Caution should be exercised when abacavir and ribavirin are coadministered. As abacavir and ribavirin share the same phosphorylation pathways a possible intracellular interaction has been postulated which could decrease ribavirin intracellular phosphorylated metabolites and result in a reduced likelihood of SVR. While some initial data suggested that HIV/HCV co-infected patients receiving abacavir-containing regimens may be at risk of lower response to ribavirin therapy, this has not been confirmed in more recent studies. In addition a well-designed study to evaluate the effects of abacavir on intracellular ribavirin triphosphate and plasma ribavirin concentrations failed to show any significant effect.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Abiraterone has multiple metabolic pathways and is an inhibitor of CYP2D6.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Acalabrutinib is a CYP3A4 and P-gp substrate.

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely as acamprosate does not undergo significant metabolism.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as aceclofenac is metabolised by CYP2C9.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as aciclovir is eliminated primarily unchanged in the urine via active renal tubular secretion.

Coadministration has not been studied. Activated charcoal absorbs substances in the stomach and intestines and may decrease absorption of orally administered medications. If coadministration is required, administration of activated charcoal and ribavirin should be separated by 4 hours. [Note: this interaction is not specific for ribavirin, but for any medication taken with activated charcoal.]

Coadministration has not been studied, but based on metabolism and clearance a clinically significant interaction is unlikely as agomelatine is metabolised predominantly via CYP1A2. Note, agomelatine is contraindicated in hepatic impairment as increases in exposure of up to 140-times have been seen in cirrhotic patients.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Albiglutide is a protein for which the expected metabolic pathway is degradation to small peptides and individual amino acids by ubiquitous proteolytic enzymes. However, as albiglutide slows gastric emptying it is advisable to take ribavirin at least 1 hour before an albiglutide injection. [Note: this interaction is not specific for ribavirin, but for any medication taken with albiglutide.]

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as alemtuzumab is a protein for which the expected metabolic pathway is degradation to small peptides and individual amino acids by widely distributed proteolytic enzymes.

Co-administration has not been studied. There is no evidence in humans or animals that alendronic acid undergoes metabolism, therefore, a pharmacokinetic interaction appears unlikely. However, if taken at the same time, it is likely that food and beverages (including mineral water), calcium supplements, antacids, and some oral medicinal products will interfere with absorption of alendronate. Therefore, patients must wait at least 30 minutes after taking alendronate before taking any other oral medicinal product. [Note: this interaction is not specific for ribavirin, but for any medication taken with alendronic acid.]

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. However, allopurinol can cause anaemia which should be monitored for when given in combination with ribavirin. Note, the European SPC and US Prescribing Information for allopurinol recommend a reduced dose in hepatic impairment.

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely. Aloe vera is only a weak inhibitor of CYPs in vitro and therefore is unlikely to cause clinically significant interactions. It does not inhibit P-gp and there is no evidence to suggest it impacts UGTs.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Alogliptin does not undergo extensive metabolism and is excreted mainly unchanged in the urine and metabolism by CYPs is minimal. No transporter interactions have been described.

Coadministration has not been studied but based on limited understanding of metabolism and clearance a clinically significant interaction is unlikely. However as alverine citrate affects gastric motility, an effect on the absorption of ribavirin cannot be ruled out. Doses of ribavirin and alverine should be separated by 4 hours if possible. [Note: this interaction is not specific for ribavirin, but for any medication taken with alverine citrate.]

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Asenapine is metabolized by glucuronidation (UGT1A4) and oxidative metabolism (mainly CYP1A2, with minor contributions from CYP3A4 and CYP2D6). As asenapine is metabolised by multiple pathways, a clinically significant effect is unlikely.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Avelumab is primarily metabolised through catabolic pathways and drug-drug interactions are not expected.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Axitinib is metabolised by CYP3A4.

