l MEDICINAL FORMS There can be variation in the licensing of

different medicines containing the same drug.

Solution for injection

▶ Viper venom antiserum, European (equine) (Imported (Croatia))

European viper snake venom antiserum 100 mg per 1 ml Viper

venom antiserum, European (equine) 1g/10ml solution for injection

vials | 1 vial P s

1372 Snake bites BNF 78

Emergency treatment of poisoning

16

Appendix 1

Interactions

Changes have been made to the interactions content in BNF

publications. For more information, see www.bnf.org/new-bnfinteractions/.

Two or more drugs given at the same time can exert their

effects independently or they can interact. Interactions may

be beneficial and exploited therapeutically; this type of

interaction is not within the scope of this appendix. Many

interactions are harmless, and even those that are

potentially harmful can often be managed, allowing the

drugs to be used safely together. Nevertheless, adverse drug

interactions should be reported to the Medicines and

Healthcare products Regulatory Agency (MHRA), through

the Yellow Card Scheme (see Adverse reactions to drugs

p. 12), as for other adverse drug reactions.

Potentially harmful drug interactions may occur in only a

small number of patients, but the true incidence is often

hard to establish. Furthermore the severity of a harmful

interaction is likely to vary from one patient to another.

Patients at increased risk from drug interactions include the

elderly and those with impaired renal or hepatic function.

Interactions can result in the potentiation or antagonism

of one drug by another, or result in another effect, such as

renal impairment. Drug interactions may develop either

through pharmacokinetic or pharmacodynamic mechanisms.

Pharmacodynamic interactions

These are interactions between drugs which have similar or

antagonistic pharmacological effects or side-effects. They

might be due to competition at receptor sites, or occur

between drugs acting on the same physiological system.

They are usually predictable from a knowledge of the

pharmacology of the interacting drugs; in general, those

demonstrated with one drug are likely to occur with related

drugs.

Pharmacokinetic interactions

These occur when one drug alters the absorption,

distribution, metabolism, or excretion of another, thus

increasing or decreasing the amount of drug available to

produce its pharmacological effects. Pharmacokinetic

interactions occurring with one drug do not necessarily

occur uniformly across a group of related drugs.

Affecting absorption The rate of absorption and the total

amount absorbed can both be altered by drug interactions.

Delayed absorption is rarely of clinical importance unless a

rapid effect is required (e.g. when giving an analgesic).

Reduction in the total amount absorbed, however, can result

in ineffective therapy.

Affecting distribution Due to changes in protein binding: To a

variable extent most drugs are loosely bound to plasma

proteins. Protein-binding sites are non-specific and one drug

can displace another thereby increasing the proportion free

to diffuse from plasma to its site of action. This only

produces a detectable increase in effect if it is an extensively

bound drug (more than 90%) that is not widely distributed

throughout the body. Even so displacement rarely produces

more than transient potentiation because this increased

concentration of free drug will usually be eliminated.

Displacement from protein binding plays a part in the

potentiation of warfarin by sulfonamides but these

interactions become clinically relevant mainly because

warfarin metabolism is also inhibited.

Induction or inhibition of drug transporter proteins: Drug

transporter proteins, such as P-glycoprotein, actively

transport drugs across biological membranes. Transporters

can be induced or inhibited, resulting in changes in the

concentrations of drugs that are substrates for the

transporter. For example, rifampicin induces P-glycoprotein,

particularly in the gut wall, resulting in decreased plasma

concentrations of digoxin, a P-glycoprotein substrate.

Affecting metabolism Many drugs are metabolised in the

liver. Drugs are either metabolised by phase I reactions

(oxidation, reduction, or hydrolysis) or by phase II reactions

(e.g. glucoronidation).

Phase I reactions are mainly carried out by the cytochrome

P450 family of isoenzymes, of which CYP3A4 is the most

important isoenzyme involved in the metabolism of drugs.

