Paroxetine interactions

Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex. (Acetaminophen and codeine label, Boxed warning)

Avoid administrations of TUDORZA PRESSAIR with other anticholinergic-containing drugs. (Aclidinium label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with serotonergic agents (e.g., SSRIs, SNRIs, triptans), but also during overdosage situations. (Amphetamine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when coadministered with serotonergic agents (e.g., selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), triptans), but also during overdosage situations. (Amphetamine and dextroamphetamine label, Warnings and precautions)

Serotonin Syndrome Serotonin-norepinephrine reuptake inhibitors (SNRIs) and SSRIs, including Paroxetine HCL CR, can precipitate serotonin syndrome, a potentially life-threatening condition. (Paroxetine label, Warnings and precautions)

• Serotonergic Drugs: Concomitant use may result in serotonin syndrome. (Belladonna and opium label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonergic Drugs : Concomitant use may result in serotonin syndrome. (Buprenorphine label, Drug interactions)

Serotonergic Drugs: Concomitant use may result in serotonin syndrome. (Buprenorphine and naloxone label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Examples: paroxetine, fluoxetine, bupropion, quinidine Benzodiazepines and Other Central Nervous System (CNS) Depressants Clinical Impact: Due to additive pharmacologic effect, the concomitant use of benzodiazepines or other CNS depressants, including alcohol, can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death. (Butalbital, acetaminophen, caffeine, and codeine label, Drug interactions)

Examples paroxetine, fluoxetine, bupropion, quinidine Benzodiazepines and other Central Nervous System (CNS) Depressants Clinical Impact: Due to additive pharmacologic effect, the concomitant use of benzodiazepines or other CNS depressants including alcohol, increases the risk of respiratory depression, profound sedation, coma, and death. (Butalbital, aspirin, caffeine, and codeine label, Drug interactions)

…medical attention if they ‎experience symptoms of hyperalgesia, including worsening pain, increased ‎sensitivity to pain, or new pain [see WARNINGS ; ADVERSE REACTIONS ].‎ Serotonin Syndrome Inform patients that butorphanol tartrate could cause a rare but potentially life-threatening condition resulting from concomitant administration of serotonergic drugs. (Butorphanol label, Precautions)

Known hypersensitivity to tricyclic antidepressants ( 4 ) (Carbamazepine label, Contraindications)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

When possible, avoid concomitant use, with other anticholinergic medications because the risk for anticholinergic toxicity or severe gastrointestinal adverse reactions is increased [see Warnings and Precautions ( 5.7 ), Drug Interactions ( 7.1 )]. (Clozapine label, Warnings and precautions)

Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex. (Codeine label, Boxed warning)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

If serotonin syndrome occurs, discontinue dextroamphetamine sulfate and the CYP2D6 inhibitor [see Warnings , Overdosage ]. (Dextroamphetamine label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Usage of MOTOFEN ® in recommended doses is not likely to cause prominent anticholinergic side effects, but MOTOFEN ® should be avoided in patients in whom anticholinergic drugs are contraindicated. (Difenoxin and atropine label, Warnings)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

…(12.3) ] • Concomitant use of drugs or herbal products that prolong the QT interval and might increase the risk of torsade de pointes, such as phenothiazine antipsychotics, tricyclic antidepressants, certain oral macrolide antibiotics, and Class I and III antiarrhythmics • Liver or lung toxicity related to the previous use of amiodarone • QTc interval >500 ms or… (Dronedarone label, Contraindications)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Anticoagulants, Antiplatelets, Thrombolytics, and Selective Serotonin Reuptake Inhibitors (SSRIs)/Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Avoid concomitant use due to increased risk of bleeding. (Edoxaban label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

• Serotonin Syndrome : Potentially life-threatening condition could result from concomitant serotonergic drug administration. (Fentanyl label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

THESE ARE MOST FREQUENT IN PATIENTS WHO HAVE BEEN ON BENZODIAZEPINES FOR LONG-TERM SEDATION OR IN OVERDOSE CASES WHERE PATIENTS ARE SHOWING SIGNS OF SERIOUS CYCLIC ANTIDEPRESSANT OVERDOSE. (Flumazenil label, Boxed warning)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Intervention Concomitant use of anticholinergic drugs with GVOKE VialDx is not recommended. (Glucagon label, Drug interactions)

• Other Conditions Exacerbated by Anticholinergic Adverse Reactions : Use is not recommended in patients with autonomic neuropathy, hyperthyroidism, cardiac disease, hiatal hernia, etc. (Glycopyrrolate label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Example: lactulose Serotonergic Drugs : Concomitant use may result in serotonin syndrome. (Hydrocodone label, Drug interactions)

Serotonin Syndrome Inform patients that hydrocodone bitartrate and acetaminophen tablets could cause a rare but potentially life-threatening condition resulting from concomitant administration of serotonergic drugs. (Hydrocodone and acetaminophen label, Precautions)

Serotonergic drugs : Concomitant use may result in serotonin syndrome. (Hydrocodone and chlorpheniramine label, Drug interactions)

Serotonergic Drugs : Concomitant use may result in serotonin syndrome. (Hydrocodone and homatropine label, Drug interactions)

S er otonin Syndrome Inform patients that opioids could cause a rare but potentially life-threatening condition resulting from concomitant administration of serotonergic drugs. (Hydrocodone and ibuprofen label, Precautions)

• Serotonergic Drugs : Concomitant use may result in serotonin syndrome. (Hydromorphone label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Avoid administration of ATROVENT HFA with other anticholinergic-containing drugs ( 7.1 ) (Ipratropium label, Drug interactions)

Paroxetine HCL CR is contraindicated in patients: Taking, or within 14 days of stopping, MAOIs (including the MAOIs linezolid and intravenous methylene blue) because of an increased risk of serotonin syndrome [See Warnings and Precautions ( 5.2 ), Drug Interactions (7)]. (Paroxetine label, Contraindications)

Co-administration with eliglustat is contraindicated in poor or intermediate metabolizers of CYP2D6 and in subjects taking strong or moderate CYP2D6 inhibitors. (Itraconazole label, Boxed warning)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome Inform patients that opioids could cause a rare but potentially life-threatening condition resulting from concomitant administration of serotonergic drugs. (Levorphanol label, Precautions)

Paroxetine HCL CR is contraindicated in patients: Taking, or within 14 days of stopping, MAOIs (including the MAOIs linezolid and intravenous methylene blue) because of an increased risk of serotonin syndrome [See Warnings and Precautions ( 5.2 ), Drug Interactions (7)]. (Paroxetine label, Contraindications)

Serotonin Syndrome: Increased risk when co-administered with serotonergic agents (e.g., SSRIs, SNRIs, triptans), but also during overdosage situations. (Lisdexamfetamine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

