Phentermine and topiramate interactions
Phentermine and topiramate (Qsymia), a CNS stimulant has 299 documented interactions across the FDA labels and fact sheets we index: 117 major, 167 moderate, 14 minor, and 1 where a label reports no significant interaction. Each entry below quotes the sentence behind it. This drug page is a starting point, not a verdict for your situation.
Major interactions (117)
- Acetazolamidecarbonic anhydrase inhibitorMajor
Avoid use of phentermine and topiramate extended-release capsules with other carbonic anhydrase inhibitors. (Phentermine and topiramate label, Warnings and precautions)
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
Avoid excessive use of alcohol ( 7 ). (Phentermine and topiramate label, Drug interactions)
• Effects on Driving and Operating Machinery: Patients receiving • alprazolam XR should be cautioned against operating machinery or driving a motor vehicle, as well as avoiding concomitant use of alcohol and other central nervous system (CNS) depressant drugs. (Alprazolam label, Warnings and precautions)
Hypersensitivity reactions such as angioedema and anaphylactic reactions have been reported in patients treated with other amphetamine products [see Adverse Reactions ( 6.2 )] . taking monoamine oxidase inhibitors (MAOIs), or within 14 days of stopping MAOIs (including MAOIs such as linezolid or intravenous methylene blue), because of an increased risk of hypertensive… (Amphetamine and dextroamphetamine label, Contraindications)
• Simultaneous use of combined P-gp and strong CYP3A4 inducers reduces blood levels of apixaban: Avoid concomitant use. (Apixaban label, Drug interactions)
- ApremilastPDE4 inhibitorMajor
Drug Interactions : Use with strong cytochrome P450 enzyme inducers (e.g., rifampin, phenobarbital, carbamazepine, phenytoin) is not recommended because loss of efficacy may occur ( 5.5 , 7.1 ) (Apremilast label, Warnings and precautions)
CYP3A4 Inducers : Avoid concomitant use for greater than 14 days ( 7.1 ) (Aripiprazole label, Drug interactions)
- Bictegravir, emtricitabine, and tenofovir alafenamideantiretroviralMajor
Concomitant administration of BIXLENVO is contraindicated with: dofetilide due to the potential for increased dofetilide plasma concentrations and associated serious and/or life-threatening events. strong CYP3A inducers due to decreased plasma concentrations of BIC and LEN, which may result in the loss of therapeutic effect and development of resistance to BIXLENVO. (Bictegravir, emtricitabine, and tenofovir alafenamide label, Contraindications)
- Budesonide and formoterolcorticosteroidMajor
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Buprenorphine label, Boxed warning)
Bupropion hydrochloride extended-release tablets (XL) are contraindicated in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs [see Warnings and Precautions (5.3) and Drug Interactions (7.3)] . (Bupropion label, Contraindications)
- ButorphanolopioidMajor
Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Butorphanol label, Boxed warning)
- CariprazineantipsychoticMajor
Intervention: Concomitant use of VRAYLAR with a CYP3A4 inducer is not recommended [see Dosage and Administration ( 2.1 , 2.6 ) ] . (Cariprazine label, Drug interactions)
Avoid concurrent use of QUZYTTIR with alcohol or other CNS depressants because additional reduction in alertness and additional impairment of CNS performance may occur. (Cetirizine label, Warnings and precautions)
Table 8: Drugs That are Affected by and Affecting Ciprofloxacin Drugs That are Affected by Ciprofloxacin Drug(s) Recommendation Comments Tizanidine Contraindicated Concomitant administration of tizanidine and ciprofloxacin is contraindicated due to the potentiation of hypotensive and sedative effects of tizanidine [see Contraindications ( 4.2 )]. (Ciprofloxacin label, Drug interactions)
Avoid use of Citalopram Capsules in CYP2C19 poor metabolizers, patients receiving concomitant cimetidine or another CYP2C19 inhibitor, patients with hepatic impairment, and patients who are greater than 60 years of age, because Citalopram Capsules are only available in a 30 mg dose strength and dosage adjustments are not possible [see Drug Interactions ( 7 ),… (Citalopram label, Warnings and precautions)
Avoid use with other central nervous system (CNS) depressants ( 5.3 ) (Clonidine label, Warnings and precautions)
CYP2C19 inhibitors: Avoid concomitant use of omeprazole or esomeprazole. (Clopidogrel label, Warnings and precautions)
- ClozapineantipsychoticMajor
• Concomitant use of Strong CYP3A4 Inducers is not recommended. (Clozapine label, Drug interactions)
- CodeineopioidMajor
Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Codeine label, Boxed warning)
Based on its structural similarity to TCAs, concomitant use of TONMYA with: MAO inhibitors may be life-threatening [see Contraindications (4) ] , Alcohol, barbiturates, and other CNS depressants may increase the risk of adverse reactions associated with these drugs, Tramadol may increase the seizure risk, Guanethidine or other similar acting drugs may block the… (Cyclobenzaprine label, Drug interactions)
- Daridorexantsedative-hypnoticMajor
Moderate or Strong CYP3A4 inducers: Avoid concomitant use. (Daridorexant label, Drug interactions)
Coadministration of diltiazem with rifampin or any known CYP3A4 inducer should be avoided when possible, and alternative therapy considered [see Clinical Pharmacology (12.3)]. a Strong and moderate inhibitors increase the AUC of sensitive substrates of CYP3A4 by ≥ 5 and ≥ 2-fold, respectively b These examples are a guide and not considered a comprehensive list… (Diltiazem label, Drug interactions)
Children under the age of two years are at a considerably increased risk of developing fatal hepatotoxicity, especially those on multiple anticonvulsants, those with congenital metabolic disorders, those with severe seizure disorders accompanied by mental retardation, and those with organic brain disease. (Divalproex (valproate) label, Boxed warning)