Induction of cytochrome P450 isoenzymes by one drug can

increase the rate of metabolism of another, resulting in

lower plasma concentrations and a reduced effect. On

withdrawal of the inducing drug, plasma concentrations

increase and toxicity can occur.

Conversely when one drug inhibits cytochrome P450

isoenzymes, it can decrease the metabolism of another,

leading to higher plasma concentrations, resulting in an

increased effect with a risk of toxicity.

Isoenzymes of the hepatic cytochrome P450 system

interact with a wide range of drugs. With knowledge of which

isoenzymes are involved in a drug’s metabolism, it is

possible to predict whether certain pharmacokinetic

interactions will occur. For example, carbamazepine is a

potent inducer of CYP3A4, ketoconazole is potent inhibitor

of CYP3A4, and midazolam is a substrate of CYP3A4.

Carbamazepine reduces midazolam concentrations, and it is

therefore likely that other drugs that are potent inducers of

CYP3A4 will interact similarly with midazolam.

Ketoconazole, however, increases midazolam

concentrations, and it can be predicted that other drugs that

are potent inhibitors of CYP3A4 will interact similarly.

Less is known about the enzymes involved in phase II

reactions. These include UDP-glucuronyltransferases which,

for example, might be induced by rifampicin, resulting in

decreased metabolism of mycophenolate (a substrate for this

enzyme) to its active form, mycophenolic acid.

Affecting renal excretion Drugs are eliminated through the

kidney both by glomerular filtration and by active tubular

secretion. Competition occurs between those which share

active transport mechanisms in the proximal tubule. For

example, salicylates and some other NSAIDs delay the

excretion of methotrexate; serious methotrexate toxicity is

possible. Changes in urinary pH can also affect the

reabsorption of a small number of drugs, including

methenamine.

BNF 78 Appendix 1 Interactions 1373

Interactions | Appendix 1

A1

Relative importance of interactions

Levels of severity: Most interactions have been assigned a

severity; this describes the likely effect of an unmanaged

interaction on the patient.

Severe—the result may be a life-threatening event or have

a permanent detrimental effect.

Moderate—the result could cause considerable distress or

partially incapacitate a patient; they are unlikely to be lifethreatening or result in long-term effects.

Mild—the result is unlikely to cause concern or

incapacitate the majority of patients.

Unknown—used for those interactions that are predicted,

but there is insufficient evidence to hazard a guess at the

outcome.

Levels of evidence: Most interactions have been assigned

a rating to indicate the weight of evidence behind the

interaction.

Study—for interactions where the information is based on

formal study including those for other drugs with same

mechanism (e.g. known inducers, inhibitors, or substrates of

cytochrome P450 isoenzymes or P-glycoprotein).

Anecdotal—interactions based on either a single case

report or a limited number of case reports.

Theoretical—interactions that are predicted based on

sound theoretical considerations. The information may have

been derived from in vitro studies or based on the way other

members in the same class act.

Action messages: Each interaction describes the effect

that occurs, and the action to be taken, either based on

manufacturer’s advice from the relevant Summary of

Product Characteristics or advice from a relevant authority

(e.g. MHRA). An action message is only included where the

combination is to be avoided, where a dose adjustment is

required, or where specific administration requirements (e.g

timing of doses) are recommended. Pharmacodynamic

interactions, with the exception of interactions with drugs

that may prolong the QT interval, do not have an action

message included as these will depend on individual patient

circumstances.

Appendix 1 structure

.1 Drugs

Drugs are listed alphabetically. If a drug is a member of a

drug class, all interactions for that drug will be listed

under the drug class entry; in this case the drug entry

provides direction to the relevant drug class where its

interactions can be found.