LOREEV XR should not be used in such patients without adequate antidepressant therapy. (Lorazepam label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin syndrome has resulted from concomitant use of metaxalone (within the recommended dosage range) and other serotonergic drugs [see Warnings and Precautions (5.1) ]. (Metaxalone label, Drug interactions)

Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The concomitant use of METHADOSE with all cytochrome P450 3A4, 2B6, 2C19, 2C9 or 2D6 inhibitors may result in an increase in methadone plasma concentrations, which could cause potentially fatal respiratory depression. (Methadone label, Boxed warning)

Serotonin Syndrome: Increased risk when coadministered with serotonergic agents (e.g., SSRIs, SNRIs, triptans), but also during overdosage situations. (Methamphetamine label, Warnings and precautions)

Paroxetine HCL CR is contraindicated in patients: Taking, or within 14 days of stopping, MAOIs (including the MAOIs linezolid and intravenous methylene blue) because of an increased risk of serotonin syndrome [See Warnings and Precautions ( 5.2 ), Drug Interactions (7)]. (Paroxetine label, Contraindications)

Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, malignant hyperthermia, drug fever, serotonin syndrome, and primary central nervous system pathology. (Metoclopramide label, Warnings and precautions)

CYP2D6 Inhibitors Monitor patients closely when the combination use of CYP2D6 inhibitor and metoprolol cannot be avoided. (Metoprolol label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

• Serotonergic Drugs: Concomitant use may result in serotonin syndrome. (Morphine label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonergic Drugs : Concomitant use may result in serotonin syndrome. (Oliceridine label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonergic Drug s: Concomitant use may result in serotonin syndrome. (Oxycodone label, Drug interactions)

Serotonergic Drugs : Concomitant use may result in serotonin syndrome. (Oxymorphone label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome Inform patients that opioids could cause a rare but potentially life-threatening condition resulting from concomitant administration of serotonergic drugs. (Pentazocine and naloxone label, Precautions)

Examples selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, methylene blue Pimozide and Thioridazine Clinical Impact Paroxetine HCL CR should not be used in patients receiving medications that can prolong QT interval and are metabolized by CYP450 2D6 such as thioridazine or pimozide (see Contraindications and Warnings and Precautions ) Intervention… (Paroxetine label, Drug interactions)

Paroxetine HCL CR should not be used in patients receiving medications that can prolong QT interval and are also metabolized by CYP450 2D6,such as thioridazine or pimozide [see Drug Interactions (7),Warnings and Precautions (5.3)]. (Paroxetine label, Contraindications)

In patients in whom there is cause for arrest or delay in tablet passage through the gastrointestinal tract, such as those suffering from delayed gastric emptying, esophageal compression, intestinal obstruction or stricture, or those taking anticholinergic medication. (Potassium citrate label, Contraindications)

…prolong, or intensify the sedative action of other central-nervous-system depressants, such as alcohol, sedatives/hypnotics (including barbiturates), narcotics, narcotic analgesics, general anesthetics, tricyclic antidepressants, and tranquilizers; therefore, such agents should be avoided or administered in reduced dosage to patients receiving promethazine HCl. (Promethazine label, Drug interactions)

Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex, requiring careful consideration of the effects on the parent drug, codeine, and the active metabolite, morphine. (Promethazine and codeine label, Boxed warning)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Quinidine is also contraindicated in patients who, like those with myasthenia gravis, might be adversely affected by an anticholinergic agent. (Quinidine label, Contraindications)

Paroxetine HCL CR is contraindicated in patients: Taking, or within 14 days of stopping, MAOIs (including the MAOIs linezolid and intravenous methylene blue) because of an increased risk of serotonin syndrome [See Warnings and Precautions ( 5.2 ), Drug Interactions (7)]. (Paroxetine label, Contraindications)

• Serotonin Syndrome : Potentially life-threatening condition could result from concomitant serotonergic drug administration. (Remifentanil label, Warnings and precautions)

Concomitant use with metoclopramide, beta-blockers, or cholinomimetic and anticholinergic drugs is not recommended ( 7.1 , 7.2 , 7.3 ) (Rivastigmine label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Examples selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, methylene blue Pimozide and Thioridazine Clinical Impact Paroxetine HCL CR should not be used in patients receiving medications that can prolong QT interval and are metabolized by CYP450 2D6 such as thioridazine or pimozide (see Contraindications and Warnings and Precautions ) Intervention… (Paroxetine label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Combining St. John's wort with antidepressants and other serotonergic drugs increases the risk of serotonin syndrome. (NCCIH, St. John's Wort)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Paroxetine HCL CR should not be used in patients receiving medications that can prolong QT interval and are also metabolized by CYP450 2D6,such as thioridazine or pimozide [see Drug Interactions (7),Warnings and Precautions (5.3)]. (Paroxetine label, Contraindications)

Avoid administration of SPIRIVA RESPIMAT with other anticholinergic-containing drugs. (Tiotropium label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Examples selegiline, tranylcypromine, isocarboxazid, phenelzine, linezolid, methylene blue Pimozide and Thioridazine Clinical Impact Paroxetine HCL CR should not be used in patients receiving medications that can prolong QT interval and are metabolized by CYP450 2D6 such as thioridazine or pimozide (see Contraindications and Warnings and Precautions ) Intervention… (Paroxetine label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Avoid administration of Umeclidinium ELLIPTA with other anticholinergic-containing drugs. (Umeclidinium label, Drug interactions)

Avoid administration of Umeclidinium and Vilanterol ELLIPTA with other anticholinergic-containing drugs. (Umeclidinium and vilanterol label, Drug interactions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome Serotonin-norepinephrine reuptake inhibitors (SNRIs) and SSRIs, including Paroxetine HCL CR, can precipitate serotonin syndrome, a potentially life-threatening condition. (Paroxetine label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

• Serotonin Syndrome : Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Ziprasidone label, Warnings and precautions)

Serotonin Syndrome: Increased risk when co-administered with other serotonergic agents, but also when taken alone. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Monoamine oxidase inhibitors and tricyclic antidepressants: Use with extreme caution. (Albuterol label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Table 5: Amiodarone Drug Interactions Concomitant Drug Class/Name Examples Clinical Comment QT Prolonging Drugs class I and III antiarrhythmics, lithium, certain phenothiazines, tricyclic antidepressants, certain fluoroquinolone and macrolide antibiotics, azole antifungals, halogenated inhalation anesthetic agents Increased risk of Torsade de Pointes. (Amiodarone label, Drug interactions)

Monitor patients for bleeding, including those receiving concomitant therapy with other drugs known to cause bleeding (e.g., anticoagulants, PDE3 inhibitors, NSAIDs, antiplatelet agents, selective serotonin reuptake inhibitors) [see Drug Interactions (7.3) , Clinical Pharmacology (12.3) ] . (Anagrelide label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

