Interactions with Experimental COVID-19 Therapies

Liverpool Drug Interactions Group Interactions with Experimental COVID-19 Therapies

Charts updated 20 March 2020 Page 1 of 5 Please check www.covid19-druginteractions.org for updates. Please note that if a drug is not listed it cannot automatically be assumed it is safe to coadminister. No recommendation to use experimental therapy for COVID-19 is made. Drug interaction data for many agents are limited or absent; therefore, risk-benefit assessment for any individual patient rests with prescribers.

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ATV LPV/r RDV FAVI CLQ HCLQ NITA RBV TCZ ATV LPV/r RDV FAVI CLQ HCLQ NITA RBV TCZ Anaesthetics & Muscle Relaxants Antibacterials Alcuronium   Amikacin  Bupivacaine   Amoxicillin  Cisatracurium  Ampicillin  Desflurane  Azithromycin  Dexmedetomidine  Bedaquiline  Enflurane  Capreomycin  Ephedrine  Cefalexin   Etidocaine   Cefazolin  Halothane  Cefixime  Isoflurane  Cefotaxime  Ketamine   Ceftazidime  Minaxolone  Ceftriaxone  Nitrous oxide  Chloramphenicol  Propofol  Ciprofloxacin  Rocuronium  Clarithromycin  Sevoflurane  Clavulanic acid  Sufentanil   Clindamycin  Suxamethonium (succinylcholine)  Clofazimine  Tetracaine  Cloxacillin  Thiopental  Cycloserine  Tizanidine  Dapsone  Vecuronium  Delamanid  Analgesics Doxycycline  Alfentanil   Ertapenem  Aspirin  Erythromycin  Buprenorphine   Ethambutol  Celecoxib  Ethionamide  Codeine   Flucloxacillin   Dextropropoxyphene   Gentamicin  Diamorphine (diacetylmorphine)  Imipenem/Cilastatin  Diclofenac  Isoniazid   Dihydrocodeine   Kanamycin  Fentanyl   Levofloxacin  Hydrocodone  Linezolid  Hydromorphone  Meropenem  Ibuprofen  Metronidazole  Mefenamic acid  Moxifloxacin  Methadone  Nitrofurantoin  Morphine  Ofloxacin  Naproxen  Para-aminosalicylic acid  Nimesulide  Penicillins   Oxycodone   Piperacillin   Paracetamol (Acetaminophen)  Pyrazinamide  Pethidine (Meperidine)   Rifabutin  Piroxicam  Rifampicin  Remifentanil  Rifapentine  Tapentadol  Rifaximin  Tramadol   Spectinomycin  Antiarrhythmics Streptomycin  Amiodarone   Sulfadiazine   Bepridil  Tazobactam   Disopyramide  Telithromycin  Dofetilide  Tetracyclines  Flecainide  Tinidazole  Lidocaine (Lignocaine)  Trimethoprim/Sulfamethoxazole  Mexiletine  Vancomycin  Propafenone  Quinidine  

Key to abbreviations Key to symbols ATV Atazanavir CLQ Chloroquine  These drugs should not be coadministered LPV/r Lopinavir/ritonavir HCLQ Hydroxychloroquine  Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration RDV Remdesivir NITAZ Nitazoxanide Potential interaction likely to be of weak intensity.

FAVI Favipiravir RBV Ribavirin Additional action/monitoring or dosage adjustment is unlikely to be required TCZ Tocilizumab  No clinically significant interaction expected

© Liverpool Drug Interaction Group, University of Liverpool, Pharmacology Research Labs, 1st Floor Block H, 70 Pembroke Place, LIVERPOOL, L69 3GF We aim to ensure that information is accurate and consistent with current knowledge and practice. However, the University of Liverpool and its servants or agents shall not be responsible or in any way liable for the continued currency of information in this publication whether arising from negligence or otherwise howsoever or for any consequences arising therefrom. The University of Liverpool expressly exclude liability for errors, omissions or inaccuracies to the fullest extent permitted by law. Liverpool Drug Interactions Group Interactions with Experimental COVID-19 Therapies

Charts updated 20 March 2020 Page 2 of 5 Please check www.covid19-druginteractions.org for updates. Please note that if a drug is not listed it cannot automatically be assumed it is safe to coadminister. No recommendation to use experimental therapy for COVID-19 is made. Drug interaction data for many agents are limited or absent; therefore, risk-benefit assessment for any individual patient rests with prescribers.