- Dorzolamidecarbonic anhydrase inhibitorMajor
Avoid use of phentermine and topiramate extended-release capsules with other carbonic anhydrase inhibitors. (Phentermine and topiramate label, Warnings and precautions)
- Dorzolamide and timololcarbonic anhydrase inhibitorMajor
Avoid use of phentermine and topiramate extended-release capsules with other carbonic anhydrase inhibitors. (Phentermine and topiramate label, Warnings and precautions)
- DronabinolcannabinoidMajor
Avoid concomitant use of other drugs that are also associated with similar cardiac effects (e.g., amphetamines, other sympathomimetic agents, atropine, amoxapine, scopolamine, antihistamines, other anticholinergic agents, amitriptyline, desipramine, other tricyclic antidepressants). (Dronabinol label, Warnings and precautions)
- DronedaroneantiarrhythmicMajor
• CYP3A inducers: Avoid concomitant use. (Dronedarone label, Drug interactions)
- DroxidopasympathomimeticMajor
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
- Elexacaftor, tezacaftor, and ivacaftorMajor
Therefore, concomitant use with strong CYP3A inducers is not recommended [see Drug Interactions (7.1) and Clinical Pharmacology (12.3) ] . (Elexacaftor, tezacaftor, and ivacaftor label, Warnings and precautions)
- Empagliflozin and metforminSGLT2 inhibitorMajor
Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, hepatic… (Empagliflozin and metformin label, Boxed warning)
- EpinephrinesympathomimeticMajor
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
The use of LUNESTA with other sedative-hypnotics at bedtime or the middle of the night is not recommended. (Eszopiclone label, Warnings and precautions)
- FelbamateanticonvulsantMajor
IT IS NOT KNOWN WHETHER CONCOMITANT USE OF OTHER ANTIEPILEPTIC DRUGS AND/OR OTHER DRUGS AFFECT THE INCIDENCE OF HEPATIC FAILURE. (Felbamate label, Boxed warning)
• Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Fentanyl label, Boxed warning)
- FlibanserinCNS depressantMajor
Preventing or Managing DI The concomitant use of ADDYI with CYP3A4 inducers is not recommended. (Flibanserin label, Drug interactions)
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
- Formoterolbeta-adrenergic agonistMajor
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
- Glyburide and metforminsulfonylureaMajor
Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g. , acute congestive heart failure), excessive alcohol intake, hepatic… (Glyburide and metformin label, Boxed warning)
Seizures: HALDOL DECANOATE is generally not recommended in patients receiving antiseizure drugs or who have a history of seizures or EEG abnormalities. (Haloperidol label, Warnings and precautions)
Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Hydrocodone and acetaminophen label, Boxed warning)
Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death . (Hydromorphone label, Boxed warning)
Rarely, cardiac arrests and death have been reported in association with the combined use of hydroxyzine hydrochloride intramuscularly and other CNS depressants. (Hydroxyzine label, Precautions)
- IsoniazidantibioticMajor
…Warnings and Precautions (5.1) and Use in Specific Populations (8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release… (Phentermine and topiramate label, Contraindications)
Anticonvulsants Carbamazepine Not recommended 2 weeks before, during, and 2 weeks after TOLSURA treatment. (Itraconazole label, Drug interactions)
- IvabradineMajor
Avoid concomitant use of CYP3A4 inducers when using Corlanor. (Ivabradine label, Drug interactions)
- KetamineCNS depressantMajor
Benzodiazepines, Opioid Analgesics, or other CNS Depressants : Concomitant use may result in profound sedation, respiratory depression, coma, or death. (Ketamine label, Drug interactions)
This may potentiate and prolong hypnotic and sedative effects, especially with repeated dosing or chronic administration of these agents. (Ketoconazole label, Contraindications)
- Lemborexantsedative-hypnoticMajor
Strong or moderate CYP3A inducers: Avoid concomitant use. (Lemborexant label, Drug interactions)
- Levalbuterolbeta-adrenergic agonistMajor
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
Avoid concurrent use of alcohol or other central nervous system depressants with XYZAL. (Levocetirizine label, Warnings and precautions)
- LevorphanolopioidMajor
Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Levorphanol label, Boxed warning)
- LinezolidantibioticMajor
…Warnings and Precautions (5.1) and Use in Specific Populations (8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release… (Phentermine and topiramate label, Contraindications)
- Liothyroninethyroid hormoneMajor
• Larger doses may produce serious or even life-threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects [see Adverse Reactions (6) , Drug Interactions (7.7) , and Overdosage (10) ] . (Liothyronine label, Boxed warning)
Caution patients receiving LOREEV XR against operating machinery or driving a motor vehicle as well to avoid the concomitant use of alcohol and other CNS depressant drugs during treatment ( 5.4 , 7 ) (Lorazepam label, Warnings and precautions)
- LumateperoneantipsychoticMajor
CYP3A4 inducers: Avoid concomitant use with CAPLYTA. (Lumateperone label, Drug interactions)
Strong CYP3A4 inducers (e.g., rifampin, avasimibe, St. (Lurasidone label, Contraindications)
- MacitentanMajor
Strong CYP3A4 inducers (rifampin) reduce exposure to macitentan: avoid co-administration with OPSUMIT ( 7.1 , 12.3 ). (Macitentan label, Drug interactions)
- MeperidineopioidMajor
Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Meperidine label, Boxed warning)
Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, and hepatic… (Metformin label, Boxed warning)
Managing Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, is a risk factor for respiratory depression and death [see Warnings and Precautions ( 5.2 )]. (Methadone label, Boxed warning)
- MidazolambenzodiazepineMajor
