Trandolapril and verapamil Dose in Adults

Risk Factor C (Monitor therapy)

Abemaciclib

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Abemaciclib.

Alcohol (Ethyl)

Verapamil may increase the serum concentration of Alcohol (Ethyl).

Alfuzosin

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Alpha1-Blockers

May enhance the hypotensive effect of Calcium Channel Blockers.

Amiodarone

Calcium Channel Blockers (Nondihydropyridine) may enhance the bradycardic effect of Amiodarone. Sinus arrest has been reported.

AmLODIPine

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of AmLODIPine.

Amphetamines

May diminish the antihypertensive effect of Antihypertensive Agents.

Angiotensin II

The therapeutic efficacy of angiotensin II may be enhanced by angiotensin-converting enzyme inhibitors.

Antipsychotic Agents (Second Generation [Atypical])

Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]).

Apixaban

Apixaban's serum levels may rise when taken with CYP3A4 Inhibitors (Moderate).

Aprotinin

May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.

ARIPiprazole

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of ARIPiprazole. Management: Monitor for increased aripiprazole pharmacologic effects. Aripiprazole dose adjustments may or may not be required based on concomitant therapy and/or indication. Consult full interaction monograph for specific recommendations.

Aspirin

Calcium Channel Blockers (Nondihydropyridine) may enhance the antiplatelet effect of Aspirin.

Atosiban

Calcium Channel Blockers may enhance the adverse/toxic effect of Atosiban. Specifically, there may be an increased risk for pulmonary edema and/or dyspnea.

AzaTHIOprine

AzaTHIOprine's myelosuppressive effects may be enhanced by angiotensin-converting enzyme inhibitors.

Barbiturates

May increase the metabolism of Calcium Channel Blockers. Management: Monitor for decreased therapeutic effects of calcium channel blockers with concomitant barbiturate therapy. Calcium channel blocker dose adjustments may be necessary. Nimodipine Canadian labeling contraindicates concomitant use with phenobarbital.

Barbiturates

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Benperidol

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Benzhydrocodone

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Benzhydrocodone. Specifically, the concentration of hydrocodone may be increased.

Beta-Blockers

Calcium Channel Blockers (Nondihydropyridine) may enhance the hypotensive effect of Beta-Blockers. Bradycardia and signs of heart failure have also been reported. Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of Beta-Blockers. Exceptions: Levobunolol; Metipranolol.

Blonanserin

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Blonanserin.

Bosentan

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Bosentan

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Bosentan. Management: Concomitant use of both a CYP2C9 inhibitor and a CYP3A inhibitor or a single agent that inhibits both enzymes with bosentan is likely to cause a large increase in serum concentrations of bosentan and is not recommended. See monograph for details.

Bradycardia-Causing Agents

May enhance the bradycardic effect of other Bradycardia-Causing Agents.

Brentuximab Vedotin

The serum concentration of Brentuximab Vedotin may rise in response to P-glycoprotein/ABCB1 Inhibitors. More specifically, levels of the substance's active monomethyl auristatin E (MMAE) component might rise.

Bretylium

May enhance the bradycardic effect of Bradycardia-Causing Agents. Bretylium may also enhance atrioventricular (AV) blockade in patients receiving AV blocking agents.

Brexpiprazole

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Brexpiprazole. Management: The brexpiprazole dose should be reduced to 25% of usual if used together with both a moderate CYP3A4 inhibitor and a strong or moderate CYP2D6 inhibitor, or if a moderate CYP3A4 inhibitor is used in a CYP2D6 poor metabolizer.

Brimonidine (Topical)

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

BusPIRone

Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of BusPIRone.

Calcium Channel Blockers (Dihydropyridine)

May enhance the hypotensive effect of Calcium Channel Blockers (Nondihydropyridine). Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of Calcium Channel Blockers (Dihydropyridine).

Calcium Salts

May diminish the therapeutic effect of Calcium Channel Blockers.

Cannabidiol

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Cannabidiol.

Cannabis

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Cannabis. More specifically, tetrahydrocannabinol and cannabidiol serum concentrations may be increased.

Cardiac Glycosides

Calcium Channel Blockers (Nondihydropyridine) may enhance the AVblocking effect of Cardiac Glycosides. Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of Cardiac Glycosides.

Clofazimine

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

CloNIDine

May enhance the AV-blocking effect of Calcium Channel Blockers (Nondihydropyridine). Sinus node dysfunction may also be enhanced.

Clopidogrel

Calcium Channel Blockers may diminish the therapeutic effect of Clopidogrel.

CloZAPine

CYP1A2 Inhibitors (Weak) may increase the serum concentration of CloZAPine. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.

Codeine

CYP3A4 Inhibitors (Moderate) may increase serum concentrations of the active metabolite(s) of Codeine.

CYP3A4 Inducers (Moderate)

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

CYP3A4 Inhibitors (Moderate)

May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).

CYP3A4 Substrates (High risk with Inhibitors)

CYP3A4 Inhibitors (Moderate) may decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors). Exceptions: Alitretinoin (Systemic); Praziquantel; Trabectedin; Vinorelbine.

Deferasirox

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

Dexmethylphenidate

Can lessen an antihypertensive drug's therapeutic impact.