MAO inhibitors, tricyclic antidepressants and drugs that prolong the QTc interval may potentiate effect on the cardiovascular system. (Arformoterol label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever, and primary central nervous system pathology. (Aripiprazole label, Warnings and precautions)

The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St. (Paroxetine label, Warnings and precautions)

The administration of local anesthetic solutions containing epinephrine to patients receiving monoamine oxidase inhibitors, nonselective beta-adrenergic antagonists, or tricyclic antidepressants may produce severe, prolonged hypertension. (Articaine and epinephrine label, Drug interactions)

Paroxetine (CYP2D6 substrate and inhibitor): Reduce paroxetine by half when used in combination with SAPHRIS. (Asenapine label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Aminoglycosides or other agents interfering with neuromuscular transmission Anticholinergic drugs Botulinum neurotoxin products Muscle relaxants Aminoglycoside antibiotics, anticholinergic agents, or any other agents that interfere with neuromuscular transmission may potentiate the effect of DAXXIFY; co-administer only with caution and close observation. (Botulinum toxin type A label, Drug interactions)

Strenuous exercise, exposure to extreme heat, dehydration, and anticholinergic medications may contribute to an elevation in core body temperature; use REXULTI with caution in patients who may experience these conditions. (Brexpiprazole label, Warnings and precautions)

Caution is advised in patients taking tricyclic antidepressants which can affect the metabolism and uptake of circulating amines. (Brimonidine label, Drug interactions)

CYP2D6 inhibitors may potentiate systemic beta-blockade. (Brimonidine and timolol label, Drug interactions)

Monoamine oxidase inhibitors and tricyclic antidepressants: Use with extreme caution. (Budesonide and formoterol label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

…Interactions with MARCAINE WITH EPINEPHRINE Risk of Severe, Persistent Hypertension Due to Drug Interactions Between MARCAINE WITH EPINEPHRINE and Monoamine Oxidase Inhibitors and Tricyclic Antidepressants Administration of MARCAINE WITH EPINEPHRINE (containing a vasoconstrictor) in patients receiving monoamine oxidase inhibitors (MAOI) or tricyclic antidepressants may… (Bupivacaine label, Warnings and precautions)

…Interactions with MARCAINE WITH EPINEPHRINE Risk of Severe, Persistent Hypertension Due to Drug Interactions Between MARCAINE WITH EPINEPHRINE and Monoamine Oxidase Inhibitors and Tricyclic Antidepressants Administration of MARCAINE WITH EPINEPHRINE (containing a vasoconstrictor) in patients receiving monoamine oxidase inhibitors (MAOI) or tricyclic antidepressants may… (Bupivacaine and epinephrine label, Warnings and precautions)

Drugs Metabolized by CYP2D6: Bupropion inhibits CYP2D6 and can increase concentrations of: antidepressants (e.g., venlafaxine, nortriptyline, imipramine, desipramine, paroxetine, fluoxetine, sertraline), antipsychotics (e.g., haloperidol, risperidone, thioridazine), beta-blockers (e.g., metoprolol), and Type 1C antiarrhythmics (e.g., propafenone, flecainide). (Bupropion label, Drug interactions)

The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever, and primary central nervous system (CNS) pathology. (Carbidopa label, Warnings)

• Tricyclic antidepressants: risk of hypertension and dyskinesia reported during concomitant use with carbidopa/levodopa ( 7.4 ) (Carbidopa, levodopa, and entacapone label, Drug interactions)

Strenuous exercise, exposure to extreme heat, dehydration, and anticholinergic medications may contribute to an elevation in core body temperature; use VRAYLAR with caution in patient who may experience these conditions. (Cariprazine label, Warnings and precautions)

Since the sedative effects of carisoprodol and other CNS depressants (e.g., alcohol, benzodiazepines, opioids, tricyclic antidepressants) may be additive, appropriate caution should be exercised with patients who take more than one of these CNS depressants simultaneously. (Carisoprodol label, Warnings and precautions)

CYP2D6 Inhibitors and Poor Metabolizers Interactions of carvedilol with potent inhibitors of CYP2D6 isoenzyme (such as quinidine, fluoxetine, paroxetine, and propafenone) have not been studied, but these drugs would be expected to increase blood levels of the R(+) enantiomer of carvedilol [see Clinical Pharmacology (12.3) ]. (Carvedilol label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Drug Interactions The administration of local anesthetic solutions containing epinephrine or norepinephrine to patients receiving monoamine oxidase inhibitors, tricyclic antidepressants or phenothiazines may produce severe, prolonged hypotension or hypertension. (Chloroprocaine label, Precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

…apparently through an effect on certain microsomal enzyme systems, has been reported to reduce the hepatic metabolism of warfarin-type anticoagulants, phenytoin, propranolol, nifedipine, chlordiazepoxide, diazepam, certain tricyclic antidepressants, lidocaine, theophylline, and metronidazole, thereby delaying elimination and increasing blood levels of these drugs. (Cimetidine label, Drug interactions)

Dose adjustments may be required for concomitant medications that are predominantly metabolized by CYP2D6 (e.g., desipramine, metoprolol, and carvedilol) and particularly those with a narrow therapeutic index (e.g., flecainide and most tricyclic antidepressants) [see Clinical Pharmacology ( 12.3 )] . (Cinacalcet label, Drug interactions)

…syndrome, uncorrected electrolyte imbalance, such as hypokalemia or hypomagnesemia and cardiac disease, such as heart failure, myocardial infarction, or bradycardia), and patients receiving Class IA antiarrhythmic agents (quinidine, procainamide), or Class III antiarrhythmic agents (amiodarone, sotalol), tricyclic antidepressants, macrolides, and antipsychotics. (Ciprofloxacin label, Warnings and precautions)

…Interactions The CNS-depressant action of the benzodiazepine class of drugs may be potentiated by alcohol, narcotics, barbiturates, nonbarbiturate hypnotics, antianxiety agents, the phenothiazines, thioxanthene and butyrophenone classes of antipsychotic agents, monoamine oxidase inhibitors and the tricyclic antidepressants, and by other anticonvulsant drugs. (Clonazepam label, Drug interactions)

Tricyclic antidepressants Clinical Implication Concomitant use of tricyclic antidepressants with clonidine can increase blood pressure and may counteract the hypotensive effects of clonidine. (Clonidine label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

The actions of the benzodiazepines may be potentiated by barbiturates, narcotics, phenothiazines, monoamine oxidase inhibitors or other antidepressants. (Clorazepate label, Drug interactions)

Sympathomimetics, postganglionic blocking agents, and tricyclic antidepressants: Concomitant administration may increase the risk of cardiovascular adverse reactions. (Cocaine label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Co-administration with other CNS depressants (e.g., benzodiazepines, opioids, tricyclic antidepressants, alcohol) increases the risk of CNS depression, which can cause daytime impairment. (Daridorexant label, Warnings and precautions)