WARNING: PERSONNEL AND EQUIPMENT FOR MONITORING AND RESUSCITATION, AND RISKS FROM CONCOMITANT USE WITH OPIOID ANALGESICS AND OTHER SEDATIVE-HYPNOTICS Personnel and Equipment for Monitoring and ResuscitationOnly personnel trained in the administration of procedural sedation, and not involved in the conduct of the diagnostic or therapeutic procedure, should administer… (Midazolam label, Boxed warning)
- Midodrinealpha-adrenergic agonistMajor
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
- Mirabegronbeta-adrenergic agonistMajor
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Morphine label, Boxed warning)
- NalbuphineopioidMajor
Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Nalbuphine label, Boxed warning)
- Naldemedineopioid antagonistMajor
John's Wort) Clinical Impact Significant decrease in plasma naldemedine concentrations, which may reduce efficacy [see Clinical Pharmacology (12.3) ] Intervention Avoid use of SYMPROIC with strong CYP3A inducers. (Naldemedine label, Drug interactions)
- Naltrexone and bupropionopioid antagonistMajor
…(e.g., buprenorphine) use, or acute opiate withdrawal [see Warnings and Precautions (5.4) and Drug Interactions (7.2) ] Patients undergoing an abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs [see Warnings and Precautions (5.3) and Drug Interactions (7.7) ] Concomitant administration of monoamine oxidase inhibitors (MAOI). (Naltrexone and bupropion label, Contraindications)
Avoid co-administration of nifedipine with phenytoin or any known CYP3A4 inducer or consider an alternative antihypertensive therapy. (Nifedipine label, Drug interactions)
Counsel patients to use a back-up method or alternative method of contraception when enzyme inducers are used with COCs ( 7.1 ) -- - ---------- ------ USE IN SPECIFIC POPULATIONS---- -- -- --------- ---- Lactation: Not recommended; Lo Loestrin Fe can decrease milk production ( 8.2 ) (Norethindrone and ethinyl estradiol label, Drug interactions)
- OliceridineopioidMajor
Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Oliceridine label, Boxed warning)
- OlopatadineantihistamineMajor
Avoid concurrent use of alcohol or other central nervous system depressants with olopatadine hydrochloride nasal spray ( 5.2 ). (Olopatadine label, Warnings and precautions)
Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Oxycodone label, Boxed warning)
…LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; CYTOCHROME P450 3A4 INTERACTION; and RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS Addiction, Abuse, and Misuse Oxycodone hydrochloride tablets exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to… (Oxycodone and acetaminophen label, Boxed warning)
- OxymorphoneopioidMajor
Risks From Concomitant Use with Benzodiazepines or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Oxymorphone label, Boxed warning)
- PalbociclibCYP3A4 inhibitorMajor
• CYP3A Inducers: Avoid concurrent use of IBRANCE with strong CYP3A inducers. (Palbociclib label, Drug interactions)
- PaliperidoneantipsychoticMajor
Strong CYP3A4 and P-glycoprotein (P-gp) inducers : Avoid using a strong inducer of CYP3A4 and/or P-gp during a dosing interval for ERZOFRI. (Paliperidone label, Drug interactions)
- Pentazocine and naloxoneopioidMajor
…MITIGATION STRATEGY (REMS); LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; and RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS Addiction, Abuse, and Misuse Pentazocine and Naloxone Tablets exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to… (Pentazocine and naloxone label, Boxed warning)
- PhenelzineMAO inhibitorMajor
…Warnings and Precautions (5.1) and Use in Specific Populations (8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release… (Phentermine and topiramate label, Contraindications)
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
- PhenylephrinedecongestantMajor
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
- PimavanserinantipsychoticMajor
Strong or Moderate CYP3A4 Inducers: Avoid concomitant use of NUPLAZID. (Pimavanserin label, Drug interactions)
- Pioglitazone and metforminthiazolidinedioneMajor
Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, hepatic… (Pioglitazone and metformin label, Boxed warning)
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
ASPRUZYO Sprinkle is contraindicated in patients: Taking strong inhibitors of CYP3A [see Drug Interactions (7.1)] Taking inducers of CYP3A [see Drug Interactions (7.1)] With liver cirrhosis [see Use in Specific Populations (8.6)] Strong CYP3A inhibitors (e.g., ketoconazole, clarithromycin, nelfinavir) (4, 7.1) (Ranolazine label, Contraindications)
- RasagilineMAO inhibitorMajor
…Warnings and Precautions (5.1) and Use in Specific Populations (8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release… (Phentermine and topiramate label, Contraindications)
- RimegepantMajor
• Strong and Moderate CYP3A Inducers: Avoid concomitant administration. (Rimegepant label, Drug interactions)
Avoid concomitant use of XARELTO with drugs that are known combined P-gp and strong CYP3A inducers [see Drug Interactions (7.3) ] . (Rivaroxaban label, Warnings and precautions)
- RoflumilastPDE4 inhibitorMajor
• Drug Interactions: Use with strong cytochrome P450 enzyme inducers (e.g., rifampicin, phenobarbital, carbamazepine, phenytoin) is not recommended. (Roflumilast label, Warnings and precautions)
- Salmeterolbeta-adrenergic agonistMajor
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
- SelegilineMAO inhibitorMajor
…Warnings and Precautions (5.1) and Use in Specific Populations (8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release… (Phentermine and topiramate label, Contraindications)
- SirolimusimmunosuppressantMajor
Interaction with Strong Inhibitors and Inducers of CYP3A4 and/or P-gp Avoid concomitant use of sirolimus with strong inhibitors of CYP3A4 and/or P-gp (such as ketoconazole, voriconazole, itraconazole, erythromycin, telithromycin, or clarithromycin) or strong inducers of CYP3A4 and/or P-gp (such as rifampin or rifabutin) [ see Drug Interactions (7.2) ]. (Sirolimus label, Warnings and precautions)