Coadministration has not been studied but based on metabolism and clearance a clinically significant drug interaction is unlikely. Aztreonam is only minimally metabolised and is eliminated mainly unchanged in the urine.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bedaquiline is metabolised by CYP3A4.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bendroflumethiazide is mainly eliminated by hepatic metabolism, although the exact pathway is not known. It is unlikely that CYP enzymes are involved in this process and no transporter interactions have been described.

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely. Benralizumab is a humanised IgG1 monoclonal antibody that is degraded by proteolytic enzymes widely distributed in the body and not restricted to hepatic tissue.

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely as benztropine is primarily metabolised by CYP2D6.

Coadministration has not been studied but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Betahistine undergoes nearly complete metabolism by monoamine oxidase. Based on in-vitro data, no inhibition of cytochrome P450 enzymes by betahistine is expected.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bevacizumab biotransformation involves proteolytic catabolism throughout the body, including endothelial cells, and does not rely primarily on elimination through the kidneys and liver.

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, the European SPC for bezafibrate contraindicates its use in significant hepatic disease.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ribavirin is partly metabolized (non CYP mediated) and partly excreted in the urine. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. No interactions are anticipated since although the drug is metabolised, the systemic concentrations of bimatoprost are extremely low (less than 0.2 ng/ml) following ocular dosing with bimatoprost.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Although limited human data suggest biperiden undergoes hydroxylation in the liver there are no known or documented interactions with other drugs that have an effect on metabolism or transport. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Absorption of bisacodyl from the GI tract is minimal and the small amount absorbed is excreted in the urine as the glucuronide. However, bisacodyl increases colonic mass movements and may affect absorption of ribavirin. The potential interaction can be resolved by giving bisacodyl at least 4 hours after ribavirin. [Note: this interaction is not specific for ribavirin, but for any medication taken with bisacodyl.]

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, the European product label for bisoprolol recommends a maximum of 10 mg in severe hepatic impairment whereas the US Prescribing Information recommends an initial 2.5 mg in hepatic impairment with caution in further dose titration.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. An indirect effect of blinatumomab on CYPs may occur due to transient release of cytokines during the first days of therapy which can inhibit CYP450 metabolism however, a clinically relevant interaction is unlikely. The metabolic pathway of blinatumomab has not been characterised. Like other protein therapeutics, blinatumomab is expected to be degraded into small peptides and amino acids via catabolic pathways.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bosutinib is metabolised principally by CYP3A4.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Brentuximab vedotin releases the active species MMAE within the tumour cell; MMAE is a substrate of CYP3A4 and possibly CYP2D6 and a weak inhibitor of CYP3A4.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Brinozolamide is metabolised by CYP3A4.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Brodalumab is degraded into small peptides.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as bromperidol is metabolised by CYP3A4.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Calcium carbimide is a prodrug requiring catalase and hydrogen peroxide to generate the active metabolite, and is an inhibitor of ALDH.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Canagliflozin is metabolised by UGTs and is a substrate and inhibitor of P-gp.

Coadministration has not been studied but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, use of candesartan in severe hepatic impairment is contraindicated in the European SPC; the US Prescribing Information recommends caution in moderate hepatic impairment.

Coadministration has not been studied, based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. However, monitor for overlapping toxicities as carvedilol can commonly cause rash and anaemia. Note,the US Prescribing Information contraindicates carvedilol in patients with severe liver impairment and the European SPC contraindicates it in patients with hepatic dysfunction.

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely as caspofungin undergoes spontaneous chemical degradation and non-CYP medicated metabolism. Note, no dose adjustment is required in patients with normal hepatic function but a dose reduction of caspofungin daily dose to 35 mg is recommended for adults with moderate hepatic impairment. There is no clinical experience in adults with severe hepatic impairment.

Coadministration has not been studied but based on metabolism and clearance a clinically significant drug interaction is unlikely. Cefaclor is predominantly eliminated unchanged by the kidneys.

Coadministration has not been studied but based on metabolism and clearance a clinically significant drug interaction is unlikely. Cefadroxil is not metabolised and is predominantly eliminated unchanged by the kidneys.