CYP2D6 Inhibitors No dosing adjustments are recommended in the presence of CYP2D6 inhibitors (for example, paroxetine, fluoxetine, quinidine and duloxetine) [see Clinical Pharmacology (12.3)] . (Darifenacin label, Drug interactions)

Antidepressants : Selective Serotonin Reuptake Inhibitors (SSRIs): paroxetine, sertraline ↓ paroxetine ↓ sertraline If either sertraline or paroxetine is initiated in patients receiving PREZISTA/ritonavir, dose titrating the SSRI based on a clinical assessment of antidepressant response is recommended. (Darunavir label, Drug interactions)

Antidepressants: Selective Serotonin Reuptake Inhibitors (SSRIs): e.g. paroxetine, sertraline SSRIs: effects unknown When co-administering with SSRIs, TCAs, or trazodone, careful dose titration of the antidepressant to the desired effect, including using the lowest feasible initial or maintenance dose, and monitoring for antidepressant response are recommended. (Darunavir and cobicistat label, Drug interactions)

…that may Increase Risk of Hyponatremia Concomitant administration of DESMODA with other drugs that may increase the risk of water intoxication with hyponatremia, (e.g., tricyclic antidepressants, selective serotonin re-uptake inhibitors, chlorpromazine, opiate analgesics, thiazide diuretics, NSAIDs, lamotrigine, sulfonylureas, particularly chlorpropamide, oxybutynin… (Desmopressin label, Drug interactions)

Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever, and primary central nervous system pathology. (Deutetrabenazine label, Warnings and precautions)

The intravenous administration of anticholinergic agents (e.g., glycopyrrolate, atropine) should be considered to modify vagal tone. (Dexmedetomidine label, Warnings and precautions)

The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St. (Paroxetine label, Warnings and precautions)

…be given to the pharmacology of the agents employed particularly with compounds that may potentiate or be potentiated by the action of Valium, such as phenothiazines, antipsychotics, anxiolytics/sedatives, hypnotics, anticonvulsants, narcotic analgesics, anesthetics, sedative antihistamines, narcotics, barbiturates, MAO inhibitors and other antidepressants. (Diazepam label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Anticholinergic agents: may affect the gastrointestinal absorption of various drugs; may also increase certain actions or side effects of other anticholinergic drugs (7) (Dicyclomine label, Drug interactions)

The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Clinical presentations vary in terms of which toxicity (anticholinergic vs. opioid) will present first or predominate; non-specific findings have been reported and include symptoms such as drowsiness (see OVERDOSAGE ). (Diphenoxylate and atropine label, Warnings)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Inhibitors of this isoenzyme (e.g., macrolide antibiotics, azole antifungal agents, protease inhibitors, serotonin reuptake inhibitors, amiodarone, cannabinoids, diltiazem, grapefruit juice, nefazadone, norfloxacin, quinine, zafirlukast) should be cautiously co-administered with dofetilide as they can potentially increase dofetilide levels. (Dofetilide label, Drug interactions)

CYP2D6 inhibitors may potentiate systemic beta-blockade. (Dorzolamide and timolol label, Drug interactions)

Concomitant use of other drugs that cause dizziness, confusion, sedation, or somnolence such as CNS depressants may increase this effect (e.g., barbiturates, benzodiazepines, lithium, opioids, buspirone, scopolamine, antihistamines, tricyclic antidepressants, other anticholinergic agents, and muscle relaxants). (Dronabinol label, Warnings and precautions)

Possible pharmacodynamic interactions can occur between droperidol and potentially arrhythmogenic agents such as class I or III antiarrhythmics, antihistamines that prolong the QT interval, antimalarials, calcium channel blockers, neuroleptics that prolong the QT interval, and antidepressants. (Droperidol label, Drug interactions)

Use caution in combination with moderate CYP3A4 inhibitors (e.g., erythromycin) or strong (e.g., paroxetine) or moderate CYP2D6 inhibitors, a combination of both CYP3A4 and CYP2D6 inhibitors, or known poor metabolizers of CYP2D6. (Dutasteride and tamsulosin label, Warnings and precautions)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (Efavirenz label, Drug interactions)

Antidepressants: Bupropion ↓ bupropion Increases in bupropion dosage should be guided by clinical response. (Efavirenz, lamivudine, and tenofovir label, Drug interactions)

Examples: alosetron, anticholinergics, opioids Table 3: Established and Other Potentially Clinically Relevant Interactions Affecting Drugs Co-Administered with VIBERZI OATP1B1 and BCRP Substrate Clinical Impact: VIBERZI may increase the exposure of co-administered OATP1B1 and BCRP substrates. (Eluxadoline label, Drug interactions)

Antidepressants: Selective Serotonin Reuptake Inhibitors (SSRIs) e.g., paroxetine Tricyclic Antidepressants (TCAs) e.g., amitriptyline desipramine imipramine nortriptyline bupropion trazodone ↑ SSRIs (except sertraline) ↑ TCAs ↑ trazodone Careful dosage titration of the antidepressant and monitoring for antidepressant response are recommended when coadministered… (Elvitegravir, cobicistat, emtricitabine, and tenofovir label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

• Drugs that potentiate the effects of epinephrine include sympathomimetics, beta blockers, tricyclic antidepressants, MAO inhibitors, COMT inhibitors, clonidine, doxapram, oxytocin, levothyroxine sodium, and certain antihistamines. (Epinephrine label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St. (Paroxetine label, Warnings and precautions)

Additive effects occur with concomitant use of other CNS depressants (e.g., benzodiazepines, opioids, tricyclic antidepressants, alcohol), including daytime use. (Eszopiclone label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Urinary Retention in Adult Patients With Bladder Outlet Obstruction The use of Toviaz, like other antimuscarinic drugs, in patients with clinically significant bladder outlet obstruction, including patients with urinary retention, may result in further urinary retention and kidney injury. (Fesoterodine label, Warnings and precautions)

Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system (CNS) pathology. (Fluphenazine label, Warnings)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Monoamine oxidase inhibitors and tricyclic antidepressants: Use with extreme caution. (Fluticasone and salmeterol label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

• MAO inhibitors, tricyclic antidepressants and drugs that prolong QTc interval may potentiate effect on the cardiovascular system. (Formoterol label, Drug interactions)

Fosamprenavir/Ritonavir Clinical Impact Co-administration of fosamprenavir/ritonavir with paroxetine significantly decreased plasma levels of paroxetine. (Paroxetine label, Drug interactions)

…prolongation and the potential for torsades de pointes, the use of FOSCAVIR should be avoided in combination with agents known to prolong the QT interval including Class IA (e.g., quinidine or procainamide) or Class III (e.g., dofetilide, amiodarone, sotalol) antiarrhythmic agents, phenothiazines, tricyclic antidepressants, and certain macrolides and fluoroquinolones. (Foscarnet label, Drug interactions)