- Sitagliptin and metforminDPP-4 inhibitorMajor
Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, hepatic… (Sitagliptin and metformin label, Boxed warning)
- Sodium oxybateCNS depressantMajor
Many patients who received Xyrem during clinical trials in narcolepsy were receiving central nervous system stimulants [see Clinical Trials ( 14 )]. (Sodium oxybate label, Boxed warning)
- Sofosbuvir and velpatasvirantiviralMajor
Anticonvulsants: carbamazepine phenytoin phenobarbital ↓ sofosbuvir ↓ velpatasvir ↓ voxilaprevir Coadministration is not recommended. (Sofosbuvir and velpatasvir label, Drug interactions)
Inducers of CYP3A4 Strong CYP3A4 inducers should not be used with tamoxifen. (Tamoxifen label, Drug interactions)
- TapentadolopioidMajor
Risks From Concomitant Use With Benzodiazepines Or Other CNS Depressants Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tapentadol label, Boxed warning)
- Tasimelteonsedative-hypnoticMajor
Strong CYP3A4 inducers (e.g., rifampin): Avoid use of HETLIOZ in combination with rifampin or other CYP3A4 inducers, because of decreased exposure ( 7.2 , 12.3 ) (Tasimelteon label, Drug interactions)
- Terbutalinebeta-adrenergic agonistMajor
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
• Avoid use with strong CYP3A inhibitors or CYP3A inducers. (Ticagrelor label, Drug interactions)
Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. (Tramadol label, Boxed warning)
- TranylcypromineMAO inhibitorMajor
…Warnings and Precautions (5.1) and Use in Specific Populations (8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release… (Phentermine and topiramate label, Contraindications)
- TretinoinretinoidMajor
Avoid concomitant use with strong CYP3A inducers if possible. (Tretinoin label, Drug interactions)
- TriazolambenzodiazepineMajor
• Effects on Driving and Operating Heavy Machinery : Patients receiving triazolam should be cautioned against driving or operating heavy machinery, as well as avoiding concomitant use with alcohol and other CNS depressant drugs. (Triazolam label, Warnings and precautions)
- UbrogepantMajor
Strong CYP3A4 Inducers: Should be avoided as concomitant use will result in reduction of ubrogepant exposure. (Ubrogepant label, Drug interactions)
- Umeclidinium and vilanterolanticholinergicMajor
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
- UpadacitinibimmunosuppressantMajor
Strong CYP3A4 Inducers : Coadministration of RINVOQ/RINVOQ LQ with strong CYP3A4 inducers is not recommended. (Upadacitinib label, Drug interactions)
- ValbenazineVMAT2 inhibitorMajor
Use of strong CYP3A4 inducers with INGREZZA or INGREZZA SPRINKLE Concomitant use is not recommended. (Valbenazine label, Drug interactions)
- Valproic acidanticonvulsantMajor
Children under the age of two years are at a considerably increased risk of developing fatal hepatotoxicity, especially those on multiple anticonvulsants, those with congenital metabolic disorders, those with severe seizure disorders accompanied by mental retardation, and those with organic brain disease. (Valproic acid label, Boxed warning)
- Vibegronbeta-adrenergic agonistMajor
…(8.1) ] With glaucoma [see Warnings and Precautions (5.3) ] With hyperthyroidism Taking or within 14 days of stopping a monoamine oxidase inhibitors [see Drug Interactions (7) ] With known hypersensitivity to phentermine, topiramate or any of the excipients in phentermine and topiramate extended-release capsules, or idiosyncrasy to the sympathomimetic amines. (Phentermine and topiramate label, Contraindications)
- Zaleplonsedative-hypnoticMajor
The use of zaleplon with other sedative-hypnotics at bedtime or the middle of the night is not recommended (see ). (Zaleplon label, Warnings)
The use of Zolpidem Tartrate with other sedative-hypnotics (including other zolpidem products) at bedtime or the middle of the night is not recommended. (Zolpidem label, Warnings and precautions)
Avoid use of phentermine and topiramate extended-release capsules with other carbonic anhydrase inhibitors. (Phentermine and topiramate label, Warnings and precautions)
Moderate interactions (167)
- AclidiniumanticholinergicModerate
Sympathomimetics, Methylxanthines, Steroids In clinical studies, concurrent administration of aclidinium bromide and other drugs commonly used in the treatment of COPD including sympathomimetics (short-acting beta 2 agonists), methylxanthines, and oral and inhaled steroids showed no increases in adverse drug reactions. (Aclidinium label, Drug interactions)
- AlbendazoleModerate
Risk of Neurologic Symptoms: Neurocysticercosis patients may experience cerebral hypertensive episodes, seizures or focal neurologic deficits after initiation of therapy; begin appropriate steroid and anticonvulsant therapy. (Albendazole label, Warnings and precautions)
Inform patients also that the central nervous system depressant effects of allopurinol tablets may be additive to those of alcohol and other CNS depressants. (Allopurinol label, Warnings and precautions)
- Amiloridepotassium-sparing diureticModerate
In addition, when phentermine and topiramate extended-release capsules are used in conjunction with nonpotassium sparing diuretics this may further potentiate potassium-wasting. (Phentermine and topiramate label, Warnings and precautions)
- Amitriptylinetricyclic antidepressantModerate
Amitriptyline Clinical Impact Some patients may experience a large increase in amitriptyline concentration in the presence of topiramate. (Phentermine and topiramate label, Drug interactions)
- Amlodipinedihydropyridine calcium channel blockerModerate
Blood pressure should be closely monitored when amlodipine is co-administered with CYP3A inducers. (Amlodipine label, Drug interactions)
- Amlodipine and benazeprildihydropyridine calcium channel blockerModerate
