], daunorubicin ---> SmPC of [1] of eMC

If patients were/are (pre)treated with medicinal products influencing the bone marrow function the possibility of a marked disorder of hematopoiesis should be borne in mind.

Antiretrovirals, bictegravir/emtricitabine/tenofovir alafenamide [2] ---> SmPC of [2] of EMA

Biktarvy should not be co-administered with other antiretroviral medicinal products.

Antiretrovirals, bosentan [2] ---> SmPC of [2] of EMA

Due to the potential for interactions related to the inducing effect of bosentan on CYP450, which could affect the efficacy of antiretroviral therapy, these patients should also be monitored carefully regarding their HIV infection.

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.

Antiretrovirals, dolutegravir/rilpivirine [2] ---> SmPC of [2] of EMA

Juluca is 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.

Antiretrovirals, doravirine/lamivudine/tenofovir disoproxil [2] ---> SmPC of [2] of EMA

Delstrigo is a complete regimen for the treatment of HIV-1 infection; therefore, Delstrigo should not be administered with other antiretroviral medicinal products.

Antiretrovirals, doxorubicine [2] ---> SmPC of [2] of eMC

(Pre-)treatment with drugs affecting the function of the bone might lead to severe hematopoetic disturbances. The dosage of doxorubicin has to be changed if necessary.

Antiretrovirals, eluxadoline [2] ---> SmPC 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

Antiretrovirals, elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide [2] ---> SmPC of [2] of EMA

Genvoya should not be co-administered with other antiretroviral medicinal products. Therefore, information regarding drug-drug interactions with other antiretroviral products (including PIs and NNRTIs]) is not provided

Antiretrovirals, elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil [2] ---> SmPC of [2] of EMA

Stribild must not be administered with other antiretroviral products.

Antiretrovirals, emtricitabine/rilpivirine/tenofovir alafenamide [2] ---> SmPC of [2] of EMA

Odefsey should not be co-administered with other antiretroviral medicinal products

Antiretrovirals, epirubicin [2] ---> SmPC of [2] of eMC

The possibility of a marked disturbance of haematopoiese needs to be kept in mind with a (pre-) treatment with agents which influence the bone marrow

Antiretrovirals, etonogestrel [2] ---> SmPC 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

Antiretrovirals, hydroxycarbamide [2] ---> SmPC of [2] of EMA

Potentially fatal pancreatitis and hepatotoxicity, and severe peripheral neuropathy have been reported in HIV-infected patients who received hydroxycarbamide in combination with antiretroviral medicinal products, particularly didanosine plus stavudine.

Antiretrovirals, orlistat [2] ---> SmPC of [2] of EMA

Orlistat may potentially reduce the absorption of antiretroviral medicines for HIV and could negatively affect the efficacy of antiretroviral medications for HIV

Antiretrovirals, para-aminosalicylic acid [2] ---> SmPC of [2] of EMA

No drug interaction studies have been conducted in patients with HIV infection taking antiretroviral agents and para-aminosalicylic acid. Given the metabolic pathway of GRANUPAS no significant drug interaction is anticipated.

Antiretrovirals, piperaquine/artenimol [2] ---> SmPC 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.

Antiretrovirals, valganciclovir [2] ---> SmPC of [2] of eMC

At clinically relevant concentrations, there is unlikely to be either a synergistic or antagonistic effect on the inhibition of either HIV in the presence of ganciclovir or CMV in the presence of a variety of antiretroviral drugs.

Antiseptics

Antiseptics [1], povidone iodine ---> SmPC of [1] of eMC

Do not mix or co-administer with disinfectants and/or antiseptics or other agents used for the treatment of wounds.

Antiseptics, chlorhexidine

Chlorhexidine should not be used concomitantly with other antiseptics

Antiseptics, collagenase clostridium histolyticum

Inhibition of collagenase activity

Antiseptics, solutions for sealant [2] ---> SmPC of [2] of EMA

Possible denaturation of tissue sealing

Antiseptics, tuberculosis vaccine

BCG bacteria are susceptible to antiseptic agents

Liposomal bupivacaine [1], topic antiseptic ---> SmPC of [1] of EMA

EXPAREL liposomal should not be allowed to come into contact with antiseptics such as povidone iodine in solution

Antispasmodic agents

Antispasmodic agents, biperiden

The combination of biperiden with other anticholinergic medicinal products may enhance the central and peripheral adverse reactions

Antispasmodic agents, bornaprine

The co-administration of bornaprine with other anticholinergic drugs may enhance the central and peripheral adverse effects

Antispasmodic agents, daclizumab [2] ---> SmPC of [2] of EMA

Drug interactions between Zinbryta and symptomatic MS therapy (e.g. antispastic agents, fampridine) are not expected; however there is limited data on concomitant use of Zinbryta with MS symptomatic therapies.

Antispasmodic agents, memantin [2] ---> SmPC of [2] of EMA

Concomitant administration of memantine with the antispasmodic agents, dantrolene or baclofen, can modify their effects and a dose adjustment may be necessary.

Antispasmodic agents, trihexyphenidyl

The combination of trihexyphenidyl with spasmolytic drugs may enhance the central and peripheral adverse reactions

Antithrombotics

Antithrombotics, defibrotide [2] ---> SmPC of [2] of EMA

Defibrotide has a profibrinolytic effect and this may potentially enhance the activity of antithrombotic/fibrinolytic medicinal products. The use of defibrotide with antithrombotic/fibrinolytic medicinal products is not recommended.

Antithrombotics, edoxaban [2] ---> SmPC of [2] of EMA

Concomitant use of medicines affecting haemostasis may increase the risk of bleeding.

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.

Antithrombotics, 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

Antithrombotics, phenindione

The co-administration may increase the risk of bleeding and is contraindicated

Antithyroid medicines

Amitriptyline, antithyroid medicines

The co-administration of amitriptyline with antithyroid drugs is not recommended due to increased risk of agranulocytosis

Antithyroid medicines, macimorelin [2] ---> SmPC of [2] of EMA

The combination may impact the accuracy of the diagnostic test. Concomitant use with macimorelin is to be avoided

Antithyroid medicines, nortriptyline

The co-administration of nortriptyline with antithyroid drugs may increase the risk of agranulocytosis

Antithyroid medicines, potassium iodide

Concomitant use of antithyroid drugs and potassium iodide may cause an additive goitrogenic effect

Antithyroid medicines, somatorelin [2] ---> SmPC of [2] of eMC

Concomitant use of somatorelin and substances influencing the release of growth hormone should be avoided.

