Terbinafine cirrhosis — GPhC CRA MCQ
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Correct answer: D — Withhold and urgently query the prescription because fluvoxamine is contraindicated with pirfenidone
Option D is correct: fluvoxamine strongly inhibits CYP1A2, reduces pirfenidone clearance and is specifically contraindicated. Option A cannot overcome enzyme inhibition by spacing. Option B invents intermittent dose adjustment for a regularly administered inhibitor. Option C names an irrelevant clinical measure. Option E makes an unauthorised substitution and ciprofloxacin itself is a CYP1A2 inhibitor requiring pirfenidone dose management.
Reference: Pirfenidone SmPC: https://www.medicines.org.uk/emc/product/13876/smpc