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Interactions

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Using bisphosphonates with proton pump inhibitors (PPIs)

4 April 2023Although no interaction between bisphosphonates and PPIs is documented, the increased risk of fractures when given together should be reviewed and managed

Using warfarin with proton pump inhibitors (PPIs)

17 June 2022PPIs may enhance warfarin anticoagulation. Patients on warfarin require counselling when starting on a PPI and INR monitored appropriately.

Using nirmatrelvir and ritonavir (Paxlovid) in practice

30 June 2023Support for prescribing decisions in people on interacting medicines, those with swallowing difficulties, renal impairment, or who are pregnant or breastfeeding

Using folic acid and phenytoin safely

12 April 2024Folic acid interacts with phenytoin and can reduce phenytoin blood levels. Concomitant use is possible with careful management of the interaction.

Interactions

All our advice relating to medicine interactions, with recommendations on management options.

Understanding drug interactions

15 January 2024This article discusses different mechanisms of drug interactions. We link to other SPS articles to help support decision making.

Using contraception with enzyme-inducing medicines

13 February 2023Enzyme-inducing medicines reduce the effectiveness of certain contraceptives. Guidance on using contraception with these medicines is given.

Using clopidogrel with proton pump inhibitors (PPIs)

22 May 2023Avoid the combined use of clopidogrel with omeprazole or esomeprazole due to a significant interaction. Other PPIs are considered safe with clopidogrel.

Managing specific interactions with smoking

31 October 2023When individuals taking certain medicines stop, start or re-start smoking, monitoring and dose changes may be needed.

Using miconazole oral gel with statins

30 November 2021Treatment of candidiasis with miconazole is complicated by concurrent HMG-CoA reductase inhibitor (statin) use because of potential for drug interactions.
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