Coadministration has not been studied but based on metabolism and clearance a clinically significant drug interaction is unlikely. Cefradine is not metabolised and is predominantly eliminated unchanged by the kidneys.

Coadministration has not been studied but based on metabolism and clearance a clinically significant drug interaction is unlikely. Ceftaroline is not metabolised by CYP enzymes and is primarily eliminated by the kidneys.

Coadministration has not been studied but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. However, celecoxib may uncommonly cause anaemia which may be exacerbated by ribavirin. Note, use in patients with severe liver impairment is contraindicated in the European SPC and not recommended in the US Prescribing Information. In patients with moderate liver impairment (serum albumin 25-35 g/L, Child-Pugh Class B), celecoxib treatment should be started at half the recommended dose.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Like other protein therapeutics, cetuximab is expected to be degraded into small peptides and amino acids via catabolic pathways.

Coadministration has not been studied but a clinically significant interaction is considered unlikely. Very little has been described about chlorambucil metabolism in humans but CYP450 enzymes are not involved.

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, the European SPC and US Prescribing Information for chloroquine both recommend caution in impaired hepatic function.

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, the European SPC for chlorpromazine advises that its use should be avoided in patients with hepatic dysfunction.

Co-administration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as chlorprothixene is metabolised by CYP2D6. Note, although no interaction is anticipated, ECG monitoring is mandatory prior to treatment with chlorprothixene.

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Cilazapril is rapidly converted to the active form, cilazaprilat, which is excreted unchanged in the urine. Note, in patients with cirrhosis, a maximum dose of 0.5 mg/day is recommended as significant hypotension may occur.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cisatracurium undergoes mainly (80% of overall elimination) spontaneous degradation in plasma and tissues at physiological pH and temperature (Hofmann elimination).

Coadministration has not been studied but based on metabolism and clearance a clinically significant drug interaction is unlikely. Clavulanic acid is extensively metabolized (likely by a non-CYP mediated pathway) and excreted in the urine by glomerular filtration.  

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clevidipine is rapidly metabolised by hydrolysis of the ester linkage and does not undergo CYP metabolism.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Clodronate is not metabolised and is primarily excreted unchanged by the kidney. However, if administered orally, clodronate should be taken more than two hours after and one hour before any other oral drugs. [Note: this interaction is not specific for ribavirin, but for any oral medication taken with clodronate.]

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, the European SPC for clopidogrel contraindicates it use in severe hepatic impairment but the US Prescribing Information states no dose alteration.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. The metabolism of clotiapine has not been well characterised but is likely to involve CYP450 enzymes.

Coadministration has not been studied but a clinically significant interaction is unlikely as colecalciferol undergoes extensive metabolism by multiple channels

Coadministration has not been studied. Colestyramine may delay or reduce the absorption of drugs. Administration of other drugs should be at least 1 hour before or 4-6 hours after colestyramine. [Note: this interaction is not specific for ribavirin, but for any medication taken with colestyramine.]

Co-administration has not been studied but based on limited data for the metabolism and clearance of cyclizine, a clinically significant interaction is unlikely. Cyclizine undergoes hepatic metabolism which may include CYP2D6.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dantron is absorbed from the small intestine and acts at the large intestine. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Like other protein therapeutics, daratumumab is expected to be degraded into small peptides and amino acids via catabolic pathways and is not anticipated to alter drug-metabolising enzymes.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dasatinib is a substrate and an inhibitor of cytochrome CYP3A4.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as deferiprone is glucuronidated by UGT1A6.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Delamanid is primarily metabolised by albumin to DM-6705; metabolism of DM-6705 to other metabolites is thought to involve pathways mediated by CYP enzymes, including CYP3A4. Note, delamanid is not recommended in patients with moderate to severe hepatic impairment.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Denosumab is not eliminated via hepatic metabolism but follows the immunoglobulin clearance pathway resulting in degradation to small peptides and individual amino acids.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Note, a maximum dose of 50 mg is recommended in moderate hepatic impairment.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. 