Diazoxide

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Dipeptidyl Peptidase-IV Inhibitors

May worsen angiotensin-converting enzyme inhibitors' toxic or severe effects. Particularly, there may be a higher incidence of angioedema.

Dronabinol

Dronabinol's serum levels may rise in response to moderate CYP3A4 inhibitors.

Drospirenone

Drospirenone's hyperkalemic impact may be enhanced by angiotensin-converting enzyme inhibitors.

DULoxetine

The hypotensive impact of DULoxetine may be enhanced by blood pressure lowering medications.

Duvelisib

May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).

Efavirenz

Calcium Channel Blockers' serum concentration can drop.

Erdafitinib

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Erdafitinib

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Erdafitinib

May increase the serum concentration of P-glycoprotein/ABCB1 Substrates.

Estrogen Derivatives

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Estrogen Derivatives.

Ferric Gluconate

Angiotensin-Converting Enzyme Inhibitors might make ferric gluconate more harmful or poisonous.

Ferric Hydroxide Polymaltose Complex

Ferric Hydroxide Polymaltose Complex may have a more negative or toxic effect when taken with angiotensin-converting enzyme inhibitors. In particular, there may be an elevated risk for angioedema or allergic responses.

Fexofenadine

Fexofenadine's serum levels may rise in response to verapamil.

Fingolimod

Verapamil may increase Fingolimod's bradycardic effects.

Flecainide

Verapamil may intensify Flecainide's harmful or hazardous effects. This combination may drastically reduce AV nodal conduction and myocardial contractility, in particular.

Fluconazole

May increase the serum concentration of Calcium Channel Blockers.

Fosnetupitant

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Gelatin (Succinylated)

Gelatin's harmful or toxic effects may be increased by angiotensin-converting enzyme inhibitors (Succinylated). Particularly, there may be a higher chance of a paradoxical hypotensive reaction.

Gold Sodium Thiomalate

Gold Sodium Thiomalate may have a more negative or toxic effect when used with angiotensin-converting enzyme inhibitors. Nitritoid responses are more likely now, it has been noted.

Grapefruit Juice

Verapamil serum levels can rise.

Halofantrine

Halofantrine's serum levels may rise in response to moderate CYP3A4 inhibitors. Management: If halofantrine is taken with mild CYP3A4 inhibitors, extreme caution and potentially increased ECG monitoring should be required. Drugs marked as exclusions from this document are covered in separate monographs on drug interactions.

Heparin

Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.

Heparins (Low Molecular Weight)

Angiotensin-Converting Enzyme Inhibitors may have an enhanced hyperkalemic impact.

Herbs (Hypertensive Properties)

May lessen the effectiveness of antihypertensive agents.

Herbs (Hypotensive Properties)

The hypotensive effects of blood pressure-lowering medications may be strengthened.

HYDROcodone

CYP3A4 Inhibitors (Moderate) may raise the level of Hydrocodone in the blood.

Hypotension-Associated Agents

The hypotensive action of hypotension-associated agents may be strengthened by blood pressure lowering medications.

Icatibant

May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.

Ifosfamide

The active metabolite(s) of ifosfamide may be present in lower serum concentrations when CYP3A4 Inhibitors (Moderate) are used.

Imatinib

Imatinib's serum levels may rise when taken with CYP3A4 Inhibitors (Moderate).

Lacosamide

Bradycardia-Causing Substances may intensify Lacosamide's AV-blocking effects.

Larotrectinib

May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).

Larotrectinib

P-glycoprotein/ABCB1 Inhibitors may raise larotrectinib's serum levels.

Levodopa-Containing Products

Levodopa-Containing Products' hypotensive effects may be strengthened by blood pressure-lowering medications.

Loop Diuretics

May strengthen angiotensin-converting enzyme inhibitors' hypotensive effects.

Lormetazepam

Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by loop diuretics.

Magnesium Salts

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Manidipine

Manidipine's serum levels may rise when taken with CYP3A4 Inhibitors (Moderate).

MetFORMIN

Verapamil may lessen MetFORMIN's therapeutic impact.

Methylphenidate

May lessen the effectiveness of antihypertensive agents.

Midodrine

Bradycardia-Causing Agents' bradycardic effect might be enhanced.

Mirodenafil

The serum concentration of Mirodenafil may rise in response to CYP3A4 Inhibitors (Moderate).

Molsidomine

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Naftopidil

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Naldemedine

Naldemedine's serum levels may rise in response to CYP3A4 Inhibitors (Moderate).

Naldemedine

The serum concentration of Naldemedine may rise in response to P-glycoprotein/ABCB1 Inhibitors.

Nalfurafine

Nalfurafine's serum levels may rise in response to CYP3A4 Inhibitors (Moderate).

Netupitant

May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).

Neuromuscular-Blocking Agents (Nondepolarizing)

The neuromuscular-blocking impact of neuromuscular-blocking agents may be enhanced by calcium channel blockers (Nondepolarizing).

Nicergoline

Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.

Nicorandil

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Nicorandil

The hypotensive effects of blood pressure-lowering medications may be strengthened.

NiMODipine

NiMODipine's serum levels may rise in response to moderate CYP3A4 inhibitors.

Nintedanib

Combination CYP3A4 and P-glycoprotein inhibitors may raise the level of Nintedanib in the blood.