Avoid co-administration of CONTEPO with drugs known to prolong the QT interval, such as class IA or class III antiarrhythmic medications, tricyclic antidepressants, macrolides, and antipsychotics [see Warnings and Precautions ( 5.2 )] . (Fosfomycin label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Other Corticosteroids, doxycycline, estrogens, furosemide, oral contraceptives, paroxetine, quinidine, rifampin, sertraline, theophylline, and vitamin D Drugs whose level is decreased by phenytoin Anticoagulants Apixaban, dabigatran, edoxaban, rivaroxaban Antiepileptic drugs The effect of phenytoin on phenobarbital, valproic acid and sodium valproate serum levels… (Fosphenytoin label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Increase IRESSA to 500 mg daily in patients receiving a strong CYP3A4 inducer (e.g., rifampicin, phenytoin, or tricyclic antidepressant) and resume IRESSA at 250 mg 7 days after discontinuation of the strong inducer [see Dosage and Administration (2.4) , Clinical Pharmacology (12.3) ] . (Gefitinib label, Drug interactions)

Increases in QTc have been observed when haloperidol was given with a combination of the metabolic inhibitors ketoconazole (400 mg/day) and paroxetine (20 mg/day). (Haloperidol label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Coadministration of paroxetine with iloperidone resulted in increased mean steady-state peak concentrations of iloperidone and its metabolite P88, by about 1.6- fold, and decreased mean steady-state peak concentrations of its metabolite P95 by one-half [see Clinical Pharmacology (12.3 , 12.5) ] . (Iloperidone label, Drug interactions)

Because of its anticholinergic effects, XEOMIN should be used with caution in patients at risk of developing narrow angle glaucoma. (IncobotulinumtoxinA label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Caution is, therefore, advised in the co-administration of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution with other drugs having anticholinergic properties. β-adrenergic agents Caution is advised in the co-administration of Ipratropium Bromide and Albuterol Sulfate Inhalation Solution and other sympathomimetic agents due to the increased risk… (Ipratropium and albuterol label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Drugs that may potentiate clinical response of Isoproterenol Clinical Impact The effects of isoproterenol may be potentiated by tricyclic antidepressants, monoamine oxidase inhibitors, levothyroxine sodium, and certain antihistamines, notably chlorpheniramine, tripelennamine, and diphenhydramine. (Isoproterenol label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Co-administration with other CNS depressants (e.g., benzodiazepines, opioids, tricyclic antidepressants, alcohol) increases the risk of CNS depression, which can cause daytime impairment. (Lemborexant label, Warnings and precautions)

Monoamine oxidase inhibitors (MAOs) or tricyclic antidepressants : May potentiate effect of albuterol on the cardiovascular system. (Levalbuterol label, Drug interactions)

Antidepressant Therapy Concurrent use of tricyclic (e.g., amitriptyline) or tetracyclic (e.g., maprotiline) antidepressants and levothyroxine may increase the therapeutic and toxic effects of both drugs, possibly due to increased receptor sensitivity to catecholamines. (Levothyroxine label, Drug interactions)

Clinically Significant Drug Interactions The administration of local anesthetic solutions containing epinephrine or norepinephrine to patients receiving monoamine oxidase inhibitors or tricyclic antidepressants may produce severe, prolonged hypertension. (Lidocaine label, Drug interactions)

…Adverse Reactions Due to Drug Interactions with FLAVALTA Risk of Severe, Persistent Hypertension Due to Drug Interactions Between FLAVALTA and Monoamine Oxidase Inhibitors and Tricyclic Antidepressants Administration of FLAVALTA (containing a vasoconstrictor, epinephrine) in patients receiving monoamine oxidase inhibitors (MAOI), or tricyclic antidepressants may result… (Lidocaine and epinephrine label, Warnings and precautions)

Antidepressant Therapy Concurrent use of tricyclic (e.g., amitriptyline) or tetracyclic (e.g., maprotiline) antidepressants and liothyronine sodium may increase the therapeutic and toxic effects of both drugs, possibly due to increased receptor sensitivity to catecholamines. (Liothyronine label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

CYP2D6 Inhibitors : Concomitant use of paroxetine resulted in increased plasma levels of Lofexidine tablets. (Lofexidine label, Drug interactions)

Fosamprenavir/Ritonavir Clinical Impact Co-administration of fosamprenavir/ritonavir with paroxetine significantly decreased plasma levels of paroxetine. (Paroxetine label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever, and primary central nervous system (CNS) pathology. (Loxapine label, Warnings)

Monitor all antidepressant-treated patients, especially during the initial few months of anti-depressant drug therapy, and at times of dosage changes. (Lumateperone label, Warnings and precautions)

Activation of Mania/Hypomania Antidepressant treatment can increase the risk of developing a manic or hypomanic episode, particularly in patients with bipolar disorder. (Lurasidone label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Other Drugs that Prolong the QTc Interval Coadministration of other drugs known to alter cardiac conduction (e.g., anti-arrhythmic or beta-adrenergic blocking agents, calcium channel blockers, antihistamines or H 1 -blocking agents, tricyclic antidepressants and phenothiazines) might also contribute to a prolongation of the QTc interval. (Mefloquine label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Likewise, solutions of mepivacaine containing a vasoconstrictor, such as epinephrine, should be used with extreme caution in patients receiving monoamine oxidase inhibitors (MAOI) or antidepressants of the triptyline or imipramine types, because severe prolonged hypertension may result. (Mepivacaine label, Warnings)

Drug interactions Additive anticholinergic effects may result from concomitant use with antipsychotics, tricyclic antidepressants, and other drugs with anticholinergic effects. (Methscopolamine label, Drug interactions)

The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

• Urinary Retention in Patients With Bladder Outlet Obstruction and in Patients Taking Muscarinic Antagonist Drugs for Overactive Bladder : Administer with caution in these patients because of risk of urinary retention. (Mirabegron label, Warnings and precautions)

The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St. (Paroxetine label, Warnings and precautions)

Pharmacokinetic studies between moxifloxacin and other drugs that prolong the QT interval such as cisapride, erythromycin, antipsychotics, and tricyclic antidepressants have not been performed. (Moxifloxacin label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Serotonergic Drugs The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system, such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that effect the serotonin neurotransmitter system… (Nalbuphine label, Drug interactions)

Drugs Metabolized by CYP2D6: Bupropion inhibits CYP2D6 and can increase concentrations of antidepressants, (e.g., selective serotonin reuptake inhibitors and many tricyclics), antipsychotics (e.g., haloperidol, risperidone and thioridazine), beta-blockers (e.g., metoprolol) and Type 1C antiarrhythmics (e.g., propafenone and flecainide). (Naltrexone and bupropion label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Use with CYP2D6 Inhibitors Nebivolol exposure increases with inhibition of CYP2D6 [see Drug Interactions ( 7 ) ] . (Nebivolol label, Warnings and precautions)