Coadministration has not been studied but based on the metabolism and clearance a clinically significant interaction is unlikely. Dexketoprofen is mainly glucuronidated, with CYP mediated metabolism (CYP2C8/9) playing only a minor role. Note, use in patients with severe hepatic impairment (Child Pugh class C) is contraindicated in the European product label for dexketoprofen.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Diosmin is a naturally occurring flavonoid. Diosmin-containing products are available as dietary supplements or on prescription (in certain countries). Interaction studies suggest that diosmin may be a weak inhibitor of CYP3A4 and P-gp.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Donepezil is metabolised by CYP3A4 and CYP2D6 (minor).

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dosulepin is extensively metabolised in the liver, likely by CYP2D6 (major) and CYP3A4.

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, the European SPC does not recommend doxazosin in severe hepatic impairment; the US Prescribing Information has a caution for use in hepatic impairment.

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, the European and US product labels for doxepin advise caution and monitoring in patients with hepatic impairment as a dosage reduction may be required.

Co-administration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Limited data available for doxylamine metabolism suggest involvement of CYP2B6.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as dulaglutide is presumed to be degraded by general protein catabolism pathways. Dulaglutide delays gastric emptying but interaction studies showed no clinically significant effect on the absorption of concomitantly administered oral medicinal products and no dose adjustment of comedications is recommended.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dupilimab is a protein and degrades to small peptides and individual amino acids. 

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, the European SPC (but not the US Prescribing Information) cautions against dutasteride use in mild to moderate hepatic impairment and contraindicates it in severe hepatic impairment.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ebastine is metabolised by CYP450.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ribavirin is partly metabolized (non CYP mediated) and partly excreted in the urine.

Ribavirin can be administered with elbasvir/grazoprevir based on a specific patient population. Refer to the product label for full prescribing details.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Eliglustat is metabolised primarily by CYP2D6 and to a lesser extent by CYP3A4.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ribavirin is partly metabolized (non CYP mediated) and partly excreted in the urine.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ribavirin is partly metabolized (non CYP mediated) and partly excreted in the urine.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Empagliflozin is metabolised by UGTs and is a substrate of P-gp, BCRP, OAT3 and OATP1B1/1B3.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ribavirin is partly metabolized (non CYP mediated) and partly excreted in the urine. 

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely. Epoprostenol is rapidly hydrolysed; there does not appear to be any involvement with CYP isoenzymes or transporter proteins.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Erlotinib is a substrate for CYP3A4 and P-gp.

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely. Estramustine is dephosphorylated and minimal data show it not to undergo any form of CYP metabolism.

Coadministration has not been studied but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, there is a concern of hepatotoxic adverse events in patients with HCV receiving anti-TNF agents. Use with caution and monitor liver enzymes and HCV viral load.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. In vitro data suggest etelcalcetide is not metabolised by CYP450 nor transported by common transporter proteins.

Coadministration with an etonogestrel-containing progestogen-only implant has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Etonogestrel is metabolized by CYP3A4.

Coadministration with etonogestrel as a combined vaginal ring (CVR) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Etonogestrel is metabolized by CYP3A4 and is coformulated in the CVR with ethinylestradiol which is mainly metabolized by hydroxylation.

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely. Etoposide is mainly metabolised by CYP3A4 and UGT1A1.

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely as exemestane is metabolised by CYP3A4.

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, use of ezetemibe is not recommended in moderate to severe hepatic dysfunction.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Febuxostat is extensively metabolised by multiple P450 (CYPs 1A1, CYP1A2, CYP2C8 and CYP2C9) and UGT enzymes (UGTs 1A1, 1A8, and 1A9). A clinically significant interaction is unlikely as febuxostat is metabolised by multiple pathways.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as fenofibrate is metabolised by multiple enzyme pathways (esterases, UGT2B7 and UGT1A1). Note, fenofibrate is contraindicated in severe hepatic disease in its European SPC, and its US Prescribing Information contraindicates it in active liver disease.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Flibanserin is primarily metabolized by CYP3A4 and to a lesser extent by CYP2C19.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Fludarabine phosphate is rapidly hydrolyzed (non-CYP mediated) to 2F-ara-A, the principal metabolite, which is then eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Fluinidone is metabolised by CYP2C9 (major) and CYP1A2 (minor).