Within a drug or drug class entry, interactions are listed

alphabetically by the interacting drug or drug class. The

interactions describe the effect that occurs, and the action

to be taken, either based on manufacturer’s advice from

the relevant Summary of Product Characteristics or advice

from a relevant authority (e.g. MHRA). An action message

is only included where the combination is to be avoided,

where a dose adjustment is required, or where specific

administration requirements (e.g. timing of doses) are

recommended. If two drugs have a pharmacodynamic

effect in addition to a pharmacokinetic interaction, a crossreference to the relevant pharmacodynamic effect table

is included at the end of the pharmacokinetic message.

.2 Drug classes

The drugs that are members of a drug class are listed

underneath the drug class entry in a blue box. Interactions

for the class are then listed alphabetically by the

interacting drug or drug class. If the interaction only

applies to certain drugs in the class, these drugs will be

shown in brackets after the drug class name.

.3 Supplementary information

If a drug has additional important information to be

considered, this is shown in a blue box underneath the

drug or drug class entry. This information might be food

and lifestyle advice (including smoking and alcohol

consumption), relate to the pharmacology of the drug or

applicability of interactions to certain routes of

administration, or it might be advice about separating

administration times.

.4 Pharmacodynamic effects

Tables at the beginning of Appendix 1 cover

pharmacodynamic effects. If a drug is included in one or

more of these tables, this will be indicated at the top of the

list of interactions for the drug or drug class. In addition to

the list of interactions for a drug or drug class, these

tables should always be consulted.

Each table describes the relevant pharmacodynamic

effect and lists those drugs that are commonly associated

with the effect. Concurrent use of two or more drugs from

the same table is expected to increase the risk of the

pharmacodynamic effect occurring. Please note these

tables are not exhaustive.

.1 Drug entry

▶ Details of interaction between drug entry and another drug

or drug class. Action statement.ZEvidence

▶ Details of interaction between drug entry and another drug

or drug class. Action statement.ZEvidence

→ Also see TABLE 1

Drug entry → see Drug class entry

.2 Drug class entry

Drug A . Drug B . Drug C . Drug D. ▶ Details of interaction between drug class entry and another

drug or drug class. Action statement.ZEvidence

.3 Drug entry or Drug class entry

Supplementary information

.4 Drug entry or Drug class entry → see TABLE 1

TABLE 1

Name of pharmacodynamic effect

Explanation of the effect

Drug

Drug

Drug

Drug

Drug

Drug

1374 Appendix 1 Interactions BNF 78

Interactions | Appendix 1

A1

TABLE 1

Drugs that cause hepatotoxicity

The following is a list of some drugs that cause hepatotoxicity (note that this list is not exhaustive). Concurrent use of two or more drugs

from the list might increase this risk.

alcohol (beverage)

alectinib

asparaginase

atorvastatin

bedaquiline

carbamazepine

clavulanic acid

crisantaspase

dactinomycin

dantrolene

demeclocycline

didanosine

doxycycline

flucloxacillin

fluconazole

fluvastatin

isoniazid

itraconazole

leflunomide

lenalidomide

lomitapide

lymecycline

mercaptopurine

methotrexate

micafungin

minocycline

oxytetracycline

paracetamol

pegaspargase

pravastatin

rosuvastatin

simvastatin

streptozocin

sulfasalazine

tetracycline

tigecycline

trabectedin

valproate

vincristine

TABLE 2

Drugs that cause nephrotoxicity

The following is a list of some drugs that cause nephrotoxicity (note that this list is not exhaustive). Concurrent use of two or more drugs

from the list might increase this risk.

aceclofenac

aciclovir

adefovir

amikacin

amphotericin

bacitracin

capreomycin

carboplatin

cefaclor

cefadroxil

cefalexin

cefixime

cefotaxime

cefradine

ceftaroline

ceftazidime

ceftobiprole

ceftolozane

ceftriaxone

cefuroxime

celecoxib

ciclosporin

cidofovir

cisplatin

colistimethate (particularly

intravenous)