Antitussives

Acetylcysteine, antitussives

Dangerous secretory congestion due to cough reflex inhibition. Co-administration is not recommended

Ambroxol, antitussives

Dangerous secretory congestion due to cough reflex inhibition. Co-administration is not recommended

Antitussives, bromhexine

Dangerous secretory congestion due to the reduced cough reflex. Co-administration is not recommended

Antitussives, brovanexine

The cough reflex inhibition may cause secretion congestion

Antitussives, carbocisteine

The concomitant use of carbocisteine and drugs that inhibit the cough reflex is not recommended

Antitussives, dihydrocodeine

The co-administration of dihydrocodeine and cough-relieving agents may enhance the effect of the cough-relieving agent

Antitussives, guaifenesin [2] ---> SmPC of [2] of eMC

Expectorants such as guaifenesin should not be combined with cough suppressants in the treatment of cough since the combination is illogical and patients may be exposed to unnecessary adverse effects.

Antitussives, 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

Buprenorphine, central antitussives [2] ---> SmPC of [2] of EMA

This combination increases central nervous system depression.

Buprenorphine/naloxone [1], central antitussives ---> SmPC of [1] of EMA

The combination increases the central nervous system depression

Anxiolytics

Alimemazine [1], anxiolytics ---> SmPC of [1] of eMC

The sedative effects of phenothiazines may be intensified (additively) by anxiolytics

Alizapride, anxiolytics

Increased CNS depressant effect

Alprazolam [1], anxiolytics ---> SmPC of [1] of eMC

Enhancement of the central depressive effect may occur in case of concomitant use of alprazolam with other CNS depressants

Amisulpride [1], anxiolytics ---> SmPC of [1] of eMC

Caution is advised when coadministering amisulpride with CNS depressants

Antihistamines, anxiolytics

Antihistamines potentiate the sedative effects of anxiolytics

Anxiolytics [1], cyproheptadine ---> SmPC of [1] of eMC

Antihistamines may have additive effects with other CNS depressants

Anxiolytics [1], diamorphine ---> SmPC of [1] of eMC

The depressant effects of diamorphine may be exaggerated and prolonged by anxiolytics

Anxiolytics [1], flupentixol ---> SmPC of [1] of eMC

In common with other antipsychotics, flupentixol enhances the response to other CNS depressants.

Anxiolytics, baclofen [2] ---> SmPC of [2] of eMC

The concomitant administration of baclofen and other medications that have a suppressing effect on functions of the central nervous system can enhance the action of baclofen

Anxiolytics, benzodiazepines

Enhancement of the central depressive effect may occur if benzodiazepines are combined with centrally-acting drugs

Anxiolytics, bromazepam

Enhancement of the depressor effect on the central nervous system

Anxiolytics, brotizolam

The co-administration of brotizolam with other central nervous system depressants may enhance the central nervous depressant effect

Anxiolytics, buprenorphine [2] ---> SmPC of [2] of EMA

This combination increases central nervous system depression.

Anxiolytics, buprenorphine/naloxone [2] ---> SmPC of [2] of EMA

The combination increases the central nervous system depression

Anxiolytics, buspirone [2] ---> SmPC of [2] of eMC

The concomitant use of buspirone with other CNS-active drugs should be approached with caution.

Anxiolytics, chlordiazepoxide [2] ---> SmPC of [2] of eMC

Enhancement of the central depressive effect may occur if chlordiazepoxide is combined with other CNS-depressant drugs.

Anxiolytics, chlorphenamine

Chlorphenamine may have an additive effect when used concurrently with anxiolytics causing potentiation of drowsiness.

Anxiolytics, chlorpromazine [2] ---> SmPC of [2] of eMC

The co-administration may increase the CNS depressant effect

Anxiolytics, clebopride

Clebopride may enhance the sedative effects

Anxiolytics, clemastine

Antihistamines potentiate the sedative effects of anxiolytics

Anxiolytics, codeine [2] ---> SmPC of [2] of eMC

Enhanced sedative and hypotensive effect, increased risk of respiratory depression

Anxiolytics, dantrolene

The co-administration of dantrolene and CNS depressants should be avoided due to the adverse reactions of dantrolene may be enhanced (specially the CNS depressant effect and muscle weakness)

Anxiolytics, dapoxetine [2] ---> SmPC of [2] of eMC

Caution is advised if the concomitant administration of dapoxetine and CNS active medicinal products is required

Anxiolytics, dexchlorpheniramine

The combination of dexchlorpheniramine with other CNS depressants may enhance the CNS depressant effect

Anxiolytics, diazepam [2] ---> SmPC of [2] of eMC

Enhancement of the central depressive effect may occur

Anxiolytics, dimethindene

The sedative effect of CNS depressant drugs may be enhanced

Anxiolytics, diphenhydramine

Mutual enhancement of CNS-depressant effect

Anxiolytics, dipotassium clorazepate

The combination of CNS depressors may mutually potentiate the depressor effect on the CNS

Anxiolytics, doxylamine

Antihistaminic agents have additive effects with other CNS depressants

Anxiolytics, flunitrazepam

The co-administration may cause a mutual potentiation of effects

Anxiolytics, flurazepam [2] ---> SmPC of [2] of eMC

Enhancement of the central depressive effect may occur if benzodiazepines are combined with centrally-acting drugs

Anxiolytics, ketamine [2] ---> SmPC of [2] of eMC

Reduced doses of ketamine may be required with concurrent administration of other anxiolytics, sedatives and hypnotics.

Anxiolytics, labetalol

Possible enhancement of hypotensive effect of labetalol

Anxiolytics, levomepromazine

The co-administration of levomepromazine with other central nervous depressants will cause a greater depressant effect on central nervous system

Anxiolytics, lofepramine

An enhanced sedative effect has been reported when taken anxiolytics with lofepramine.

Anxiolytics, loprazolam [2] ---> SmPC of [2] of eMC

The risk of a withdrawal syndrome occurring is increased when loprazolam is combined with other benzodiazepines prescribed as anxiolytics or hypnotics.