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CZ ATV LPV/r RDV FAVI CLQ HCLQ NITA RBV T ATV LPV/r RDV FAVI CLQ HCLQ NITA RBV TCZ Anti-coagulant, Anti-platelet and Fibrinolytic Antidepressants Acenocoumarol   Agomelatine  Apixaban     Amitriptyline  Argatroban  Bupropion  Aspirin (anti-platelet)  Citalopram  Betrixaban  Clomipramine  Clopidogrel   Desipramine  Dabigatran  Doxepin   Dalteparin  Duloxetine   Dipyridamole  Escitalopram  Edoxaban  Fluoxetine   Eltrombopag  Fluvoxamine   Enoxaparin  Imipramine  Fondaparinux  Lithium  Heparin  Maprotiline  Phenprocoumon   Mianserin   Prasugrel   Milnacipran  Rivaroxaban     Mirtazapine  Streptokinase  Nefazodone  Ticagrelor   Nortriptyline  Warfarin   Paroxetine  Anticonvulsants Phenelzine  Carbamazepine   Reboxetine  Clonazepam  Sertraline  Eslicarbazepine  St John’s wort  Ethosuximide  Tranylcypromine  Gabapentin  Trazodone  Lacosamide   Trimipramine   Lamotrigine  Venlafaxine   Levetiracetam  Vortioxetine   Oxcarbazepine  Anti-diabetics Perampanel  Acarbose  Phenobarbital (Phenobarbitone)   Canagliflozin  Phenytoin   Dapagliflozin  Pregabalin  Dulaglutide  Primidone   Empagliflozin  Retigabine  Exanatide  Rufinamide  Glibenclamide (Glyburide)  Sultiame  Gliclazide  Tiagabine  Glimepiride  Topiramate  Glipizide  Valproate (Divalproex)  Insulin  Vigabatrin  Linagliptin  Zonisamide  Liraglutide  Metformin  Nateglinide  Pioglitazone   Repaglinide  Rosiglitazone   Saxagliptin  Sitagliptin  Tolbutamide  Vildagliptin 

Key to abbreviations Key to symbols ATV Atazanavir CLQ Chloroquine  These drugs should not be coadministered LPV/r Lopinavir/ritonavir HCLQ Hydroxychloroquine  Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration RDV Remdesivir NITAZ Nitazoxanide Potential interaction likely to be of weak intensity.

FAVI Favipiravir RBV Ribavirin Additional action/monitoring or dosage adjustment is unlikely to be required TCZ Tocilizumab  No clinically significant interaction expected

© Liverpool Drug Interaction Group, University of Liverpool, Pharmacology Research Labs, 1st Floor Block H, 70 Pembroke Place, LIVERPOOL, L69 3GF We aim to ensure that information is accurate and consistent with current knowledge and practice. However, the University of Liverpool and its servants or agents shall not be responsible or in any way liable for the continued currency of information in this publication whether arising from negligence or otherwise howsoever or for any consequences arising therefrom. The University of Liverpool expressly exclude liability for errors, omissions or inaccuracies to the fullest extent permitted by law. Liverpool Drug Interactions Group Interactions with Experimental COVID-19 Therapies

Charts updated 20 March 2020 Page 3 of 5 Please check www.covid19-druginteractions.org for updates. Please note that if a drug is not listed it cannot automatically be assumed it is safe to coadminister. No recommendation to use experimental therapy for COVID-19 is made. Drug interaction data for many agents are limited or absent; therefore, risk-benefit assessment for any individual patient rests with prescribers.