dexibuprofen

dexketoprofen

diclofenac

etodolac

etoricoxib

flurbiprofen

foscarnet

ganciclovir

gentamicin

ibuprofen

ifosfamide

indometacin

ketoprofen

ketorolac

mefenamic acid

meloxicam

methotrexate

nabumetone

naproxen

neomycin

oxaliplatin

parecoxib

pemetrexed

penicillamine

pentamidine

piroxicam

polymyxins

streptomycin

streptozocin

sulindac

tacrolimus

telavancin

tenofovir disoproxil

tenoxicam

tiaprofenic acid

tobramycin

tolfenamic acid

trimethoprim

valaciclovir

valganciclovir

vancomycin

zidovudine

zoledronic acid

TABLE 3

Drugs with anticoagulant effects

The following is a list of drugs that have anticoagulant effects. Concurrent use of two or more drugs from this list might increase the risk

of bleeding; concurrent use of drugs with antiplatelet effects (see table of drugs with antiplatelet effects) might also increase this risk.

acenocoumarol

alteplase

apixaban

argatroban

bivalirudin

dabigatran

dalteparin

danaparoid

edoxaban

enoxaparin

fondaparinux

heparin (unfractionated)

nicotinic acid

omega-3-acid ethyl esters

phenindione

rivaroxaban

streptokinase

tenecteplase

tinzaparin

urokinase

warfarin

TABLE 4

Drugs with antiplatelet effects

The following is a list of drugs that have antiplatelet effects (note that this list is not exhaustive). Concurrent use of two or more drugs

from this list might increase the risk of bleeding; concurrent use of drugs with anticoagulant effects (see table of drugs with anticoagulant

effects) might also increase this risk.

aceclofenac

anagrelide

aspirin

bevacizumab

cangrelor

celecoxib

cilostazol

citalopram

clopidogrel

dapoxetine

dasatinib

dexibuprofen

dexketoprofen

diclofenac

dipyridamole

duloxetine

epoprostenol

eptifibatide

escitalopram

etodolac

etoricoxib

fluoxetine

flurbiprofen

fluvoxamine

ibrutinib

ibuprofen

iloprost

indometacin

inotersen

ketoprofen

ketorolac

mefenamic acid

meloxicam

nabumetone

naproxen

parecoxib

paroxetine

piroxicam

prasugrel

regorafenib

sertraline

sulindac

tenoxicam

tiaprofenic acid

ticagrelor

tirofiban

tolfenamic acid

trastuzumab emtansine

venlafaxine

vortioxetine

TABLE 5

Drugs that cause thromboembolism

The following is a list of some drugs that cause thromboembolism (note that this list is not exhaustive). Concurrent use of two or more

drugs from the list might increase this risk.

bleomycin

cyclophosphamide

darbepoetin alfa

doxorubicin

epoetin alfa

epoetin beta

epoetin zeta

fluorouracil

fulvestrant

lenalidomide

methotrexate

mitomycin

pentostatin

pomalidomide

raloxifene

tamoxifen

thalidomide

tibolone

toremifene

tranexamic acid

tretinoin

vinblastine

vincristine

vindesine

vinflunine

vinorelbine

BNF 78 Appendix 1 Interactions 1375

Interactions | Appendix 1

A1

TABLE 6

Drugs that cause bradycardia

The following is a list of drugs that cause bradycardia (note that this list is not exhaustive). Concurrent use of two or more drugs from the

list might increase this risk.

acebutolol

alectinib

alfentanil

amiodarone

apraclonidine

atenolol

betaxolol

bisoprolol

brimonidine

carvedilol

celiprolol

cisatracurium

clonidine

crizotinib

digoxin

diltiazem

donepezil

esmolol

fentanyl

fingolimod

flecainide

galantamine

ivabradine

labetalol

levobunolol

methadone

metoprolol

nadolol

nebivolol

neostigmine

pasireotide

pindolol

propranolol

pyridostigmine

remifentanil

rivastigmine

selegiline

sotalol

sufentanil

thalidomide

timolol

tizanidine

verapamil

TABLE 7

Drugs that cause first dose hypotension

The following is a list of some drugs that can cause first-dose hypotension (note that this list is not exhaustive). Concurrent use of two or

more drugs from the list might increase this risk.