Anxiolytics, lorazepam [2] ---> SmPC of [2] of eMC

Enhancement of the central depressive effect may occur if lorazepam is combined with other CNS depressants

Anxiolytics, lormetazepam

The benzodiazepines, including lormetazepam produce additive CNS depressant effects when co-administered with other medications which themselves produce CNS depression

Anxiolytics, loxapine [2] ---> SmPC of [2] of EMA

Loxapine should be used with caution in combination with other centrally acting medicinal products

Anxiolytics, medazepam

The co-administration of medazepam with other central nervous system depressants may enhance the central nervous depressant effect.

Anxiolytics, meptazinol

Enhanced sedative effect.

Anxiolytics, methyldopa

Concomitant use of methyldopa and anxiolytics may enhance the hypotensive effect.

Anxiolytics, methylprednisolone

Possible decrease of anxiolytic effect

Anxiolytics, metoclopramide

The co-administration may mutually enhance the sedative effects of the CNS. The combination requires caution

Anxiolytics, metoprolol [2] ---> SmPC of [2] of eMC

Concomitant use of metoprolol with anxiolytics may result in an enhanced hypotensive effect.

Anxiolytics, mianserin

Mianserin may enhance the central depressive effect of anxiolytic agent

Anxiolytics, midazolam [2] ---> SmPC of [2] of EMA

The co-administration of midazolam with other sedative/hypnotic agents and CNS depressants, including alcohol, is likely to result in enhanced sedation and respiratory depression.

Anxiolytics, 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

Anxiolytics, narcotine

Noscapine with other CNS depressant drugs may increase the sedation and somnolence of the CNS depressants

Anxiolytics, neuroleptics

The co-administration may cause a mutual potentiation of effects

Anxiolytics, nitrazepam

Enhancement of the central depressive effect may occur if benzodiazepines are combined with centrally-acting drugs

Anxiolytics, oxazepam

Enhancement of other CNS depressant drugs

Anxiolytics, oxomemazine

Enhancement of CNS depressant effect

Anxiolytics, paliperidone [2] ---> SmPC of [2] of EMA

Given the primary CNS effects of paliperidone, it should be used with caution in combination with other centrally acting medicines.

Anxiolytics, perphenazine

Risk of sedation and/or toxicity when perphenazine is administered with CNS depressants

Anxiolytics, pethidine [2] ---> SmPC of [2] of eMC

The central depressant effects of pethidine may be potentiated by the concurrent use of other CNS depressants; respiratory depression and profound sedation or coma may occur.

Anxiolytics, phenobarbital [2] ---> SmPC of [2] of eMC

Concurrent administration of phenobarbital with other CNS depressants may lead to an additive CNS depressant effects

Anxiolytics, pipotiazine [2] ---> SmPC of [2] of eMC

The CNS depressant actions of neuroleptic agents may be intensified (additively) by other sedatives. Respiratory depression may occur.

Anxiolytics, prednisolone

The co-administration may decrease the effect of anxiolytic agent

Anxiolytics, promethazine

The co-administration of promethazine and other central nervous depressants can mutually enhance the effects and adverse reactions (particularly sedation and hypotension)

Anxiolytics, quazepam

The co-administration may cause a mutual potentiation of the depressor effect on the CNS

Anxiolytics, sufentanil

The co-administration may enhance the respiratory depressor effect of sufentanil

Anxiolytics, sulpiride

Sulpiride enhances the sedative effect of anxiolytic agent

Anxiolytics, temazepam

Concomitant use of anxiolytics and other CNS depressant drugs can mutually enhance the CNS depressant effects

Anxiolytics, thalidomide [2] ---> SmPC of [2] of EMA

Thalidomide has sedative properties thus may enhance the sedative effects of other medicinal products

Anxiolytics, tiapride

Enhancement of CNS depressant effect

Anxiolytics, tramadol [2] ---> SmPC of [2] of eMC

Concomitant administration of tramadol with other centrally acting drugs may potentiate CNS depressant effects.

Anxiolytics, trazodone [2] ---> SmPC of [2] of eMC

The sedative effects of anxiolytics may be intensified; dosage reduction is recommended in such instance.

Anxiolytics, triamterene [2] ---> SmPC of [2] of eMC

The co-administration of triamterene and anxiolytics may enhance the hypotensive effect

Anxiolytics, triazolam

Increased CNS depressant effect with the co-administration of triazolam and anxiolytic drugs may occur

Anxiolytics, trimipramine [2] ---> SmPC of [2] of eMC

The co-administration of trimipramine with other CNS depressants may increase the CNS depressant effect.

Anxiolytics, zaleplon [2] ---> SmPC of [2] of EMA

Combination of zaleplon with other CNS-acting compounds may enhance the central sedation

Anxiolytics, zolpidem [2] ---> SmPC of [2] of eMC

Enhancement of the central depressive effect may occur in case of concomitant use of zolpidem with other central nervous system depressants

Anxiolytics, zopiclone [2] ---> SmPC of [2] of eMC

The combination with CNS depressants an enhancement of the central depressive effect may occur.

Arrhytmogenic agents

Amiodarone, arrhytmogenic agents

The use of amiodarone with other antiarrhythmics or arrhytmogenic medicinal products may increase the incidence of cardiac arrhythmias and should be avoided

Arrhytmogenic agents, chloroquine

Co-administration of chloroquine and other drugs that have arrhythmogenic potential may increase the risk of cardiac arrhythmias.

Arrhytmogenic agents, dronedarone [2] ---> SmPC of [2] of EMA

Proarrhythmic effects may occur in particular situations such as concomitant use with medicinal products favouring arrhythmia and/or electrolytic disorders

Arrhytmogenic agents, halofantrine

Halofantrine prolongs the QT interval and should not be used together with other drugs that may induce cardiac arrhythmias

Arrhytmogenic agents, hydroxychloroquine

Concomitant use of hydroxychloroquine and arrhytmogenic agents may increase the risk of cardiac arrhythmias

Arrhytmogenic agents, terfenadine

The co-administration of terfenadine with potential arrhytmogenic medicinal products is contraindicated

QT-prolonging medicinal products with known arrhythmogenic properties, siponimod [2] ---> SmPC of [2] of EMA

Concomitant use of these substances during treatment initiation may be associated with severe bradycardia and heart block.

Bactericides

Bactericides, bacteriostatic antibiotics

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bactericides, chloramphenicol

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bactericides, doxycycline

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bactericides, flucloxacillin

The co-administration may have a synergistic effect

Bactericides, macrolide antibiotics ---> SmPC of [roxithromycin] of eMC

The macrolide may interfere with the bactericidal effects of beta-lactamic antibiotic.