Nitroprusside

Nitroprusside's hypotensive impact may be strengthened by blood pressure-lowering medications.

Nonsteroidal Anti-Inflammatory Agents

Nonsteroidal Anti-Inflammatory Agents' negative/toxic effects may be increased by angiotensin-converting enzyme inhibitors. In particular, the combination may cause a marked decline in renal function. Angiotensin-Converting Enzyme Inhibitors' antihypertensive effects may be lessened by nonsteroidal anti-inflammatory drugs.

Opioids (Anilidopiperidine)

Calcium Channel Blockers' bradycardic impact might be boosted (Nondihydropyridine). Anilidopiperidine, a kind of opioid, may increase the hypotensive effects of calcium channel blockers (Nondihydropyridine).

OxyCODONE

CYP3A4 Inhibitors (Moderate) may intensify OxyCODONE's harmful/toxic effects. The serum concentration of OxyCODONE may rise in response to moderately potent CYP3A4 inhibitors. The active metabolite Oxymorphone's serum concentrations could also rise.

Palbociclib

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Pentoxifylline

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Pexidartinib

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Pexidartinib.

P-glycoprotein/ABCB1 Inhibitors

May increase the serum concentration of Pglycoprotein/ABCB1 Substrates. P-glycoprotein inhibitors may also enhance the distribution of pglycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.).

P-glycoprotein/ABCB1 Substrates

P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of P-glycoprotein/ABCB1 Substrates. P-glycoprotein inhibitors may also enhance the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Exceptions: Loperamide.

Pholcodine

Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine.

Phosphodiesterase 5 Inhibitors

May enhance the hypotensive effect of Blood Pressure Lowering Agents.

Pimecrolimus

CYP3A4 Inhibitors (Moderate) may decrease the metabolism of Pimecrolimus.

Potassium Salts

Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.

Potassium-Sparing Diuretics

Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.

Pregabalin

Angiotensin-Converting Enzyme Inhibitors may intensify Pregabalin's negative/toxic effects. Particularly, there may be a higher incidence of angioedema.

Propafenone

Propafenone's serum levels may rise when taking CYP3A4 Inhibitors (Moderate). Management: Separate drug interaction monographs go into further detail about the medications indicated as exceptions to this book.

Prostacyclin Analogues

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Prucalopride

Prucalopride's serum levels may rise in response to P-glycoprotein/ABCB1 inhibitors.

Quinagolide

The hypotensive effects of blood pressure-lowering medications may be strengthened.

QuiNIDine

Verapamil's hypotensive effects should be improved. QuiNIDine's serum levels may rise in response to verapamil.

Racecadotril

May intensify angiotensin-converting enzyme inhibitors' harmful or hazardous effects. In particular, this combination may make angioedema more likely.

Red Yeast Rice

The blood content of Red Yeast Rice may rise in response to Calcium Channel Blockers (Nondihydropyridine). Particularly, levels of lovastatin (and perhaps other similar substances) may rise.

Regorafenib

Calcium Channel Blockers' bradycardic impact might be boosted (Nondihydropyridine).

RifAXIMin

The concentration of RifAXIMin in the serum may rise in response to P-glycoprotein/ABCB1 inhibito

RisperiDONE

RisperiDONE's serum levels may rise in response to verapamil.

Rupatadine

Rupatadine's serum levels may rise in response to moderate CYP3A4 inhibitors.

Ruxolitinib

Bradycardia-Causing Agents' bradycardic effect might be enhanced. Treatment with roxolitinib Canadian product labels advise against using bradycardia-inducing substances as much as possible.

Ruxolitinib

Ruxolitinib's serum levels may rise when taken with CYP3A4 Inhibitors (Moderate).

Salicylates

May intensify angiotensin-converting enzyme inhibitors' nephrotoxic effects. The therapeutic benefit of angiotensin-converting enzyme inhibitors may be reduced by salicylates.

Salmeterol

Salmeterol's serum levels may rise in response to CYP3A4 Inhibitors (Moderate).

Sarilumab

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

SAXagliptin

The serum levels of SAXagliptin may rise in response to moderately potent CYP3A4 inhibitors.

Sildenafil

The serum concentration of Sildenafil may rise in response to CYP3A4 Inhibitors (Moderate).

Silodosin

The serum concentration of Silodosin may rise in response to P-glycoprotein/ABCB1 Inhibitors.

Silodosin

Silodosin's serum levels may rise in response to moderate CYP3A4 inhibitors.

Siltuximab

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

Tacrolimus (Systemic)

Tacrolimus metabolism may be slowed down by calcium channel blockers (nonhydropyridine) (Systemic).

Tacrolimus (Systemic)

Angiotensin-Converting Enzyme Inhibitors may enhance the hyperkalemic effect of Tacrolimus (Systemic).

Tacrolimus (Topical)

Calcium Channel Blockers (Nondihydropyridine) may decrease the metabolism of Tacrolimus (Topical).

Tamsulosin

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Tamsulosin.

Tegaserod

P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Tegaserod.

Temsirolimus

May intensify angiotensin-converting enzyme inhibitors' harmful or hazardous effects.

Terlipressin

Bradycardia-Causing Agents' bradycardic effect might be enhanced.

Tetrahydrocannabinol

Tetrahydrocannabinol's serum levels may rise in response to moderate CYP3A4 inhibitors.