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ATV LPV/r RDV FAVI CLQ HCLQ NITA RBV TCZ ATV LPV/r RDV FAVI CLQ HCLQ NITA RBV TCZ Antifungals Anxiolytics/Hypnotics/Sedatives Amphotericin B  Alprazolam  Anidulafungin  Bromazepam   Caspofungin  Buspirone  Fluconazole    Chlordiazepoxide  Flucytosine  Clobazam  Griseofulvin  Clorazepate  Isavuconazole    Diazepam  Itraconazole    Estazolam  Ketoconazole    Flunitrazepam  Micafungin  Flurazepam  Miconazole  Hydroxyzine  Nystatin  Lorazepam  Posaconazole    Lormetazepam  Terbinafine   Midazolam (oral)  Voriconazole    Midazolam (parenteral)  Antipsychotics/Neuroleptics Oxazepam  Amisulpride  Temazepam  Aripiprazole  Triazolam  Asenapine  Zaleplon   Chlorpromazine  Zolpidem  Clozapine  Zopiclone  Fluphenazine  Beta Blockers Haloperidol  Atenolol  Iloperidone  Bisoprolol  Levomepromazine  Carvedilol  Olanzapine  Metoprolol    Paliperidone   Nebivolol    Perazine  Oxprenolol  Periciazine  Pindolol  Perphenazine  Propranolol    Pimozide  Timolol    Pipotiazine  Bronchodilators Quetiapine  Aclidinium bromide  Risperidone  Aminophylline  Sulpiride  Formoterol  Thioridazine  Glycopyrronium bromide  Tiapride  Indacaterol  Ziprasidone  Ipratropium bromide  Zotepine  Montelukast    Zuclopenthixol  Olodaterol   Antivirals Roflumilast   Atazanavir      Salbutamol  Lopinavir/ritonavir    Salmeterol  Remdesivir   Theophylline   Favipiravir   Tiotropium bromide  Chloroquine    Umeclidinium bromide     Hydroxychloroquine    Vilanterol   Nitazoxanide   Calcium Channel Blockers Ribavirin   Amlodipine  Tocilizumab  Diltiazem  Oseltamivir  Felodipine  Nicardipine   ATV and LPV/r are not intended to be Nifedipine  combined for the treatment of COVID-19 Nisoldipine  Nitrendipine  Verapamil   

Key to abbreviations Key to symbols ATV Atazanavir CLQ Chloroquine  These drugs should not be coadministered LPV/r Lopinavir/ritonavir HCLQ Hydroxychloroquine  Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration RDV Remdesivir NITAZ Nitazoxanide Potential interaction likely to be of weak intensity.

FAVI Favipiravir RBV Ribavirin Additional action/monitoring or dosage adjustment is unlikely to be required TCZ Tocilizumab  No clinically significant interaction expected

© Liverpool Drug Interaction Group, University of Liverpool, Pharmacology Research Labs, 1st Floor Block H, 70 Pembroke Place, LIVERPOOL, L69 3GF We aim to ensure that information is accurate and consistent with current knowledge and practice. However, the University of Liverpool and its servants or agents shall not be responsible or in any way liable for the continued currency of information in this publication whether arising from negligence or otherwise howsoever or for any consequences arising therefrom. The University of Liverpool expressly exclude liability for errors, omissions or inaccuracies to the fullest extent permitted by law. Liverpool Drug Interactions Group Interactions with Experimental COVID-19 Therapies

Charts updated 20 March 2020 Page 4 of 5 Please check www.covid19-druginteractions.org for updates. Please note that if a drug is not listed it cannot automatically be assumed it is safe to coadminister. No recommendation to use experimental therapy for COVID-19 is made. Drug interaction data for many agents are limited or absent; therefore, risk-benefit assessment for any individual patient rests with prescribers.

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ATV LPV/r RDV FAVI CLQ HCLQ NITA RBV TCZ ATV LPV/r RDV FAVI CLQ HCLQ NITA RBV TCZ Contraceptives/HRT Hypertension / Heart Failure Agents Desogestrel (COC)   Aliskiren  Desogestrel (POP)    Ambrisentan  Drospirenone (COC)   Amiloride  Drospirenone (HRT)  Benazepril  Dydrogesterone (HRT)   Bendroflumethiazide  Estradiol   Bosentan  Ethinylestradiol   Candesartan  Etonogestrel (implant)    Captopril  Etonogestrel (vaginal ring)   Chlortalidone  Gestodene (COC)   Cilazapril  Levonorgestrel (COC)   Clonidine  Levonorgestrel (emergency contrac.)    Digoxin  Levonorgestrel (HRT)   Dopamine  Levonorgestrel (implant)    Doxazosin  Levonorgestrel (IUD)  Enalapril  Levonorgestrel (POP)    Eplerenone  Medroxyprogesterone (depot inj.)  Epoprostenol  Medroxyprogesterone (oral)   Eprosartan  Norelgestromin (patch)   Fosinopril   Norethisterone (COC)   Furosemide  Norethisterone (HRT)   Hydralazine  Norethisterone (IM depot)   Hydrochlorothiazide  Norethisterone(POP)    Iloprost  Norgestimate (COC)   Indapamide  Norgestrel (COC)   Irbesartan   Norgestrel (HRT)   Isosorbide dinitrate  Ulipristal    Ivabradine  Gastrointestinal Agents Labetalol  Alosetron  Lacidipine  Antacids  Lercanidipine  Bisacodyl  Lisinopril  Cimetidine  Losartan   Cisapride  Macitentan  Esomeprazole  Methyldopa  Famotidine  Metolazone  Lactulose  Moxonidine  Lansoprazole  Olmesartan  Loperamide  Perindopril  Mesalazine  Prazosin  Omeprazole  Quinapril  Pantoprazole  Ramipril  Prucalopride  Ranolazine  Rabeprazole  Riociguat  Ranitidine  Sacubitril  Senna  Selexipag  Gastrointestinal Agents (anti-emetics) Sildenafil (PAH)  Aprepitant  Sodium nitroprusside  Dolasetron  Spironolactone  Domperidone  Tadalafil (PAH)  Dronabinol   Telmisartan  Granisetron  Terazosin  Metoclopramide  Torasemide   Ondansetron  Trandolapril  Prochlorperazine  Treprostinil  Valsartan  Xipamide 