Blood pressure should be monitored when amlodipine is coadministered with CYP3A4 inducers (e.g. rifampicin, St. (Amlodipine and benazepril label, Drug interactions)
- AsenapineantipsychoticModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- Aspirin and dipyridamoleantiplatelet agentModerate
Anticonvulsants Salicylic acid can displace protein-bound phenytoin and valproic acid, leading to a decrease in the total concentration of phenytoin and an increase in serum valproic acid levels. (Aspirin and dipyridamole label, Drug interactions)
- Baclofenmuscle relaxantModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- Bisoprolol and hydrochlorothiazidebeta blockerModerate
Concomitant administration of hydrochlorothiazide alone with topiramate alone has been shown to increase the C max and AUC of topiramate by 27% and 29%, respectively. (Phentermine and topiramate label, Drug interactions)
- BrexpiprazoleantipsychoticModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- Brimonidinealpha-adrenergic agonistModerate
Use with CNS depressants may result in an additive or potentiating effect. (Brimonidine label, Drug interactions)
- BudesonidecorticosteroidModerate
Patients with major risk factors for decreased bone mineral content, such as prolonged immobilization, family history of osteoporosis, post menopausal status, tobacco use, advance age, poor nutrition, or chronic use of drugs that can reduce bone mass (e.g., anticonvulsants, oral corticosteroids) should be monitored and treated with established standards of care. (Budesonide label, Warnings and precautions)
- Bumetanideloop diureticModerate
In addition, when phentermine and topiramate extended-release capsules are used in conjunction with nonpotassium sparing diuretics this may further potentiate potassium-wasting. (Phentermine and topiramate label, Warnings and precautions)
- Buprenorphine and naloxoneopioidModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- Buspironeserotonergic drugModerate
Triazolam/flurazepam: Coadministration of buspirone with either triazolam or flurazepam did not appear to prolong or intensify the sedative effects of either benzodiazepine. (Buspirone label, Drug interactions)
- Butalbital, acetaminophen, and caffeinebarbiturateModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- CalciumVitamin and mineralModerate
Increased ratio of urinary calcium/citrate increases the risk of kidney stones and/or nephrocalcinosis. (Phentermine and topiramate label, Warnings and precautions)
- CanagliflozinSGLT2 inhibitorModerate
Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Canagliflozin label, Drug interactions)
- Cannabidiol (prescription)anticonvulsantModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- CarbamazepineanticonvulsantModerate
Antiepileptic Drugs Clinical Impact Concomitant administration of phenytoin or carbamazepine with topiramate in patients with epilepsy, decreased plasma concentrations of topiramate by 48% and 40%, respectively, when compared to topiramate given alone [see Clinical Pharmacology (12.3) ] . (Phentermine and topiramate label, Drug interactions)
- Carisoprodolmuscle relaxantModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- CenobamateanticonvulsantModerate
Concomitant use with other CNS depressants or alcohol may have additive effects. (Cenobamate label, Warnings and precautions)
- ChlordiazepoxidebenzodiazepineModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- ChlorpromazineantipsychoticModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- Chlorthalidonethiazide diureticModerate
In addition, when phentermine and topiramate extended-release capsules are used in conjunction with nonpotassium sparing diuretics this may further potentiate potassium-wasting. (Phentermine and topiramate label, Warnings and precautions)
- Cilostazolantiplatelet agentModerate
Strong and moderate CYP3A4 and CYP2C19 inhibitors: Increase exposure to cilostazol. (Cilostazol label, Drug interactions)
- Clarithromycinmacrolide antibioticModerate
Antiepileptics: Carbamazepine Use With Caution Carbamazepine: Concomitant administration of single doses of clarithromycin and carbamazepine has been shown to result in increased plasma concentrations of carbamazepine. (Clarithromycin label, Drug interactions)
- ClindamycinantibioticModerate
Inducers of CYP3A4 and CYP3A5 Inducers of CYP3A4 and/or CYP3A5 may reduce plasma concentrations of clindamycin. (Clindamycin label, Drug interactions)
- ClobazambenzodiazepineModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- ClonazepambenzodiazepineModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- Conjugated estrogensestrogenModerate
Oral Contraceptives Clinical Impact Co-administration of multiple-dose phentermine and topiramate extended-release capsules 15 mg/92 mg once daily with a single dose of oral contraceptive containing 35 µg ethinyl estradiol (estrogen component) and 1 mg norethindrone (progestin component), in obese otherwise healthy volunteers, decreased the exposure of ethinyl… (Phentermine and topiramate label, Drug interactions)
- CyclosporineimmunosuppressantModerate
Drugs/Dietary Supplements That Decrease Cyclosporine Concentrations Antibiotics Anticonvulsants Other Drugs/Dietary Supplements nafcillin carbamazepine bosentan St. (Cyclosporine label, Drug interactions)
- Dantrolenemuscle relaxantModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- DesvenlafaxineSNRIModerate
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. (Desvenlafaxine label, Warnings and precautions)
- DeutetrabenazineVMAT2 inhibitorModerate
Alcohol or other sedating drugs: May have additive sedation and somnolence ( 7.5 ) (Deutetrabenazine label, Drug interactions)
- Dexlansoprazoleproton pump inhibitorModerate
Clinically Relevant Interactions Affecting DEXILANT When Coadministered with Other Drugs and Substances CYP2C19 or CYP3A4 Inducers Clinical Impact: Decreased exposure of dexlansoprazole when used concomitantly with strong inducers [see Clinical Pharmacology (12.3) ] . (Dexlansoprazole label, Drug interactions)
- DiazepambenzodiazepineModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- DiclofenacNSAIDModerate
Exercise caution when prescribing Diclofenac Potassium with concomitant drugs that are known to be potentially hepatotoxic (e.g., acetaminophen, antibiotics, antiepileptics). (Diclofenac label, Warnings and precautions)
- DicyclomineanticholinergicModerate
…drugs including dicyclomine hydrochloride: amantadine, antiarrhythmic agents of Class I (e.g., quinidine), antihistamines, antipsychotic agents (e.g., phenothiazines), benzodiazepines, MAO inhibitors, narcotic analgesics (e.g., meperidine), nitrates and nitrites, sympathomimetic agents, tricyclic antidepressants, and other drugs having anticholinergic activity. (Dicyclomine label, Drug interactions)
- Digoxindigitalis glycosideModerate
Sympathomimetics Epinephrine Can increase the risk of cardiac arrhythmias. (Digoxin label, Drug interactions)
- DimenhydrinateantihistamineModerate
The concomitant use of alcohol or other central nervous system depressants may have an additive effect. (Dimenhydrinate label, Warnings)
- DiphenhydramineantihistamineModerate
Drug Interactions Diphenhydramine hydrochloride has additive effects with alcohol and other CNS depressants (hypnotics, sedatives, tranquilizers, etc). (Diphenhydramine label, Drug interactions)
- DofetilideantiarrhythmicModerate
Concomitant medications were grouped as ACE inhibitors, oral anticoagulants, calcium channel blockers, beta blockers, cardiac glycosides, inducers of CYP3A4, substrates and inhibitors of CYP3A4, substrates and inhibitors of P-glycoprotein, nitrates, sulphonylureas, loop diuretics, potassium sparing diuretics, thiazide diuretics, substrates and inhibitors of tubular… (Dofetilide label, Drug interactions)
- Doxepintricyclic antidepressantModerate
Although behaviors such as "sleep-driving" may occur with hypnotics alone at therapeutic doses, the use of alcohol and other CNS depressants with hypnotics appears to increase the risk of such behaviors, as does the use of hypnotics at doses exceeding the maximum recommended dose. (Doxepin label, Warnings and precautions)
- Doxycyclinetetracycline antibioticModerate
Barbiturates and Anti-Epileptics Barbiturates, carbamazepine, and phenytoin decrease the half-life of doxycycline. (Doxycycline label, Drug interactions)
- Drospirenone and ethinyl estradioloral contraceptiveModerate
Oral Contraceptives Clinical Impact Co-administration of multiple-dose phentermine and topiramate extended-release capsules 15 mg/92 mg once daily with a single dose of oral contraceptive containing 35 µg ethinyl estradiol (estrogen component) and 1 mg norethindrone (progestin component), in obese otherwise healthy volunteers, decreased the exposure of ethinyl… (Phentermine and topiramate label, Drug interactions)
- DuloxetineSNRIModerate
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. (Duloxetine label, Warnings and precautions)
- EluxadolineopioidModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- Emtricitabine and tenofovirantiretroviralModerate
Other Agents Anticonvulsants: carbamazepine oxcarbazepine phenobarbital phenytoin ↓ TAF Consider alternative anticonvulsant. (Emtricitabine and tenofovir label, Drug interactions)
- Eplerenonealdosterone antagonistModerate
In addition, when phentermine and topiramate extended-release capsules are used in conjunction with nonpotassium sparing diuretics this may further potentiate potassium-wasting. (Phentermine and topiramate label, Warnings and precautions)
- EscitalopramSSRIModerate
The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, meperidine, methadone, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. (Escitalopram label, Warnings and precautions)
- EslicarbazepineanticonvulsantModerate
Anyone considering prescribing APTIOM or any other AED must balance this risk with the risk of untreated illness. (Eslicarbazepine label, Warnings and precautions)
- Esmololbeta blockerModerate
• Sympathomimetic drugs: Dose adjustment needed ( 7 ) (Esmolol label, Drug interactions)
- Esomeprazoleproton pump inhibitorModerate
Table 4: Clinically Relevant Interactions Affecting Esomeprazole When Co-Administered with Other Drugs CYP2C19 or CYP3A4 Inducers Clinical Impact: Decreased exposure of esomeprazole when used concomitantly with strong inducers [see Clinical Pharmacology (12.3) ]. (Esomeprazole label, Drug interactions)
- EstradiolestrogenModerate
Oral Contraceptives Clinical Impact Co-administration of multiple-dose phentermine and topiramate extended-release capsules 15 mg/92 mg once daily with a single dose of oral contraceptive containing 35 µg ethinyl estradiol (estrogen component) and 1 mg norethindrone (progestin component), in obese otherwise healthy volunteers, decreased the exposure of ethinyl… (Phentermine and topiramate label, Drug interactions)
- Ethacrynic acidloop diureticModerate
In addition, when phentermine and topiramate extended-release capsules are used in conjunction with nonpotassium sparing diuretics this may further potentiate potassium-wasting. (Phentermine and topiramate label, Warnings and precautions)
- EverolimusimmunosuppressantModerate
Interaction With Strong Inhibitors and Inducers of CYP3A4 Coadministration of Zortress with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, voriconazole, clarithromycin, telithromycin, ritonavir, boceprevir, telaprevir) or strong CYP3A4 inducers (e.g., rifampin, rifabutin) is not recommended without close monitoring of everolimus whole blood trough… (Everolimus label, Warnings and precautions)
- Felodipinedihydropyridine calcium channel blockerModerate
Anticonvulsants - In a pharmacokinetic study, maximum plasma concentrations of felodipine were considerably lower in epileptic patients on long-term anticonvulsant therapy (e.g., phenytoin, carbamazepine, or phenobarbital) than in healthy volunteers. (Felodipine label, Drug interactions)
- FesoterodineanticholinergicModerate