Thiazide and Thiazide-Like Diuretics

May increase the angiotensin-converting enzyme inhibitors' hypotensive effects.

Ticagrelor

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Ticagrelor.

Tocilizumab

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).

Tofacitinib

May enhance the bradycardic effect of Bradycardia-Causing Agents.

Trabectedin

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Trabectedin.

Trimethoprim

Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects.

Udenafil

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Udenafil.

Vilazodone

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Vilazodone.

Vindesine

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Vindesine.

Yohimbine

May diminish the antihypertensive effect of Antihypertensive Agents.

Zuclopenthixol

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Zuclopenthixol.

Risk Factor D (Consider therapy modification)

Acalabrutinib

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Acalabrutinib. Management: Reduce acalabrutinib dose to 100 mg once daily with concurrent use of a moderate CYP3A4 inhibitor. Monitor patient closely for both acalabrutinib response and evidence of adverse effects with any concurrent use.

Afatinib

P-glycoprotein/ABCB1 Inhibitors may raise the level of Afatinib in the serum. Management: If afatinib is poorly tolerated, reduce the dose by 10 mg. Some non-US labelling advises staying away from combinations wherever possible. If using, give the P-gp inhibitor either right away or right after the afatinib dose.

Aliskiren

Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. Angiotensin-Converting Enzyme Inhibitors' hypotensive effects may be strengthened by aliskiren. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be made worse by aliskiren. Treatment: It is not advised for diabetic patients to take aliskiren along with ACEIs or ARBs. Combination therapy should be avoided in other patients, especially when CrCl is less than 60 mL/min. If combined, keep a close eye on your blood pressure, potassium, and creatinine levels.

Allopurinol

Angiotensin-Converting Enzyme Inhibitors might make Allopurinol more likely to cause allergic or hypersensitive reactions.

Amifostine

Amifostine's hypotensive impact may be strengthened by blood pressure lowering medications. Treatment: Blood pressure-lowering drugs need to be avoided for 24 hours before amifostine is administered when used at chemotherapeutic doses. Amifostine should not be given if blood pressure lowering treatment cannot be stopped.

Angiotensin II Receptor Blockers

May worsen angiotensin-converting enzyme inhibitors' toxic or severe effects. Angiotensin-Converting Enzyme Inhibitors' serum levels may rise in response to angiotensin II receptor blockers. Management: According to US labelling, it is not advisable to take telmisartan and ramipril. It is unclear whether another ACE inhibitor and ARB combo would be any safer. When possible, take into account alternatives to the mix.

Antifungal Agents (Azole Derivatives, Systemic)

May enhance the adverse/toxic effect of Calcium Channel Blockers. Specifically, itraconazole may enhance the negative inotropic effects of verapamil or diltiazem. Antifungal Agents (Azole Derivatives, Systemic) may decrease the metabolism of Calcium Channel Blockers. Fluconazole and isavuconazonium likely exert weaker effects than other azoles and are addressed in separate monographs. Management: Concurrent use of felodipine or nisoldipine with itraconazole is specifically contraindicated. Frequent monitoring is warranted with any such combination; calcium channel blocker dose reductions may be required. Exceptions: Fluconazole; Isavuconazonium Sulfate.

AtorvaSTATin

May increase the serum concentration of Verapamil. Verapamil may increase the serum concentration of AtorvaSTATin. Management: Consider using lower atorvastatin doses when used together with verapamil.

Avanafil

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Avanafil. Management: The maximum avanafil adult dose is 50 mg per 24-hour period when used together with a moderate CYP3A4 inhibitor. Patients receiving such a combination should also be monitored more closely for evidence of adverse effects.

Betrixaban

The serum concentration of betrixaban may rise in response to P-glycoprotein/ABCB1 inhibitors. Treatment: If betrixaban is used with a P-glycoprotein inhibitor, reduce the adult dose to an initial single dose of 80 mg, followed by a dose of 40 mg once day.

Bilastine

The serum concentration of bilastine may rise in response to P-glycoprotein/ABCB1 inhibitors. Management: When possible, look into alternatives; bilastine should be avoided in patients using p-glycoprotein inhibitors who have moderate to severe renal insufficiency.

Brigatinib

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Brigatinib. Management: Avoid concurrent use of brigatinib with moderate CYP3A4 inhibitors when possible. If such a combination cannot be avoided, reduce the dose of brigatinib by approximately 40% (ie, from 180 mg to 120 mg, from 120 mg to 90 mg, or from 90 mg to 60 mg).

Bromocriptine

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Bromocriptine. Management: The bromocriptine dose should not exceed 1.6 mg daily with use of a moderate CYP3A4 inhibitor. The Cycloset brand specifically recommends this dose limitation, but other bromocriptine products do not make such specific recommendations.

Budesonide (Topical)

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Budesonide (Topical). Management: Per US prescribing information, avoid this combination. Canadian product labeling does not recommend strict avoidance. If combined, monitor for excessive glucocorticoid effects as budesonide exposure may be increased.

CarBAMazepine

Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of CarBAMazepine. CarBAMazepine may decrease the serum concentration of Calcium Channel Blockers (Nondihydropyridine). Management: Consider empiric reductions in carbamazepine dose with initiation of nondihydropyridine calcium channel blockers. Monitor for increased toxic effects of carbamazepine and reduced therapeutic effects of the calcium channel blocker.