alfuzosin

azilsartan

candesartan

captopril

doxazosin

enalapril

eprosartan

fosinopril

glyceryl trinitrate

imidapril

indoramin

irbesartan

isosorbide dinitrate

isosorbide mononitrate

lisinopril

losartan

olmesartan

perindopril

prazosin

quinapril

ramipril

tamsulosin

telmisartan

terazosin

trandolapril

valsartan

TABLE 8

Drugs that cause hypotension

The following is a list of some drugs that cause hypotension (note that this list is not exhaustive). Concurrent use of two or more drugs

from the list might increase this risk.

acebutolol

alcohol (beverage)

alfuzosin

aliskiren

alprostadil

amantadine

amitriptyline

amlodipine

apomorphine

apraclonidine

aripiprazole

asenapine

atenolol

avanafil

azilsartan

baclofen

bendroflumethiazide

benperidol

betaxolol

bisoprolol

bortezomib

brimonidine

bromocriptine

bumetanide

cabergoline

canagliflozin

candesartan

captopril

cariprazine

carvedilol

celiprolol

chlorothiazide

chlorpromazine

chlortalidone

clevidipine

clomipramine

clonidine

clozapine

dapagliflozin

desflurane

diazoxide

diltiazem

dipyridamole

dosulepin

doxazosin

doxepin

droperidol

empagliflozin

enalapril

eplerenone

eprosartan

ertugliflozin

esketamine

esmolol

etomidate

felodipine

flupentixol

fluphenazine

fosinopril

furosemide

glyceryl trinitrate

guanethidine

guanfacine

haloperidol

hydralazine

hydrochlorothiazide

hydroflumethiazide

imidapril

imipramine

indapamide

indoramin

irbesartan

isocarboxazid

isoflurane

isosorbide dinitrate

isosorbide mononitrate

ketamine

labetalol

lacidipine

lercanidipine

levobunolol

levodopa

levomepromazine

lisinopril

lofepramine

lofexidine

losartan

loxapine

lurasidone

methoxyflurane

methyldopa

metolazone

metoprolol

minoxidil

moxisylyte

moxonidine

nadolol

nebivolol

nicardipine

nicorandil

nifedipine

nimodipine

nitrous oxide

nortriptyline

olanzapine

olmesartan

paliperidone

pergolide

pericyazine

perindopril

phenelzine

pimozide

pindolol

pramipexole

prazosin

prochlorperazine

promazine

propofol

propranolol

quetiapine

quinagolide

quinapril

ramipril

riociguat

risperidone

ropinirole

rotigotine

sacubitril

sapropterin

selegiline

sevoflurane

sildenafil

sodium nitroprusside

sodium oxybate

sotalol

spironolactone

sulpiride

tadalafil

tamsulosin

telmisartan

terazosin

thiopental

timolol

tizanidine

torasemide

trandolapril

tranylcypromine

trifluoperazine

trimipramine

valsartan

vardenafil

verapamil

xipamide

zuclopenthixol

1376 Appendix 1 Interactions BNF 78

Interactions | Appendix 1

A1

TABLE 9

Drugs that prolong the QT interval

The following is a list of some drugs that prolong the QT-interval (note that this list is not exhaustive). In general, manufacturers advise

that the use of two or more drugs that are associated with QT prolongation should be avoided. Increasing age, female sex, cardiac disease,

and some metabolic disturbances (notably hypokalaemia) predispose to QT prolongation—concurrent use of drugs that reduce serum

potassium might further increase this risk (see table of drugs that reduce serum potassium).