Bactericides, minocycline

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bactericides, roxithromycin

The macrolide may interfere with the bactericidal effects of beta-lactamic antibiotic.

Bactericides, sulfacetamide

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bactericides, sulphamides

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bactericides, sulphonamides

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics

Amoxicillin, bacteriostatic antibiotics

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Ampicillin, bacteriostatic antibiotics

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Ampicillin/sulbactam, bacteriostatic antibiotics

Ampicillin/Sulbactam should not be combined with bacteriostatic antibiotics or chemotherapeutics agents due to the possibility of weakening of effect

Bactericides, bacteriostatic antibiotics

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics [1], penicillins ---> SmPC of [1] of eMC

Bacteriostatic antibiotics have been reported to antagonise the bactericidal activity of penicillins and concomitant use is not recommended.

Bacteriostatic antibiotics, benzylpenicillin

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, cefaclor

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, cefadroxil [2] ---> SmPC of [2] of eMC

Cefadroxil should not be combined with bacteriostatic antibiotics since an antagonistic effect is possible.

Bacteriostatic antibiotics, cefazolin

The co-administration of a bactericide antibiotic with a bacteriostatic should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, cefepime

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, cefixime

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, cefotaxime

Cefotaxime should not be combined with bacteriostatic drugs as it was observed an antagonic effect on the antibacterial action

Bacteriostatic antibiotics, cefpodoxime

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, ceftazidime

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, ceftibuten

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, ceftriaxone

The co-administration of a bactericide antibiotic with a bacteriostatic should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, cefuroxime

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, cephalosporins

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, flucloxacillin

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, gentamicin

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, mezlocillin

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Bacteriostatic antibiotics, penicillin G

Bacteriostatic antibiotics have been reported to antagonise the bactericidal activity of penicillins and concomitant use is not recommended.

Bacteriostatic antibiotics, phenoxymethylpenicillin

Bacteriostatic antibiotics have been reported to antagonise the bactericidal activity of penicillins and concomitant use is not recommended.

Bacteriostatic antibiotics, piperacillin

Bacteriostatic antibiotics may reduce the bactericidal activity of piperacillin

Benzylpenicillins

Alcohol, benzylpenicillin

The co-administration may inactivate benzylpenicillin

Anticoagulants, benzylpenicillin

Carefully control of the prothrombin time

Bacteriostatic antibiotics, benzylpenicillin

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Benzylpenicillin, bleomycin

Incompatibility

Benzylpenicillin, breast-feeding

Strict indication

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.

Benzylpenicillin, chlorpromazine

Incompatible with benzylpenicillin in solution

Benzylpenicillin, cimetidine

Incompatible with benzylpenicillin in solution

Benzylpenicillin, cytarabine

Incompatible with benzylpenicillin in solution

Benzylpenicillin, digital glycosides ---> SmPC of [metildigoxin] of eMC

Electrolyte imbalance may increase the toxicity of cardiac glycosides

Benzylpenicillin, dopamine

Incompatible with benzylpenicillin in solution

Benzylpenicillin, estrogens

Antibiotic may affect the gut flora, leading to lower estrogen reabsorption and reduced efficacy of combined oral estrogen/progesterone contraceptives.

Benzylpenicillin, glycerol

The co-administration may inactivate benzylpenicillin

Benzylpenicillin, hydroxyzine

Incompatible with benzylpenicillin in solution

Benzylpenicillin, indometacin

The co-administration may delay the elimination of the penicillin and increase its plasma levels

Benzylpenicillin, leflunomide [2] ---> SmPC of [2] of EMA

A771726 is an inhibitor of OAT3 in vivo .Therefore, when co-administered leflunomide with substrates of OAT3 caution is recommended.

Benzylpenicillin, lincomycin

Incompatible with benzylpenicillin in solution

Benzylpenicillin, macrogol

The co-administration may inactivate benzylpenicillin

Benzylpenicillin, metaraminol

Incompatible with benzylpenicillin in solution

Benzylpenicillin, oxytetracycline

Incompatible with benzylpenicillin in solution

Benzylpenicillin, pentobarbital

Incompatible with benzylpenicillin in solution

Benzylpenicillin, phenylbutazone

The co-administration may delay the elimination of the penicillin and increase its plasma levels

Benzylpenicillin, platelet aggregation inhibitors

Carefully control of the prothrombin time

Benzylpenicillin, pretomanid [2] ---> SmPC of [2] of EMA

If pretomanid is co-administered with OAT3 substrate medicinal products, monitoring for OAT3 substrate drug-related adverse reactions should be performed and dosage reductions for OAT3 medicinal product should be considered, if needed

Benzylpenicillin, salicylates

The co-administration may delay the elimination of the penicillin and increase its plasma levels

Benzylpenicillin, sodium bicarbonate

Incompatible with benzylpenicillin in solution

Benzylpenicillin, sotagliflozin [2] ---> SmPC of [2] of EMA

It cannot be ruled out that sotagliflozin may interact with other sensitive OAT3, OATP- and/or BCRP- substrates resulting in potentially larger increases of exposure than seen for rosuvastatin.

Benzylpenicillin, teriflunomide [2] ---> SmPC of [2] of EMA

When teriflunomide (OAT3 inhibitor) is coadministered with substrates of OAT3 caution is recommended.

Benzylpenicillin, thiopental

Incompatible with benzylpenicillin in solution

Benzylpenicillin, vancomycin

Incompatible with benzylpenicillin in solution

Beta-lactam antibiotics

Amikacine [1], beta-lactam antibiotics ---> SmPC of [1] of eMC

In vitro admixture of aminoglycosides with beta-lactam antibiotics (penicillins or cephalosporins) may result in significant mutual inactivation.

Aminoglycoside antibiotics, beta-lactam antibiotics ---> SmPC of [amikacine] of eMC

In vitro admixture of aminoglycosides with beta-lactam antibiotics (penicillins or cephalosporins) may result in significant mutual inactivation.

Beta-lactam antibiotics, doxycycline

The co-administration of a bactericide antibiotic with a bacteriostatic should be avoided due to possible antagonist effects

Beta-lactam antibiotics, erythromycin

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Beta-lactam antibiotics, fosfomycin [2] ---> SmPC of [2] of eMC

In-vitro tests have shown that the combination of fosfomycin with a beta-lactam antibiotics

Beta-lactam antibiotics, gentamicin [2] ---> SmPC of [2] of eMC

In vitro admixture of aminoglycosides with beta-lactam antibiotics (penicillins or cephalosporins) may result in significant mutual inactivation.