An anticholinergic agent, (e.g., atropine sulfate or glycopyrrolate) should be administered prior to Neostigmine Methylsulfate Injection administration to lessen the risk of bradycardia [ see Dosage and Administration ( 2.4 ) ]. (Neostigmine label, Warnings and precautions)

Fosamprenavir/Ritonavir Clinical Impact Co-administration of fosamprenavir/ritonavir with paroxetine significantly decreased plasma levels of paroxetine. (Paroxetine label, Drug interactions)

Anticholinergic (antimuscarinic) Effects: Use with caution with other anticholinergic drugs and in patients with urinary retention, prostatic hypertrophy, constipation, paralytic ileus or related conditions. (Olanzapine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Anticholinergic Drugs Use of anticholinergic drugs after administration of BOTOX may potentiate systemic anticholinergic effects. (OnabotulinumtoxinA label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Oxybutynin chloride extended-release tablets, like other anticholinergic drugs, may decrease gastrointestinal motility and should be used with caution in patients with conditions such as ulcerative colitis and intestinal atony. (Oxybutynin label, Warnings and precautions)

Anticholinergic Drugs Clinical Impact: The concomitant use of anticholinergic drugs may result in increased risk of urinary retention and/or severe constipation, which may lead to paralytic ileus. (Oxycodone and acetaminophen label, Drug interactions)

Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system (CNS) pathology. (Perphenazine label, Warnings)

The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St. (Paroxetine label, Warnings and precautions)

The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St. (Paroxetine label, Warnings and precautions)

The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, meperidine, methadone, tryptophan, buspirone, amphetamines, and St. (Paroxetine label, Warnings and precautions)

Agonistic Effects (increase in BIORPHEN blood pressure effect) can occur with monoamine oxidase inhibitors (MAOI), oxytocin and oxytocic drugs, tricyclic antidepressants, angiotensin and aldosterone, atropine, steroids, norepinephrine transporter inhibitors, ergot alkaloids. (Phenylephrine label, Drug interactions)

…Increased and decreased PT/INR responses have been reported when phenytoin is coadministered with warfarin Other Corticosteroids, doxycycline, estrogens, furosemide, oral contraceptives, paroxetine, quinidine, rifampin, sertraline, theophylline, and vitamin D Drugs whose level is decreased by phenytoin Anticoagulants Apixaban, dabigatran, edoxaban, rivaroxaban Antiepileptic… (Phenytoin label, Drug interactions)

Acute cardiac arrest may be possible during treatment with tricyclic antidepressants; therefore, Anticholium should only be considered as an antidote for this indication while the patient has continuous ECG monitoring. (Physostigmine label, Warnings and precautions)

These effects should be considered when anticholinergic properties may be contributing to the therapeutic effect of concomitant medication (e.g., atropine, inhaled ipratropium). (Pilocarpine label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Strong CYP2D6 Inhibitors: Increased exposure of WAKIX; reduce the maximum recommended dose of WAKIX by half ( 2.6 , 7.1 ) (Pitolisant label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

…Anticonvulsants phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine The administration of local anesthetic injections containing epinephrine or norepinephrine to patients receiving monoamine oxidase inhibitors, tricyclic antidepressants or phenothiazines may produce severe, prolonged hypotension or hypertension. (Prilocaine and epinephrine label, Drug interactions)

Effects of Other Drugs on the Pharmacokinetics of Primaquine Strong CYP2D6 Inhibitors Published clinical and non-clinical reports indicate reduced CYP2D6 activity may decrease the formation of active metabolites of primaquine, which may reduce antimalarial efficacy of Primaquine phosphate Tablets (see CLINICAL PHARMACOLOGY, Pharmacogenomics ). (Primaquine label, Drug interactions)

Anticholinergic drugs administered concurrently with PA may produce additive antivagal effects on A-V nodal conduction, although this is not as well documented for PA as for quinidine. (Procainamide label, Drug interactions)

Drugs that inhibit these CYP pathways (such as desipramine, paroxetine, ritonavir, sertraline for CYP2D6; ketoconazole, erythromycin, saquinavir, and grapefruit juice for CYP3A4; and amiodarone and tobacco smoke for CYP1A2) can be expected to cause increased plasma levels of propafenone. (Propafenone label, Warnings and precautions)

The intravenous administration of anticholinergic agents (e.g., atropine or glycopyrrolate) should be considered to modify potential increases in vagal tone due to concomitant agents (e.g., succinylcholine) or surgical stimuli. (Propofol label, Warnings and precautions)

Impact of Other Drugs on Propranolol CYP2D6, CYP1A2 and CYP2C19 Inhibitors: CYP2D6 inhibitors (e.g. bupropion, fluoxetine, paroxetine, quinidine), CYP1A2 inhibitors (e.g., ciprofloxacin, enoxamine, fluvoxamine) and CYP2C19 inhibitors (e.g., fluconazole, fluvoxamine, ticlopidine) increase exposure to propranolol when co-administered with INNOPRAN XL. (Propranolol label, Drug interactions)

Use with caution in persons with increased risk of anticholinergic reactions, such as persons with bronchial asthma, chronic obstructive pulmonary disease, bradycardia, cardiac arrhythmias, beta blocker treatment (increased risk of anticholinergic reactions). (Pyridostigmine label, Warnings and precautions)

• Anticholinergic (antimuscarinic) Effects: Use with caution with other anticholinergic drugs and in patients with urinary retention, prostatic hypertrophy, or constipation (5.20) (Quetiapine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Although clinical drug interaction studies have not been performed, antimalarial doses (greater than or equal to 600 mg) of quinine may inhibit the metabolism of other drugs that are CYP2D6 substrates (e.g., flecainide, debrisoquine, dextromethorphan, metoprolol, paroxetine ). (Quinine label, Drug interactions)

Drugs transported by P-gp (e.g., digoxin), or drugs metabolized by CYP2D6 (e.g., tricyclic antidepressants) may need reduced doses when used with ASPRUZYO Sprinkle. (Ranolazine label, Drug interactions)

…5-HT 3 Receptor Antagonists Ondansetron Decrease exposure Statins Metabolized by CYP3A4 Simvastatin Decrease exposure Thiazolidinediones Rosiglitazone Decrease AUC by 66% Tricyclic Antidepressants Nortriptyline A tuberculosis treatment regimen including rifampin (600 mg/day), isoniazid (300 mg/day), pyrazinamide (500 mg 3× per day), and pyridoxine (25 mg) was… (Rifampin label, Drug interactions)

…levonorgestrel Immunosuppressants Cyclosporine, tacrolimus Methylxanthines Theophylline Narcotic analgesics Methadone Phosphodiesterase-5 (PDE-5) Inhibitors Sildenafil Thyroid preparations Levothyroxine Tricyclic antidepressants Amitriptyline, nortriptyline 7.5 Other Interactions The conversion of PRIFTIN to 25-desacetyl rifapentine is mediated by an esterase enzyme. (Rifapentine label, Drug interactions)