Celiprolol

Celiprolol's bradycardic action may be enhanced by verapamil. Celiprolol's serum levels may rise in response to verapamil. Treatment: It is not advised to use verapamil and celiprolol simultaneously, especially in patients who already have conduction issues. A drug-free interval is advised when transitioning from one agent to another, and heart rate should be constantly watched.

Ceritinib

Bradycardia-Causing Agents may intensify Ceritinib's bradycardic impact. Management: If this combination cannot be avoided, continuously monitor patients' blood pressure and heart rate throughout therapy and look for any signs of symptomatic bradycardia in them. A separate monograph is dedicated to discussing exceptions.

Cilostazol

Cilostazol's serum levels may rise in response to CYP3A4 Inhibitors (Moderate). Management: When treating adult patients who are already using mild CYP3A4 inhibitors, think about lowering the dose of cilostazol to 50 mg twice daily.

Cimetidine

Calcium Channel Blockers' serum levels can rise. Management: Take cimetidine substitutes into consideration. If there is no suitable substitute, watch for increased calcium channel blocker effects after starting or increasing the dosage of cimetidine and decreased effects after stopping or decreasing the dosage.

Colchicine

Colchicine's serum levels may rise after taking CYP3A4 Inhibitors (Moderate). Management: Increase monitoring for colchicine-related toxicity and decrease colchicine dose as advised when used with a moderate CYP3A4 inhibitor. For information, see the entire monograph. Patients with weakened liver or kidney function should be treated with extreme caution.

Colchicine

The serum concentration of colchicine may rise in response to P-glycoprotein/ABCB1 inhibitors. It's possible that colchicine will distribute more widely throughout some tissues, like the brain. Treatment: Patients receiving a p-glycoprotein inhibitor and having compromised renal or hepatic function should not take colchicine. Colchicine dosage should be decreased in patients with normal renal and hepatic function as instructed. For information, see the entire monograph.

CycloSPORINE (Systemic

Nondihydropyridine, a calcium channel blocker, may slow the metabolism of cycloSPORINE (Systemic). Calcium Channel Blockers may have slower metabolism when CycloSPORINE (Systemic) is taken (Nondihydropyridine).

CYP3A4 Inducers (Strong)

May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.

CYP3A4 Inhibitors (Strong)

May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).

Dabigatran Etexilate

The active metabolite(s) of dabigatran etexilate may be present in higher serum quantities when verapamil is used. Treatment: You might want to give dabigatran two hours before taking oral verapamil; you could also need to lower other doses. Regarding renal function, dabigatran indication, and US vs. Canadian labelling, different recommendations apply. Refer to the dabigatran labelling or the complete monograph.

Dabrafenib

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).

Dapoxetine

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Dapoxetine. Management: The dose of dapoxetine should be limited to 30 mg per day when used together with a moderate inhibitor of CYP3A4.

Deflazacort

CYP3A4 Inhibitors (Moderate) may increase serum concentrations of the active metabolite(s) of Deflazacort. Management: Administer one third of the recommended deflazacort dose when used together with a strong or moderate CYP3A4 inhibitor.

DOXOrubicin (Conventional)

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of DOXOrubicin (Conventional). Management: Seek alternatives to moderate CYP3A4 inhibitors in patients treated with doxorubicin whenever possible. One U.S. manufacturer (Pfizer Inc.) recommends that these combinations be avoided.

DOXOrubicin (Conventional)

P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of DOXOrubicin (Conventional). Management: Seek alternatives to P-glycoprotein inhibitors in patients treated with doxorubicin whenever possible. One U.S. manufacturer (Pfizer Inc.) recommends that these combinations be avoided.

Dronedarone

Calcium Channel Blockers (Nondihydropyridine) may enhance the AV-blocking effect of Dronedarone. Other electrophysiologic effects of Dronedarone may also be increased. Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of Dronedarone. Dronedarone may increase the serum concentration of Calcium Channel Blockers (Nondihydropyridine). Management: Use lower starting doses of the nondihydropyridine calcium channel blockers (i.e., verapamil, diltiazem), and only consider increasing calcium channel blocker dose after obtaining ECG-based evidence that the combination is being well-tolerated.

Edoxaban

The concentration of Edoxaban in the serum may rise in response to P-glycoprotein/ABCB1 inhibitors. Management: For more, see the whole monograph. Patients taking edoxaban for venous thromboembolism in conjunction with specific P-gp inhibitors are advised to take it in lower doses. It is not advised to modify the dosage when using edoxaban for atrial fibrillation.

Eletriptan

Eletriptan's serum levels may rise when taken with CYP3A4 Inhibitors (Moderate). Management: Eletriptan shouldn't be taken within 72 hours of a moderate CYP3A4 inhibitor.

Eliglustat

Eliglustat's serum levels may rise when taken with CYP3A4 Inhibitors (Moderate). Management: There are specific situations when use should be avoided. For information, consult the entire medication interaction monograph.

Encorafenib

Encorafenib's serum levels may rise when taken with CYP3A4 Inhibitors (Moderate). Management: Whenever possible, refrain from taking moderate CYP3A4 inhibitors and encorafenib concurrently. Reduce the encorafenib dose before beginning to use the CYP3A4 inhibitor if concurrent administration is required. For information, see the entire monograph.