Drugs that are not known to prolong the QT interval but are predicted (by the manufacturer) to increase the risk of QT prolongation

include: domperidone, fingolimod, granisetron, ivabradine, mefloquine, mizolastine, palonosetron, and intravenous pentamidine. Most

manufacturers advise avoiding concurrent use with drugs that prolong the QT interval.

amifampridine

amiodarone

amisulpride

anagrelide

apalutamide

apomorphine

arsenic trioxide

artemether

artenimol

bedaquiline

bosutinib

cabozantinib

ceritinib

chlorpromazine

citalopram

clarithromycin

clomipramine

crizotinib

dasatinib

delamanid

disopyramide

dronedarone

droperidol

efavirenz

encorafenib

eribulin

erythromycin

escitalopram

flecainide

fluconazole

fluphenazine

haloperidol

hydroxyzine

inotuzumab ozogamicin

lapatinib

lenvatinib

levomepromazine

lithium

lofexidine

methadone

moxifloxacin

nilotinib

ondansetron

osimertinib

paliperidone

panobinostat

pasireotide

pazopanib

pimozide

quinine

ranolazine

ribociclib

risperidone

saquinavir

sildenafil

sorafenib

sotalol

sulpiride

sunitinib

telavancin

tetrabenazine

tizanidine

tolterodine

toremifene

vandetanib

vardenafil

vemurafenib

venlafaxine

vinflunine

voriconazole

zuclopenthixol

TABLE 10

Drugs with antimuscarinic effects

The following is a list of some drugs that have antimuscarinic effects (note that this list is not exhaustive). Concurrent use of two or more

drugs from this list might increase the risk of these effects occurring. Drugs with antimuscarinic effects decrease the absorption of

levodopa.

aclidinium

amantadine

amitriptyline

atropine

baclofen

chlorphenamine

chlorpromazine

clemastine

clomipramine

clozapine

cyclizine

cyclopentolate

cyproheptadine

darifenacin

dicycloverine

dimenhydrinate

disopyramide

dosulepin

doxepin

fesoterodine

flavoxate

glycopyrronium

haloperidol

homatropine

hydroxyzine

hyoscine

imipramine

ipratropium

levomepromazine

lofepramine

loxapine

nefopam

nortriptyline

orphenadrine

oxybutynin

pimozide

prochlorperazine

procyclidine

promethazine

propafenone

propantheline

propiverine

solifenacin

tiotropium

tolterodine

trifluoperazine

trihexyphenidyl

trimipramine

tropicamide

trospium

umeclidinium

TABLE 11

Drugs with CNS depressant effects

The following is a list of some drugs with CNS depressant effects (note that this list is not exhaustive). Concurrent use of two or more

drugs from this list might increase the risk of CNS depressant effects, such as drowsiness, which might affect the ability to perform skilled

tasks (see ’Drugs and Driving’ in Guidance on Prescribing p. 1).

agomelatine

alcohol (beverage)

