What can interfere with antimalarial effectiveness

What can interfere with antimalarial effectiveness? What drug interactions can occur?

Smoking can induce hepatic cytochrome P450 enzymes resulting in accelerated metabolism of antimalarials, causing them to be less effective. Cimetidine can decrease the clearance of antimalarials. Antimalarials can increase digoxin levels and conversely antagonize the effects of anticonvulsants and amiodarone. Due to the effects on insulin degradation, they may also potentiate the glucose-lowering effects of hypoglycemic agents, and diabetic patients are advised to closely monitor blood sugars with initiation of treatment.

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