Entrectinib

Entrectinib's serum levels may rise when used with CYP3A4 Inhibitors (Moderate). Management: When taking entrectinib, stay away from mild CYP3A4 inhibitors. If the combination cannot be avoided in adults and children 12 years of age and older with a BSA of at least 1.5 square metres, reduce the dose to 200 mg/day. There isn't a substitute dosage offered for others.

Enzalutamide

May lower the serum level of CYP3A4 substrates (High risk with Inducers). Treatment: Enzalutamide should not be used concurrently with CYP3A4 substrates that have a limited therapeutic index. Enzalutamide use, like with the use of any other CYP3A4 substrate, should be done cautiously and under close observation.

Eplerenone

Eplerenone's serum levels may rise in response to CYP3A4 Inhibitors (Moderate). Management: Depending on the indication and foreign labelling, different doses of eplerenone should be used concurrently with mild CYP3A4 inhibitors. For information, consult the entire medication interaction monograph.

Esmolol

Calcium Channel Blockers (Nondihydropyridine) may enhance the bradycardic effect of Esmolol. Management: Administration of IV verapamil or diltiazem together with esmolol is contraindicated if one agent is given while the effects of the other are still present. Canadian esmolol labeling specifies that use within 24 hours is contraindicated.

Everolimus

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Everolimus. Management: Everolimus dose reductions are required for most indications. See full monograph or prescribing information for specific dose adjustment and monitoring recommendations.

Everolimus

Inhibitors of CYP3A4 (Moderate) and P-glycoprotein may increase the serum concentration of Everolimus. Management: Everolimus dose reductions are required for most indications. See full monograph or prescribing information for specific dose adjustment and monitoring recommendations.

FentaNYL

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of FentaNYL. Management: Monitor patients closely for several days following initiation of this combination, and adjust fentanyl dose as necessary.

Fosphenytoin

Calcium Channel Blockers may increase the serum concentration of Fosphenytoin. Management: Monitor for phenytoin toxicity with concomitant use of a calcium channel blocker (CCB) or decreased phenytoin effects with CCB discontinuation. Monitor for decreased CCB therapeutic effects. Nimodipine Canadian labeling contraindicates use with phenytoin.

Grass Pollen Allergen Extract (5 Grass Extract)

Grass pollen allergen extract may have a more negative or toxic effect if angiotensin-converting enzyme inhibitors are used (5 Grass Extract). With regard to grass pollen allergen extract, ACE inhibitors may specifically enhance the likelihood of a severe allergic reaction (5 Grass Extract).

GuanFACINE

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of GuanFACINE. Management: Reduce the guanfacine dose by 50% when initiating this combination.

Ibrutinib

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Ibrutinib. Management: When treating B-cell malignancies, decrease ibrutinib to 280 mg daily when combined with moderate CYP3A4 inhibitors. When treating graft versus host disease, monitor patients closely and reduce the ibrutinib dose as needed based on adverse reactions.

Iron Dextran Complex

Angiotensin-Converting Enzyme Inhibitors might make Iron Dextran Complex more harmful or poisonous. Patients taking an ACE inhibitor may be more susceptible to events of the anaphylactic variety. Management: Adhere strictly to the instructions for iron dextran administration, including the use of a test dose before the initial therapeutic dose and the availability of resuscitation tools and qualified people.

Ivacaftor

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Ivacaftor. Management: Ivacaftor dose reductions are required; consult full monograph content for specific age- and weight-based recommendations. No dose adjustment is needed when using ivacaftor/lumacaftor with a moderate CYP3A4 inhibitor.

Ivosidenib

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Ivosidenib. Management: Avoid use of moderate CYP3A4 inhibitors with ivosidenib whenever possible. If combined, monitor for increased ivosidenib toxicities. Drugs listed as exceptions are discussed in further detail in separate drug interaction monographs.

Lanthanum

May lower angiotensin-converting enzyme inhibitors' serum concentration. Angiotensin-converting enzyme inhibitors should be given at least two hours before or after lanthanum.

Lefamulin

Lefamulin's levels in the serum may rise in response to P-glycoprotein/ABCB1 inhibitors. Avoid taking lefamulin tablets at the same time as P-glycoprotein/ABCB1 inhibitors. Watch for any negative effects of lefamulin if concurrent use is necessary.

Lithium

The serum concentration of lithium may rise in response to angiotensin-converting enzyme inhibitors. Management: After adding an ACE inhibitor, lithium dosage decreases will probably be required. Following the addition or discontinuation of concurrent ACE inhibitor therapy, carefully monitor the patient's response to lithium.

Lorlatinib

May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: Avoid taking lorlatinib at the same time as any CYP3A4 substrates for which even a small drop in serum levels of the substrate could result in therapeutic failure and negative clinical outcomes.

Lovastatin

Lovastatin's serum levels may rise in response to verapamil. Treatment: In patients on verapamil, start lovastatin at a maximum adult dose of 10 mg/day and do not go over 20 mg/day. Watch out for HMG-CoA reductase inhibitor toxicity symptoms (e.g., myositis, rhabdomyolysis).

