Interactions
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Understanding drug interactions
22 May 2024This article discusses different mechanisms of drug interactions. We link to other SPS articles to help support decision making.
Managing interactions with direct oral anticoagulants (DOACs)
20 June 2025Interactions with apixaban, dabigatran, edoxaban or rivaroxaban can result in increased risks of a bleed or thrombosis. We advise on management options.
Understanding direct oral anticoagulant (DOAC) interactions
5 January 2024It is important to understand the risks, mechanisms of interactions and actions to take when prescribing medicines with DOACs.
Managing interactions with methotrexate
30 June 2025Guidance on frequently asked questions on medicine interactions with low dose methotrexate.
Managing interactions between macrolides and statins
12 July 2024The use of statins can be continued with azithromycin. However, the interaction risks need to be managed if clarithromycin or erythromycin are required.
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.
Considering drug interactions with smoking
8 November 2023Tobacco smoke can induce liver enzymes, affecting drug metabolism. Some medicines may need dose adjustment or monitoring if a person stops or starts smoking.
Using clopidogrel with proton pump inhibitors (PPIs)
14 September 2023Avoid the combined use of clopidogrel with omeprazole or esomeprazole due to a significant interaction. Other PPIs are considered safe with clopidogrel.
Identifying risk factors for developing a long QT interval
17 February 2026Some medicines (erythromycin, citalopram, ondansetron) can cause a long QT interval. Consider risk factors and follow MHRA recommendations for safe use.
Interactions
All our advice relating to medicine interactions, with recommendations on management options.