Interactions : אינטראקציות

4.5 Interactions with other medicinal products and other forms of interaction

Other fibrates: As with other fibrates, the risk of rhabdomyolysis and myoglobinuria may be increased if ciprofibrate is used in combination with other fibrates (see sections 4.3 and 4.4.).

• Not recommended combinations
HMG CoA reductase inhibitors: As with other fibrates, the risk of myopathy, rhabdomyolysis and myoglobinuria may be increased if ciprofibrate is used in combination with HMG CoA reductase inhibitors (see section 4.4). The benefits of combined use should be carefully weighed against the risks. Physicians contemplating concomitant therapy with HMG-CoA reductase inhibitors should consult the SPC of the relevant HMG CoA reductase inhibitor as some higher doses are contraindicated/ not recommended with fibrates.

• Combination requiring caution
Oral anticoagulant therapy: Ciprofibrate is highly protein bound and therefore likely to displace other drugs from plasma protein binding sites. This may increase the effects of drugs like phenytoin, tolbutamide and other sulphonylurea derivatives and coumarin-like anticoagulants. Ciprofibrate has been shown to potentiate the effect of warfarin, indicating that concomitant oral anticoagulant therapy should be given at reduced dosage and adjusted according to INR (see section 4.4).

• Combination to be taken into account
Cholestyramine and colestipol may reduce the absorption of ciprofibrate. These drugs should not be taken together or close to each other.

No clinically relevant interactions exist with cytochrome P450, beta blocking agents, calcium antagonists, diuretics, other hypertensives digoxin and nitroglycerin 
Oral hypoglycaemics: Although ciprofibrate may potentiate the effect of oral hypoglycaemics, available data do not suggest that such an interaction may be clinically significant.

Oesrogens: Oestrogens can raise lipid levels. Although pharmacodynamic interaction may be suggested, no clinical data are currently available.