Beta-lactam antibiotics, macrolide antibiotics

The macrolide may interfere with the bactericidal effects of beta-lactamic antibiotic.

Beta-lactam antibiotics, midecamycin

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Beta-lactam antibiotics, minocycline

The co-administration of bactericide with bacteriostatic antibiotics should be avoided due to possible antagonist effects

Beta-lactam antibiotics, 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.

Beta-lactam antibiotics, phenprocoumon

Weakening of phenprocoumon effect with the use concomitant or prior of beta-lactam antibiotics

Beta-lactam antibiotics, piperacillin

Large doses of piperacillin may prolong the half-life of other beta-lactam antibiotics by competitive inhibition of tubular secretion

Beta-lactam antibiotics, tobramycin

Significant mutual inactivation

Beta-lactam antibiotics, warfarin ---> SmPC of [imipenem/cilastatin] of eMC

Bicarbonate

Acetazolamide, bicarbonate

The co-administration increases the risk of renal calculus formation.

Amphetamine [1], bicarbonate ---> SmPC of [1] of eMC

Bicarbonate alkalizes the urine and decreases urinary excretion and extends the half-life of amfetamine.

Benzylpenicillin, sodium bicarbonate

Incompatible with benzylpenicillin in solution

Bicarbonate [1], lithium ---> SmPC of [1] of eMC

The combination may decrease serum lithium levels due to an increase in lithium renal clearance

Bicarbonate, cysteamine [2] ---> SmPC of [2] of EMA

Bicarbonate should be administered at least one hour before or one hour after PROCYSBI to avoid potential earlier release of cysteamine.

Bicarbonate, lisdexamfetamine [2] ---> SmPC of [2] of eMC

Bicarbonate alkalizes the urine and decreases urinary excretion and extends the half-life of amfetamine.

Bicarbonate, tetracyclines

Absorption of tetracyclines is impaired by preparations containing sodium bicarbonate. Administer tetracycline 1 hour before or 2 hours after. NOT together by infusion!

Bicarbonate, trandolapril

Sodium bicarbonate may decrease the absorption of trandolapril.

Flucytosine, sodium bicarbonate

The co-administration may shorten the excretion half-life of flucytosine

Hydroquinidine, sodium bicarbonate

The urinary alkalinizing agent alkalizes the urine and decreases urinary excretion of hydroquinidine and increases plasma levels and overdose risk of hydroquinidine

Lithium, sodium bicarbonate [2] ---> SmPC of [2] of eMC

The combination may decrease serum lithium levels due to an increase in lithium renal clearance

Milrinone [1], sodium bicarbonate ---> SmPC of [1] of eMC

Milrinone should not be diluted in sodium bicarbonate intravenous infusion.

Pseudoephedrine, sodium bicarbonate

The urinary alkalinizing agent increases the pH of renal tubular urine and decreases the urinary excretion of pseudoephedrine

Bronchodilators

Acebutolol, sympathomimetic bronchodilator

Acebutolol may antagonize the effect of sympathomimetic bronchodilators

Acebutolol, xanthines (bronchodilator)

Acebutolol may antagonize the effect of xanthine bronchodilator

Adrenergic bronchodilators, glycopyrronium/formoterol [2] - - - > SmPC of [2] of EMA

Studies indicate no clinical evidence of interactions when used concomitantly with other COPD medicinal products including short- acting beta2- adrenergic bronchodilators, methylxanthines, and oral and inhaled steroids.

Adrenergic bronchodilators, xylometazoline

Xylometazoline should not be used, when the patient is treated with adrenergic bronchodilators

Bronchodilatators, macrosalb

Pharmacological interactions may occur

Bronchodilatators, regadenoson

Antagonism bronchodilatation/bronchoconstriction (regadenoson)

Cardiac glycosides

Aceclofenac [1], cardiac glycosides ---> SmPC of [1] of eMC

NSAIDs may exacerbate cardiac failure, reduce GFR (glomerular filtration rate) and inhibit the renal clearance of glycosides, resulting in increased plasma glycoside levels.

Acetazolamide, cardiac glycosides

The toxicity of the cardiac glycoside may be enhanced because of potassium loss

ACTH, cardiac glycosides

The co-administration of cardiac glycosides and drugs that cause potassium and magnesium loss may enhance the effects and adverse reactions of cardiac glycosides

Ajmaline, cardiac glycosides

Ajmaline enhances dose-dependent glycoside-induced conduction disorders

Alfacalcidol, cardiac glycosides

Hypercalcaemia in patients taking digitalis preparations may precipitate cardiac arrhythmias. Close monitorization.

Amiloride/hydrochlorothiazide, cardiac glycosides

The effect of the cardiac glycoside may be enhanced in case of potassium and/or magnesium loss

Aminobenzoate potassium, cardiac glycosides

Decreased effect of the cardiac glycoside

Amphotericin, cardiac glycosides

The co-administration of cardiac glycosides and drugs that cause potassium and magnesium loss may enhance the effects and adverse reactions of cardiac glycosides

Apraclonidine [1], cardiac glycosides ---> SmPC of [1] of eMC

Since apraclonidine may reduce pulse and blood pressure, caution in using drugs such as cardiac glycosides

Bisacodyl [1], cardiac glycosides ---> SmPC of [1] of eMC

Electrolyte imbalance may lead to increased sensitivity to cardiac glycosides.

Brimonidine [1], cardiac glycosides ---> SmPC of [1] of EMA

Caution is advised when using medicinal products such as anti-hypertensives and/or cardiac glycosides concomitantly with brimonidine.

Brinzolamide/brimonidine [1], cardiac glycosides ---> SmPC of [1] of EMA

Caution is advised when using medicinal products such as cardiac glycosides concomitantly with brinzolamide/brimonidine.