Fluoxetine and paroxetine increase plasma concentrations of risperidone. (Risperidone label, Drug interactions)

Fosamprenavir/Ritonavir Clinical Impact Co-administration of fosamprenavir/ritonavir with paroxetine significantly decreased plasma levels of paroxetine. (Paroxetine label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

• Monoamine oxidase inhibitors and tricyclic antidepressants: Use with extreme caution. (Salmeterol label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

• Gastrointestinal and Urinary Disorders : Consider more frequent monitoring during treatment in patients suspected of having intestinal obstruction; patients with pyloric obstruction, patients with impeded urine flow or receiving other anticholinergic drugs. (Scopolamine label, Warnings and precautions)

Consider having an anticholinergic and epinephrine available when administering sevoflurane for induction in this patient population. (Sevoflurane label, Warnings)

The concurrent use of Xyrem with other CNS depressants, including but not limited to opioid analgesics, benzodiazepines, sedating antidepressants or antipsychotics, sedating anti-epileptic drugs, general anesthetics, muscle relaxants, and/or illicit CNS depressants, may increase the risk of respiratory depression, hypotension, profound sedation, syncope, and… (Sodium oxybate label, Warnings and precautions)

Urinary Retention The use of Solifenacin succinate tablets, like other antimuscarinic drugs, in patients with clinically significant bladder outlet obstruction including patients with urinary retention, may result in further urinary retention and kidney injury. (Solifenacin label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Pretreatment with anticholinergic agents (e.g., atropine) may reduce the occurrence of bradyarrhythmias. (Succinylcholine label, Warnings and precautions)

Monitor for hemodynamic changes and administer anticholinergic agents such as atropine if clinically significant bradycardia is observed. (Sugammadex label, Warnings and precautions)

The efficacy of tricyclic antidepressants can decrease when coadministered with sulfamethoxazole and trimethoprim. (Sulfamethoxazole and trimethoprim label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Co-administration with other CNS depressants (e.g., benzodiazepines, opioids, tricyclic antidepressants, alcohol) increases the risk of CNS depression. (Suvorexant label, Warnings and precautions)

Reduction of Efficacy of Tamoxifen Some studies have shown that the efficacy of tamoxifen, as measured by the risk of breast cancer relapse/mortality, may be reduced with concomitant use of paroxetine as a result of paroxetine’s irreversible inhibition of CYP2D6 and lower blood levels of tamoxifen [see Drug Interactions ( 7.1 )]. (Paroxetine label, Warnings and precautions)

Use with caution in combination with moderate inhibitors of CYP3A4, with strong or moderate inhibitors of CYP2D6, in patients known to be CYP2D6 poor metabolizers, or in combination with other cytochrome P450 inhibitors. (Tamsulosin label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

The benzodiazepines, including temazepam, produce additive CNS-depressant effects when co-administered with other CNS depressants such as alcohol, barbiturates, antipsychotics, sedative/hypnotics, anxiolytics, antidepressants, narcotic analgesics, sedative antihistamines, anticonvulsants, and anesthetics. (Temazepam label, Drug interactions)

Monoamine Oxidase Inhibitors and Tricyclic Antidepressants Terbutaline sulfate should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents, since the action of terbutaline sulfate on the vascular system may be potentiated. (Terbutaline label, Precautions)

• Do not exceed 50 mg/day and the maximum single dose should not exceed 25 mg if administered in conjunction with a strong CYP2D6 inhibitor (e.g., fluoxetine, paroxetine). (Tetrabenazine label, Warnings and precautions)

Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system (CNS) pathology. (Thiothixene label, Warnings)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

CYP2D6 Inhibitors Potentiated systemic beta-blockade (e.g., decreased heart rate) has been reported during combined treatment with CYP2D6 inhibitors (e.g., quinidine) and timolol. (Timolol label, Drug interactions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

The CNS depressant effects of Zanaflex with alcohol and other CNS depressants (e.g., benzodiazepines, opioids, tricyclic antidepressants) may be additive [see Drug Interactions ( 7.4 )] . (Tizanidine label, Warnings and precautions)

Increased Risk of Bleeding: Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, other antiplatelet drugs, warfarin, and other anticoagulant drugs may increase risk. (Paroxetine label, Warnings and precautions)

Caution should be used when topiramate extended-release capsules are prescribed with other drugs that predispose patients to heat-related disorders; these drugs include, but are not limited to, other carbonic anhydrase inhibitors and drugs with anticholinergic activity. (Topiramate label, Warnings and precautions)

…quinidine, procainamide, disopyramide) and Class III (e.g., amiodarone, sotalol, ibutilide, dofetilide) antiarrhythmics; certain antipsychotics (e.g., thioridazine, haloperidol); certain antidepressants (e.g., venlafaxine, amitriptyline); certain antibiotics (e.g., erythromycin, clarithromycin, levofloxacin, ofloxacin); and certain anti-emetics (e.g., ondansetron, granisetron). (Toremifene label, Drug interactions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system (CNS) pathology. (Trifluoperazine label, Warnings)

The recent use of other drugs that cause CNS depression or EPS symptoms (e.g., alcohol, sedatives, hypnotics, opiates, anxiolytics, antipsychotics, and anticholinergics) may also increase the risk for these serious CNS reactions [see Warnings and Precautions ( 5.1 , 5.5 )] . (Trimethobenzamide label, Warnings and precautions)

Trospium chloride extended-release capsules, like other antimuscarinic agents, may decrease gastrointestinal motility and should be used with caution in patients with conditions such as ulcerative colitis, intestinal atony and myasthenia gravis. (Trospium label, Warnings and precautions)

For patients who are CYP2D6 poor metabolizers or are taking a strong CYP2D6 inhibitor, dose reduction may be necessary. (Valbenazine label, Warnings and precautions)

Elderly patients, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing hyponatremia with SNRIs and SSRIs. [see Use in Specific Populations ( 8.5 )]. (Paroxetine label, Warnings and precautions)

Drugs Suspected of Causing SIADH Use with drugs suspected of causing SIADH (e.g., SSRIs, tricyclic antidepressants, haloperidol, chlorpropamide, enalapril, methyldopa, pentamidine, vincristine, cyclophosphamide, ifosfamide, felbamate) may increase the pressor effect in addition to the antidiuretic effect of Vasostrict ® . (Vasopressin label, Drug interactions)

Urinary Retention : Monitor for urinary retention, especially in patients with bladder outlet obstruction and also in patients taking muscarinic antagonist medications for OAB, in whom the risk of urinary retention may be greater. (Vibegron label, Warnings and precautions)