alfentanil

alimemazine

alprazolam

amisulpride

apraclonidine

aripiprazole

articaine

asenapine

baclofen

benperidol

brimonidine

buclizine

bupivacaine

buprenorphine

cannabis extract

cariprazine

chloral hydrate

chlordiazepoxide

chlorphenamine

chlorpromazine

cinnarizine

clemastine

clobazam

clomethiazole

clonazepam

clonidine

clozapine

codeine

cyclizine

cyproheptadine

desflurane

dexmedetomidine

diamorphine

diazepam

dihydrocodeine

dipipanone

droperidol

esketamine

etomidate

fentanyl

flupentixol

fluphenazine

flurazepam

gabapentin

guanfacine

haloperidol

hydromorphone

hydroxyzine

isoflurane

ketamine

ketotifen

lamotrigine

levetiracetam

levomepromazine

lidocaine

lofexidine

loprazolam

lorazepam

lormetazepam

loxapine

lurasidone

melatonin

mepivacaine

meprobamate

meptazinol

methadone

methocarbamol

methoxyflurane

mianserin

midazolam

mirtazapine

morphine

moxonidine

nabilone

nitrazepam

nitrous oxide

olanzapine

oxazepam

oxycodone

paliperidone

papaveretum

pentazocine

perampanel

pericyazine

pethidine

phenobarbital

pimozide

pizotifen

pregabalin

prilocaine

primidone

prochlorperazine

promazine

promethazine

propofol

quetiapine

remifentanil

risperidone

ropivacaine

sevoflurane

sodium oxybate

sufentanil

sulpiride

tapentadol

temazepam

tetracaine

thalidomide

thiopental

tizanidine

tramadol

trazodone

trifluoperazine

venlafaxine

zolpidem

zopiclone

zuclopenthixol

BNF 78 Appendix 1 Interactions 1377

Interactions | Appendix 1

A1

TABLE 12

Drugs that cause peripheral neuropathy

The following is a list of some drugs that cause peripheral neuropathy (note that this list is not exhaustive). Concurrent use of two or more

drugs from the list might increase this risk.

amiodarone

bortezomib

brentuximab vedotin

cabazitaxel

cisplatin

didanosine

disulfiram

docetaxel

eribulin

fosphenytoin

isoniazid

lamivudine

metronidazole

nitrofurantoin

paclitaxel

phenytoin

stavudine

thalidomide

vinblastine

vincristine

vindesine

vinflunine

vinorelbine

TABLE 13

Drugs that cause serotonin syndrome

The following is a list of some drugs that cause serotonin syndrome (note that this list is not exhaustive). See ’Serotonin Syndrome’ and

’Monoamine-Oxidase Inhibitors’ under Antidepressant drugs p. 359 for more information and for specific advice on avoiding monoamineoxidase inhibitors during and after administration of other serotonergic drugs.

almotriptan

bupropion

buspirone

citalopram

clomipramine

dapoxetine

dexamfetamine

duloxetine

eletriptan

escitalopram

fentanyl

fluoxetine

fluvoxamine

frovatriptan

granisetron

imipramine

isocarboxazid

linezolid

lisdexamfetamine

lithium

methadone

methylthioninium chloride

mianserin

mirtazapine

moclobemide

naratriptan

ondansetron

palonosetron

paroxetine

pentazocine

pethidine

phenelzine

procarbazine

rasagiline

rizatriptan

safinamide

selegiline

sertraline

St John’s Wort

sumatriptan

tapentadol

tramadol

tranylcypromine

trazodone

tryptophan

venlafaxine

vortioxetine

zolmitriptan

TABLE 14

Antidiabetic drugs

The following is a list of antidiabetic drugs (note that this list is not exhaustive). Concurrent use of two or more drugs from the list might

increase the risk of hypoglycaemia.

acarbose

alogliptin

canagliflozin

dapagliflozin

dulaglutide

empagliflozin

ertugliflozin

exenatide

glibenclamide

gliclazide

glimepiride

glipizide

insulins

linagliptin

liraglutide

lixisenatide

metformin

nateglinide

pioglitazone

repaglinide

saxagliptin

semaglutide

sitagliptin

tolbutamide

vildagliptin

TABLE 15

Drugs that cause myelosuppression

The following is a list of some drugs that cause myelosuppression (note that this list is not exhaustive). Concurrent use of two or more

drugs from the list might increase this risk.

afatinib

aflibercept

alemtuzumab

amsacrine

anakinra

arsenic trioxide

asparaginase

axitinib

azacitidine

azathioprine

balsalazide

belimumab

bendamustine

bevacizumab

bleomycin

blinatumomab

bortezomib

bosutinib

brentuximab vedotin

busulfan

cabazitaxel

cabozantinib

canakinumab

capecitabine

carbimazole

carboplatin

carfilzomib

carmustine

ceritinib

cetuximab

chlorambucil

cisplatin

cladribine

clofarabine

clozapine

crisantaspase

crizotinib

cyclophosphamide

cytarabine

dabrafenib

dacarbazine

dactinomycin

dasatinib

daunorubicin

decitabine

deferiprone

docetaxel

doxorubicin