CYP3A4 Inducers No dosing adjustments are recommended in the presence of CYP3A4 inducers, such as rifampin and carbamazepine. (Fesoterodine label, Drug interactions)
- FlecainideantiarrhythmicModerate
Limited data in patients receiving known enzyme inducers ( phenytoin, phenobarbital, carbamazepine ) indicate only a 30% increase in the rate of flecainide elimination. (Flecainide label, Drug interactions)
- FluoxetineSSRIModerate
The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, meperidine, methadone, buspirone, amphetamines, and St. (Fluoxetine label, Warnings and precautions)
- FluticasonecorticosteroidModerate
Patients with major risk factors for decreased bone mineral content, such as prolonged immobilization, family history of osteoporosis, postmenopausal status, tobacco use, advanced age, poor nutrition, or chronic use of drugs that can reduce bone mass (e.g., anticonvulsants, oral corticosteroids), should be monitored and treated with established standards of care. (Fluticasone label, Warnings and precautions)
- FluvoxamineSSRIModerate
The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, meperidine, methadone, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. (Fluvoxamine label, Warnings and precautions)
- Furosemideloop diureticModerate
In addition, when phentermine and topiramate extended-release capsules are used in conjunction with nonpotassium sparing diuretics this may further potentiate potassium-wasting. (Phentermine and topiramate label, Warnings and precautions)
- GabapentinanticonvulsantModerate
When the decision is made to co-prescribe NEURONTIN with another CNS depressant, particularly an opioid, or to prescribe NEURONTIN to patients with underlying respiratory impairment, monitor patients for symptoms of respiratory depression and sedation, and consider initiating NEURONTIN at a low dose. (Gabapentin label, Warnings and precautions)
- GlimepiridesulfonylureaModerate
…somatropin, protease inhibitors, atypical antipsychotic medications (e.g., olanzapine and clozapine), barbiturates, diazoxide, laxatives, rifampin, thiazides and other diuretics, corticosteroids, phenothiazines, thyroid hormones, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics (e.g., epinephrine, albuterol, terbutaline), and isoniazid. (Glimepiride label, Drug interactions)
- GlipizidesulfonylureaModerate
…olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), thyroid hormones, phenytoin, nicotinic acid, and calcium channel blocking drugs. (Glipizide label, Drug interactions)
- GlycopyrrolateanticholinergicModerate
Other Anticholinergic Drugs There is potential for an additive interaction between glycopyrrolate and concomitantly used anticholinergic drugs (e.g., tricyclic antidepressants, anti-epileptics, class I antiarrhythmics, anti-spasmodics, amantadine) resulting in increased anticholinergic adverse reactions. (Glycopyrrolate label, Drug interactions)
- Guanfacinealpha-adrenergic agonistModerate
In these cases, high-dosage guanfacine was discontinued; concomitant stimulant use was also reported, which may potentially increase hypertensive response upon abrupt discontinuation of guanfacine. (Guanfacine label, Warnings and precautions)
- Hydrochlorothiazidethiazide diureticModerate
Concomitant administration of hydrochlorothiazide alone with topiramate alone has been shown to increase the C max and AUC of topiramate by 27% and 29%, respectively. (Phentermine and topiramate label, Drug interactions)
- HydrocortisonecorticosteroidModerate
Concomitant administration of inducers of CYP3A4 may lead to decreases in serum concentrations of ALKINDI SPRINKLE and increase the risk of adverse reactions, including adrenal crisis. (Hydrocortisone label, Drug interactions)
- IloperidoneantipsychoticModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- ImatinibCYP3A4 inhibitorModerate
CYP3A4 inducers may decrease Gleevec C max and area under curve (AUC). (Imatinib label, Drug interactions)
- Indapamidethiazide diureticModerate
In addition, when phentermine and topiramate extended-release capsules are used in conjunction with nonpotassium sparing diuretics this may further potentiate potassium-wasting. (Phentermine and topiramate label, Warnings and precautions)
- Insulin aspartinsulinModerate
…Insulin Aspart Drugs: Atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), and thyroid hormones. (Insulin aspart label, Drug interactions)
- Insulin degludecinsulinModerate
…Insulin Degludec Drugs: Atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), and thyroid hormones. (Insulin degludec label, Drug interactions)
- Insulin detemirinsulinModerate
…Effect of LEVEMIR Drugs: Atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), and thyroid hormones. (Insulin detemir label, Drug interactions)
- Insulin glargineinsulinModerate
…Glargine-yfgn Drugs: Atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), and thyroid hormones. (Insulin glargine label, Drug interactions)
- Insulin lisproinsulinModerate
…Effect of LYUMJEV Drugs: Atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), and thyroid hormones. (Insulin lispro label, Drug interactions)
- IvacaftorCYP3A4 inhibitorModerate
Concomitant Use with CYP3A Inducers Use of KALYDECO with strong CYP3A inducers, such as rifampin, substantially decreases the exposure of ivacaftor, which may reduce the therapeutic effectiveness of KALYDECO. (Ivacaftor label, Warnings and precautions)
- LacosamideanticonvulsantModerate
Anyone considering prescribing VIMPAT or any other AED must balance this risk with the risk of untreated illness. (Lacosamide label, Warnings and precautions)
- LamotrigineanticonvulsantModerate
Patients with History of Allergy or Rash to Other Antiepileptic Drugs The risk of rash may be increased in patients with a history of allergy or rash to other AEDs. (Lamotrigine label, Warnings and precautions)
- Lansoprazoleproton pump inhibitorModerate