Buckthorn berries, cardiac glycosides

Potassium loss due to chronic use: Increased cardiac glycoside effect

Calcitonin preparations, cardiac glycosides

Dosage of the cardiac glycoside may require adjustment in view of the fact that their effects may be modified by changes in cellular electrolyte concentrations

Calcium acetate [1], cardiac glycosides ---> SmPC of [1] of eMC

The combination may increase the effect of cardiac glycosides

Calcium aminoethyl phosphate, cardiac glycosides

Hypercalcaemia may increase the sensitivity to the cardiac glycoside and the risk of heart rhythm disorders. Caution is recommended

Calcium aspartate, cardiac glycosides

Hypercalcaemia may increase the sensitivity to the cardiac glycoside and the risk of heart rhythm disorders. Caution is recommended

Calcium carbonate [1], cardiac glycosides ---> SmPC 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], cardiac glycosides ---> SmPC 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 citrate, cardiac glycosides

Hypercalcaemia may increase the sensitivity to the cardiac glycoside and the risk of heart rhythm disorders. Caution is recommended

Calcium gluconate, cardiac glycosides

Patients receiving therapy with cardiac glycosides such as digoxin must not be given calcium supplements.

Calcium saccharate, cardiac glycosides

Hypercalcaemia may increase the sensitivity to the cardiac glycoside and the risk of heart rhythm disorders. Caution is recommended

Calcium, cardiac glycosides

Hypercalcaemia may increase the sensitivity to the cardiac glycoside and the risk of heart rhythm disorders. Caution is recommended

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.

Carbachol, cardiac glycosides

The negative chronotropic effect of cardiac glycosides may be enhanced by carbachol

Cardiac glycosides [1], diclofenac ---> SmPC of [1] of eMC

NSAID may exacerbate cardiac failure, reduce the glomerular filtration rate and increase plasma levels of the cardiac glycoside

Cardiac glycosides [1], doubutamine ---> SmPC of [1] of eMC

An increased risk of arrhythmias may occur if sympathomimetic agents are given to patients receiving cardiac glycosides.

Cardiac glycosides [1], sympathomimetics ---> SmPC of [1] of eMC

An increased risk of arrhythmias may occur if sympathomimetic agents are given to patients receiving cardiac glycosides.

Cardiac glycosides, cascara bark

Potassium loss due to chronic use: Increased cardiac glycoside effect

Cardiac glycosides, cholecalciferol [2] ---> SmPC 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.

Cardiac glycosides, cholestyramine

Decreased intestinal absorption of digitalis.

Cardiac glycosides, cloprednol

Increased cardiac glycoside effect by hypokaliemia

Cardiac glycosides, corticosteroids

The co-administration of cardiac glycosides and drugs that cause potassium and magnesium loss may enhance the effects and adverse reactions of cardiac glycosides

Cardiac glycosides, dexibuprofen

NSAID may exacerbate cardiac failure, reduce the glomerular filtration rate and increase plasma levels of the cardiac glycoside

Cardiac glycosides, dexketoprofen [2] ---> SmPC of [2] of eMC

NSAID may exacerbate cardiac failure, reduce the glomerular filtration rate and increase plasma levels of the cardiac glycoside

Cardiac glycosides, dihydrotachysterol [2] ---> SmPC of [2] of eMC

Hypercalcaemia induced by excessive dosaging of dihydrotachysterol may enhance the toxic effects of cardiac glycosides.

Cardiac glycosides, docusate

The co-administration may cause uncontrolled effects.

Cardiac glycosides, elcatonin

Dosage of the cardiac glycoside may require adjustment in view of the fact that their effects may be modified by changes in cellular electrolyte concentrations

Cardiac glycosides, ephedrine

The co-administration of cardiac glycosides and ephedrine may cause paroxysmal hypertension and life-threatening arrythmias due to sensitization of the myocardium to sympathomimetic agents

Cardiac glycosides, etilefrine

The co-administration may enhance the sympathicomimetic effect on the cardiac muscle and cause heart rhythm disorders

Cardiac glycosides, etodolac

NSAID may exacerbate cardiac failure, reduce the glomerular filtration rate and increase plasma levels of the cardiac glycoside

Cardiac glycosides, fluocortolone

Increased cardiac glycoside effect by hypokaliemia

Cardiac glycosides, flurbiprofen [2] ---> SmPC of [2] of eMC

NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma cardiac glycoside levels.

Cardiac glycosides, formoterol/glycopyrronium/budesonide [2] ---> SmPC of [2] of EMA

Hypokalaemia may increase the disposition towards arrhythmias in patients who are treated with digitalis glycosides.

Cardiac glycosides, frangula bark

Potassium loss due to chronic use: Increased cardiac glycoside effect

Cardiac glycosides, glucocorticoids

Increased cardiac glycoside effect by hypokaliemia

Cardiac glycosides, hydrocortisone

Increased cardiac glycoside effect by hypokaliemia

Cardiac glycosides, 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

Cardiac glycosides, hyperkalemia

The increase of extracellular potasium concentrations decreases the effect of the cardiac glycoside

Cardiac glycosides, hypokalemia

The decrease of extracellular potasium concentrations enhances the arrhythmogenic effect of the cardiac glycoside

Cardiac glycosides, hypomagnesemia

The co-administration of cardiac glycosides and drugs that cause potassium and magnesium loss may enhance the effects and adverse reactions of cardiac glycosides

Cardiac glycosides, ibuprofen [2] ---> SmPC of [2] of eMC

NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma cardiac glycoside levels.

Cardiac glycosides, indometacin

NSAID may exacerbate cardiac failure, reduce the glomerular filtration rate and increase plasma levels of the cardiac glycoside

Cardiac glycosides, kaliuretic medicines

The co-administration of cardiac glycosides and drugs that cause potassium and magnesium loss may enhance the effects and adverse reactions of cardiac glycosides

Cardiac glycosides, ketoprofen [2] ---> SmPC of [2] of eMC

NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma glycoside levels.

Cardiac glycosides, ketorolac [2] ---> SmPC of [2] of eMC

NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma cardiac glycoside levels when co-administered with cardiac glycosides.

Cardiac glycosides, lactitol

The chronic use of laxatives may cause hypokaliemia, which enhances the effect of cardiac glycoside

Cardiac glycosides, lactulose

The co-administration may enhance the glycoside effect due to hypokalemia

Cardiac glycosides, laxatives

The chronic use of laxatives may cause hypokaliemia, which enhances the effect of cardiac glycoside

Cardiac glycosides, levothyroxine

Levothyroxine enhances the effect of cardiac glycoside

Cardiac glycosides, liothyronine

If co-administered liothyronine with cardiac glycosides, adjustment of dosage of cardiac glycoside may be necessary.