Lurasidone

Lurasidone's serum levels may rise in response to moderate CYP3A4 inhibitors. Treatment: According to the US labelling for lurasidone, the dose should be cut in half and used with a mild CYP3A4 inhibitor. Some non-US labelling advises starting with 20 mg/day of lurasidone and limiting the dosage to 40 mg/day; concurrent use of grapefruit products should be avoided.

Macrolide Antibiotics

Calcium Channel Blockers' metabolic rate might be decreased. Use a noninteracting macrolide as a possible management strategy. The Canadian labelling for felodipine expressly advises against using it in conjunction with clarithromycin. Azithromycin (Systemic), Fidaxomicin, Roxithromycin, and Spiramycin are exceptions.

Meperidine

Meperidine's serum levels may rise in response to moderate CYP3A4 inhibitors. Management: If concomitant usage with mild CYP3A4 inhibitors is necessary, take into account lowering the dose of meperidine. When these medications are taken together, keep an eye out for any signs and symptoms of sedation and respiratory depression.

MiFEPRIStone

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus.

Mitotane

May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane.

Obinutuzumab

May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion.

Olaparib

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Olaparib. Management: Avoid use of moderate CYP3A4 inhibitors in patients being treated with olaparib, if possible. If such concurrent use cannot be avoided, the dose of olaparib should be reduced to 150 mg twice daily.

Phenytoin

Calcium Channel Blockers may increase the serum concentration of Phenytoin. Phenytoin may decrease the serum concentration of Calcium Channel Blockers. Management: Avoid use of nimodipine or nifedipine with phenytoin. Monitor for phenytoin toxicity and/or decreased calcium channel blocker effects with any concurrent use.

Protease Inhibitors

May decrease the metabolism of Calcium Channel Blockers (Nondihydropyridine). Increased serum concentrations of the calcium channel blocker may increase risk of AV nodal blockade. Management: Avoid concurrent use when possible. If used, monitor for CCB toxicity. The manufacturer of atazanavir recommends a 50% dose reduction for diltiazem be considered. Saquinavir, tipranavir, and darunavir/cobicistat use with bepridil is contraindicated.

Ranolazine

Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of Ranolazine. Management: Limit ranolazine dose to a maximum of 500 mg twice daily when used with diltiazem or verapamil.

Ranolazine

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Ranolazine. Management: Limit the ranolazine adult dose to a maximum of 500 mg twice daily in patients concurrently receiving moderate CYP3A4 inhibitors (e.g., diltiazem, verapamil, erythromycin, etc.).

Rifamycin Derivatives

May decrease the serum concentration of Calcium Channel Blockers. This primarily affects oral forms of calcium channel blockers. Management: The labeling for some US and Canadian calcium channel blockers contraindicate use with rifampin, however recommendations vary. Consult appropriate labeling.

Rivaroxaban

Rivaroxaban's serum levels may rise in response to P-glycoprotein and CYP3A4 (Moderate) inhibitors. Management: In patients with normal renal function, nothing needs to be done. In individuals with estimated creatinine clearances of 15 to 80 mL/min, US labelling advises against using it unless the potential benefits exceed the hazards. Different labels from other countries may exist.

Simvastatin

Simvastatin's serum levels may rise in response to verapamil. Management: When at all feasible, refrain from taking simvastatin and verapamil together. Simcor (simvastatin/niacin) should not be used since the fixed simvastatin doses in the product surpass the adult maximum dose of 10 mg/day when used jointly.

Sincalide

The therapeutic benefit of Sincalide may be reduced by medications that affect gallbladder function. Prior to using sincalide to induce gallbladder contraction, you should think about stopping any medications that can impair gallbladder motility.

Siponimod

Siponimod's bradycardic action may be enhanced by bradycardia-causing substances. Management: Steer clear of combining siponimod with medications that can slow your heart rate.

Sirolimus

The serum concentration of Sirolimus may rise after taking CYP3A4 Inhibitors (Moderate). Management: If sirolimus is taken with a mild CYP3A4 inhibitor, keep an eye out for elevated serum concentrations. Lower starting dosages of sirolimus or dose reductions of sirolimus will probably be needed.

Sodium Phosphates

The nephrotoxic impact of sodium phosphates may be enhanced by angiotensin-converting enzyme inhibitors. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking ACEIs or look into alternatives to the oral sodium phosphate bowel preparation in order to prevent this combo. Maintaining appropriate hydration and properly monitoring renal function should be done if the combination cannot be avoided.

Sonidegib

Sonidegib's serum levels may rise when taken with CYP3A4 Inhibitors (Moderate). Management: Whenever possible, refrain from taking moderate CYP3A4 inhibitors and sonidegib concurrently. Limit the use of CYP3A4 inhibitors to less than 14 days when concurrent usage cannot be avoided, and keep an eye out for sonidegib toxicity (particularly musculoskeletal adverse reactions).

St John's Wort

May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: Take into account a substitute for one of the interfering medications. Specific contraindications may apply to some combinations. the relevant manufacturer's label.

Stiripentol

May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors). Management: Due to the increased potential for side effects and toxicity, stiripentol should not be used with CYP3A4 substrates that are thought to have a narrow therapeutic index. With stiripentol, any CYP3A4 substrate may be utilised.