For patients taking warfarin, carefully monitor the international normalized ratio. (Paroxetine label, Warnings and precautions)

Paroxetine: Coadministration of a single dose of zaleplon 20 mg and paroxetine 20 mg daily for 7 days did not produce any interaction on psychomotor performance. (Zaleplon label, Drug interactions)

Additive effects occur with concomitant use of other CNS depressants (e.g., benzodiazepines, opioids, tricyclic antidepressants, alcohol), including daytime use [see Drug Interactions (7.1) ] . (Zolpidem label, Warnings and precautions)

Caution should be used when ZONISADE is prescribed with other drugs that predispose patients to heat-related disorders; these drugs include, but are not limited to, carbonic anhydrase inhibitors and drugs with anticholinergic activity. (Zonisamide label, Warnings and precautions)

Antidepressants: tricyclic antidepressants ↑ tricyclic antidepressants Coadministration with REYATAZ has the potential to produce serious and/or life-threatening adverse events and has not been studied. (Atazanavir label, Drug interactions)

When benztropine mesylate is given concomitantly with phenothiazines, haloperidol, or other drugs with anticholinergic or antidopaminergic activity, patients should be advised to report gastrointestinal complaints, fever or heat intolerance promptly. (Benztropine label, Warnings)

Cevimeline might interfere with desirable antimuscarinic effects of drugs used concomitantly. (Cevimeline label, Drug interactions)

As with other anticholinergic drugs, clidinium may cause suppression of lactation. (Chlordiazepoxide and clidinium label, Drug interactions)

In contrast, drugs that are inhibitors of cytochrome P450 isozymes, e.g., antidepressants, may be expected to have little effect on valproate clearance because cytochrome P450 microsomal mediated oxidation is a relatively minor secondary metabolic pathway compared to glucuronidation and beta-oxidation. (Divalproex (valproate) label, Drug interactions)

Cholinesterase inhibitors have the potential to interfere with the activity of anticholinergic medications ( 7.1 ) (Donepezil label, Drug interactions)

Examples propafenone, flecainide, atomoxetine, desipramine, dextromethorphan, metoprolol, nebivolol, perphenazine, tolterodine, venlafaxine, risperidone. (Paroxetine label, Drug interactions)

Potential to interfere with the activity of anticholinergic medications ( 7.1 ) (Galantamine label, Drug interactions)

…quinidine, procainamide) or Class III (e.g., amiodarone, sotalol) antiarrhythmics, certain antipsychotics (e.g., ziprasidone, iloperidone, clozapine, quetiapine, chlorpromazine), certain antidepressants (e.g., citalopram, fluoxetine), certain antibiotics (e.g., azithromycin, erythromycin, clarithromycin, gatifloxacin, moxifloxacin); and others (e.g., pentamidine, methadone,… (Hydroxyzine label, Precautions)

These included patients with a history of seizures, epilepsy, cerebrovascular disorders, central nervous system anomalies or tumors, and in patients on concomitant medications that have been associated with convulsions such as bupropion and SSRIs. (Leuprolide label, Warnings and precautions)

These include itraconazole, ketoconazole, posaconazole, voriconazole, the macrolide antibiotics erythromycin and clarithromycin, the ketolide antibiotic telithromycin, HIV protease inhibitors, boceprevir, telaprevir, the antidepressant nefazodone, or cobicistat-containing products. (Lovastatin label, Warnings)

• CYP2D6 inhibitors: As meclizine is metabolized by CYP2D6, there is a potential for drug-drug interactions between meclizine hydrochloride and CYP2D6 inhibitors ( 7.2 ). (Meclizine label, Drug interactions)

NAMZARIC may interfere with anticholinergic medications. (Memantine and donepezil label, Drug interactions)

Appropriate care is advised when prescribing ERZOFRI to patients who will be experiencing conditions which may contribute to an elevation in core body temperature, e.g., exercising strenuously, exposure to extreme heat, receiving concomitant medication with anticholinergic activity, or being subject to dehydration. (Paliperidone label, Warnings and precautions)

Drugs predominantly metabolized by the CYP450 2D6 isozyme include the following drug classes: tricyclic antidepressants, selective serotonin reuptake inhibitors, beta-blockers, antiarrhythmics class 1C (e.g., flecainide and propafenone) and monoamine oxidase inhibitors Type B. (Terbinafine label, Drug interactions)

In most cases, patients were using concomitant medications (antidepressants, antipsychotics, stimulants, narcotics) that are thought to lower the seizure threshold. (Tiagabine label, Warnings)

It is difficult to determine if Tolcapone tablets played a role in the pathogenesis of these events because these patients received several concomitant medications affecting the central nervous system such as monoaminergic (i.e., MAO-I, tricyclic and selective serotonin reuptake inhibitors) and anticholinergic agents. (Tolcapone label, Precautions)

Examples propafenone, flecainide, atomoxetine, desipramine, dextromethorphan, metoprolol, nebivolol, perphenazine, tolterodine, venlafaxine, risperidone. (Paroxetine label, Drug interactions)

Monoamine oxidase inhibitors and tricyclic antidepressants possessing significant anticholinergic activity may intensify the anticholinergic effects of antidyskinetic agents because of the secondary anticholinergic activities of these medications. (Trihexyphenidyl label, Drug interactions)

In contrast, drugs that are inhibitors of cytochrome P450 isozymes, e.g., antidepressants, may be expected to have little effect on valproate clearance because cytochrome P450 microsomal mediated oxidation is a relatively minor secondary metabolic pathway compared to glucuronidation and beta-oxidation. (Valproic acid label, Drug interactions)

…changes in the safety profile of desloratadine. [See Clinical Pharmacology (12.3) .] 7.2 Fluoxetine In controlled clinical studies co-administration of desloratadine with fluoxetine, a selective serotonin reuptake inhibitor (SSRI), resulted in increased plasma concentrations of desloratadine and 3 hydroxydesloratadine, but there were no clinically relevant changes… (Desloratadine label, Drug interactions)

No interaction with the tricyclic antidepressant imipramine was shown in a single-dose study with entacapone without coadministered levodopa and dopa-decarboxylase inhibitor. (Entacapone label, Precautions)

…to the drugs included in Table 4, the interaction between Etravirine and the following drugs were evaluated in clinical studies and no dose adjustment is needed for either drug [see Clinical Pharmacology (12.3) ] : didanosine, enfuvirtide (ENF), ethinylestradiol/norethindrone, omeprazole, paroxetine, raltegravir, ranitidine, and tenofovir disoproxil fumarate. (Etravirine label, Drug interactions)

Commonly Administered Drugs: Population analysis showed that commonly administered drugs (e.g., selegiline, amantadine, tricyclic antidepressants, benzodiazepines, ibuprofen, thiazides, antihistamines, anticholinergics) did not affect the clearance of ropinirole. (Ropinirole label, Drug interactions)