Cardiac glycosides, lormetazepam

Type and scope of interactions are unpredictable in long-term therapy with drugs affecting respiratory and circulatory function

Cardiac glycosides, mefenamic acid

NSAID may exacerbate cardiac failure, reduce the glomerular filtration rate and increase plasma levels of the cardiac glycoside

Cardiac glycosides, methylprednisolone [2] ---> SmPC of [2] of eMC

Care should be taken for patients receiving cardioactive drugs because of steroid induced electrolyte disturbance/potassium loss

Cardiac glycosides, nabumetone ---> SmPC of [flurbiprofen] of eMC

NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma glycoside levels.

Cardiac glycosides, naproxen [2] ---> SmPC of [2] of eMC

NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma cardiac glycoside levels when co-administered with cardiac glycosides.

Cardiac glycosides, naproxen/esomeprazole [2] ---> SmPC of [2] of eMC

NSAIDs may increase plasma cardiac glycoside levels when co-administered with cardiac glycosides such as digoxin.

Cardiac glycosides, non-potassium-sparing diuretics

The co-administration of cardiac glycosides and drugs that cause potassium and magnesium loss may enhance the effects and adverse reactions of cardiac glycosides

Cardiac glycosides, NSAID

NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma cardiac glycoside levels when co-administered with cardiac glycosides.

Cardiac glycosides, parasympathomimetics

Increased negative chronotrop effect and bradycardia

Cardiac glycosides, phenylephrine [2] ---> SmPC of [2] of eMC

An increased risk of arrhythmias may occur if phenylephrine injection is given to patients receiving cardiac glycosides

Cardiac glycosides, piretanide

The effect of the cardiac glycoside may be enhanced in case of potassium and/or magnesium loss

Cardiac glycosides, piroxicam [2] ---> SmPC of [2] of eMC

NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma glycoside levels.

Cardiac glycosides, potassium

The increase of extracellular potasium concentrations decreases the effect of the cardiac glycoside

Cardiac glycosides, potassium chloride

The increase of extracellular potasium concentrations decreases the effect of the cardiac glycoside

Cardiac glycosides, potassium sodium hydrogen citrate

The increase of extracellular potasium concentrations decreases the effect of the cardiac glycoside

Cardiac glycosides, prajmalium

Prajmaline enhances dose-dependent glycoside-induced conduction disorders

Cardiac glycosides, prednisolone

Increased cardiac glycoside effect by hypokaliemia

Cardiac glycosides, primidone

Primidone may decrease the effect of cardiac glycoside drug

Cardiac glycosides, quinine

The co-administration may increase the plasma levels of the cardiac glycoside

Cardiac glycosides, recombinant salmon calcitonin [2] ---> SmPC 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

Cardiac glycosides, roxithromycin

Roxitromycin may increase the absorption and the plasma levels of cardiac glycoside

Cardiac glycosides, senna

The chronic use of laxatives may cause hypokaliemia, which enhances the effect of cardiac glycoside

Cardiac glycosides, senna leaf

Potassium loss due to chronic use: Increased cardiac glycoside effect

Cardiac glycosides, talinolol

Strong decrease in the heart rate or delay in conduction

Cardiac glycosides, tenoxicam ---> SmPC of [ibuprofen] of eMC

NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma cardiac glycoside levels when co-administered with cardiac glycosides.

Cardiac glycosides, tetracosactide

Increased cardiac glycoside effect by hypokaliemia

Cardiac glycosides, tiapride

Bradycardia-inducing medicinal products increase the risk of ventricular arrhythmias, particularly torsades de pointes. Clinical and electrocardiographic monitoring

Cardiac glycosides, tiaprofenic acid

NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma cardiac glycoside levels.

Cardiac glycosides, tolfenamic acid

NSAID may exacerbate cardiac failure, reduce the glomerular filtration rate and increase plasma levels of the cardiac glycoside

Cardiac glycosides, torasemid [2] ---> SmPC of [2] of eMC

When used simultaneously with cardiac glycosides, a potassium and/or magnesium deficiency may increase sensitivity of the cardiac muscle to such drugs.

Cardiac glycosides, triiodthyronine

If co-administered liothyronine with cardiac glycosides, adjustment of dosage of cardiac glycoside may be necessary.

Cardiac glycosides, vitamin D

The toxicity of the cardiac glycoside may increase in case of hypercalcaemia (risk of cardiac arrhythmias). Caution is recommended

Catecholamine depleting drugs

Acebutolol, catecholamine depleting drugs

Enhanced hypotension

Betablockers, catecholamine depleting drugs ---> SmPC of [esmolol] of eMC

Catecholamine-depleting agents may have an additive effect when given with beta-blocking agents. Patients should be closely observed for evidence of hypotension or marked bradycardia

Betaxolol [1], catecholamine depleting drugs ---> SmPC of [1] of eMC

Close observation of the patient is recommended when a beta-blocker is administered to patients receiving catecholamine-depleting drugs such as reserpine, because of possible additive effects and the production of hypotension and/or bradycardia.

Carteolol, catecholamine depleting drugs

The co-administration may cause an additive beta-adrenergic blockade und bradycardia und hypotension mit dizziness, syncope or postural hypotension

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.

Catecholamine depleting drugs, celiprolol

The co-administration may increase the hypotensive effect and the negative chronotropic and dromotropic effect

Catecholamine depleting drugs, dorzolamide/timolol [2] ---> SmPC of [2] of eMC

There is a potential for additive effects resulting in hypotension and/or marked bradycardia when ophthalmic betablockers solution is administered concomitantly with catecholamine-depleting medicines

Catecholamine depleting drugs, esmolol [2] ---> SmPC of [2] of eMC

Catecholamine-depleting agents may have an additive effect when given with beta-blocking agents. Patients should be closely observed for evidence of hypotension or marked bradycardia

Catecholamine depleting drugs, nadolol [2] ---> SmPC of [2] of eMC

Catecholamine depleting drugs with nadolol may cause additive effects; monitor closely for evidence of hypotension and/or excessive bradycardia (e.g. vertigo, syncope, postural hypotension).

Catecholamine depleting drugs, oxprenolol [2] ---> SmPC of [2] of eMC

Catecholamine-depleting drugs may have an additive effect when administered concomitantly with beta-blockers. Patients should be closely observed for hypotension.

Catecholamine depleting drugs, pindolol

The potential exists for additive effects and production of hypotension and/or marked bradycardia.