Suvorexant

Suvorexant's serum levels may rise when taken with CYP3A4 Inhibitors (Moderate). Treatment: Suvorexant is administered at a dose of 5 mg per day to patients who are on a mild CYP3A4 inhibitor. If more dosage is required for effectiveness, the maximum amount per day is 10 mg.

Talazoparib

Talazoparib's serum levels may rise in response to verapamil. Management: Lower the dose of talazoparib to 0.75 mg once daily if concomitant use cannot be avoided. Increase the talazoparib dosage to the level used before the start of verapamil after a period of 3 to 5 times the half-life of verapamil.

Telithromycin

Verapamil's bradycardic effects could be boosted. Telithromycin might make Verapamil's hypotensive impact even stronger.

Tezacaftor

Tezacaftor's serum levels may rise when taken with CYP3A4 Inhibitors (Moderate). Treatment: Tezacaftor/ivacaftor should be administered in the morning, every other day, when taken with mild CYP3A4 inhibitors. Every other day, on days when tezacaftor and ivacaftor are given alternately, ivacaftor alone should be administered in the morning.

TiZANidine

The concentration of TiZANidine in the serum may rise in response to CYP1A2 Inhibitors (Weak). Management: Whenever you can, stay away from these pairings. Tizanidine should be started at an adult dose of 2 mg and increased in 2 to 4 mg increments depending on the patient's reaction if combination use is required. Watch out for tizanidine side effects, such as increased effects.

Tolvaptan

Tolvaptan's serum levels may rise in response to CYP3A4 Inhibitors (Moderate). Management: When used with a mild CYP3A4 inhibitor, jynarque dosage must be adjusted. For more detailed advice, consult the complete interaction monograph or labelling.

Urapidil

Angiotensin-Converting Enzyme Inhibitors may interact with them through an unidentified method. Avoid taking urapidil and ACE inhibitors simultaneously as a management strategy.

Venetoclax

Venetoclax's serum levels may rise in response to moderate CYP3A4 inhibitors. Management: In patients who need these combinations, lower the dose of venetoclax by at least 50%.

Venetoclax

Venetoclax serum levels may rise in response to P-glycoprotein/ABCB1 inhibitors. In patients who need concurrent treatment with P-glycoprotein (P-gp) inhibitors, consider reducing the dose of venetoclax by at least 50%.

Zopiclone

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Zopiclone. Management: The starting adult dose of zopiclone should not exceed 3.75 mg if combined with a moderate CYP3A4 inhibitor. Monitor patients for signs and symptoms of zopiclone toxicity if these agents are combined.

Risk Factor X (Avoid combination)

Aprepitant

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Aprepitant.

Asunaprevir

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Asunaprevir.

Bosutinib

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Bosutinib.

Bromperidol

The hypotensive impact of bromperidol may be enhanced by blood pressure lowering medications. Blood Pressure Lowering Agents' hypotensive effects may be lessened by bromperidol.

Budesonide (Systemic)

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Budesonide (Systemic).

Cobimetinib

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Cobimetinib. Management: Avoid the concomitant use of cobimetinib and moderate CYP3A4 inhibitors. If concurrent short term (14 days or less) use cannot be avoided, reduce the cobimetinib dose to 20 mg daily.

Conivaptan

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Dantrolene

May enhance the hyperkalemic effect of Calcium Channel Blockers (Nondihydropyridine). Dantrolene may enhance the negative inotropic effect of Calcium Channel Blockers (Nondihydropyridine). Management: This interaction has only been described with intravenous dantrolene administration.

Disopyramide

May make calcium channel blockers' hyperkalemic impact stronger (Nondihydropyridine). Dantrolene may intensify Calcium Channel Blockers' adverse inotropic impact (Nondihydropyridine). Management: Only intravenous dantrolene administration has been used to characterise this interaction.

Dofetilide

Dofetilide's serum levels may rise in response to verapamil.

Domperidone

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Domperidone. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.

Flibanserin

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Flibanserin.

Fosaprepitant

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Fosaprepitant.

Fusidic Acid (Systemic)

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Idelalisib

May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Ivabradine

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Ivabradine.

Ivabradine

Calcium Channel Blockers (Nondihydropyridine) may enhance the bradycardic effect of Ivabradine. Ivabradine may enhance the QTc-prolonging effect of Calcium Channel Blockers (Nondihydropyridine). Specifically, the QTc prolonging effects of bepridil may be enhanced. Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of Ivabradine. Specifically, verapamil or diltiazem may increase serum ivabradine concentrations.

Lomitapide

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Lomitapide.

Naloxegol

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Naloxegol.

Neratinib

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Neratinib.

PAZOPanib

P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of PAZOPanib.

Pimozide

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Pimozide.

Sacubitril

The negative or hazardous effects of sacubitril may be increased by angiotensin-converting enzyme inhibitors. In particular, this combination may raise the risk of angioedema.

Simeprevir

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Simeprevir.

Topotecan

The serum concentration of topotecan may rise in response to P-glycoprotein/ABCB1 inhibitors.

Ulipristal

CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Ulipristal. Management: This is specific for when ulipristal is being used for signs/symptoms of uterine fibroids (Canadian indication). When ulipristal is used as an emergency contraceptive, patients receiving this combination should be monitored for ulipristal toxicity.

VinCRIStine (Liposomal)

P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of VinCRIStine (Liposomal).