Key to abbreviations Key to symbols ATV Atazanavir CLQ Chloroquine  These drugs should not be coadministered LPV/r Lopinavir/ritonavir HCLQ Hydroxychloroquine  Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration RDV Remdesivir NITAZ Nitazoxanide Potential interaction likely to be of weak intensity.

FAVI Favipiravir RBV Ribavirin Additional action/monitoring or dosage adjustment is unlikely to be required TCZ Tocilizumab  No clinically significant interaction expected

© Liverpool Drug Interaction Group, University of Liverpool, Pharmacology Research Labs, 1st Floor Block H, 70 Pembroke Place, LIVERPOOL, L69 3GF We aim to ensure that information is accurate and consistent with current knowledge and practice. However, the University of Liverpool and its servants or agents shall not be responsible or in any way liable for the continued currency of information in this publication whether arising from negligence or otherwise howsoever or for any consequences arising therefrom. The University of Liverpool expressly exclude liability for errors, omissions or inaccuracies to the fullest extent permitted by law. Liverpool Drug Interactions Group Interactions with Experimental COVID-19 Therapies

Charts updated 20 March 2020 Page 5 of 5 Please check www.covid19-druginteractions.org for updates. Please note that if a drug is not listed it cannot automatically be assumed it is safe to coadminister. No recommendation to use experimental therapy for COVID-19 is made. Drug interaction data for many agents are limited or absent; therefore, risk-benefit assessment for any individual patient rests with prescribers.

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ATV LPV/r RDV FAVI CLQ HCLQ NITA RBV TCZ Immunosuppressants Adalimumab  Anti-thymocyte globulin  Azathioprine  Basiliximab  Belatacept  Ciclosporin   Mycophenolate  Sirolimus   Tacrolimus   Inotropes & Vasopressors Adrenaline (Epinephrine)  Dobutamine  Noradrenaline  Vasopressin  Lipid Lowering Agents Atorvastatin  Bezafibrate  Clofibrate  Evolocumab  Ezetimibe  Fenofibrate  Fish oils  Fluvastatin  Gemfibrozil   Lovastatin  Pitavastatin  Pravastatin  Rosuvastatin  Simvastatin  Steroids Beclometasone  Betamethasone  Budesonide  Ciclesonide  Clobetasol  Dexamethasone  Fludrocortisone  Flunisolide  Fluocinolone  Fluticasone  Hydrocortisone (oral)  Hydrocortisone (topical)  Megestrol acetate  Methylprednisolone  Mometasone  Nandrolone  Oxandrolone  Prednisolone  Prednisone  Stanazolol  Testosterone  Triamcinolone 

Key to abbreviations Key to symbols ATV Atazanavir CLQ Chloroquine  These drugs should not be coadministered LPV/r Lopinavir/ritonavir HCLQ Hydroxychloroquine  Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration RDV Remdesivir NITAZ Nitazoxanide Potential interaction likely to be of weak intensity.

FAVI Favipiravir RBV Ribavirin Additional action/monitoring or dosage adjustment is unlikely to be required TCZ Tocilizumab  No clinically significant interaction expected

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