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, use of fluvastatin in active liver disease is contraindicated.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ribavirin is partly metabolized (non CYP mediated) and partly excreted in the urine.

Coadministration has not been studied but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Fosinopril is a prodrug metabolised in the liver by a non-CYP mechanism to the active metabolite.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Gefitinib is a metabolized by CYP3A4.

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, use of gemfibrozil in hepatic impairment is contraindicated.

Co-administration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely with standard doses (up to 240 mg) of Ginkgo biloba.

Ribavirin had no effect on exposures of glecaprevir or pibrentasvir in studies evaluating the efficacy, safety and pharmacokinetics of glecaprevir and pibrentasvir. However, glecaprevir/pibrentasvir is a complete directly acting antiviral combination and there is no requirement for adding ribavirin.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely.

Coadministration has not been studied but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. There is minimal metabolism of goserelin and no clinically relevant accumulation with higher doses of the implant. Goserelin is renally cleared with no dose alteration required in renal or hepatic impairment.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Granisetron is metabolised by CYP3A4.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Note, use of hydromorphone in patients with ANY degree of hepatic impairment is contraindicated in its European SPC, but the US Prescribing Information does not recommend it for patients with severe hepatic impairment and suggests a dose reduction for patients with moderate hepatic impairment.

Coadministration has not been studied, but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely. Note, the European SPC for hydroxychloroquine recommends caution in impaired hepatic function.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Hyoscine acts predominantly locally and undergoes minimal absorption.

Coadministration has not been studied but ibandronate can be administered with ribavirin and no dose alteration is required. The portion of ibandronate that is not removed from the circulation via bone absorption is eliminated unchanged by the kidney (approximately 50% of the absorbed dose). However, administration of ibandronate should be separated from food or other medicinal products. [Note: this interaction is not specific for ribavirin, but for any medication taken with ibandronic acid.]

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Idarubicin is converted to idarubicinol by aldoketoreductase.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Iloprost is metabolised by beta-oxidation of the carboxyl side chain with only a minor role for CYP metabolism.

Coadministration has not been studied but based on metabolism and clearance a clinically significant drug interaction is unlikely. Imipenem is metabolised renally and is predominantly eliminated in the urine.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Although indacaterol is metabolised via CYP3A4 and transported by P-gp, any inhibition of these pathways is unlikely to be of clinical significance. The increased magnitude of exposure due to such interactions does not raise any concerns given the safety experience with indacaterol at doses up to twice the recommended therapeutic dose. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ribavirin is partly metabolized (non CYP mediated) and partly excreted in the urine.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Isoflurane is mainly metabolised by CYP2E1.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as isoniazid is metabolised by N-acetyl transferase and CYP2E1. Note, use of isoniazid should be carefully monitored with patients with current chronic liver disease. Severe and sometimes fatal hepatitis associated with isoniazid therapy may occur and may develop even after many months of treatment.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Isosorbide mononitrate is completely absorbed and is not subject to first pass metabolism by the liver. It is excreted mainly in the urine.

Coadministration has not been studied. The mode of action of ispaghula husk is physical and does not depend on absorption into the systemic circulation. However, ispaghula husk may delay or reduce gastrointestinal absorption of other drugs and it is advisable to separate administration if possible. [Note: this interaction is not specific for ribavirin, but for any medication taken with ispaghula husk.]

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as isradipine is metabolised by CYP3A4.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ixazomib is metabolised by multiple CYP and non-CYP enzymes. Ixazomib is not expected to cause transporter-mediated drug-drug interactions.