Catecholamine depleting drugs, timolol

The potential exists for additive effects and production of hypotension and/or marked bradycardia.

Cationic drugs

Almasilate, cationic drugs

Almasilate, urinary alkalinizing agent, decreases the urinary excretion of cationic drug

Alogliptin/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

Ascorbic acid, cationic drugs

Ascorbic acid, urinary acidifying agent, increases the elimination of the basic (cationic) medicinal product

Baloxavir [1], polyvalent cations ---> SmPC of [1] of EMA

Products that contain polyvalent cations may decrease plasma concentrations of baloxavir. Xofluza should not be taken with products that contain polyvalent cations

Bleomycin, divalent cations

Incompatibility

Bleomycin, trivalent cations

Incompatibility

Canagliflozin/metformin [1], cationic substances eliminated by renal tubular secretion ---> SmPC of [1] of EMA

Cationic drugs, certoparin

Decreased effect of basic (cationic) medicinal product

Cationic drugs, dalteparin

Dalteparin weakens the effect of basic medicinal products (cationic drugs)

Cationic drugs, enoxaparin

Enoxaparin binds the basic medicinal product and decreases its effects

Cationic drugs, hydrotalcite

Hydrotalcite, urinary alkalinizing agent, may decrease the renal elimination of the basic (cationic) medicinal products (e.g. quinidine)

Cationic drugs, magnesium hydroxide

The magnesium hydroxide, urinary alkalinizing agent, decreases the renal elimination of the basic (cationic) medicinal product

Cationic drugs, reviparin

Reviparin binds the basic medicinal product and decreases its effects

Cationic drugs, trometamol

The urinary alkalinizing agent (trometamol) decreases the renal elimination of the basic (cationic) medicinal product

Cationic substances eliminated by renal tubular secretion, cotrimoxazole [2] ---> SmPC 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, dapagliflozin/metformin [2] ---> SmPC of [2] of EMA

Cationic substances eliminated by renal tubular secretion, empagliflozin/metformin [2] ---> SmPC 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.

Cationic substances eliminated by renal tubular secretion, linagliptin/metformin [2] ---> SmPC of [2] of EMA

Cationic substances eliminated by renal tubular secretion, metformin ---> SmPC of [linagliptin/metformin] of EMA

Cationic substances eliminated by renal tubular secretion, pioglitazone/metformin [2] ---> SmPC of [2] of EMA

Cationic substances eliminated by renal tubular secretion, saxagliptin/metformin [2] ---> SmPC of [2] of EMA

Cationic substances eliminated by renal tubular secretion, sitagliptin/metformin [2] ---> SmPC of [2] of EMA

Cationic substances eliminated by renal tubular secretion, trimethoprim/sulfamethoxazol ---> SmPC of [cotrimoxazol

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, vildagliptin/metformin [2] ---> SmPC of [2] of EMA

Chlortetracycline, divalent cations ---> SmPC 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, trivalent cations

Decreased absorption of tetracycline. It is recommended to administer the two substances at least 2 to 3 hours apart.

Ciprofloxacin [1], divalent cations ---> SmPC of [1] of eMC

Decreased absorption of ciprofloxacin. It is recommended to administer the two substances at least 3 hours apart.

Ciprofloxacin [1], trivalent cations ---> SmPC of [1] of eMC

Decreased absorption of ciprofloxacin. It is recommended to administer the two substances at least 3 hours apart.

Clodronate [1], divalent cations ---> SmPC of [1] of eMC

Clodronate forms complexes with divalent metal ions, and therefore simultaneous administration with food, antacids and mineral supplements may impair absorption.

Clodronic acid [1], divalent cations ---> SmPC of [1] of eMC

Clodronate forms complexes with divalent metal ions, and therefore simultaneous administration with food, antacids and mineral supplements may impair absorption.

Delafloxacin [1], divalent cations ---> SmPC of [1] of EMA

Oral dosing of delafloxacin with this agent may substantially interfere with the absorption of delafloxacin, resulting in systemic levels considerably lower than desired. Delafloxacin should be taken at least 2 hours before or 6 hours after this agent.

Delafloxacin [1], trivalent cations ---> SmPC of [1] of EMA

Divalent cations, doxycycline [2] ---> SmPC of [2] of eMC

Absorption of doxycycline may be impaired by concurrently administered with drugs containing aluminium, calcium, magnesium or other these cations; oral zinc, iron salts or bismuth preparations. Dosages should be maximally separated.

Divalent cations, etidronic acid [2] ---> SmPC of [2] of eMC

Vitamins with mineral supplements such as iron, calcium supplements, laxatives containing magnesium, or antacids containing calcium or aluminium should not be taken within two hours of dosing etidronate disodium.

Divalent cations, lamivudine/raltegravir [2] ---> SmPC of [2] of EMA

Co-administration of lamivudine/raltegravir with antacids containing divalent metal cations may reduce raltegravir absorption by chelation, resulting in a decrease of raltegravir plasma levels.

Divalent cations, moxifloxacin [2] ---> SmPC of [2] of eMC

An interval of about 6 hours should be left between administration of agents containing bivalent or trivalent cations and administration of moxifloxacin.

Divalent cations, quinolones ---> SmPC of [strontium ranelate] 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.

Divalent cations, raltegravir ---> SmPC of [lamivudine/raltegravir] of EMA

Co-administration of lamivudine/raltegravir with antacids containing divalent metal cations may reduce raltegravir absorption by chelation, resulting in a decrease of raltegravir plasma levels.

Dolutegravir/abacavir/lamivudine [1], polyvalent cations ---> SmPC of [1] of EMA

Triumeq should not be co-administered with polyvalent cation-containing antacids. Triumeq is recommended to be administered 2 hours before or 6 hours after these agents

Doxycycline [1], trivalent cations ---> SmPC of [1] of eMC

Etidronic acid [1], trivalent cations ---> SmPC of [1] of eMC

Ibandronic acid [1], polyvalent cations ---> SmPC of [1] of EMA

Possible decreased ibandronic acid absorption. It is recommended to take ibandronic acid at least 30 minutes before taking the other product

Moxifloxacin [1], trivalent cations ---> SmPC of [1] of eMC

An interval of about 6 hours should be left between administration of agents containing bivalent or trivalent cations and administration of moxifloxacin.

Cationic substances eliminated by renal tubular secretion