Clinically Relevant Interactions Affecting PREVACID or PREVACID SoluTab When Coadministered with Other Drugs CYP2C19 OR CYP3A4 Inducers Clinical Impact: Decreased exposure of lansoprazole when used concomitantly with strong inducers [see Clinical Pharmacology (12.3) ] . (Lansoprazole label, Drug interactions)
- LevomilnacipranSNRIModerate
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. (Levomilnacipran label, Warnings and precautions)
- LevonorgestrelprogestinModerate
Oral Contraceptives Clinical Impact Co-administration of multiple-dose phentermine and topiramate extended-release capsules 15 mg/92 mg once daily with a single dose of oral contraceptive containing 35 µg ethinyl estradiol (estrogen component) and 1 mg norethindrone (progestin component), in obese otherwise healthy volunteers, decreased the exposure of ethinyl… (Phentermine and topiramate label, Drug interactions)
- Levonorgestrel and ethinyl estradioloral contraceptiveModerate
Oral Contraceptives Clinical Impact Co-administration of multiple-dose phentermine and topiramate extended-release capsules 15 mg/92 mg once daily with a single dose of oral contraceptive containing 35 µg ethinyl estradiol (estrogen component) and 1 mg norethindrone (progestin component), in obese otherwise healthy volunteers, decreased the exposure of ethinyl… (Phentermine and topiramate label, Drug interactions)
- Levothyroxinethyroid hormoneModerate
Sympathomimetics Concurrent use may of sympathomimetics and levothyroxine may increase the effects of sympathomimetics or thyroid hormone. (Levothyroxine label, Drug interactions)
- Lidocaine and prilocainelocal anestheticModerate
…prilocaine, procaine, ropivacaine, tetracaine Antineoplastic agents cyclophosphamide, flutamide, hydroxyurea, isofamide, rasburicase Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sufonamides Antimalarials chloroquine, primaquine Anticonvulsants Phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine (Lidocaine and prilocaine label, Drug interactions)
- LinagliptinDPP-4 inhibitorModerate
Strong P-glycoprotein/CYP3A4 inducer: The efficacy of TRADJENTA may be reduced when administered in combination (e.g., with rifampin). (Linagliptin label, Drug interactions)
- LisdexamfetamineCNS stimulantModerate
Additionally, in studies of another stimulant, there was slowing of the increase in height [see Adverse Reactions (6.1) ] . (Lisdexamfetamine label, Warnings and precautions)
- Lisinopril and hydrochlorothiazideACE inhibitorModerate
Concomitant administration of hydrochlorothiazide alone with topiramate alone has been shown to increase the C max and AUC of topiramate by 27% and 29%, respectively. (Phentermine and topiramate label, Drug interactions)
- Lofexidinealpha-adrenergic agonistModerate
Increased Risk of CNS Depression with Concomitant use of CNS Depressant Drugs : Lofexidine tablets potentiates the CNS depressant effects of benzodiazepines and may potentiate the CNS depressant effects of alcohol, barbiturates, and other sedating drugs. (Lofexidine label, Warnings and precautions)
- Losartan and hydrochlorothiazideangiotensin II receptor blocker (ARB)Moderate
Concomitant administration of hydrochlorothiazide alone with topiramate alone has been shown to increase the C max and AUC of topiramate by 27% and 29%, respectively. (Phentermine and topiramate label, Drug interactions)
- MeclizineantihistamineModerate
• Coadministration of meclizine hydrochloride with other CNS depressants, including alcohol, may result in increased CNS depression ( 7.1 ). (Meclizine label, Drug interactions)
- MedroxyprogesteroneprogestinModerate
Oral Contraceptives Clinical Impact Co-administration of multiple-dose phentermine and topiramate extended-release capsules 15 mg/92 mg once daily with a single dose of oral contraceptive containing 35 µg ethinyl estradiol (estrogen component) and 1 mg norethindrone (progestin component), in obese otherwise healthy volunteers, decreased the exposure of ethinyl… (Phentermine and topiramate label, Drug interactions)
- MegestrolprogestinModerate
Oral Contraceptives Clinical Impact Co-administration of multiple-dose phentermine and topiramate extended-release capsules 15 mg/92 mg once daily with a single dose of oral contraceptive containing 35 µg ethinyl estradiol (estrogen component) and 1 mg norethindrone (progestin component), in obese otherwise healthy volunteers, decreased the exposure of ethinyl… (Phentermine and topiramate label, Drug interactions)
- Methocarbamolmuscle relaxantModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- MethylprednisolonecorticosteroidModerate
Hepatic Enzyme Inducers (e.g., barbiturates, phenytoin, carbamazepine, rifampin) : Drugs which induce cytochrome P450 3A4 enzyme activity may enhance the metabolism of corticosteroids and require that the dosage of the corticosteroid be increased. (Methylprednisolone label, Drug interactions)
- Metolazonethiazide diureticModerate
In addition, when phentermine and topiramate extended-release capsules are used in conjunction with nonpotassium sparing diuretics this may further potentiate potassium-wasting. (Phentermine and topiramate label, Warnings and precautions)
- MirtazapineantidepressantModerate
The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. (Mirtazapine label, Warnings and precautions)
- MometasonecorticosteroidModerate
Patients with major risk factors for decreased bone mineral content, such as prolonged immobilization, family history of osteoporosis, or chronic use of drugs that can reduce bone mass (e.g., anticonvulsants and corticosteroids) should be monitored and treated with established standards of care. (Mometasone label, Warnings and precautions)
- Naloxoneopioid antagonistModerate
WARNINGS AND PRECAUTIONS Risk of Recurrent Respiratory and CNS Depression : Due to the duration of action of naloxone relative to the opioid, respiratory and CNS depression may recur after the first dose of naloxone. (Naloxone label, Warnings and precautions)
- NintedanibModerate
Coadministration with oral doses of a P-gp and CYP3A4 inducer, rifampicin, decreased exposure to nintedanib by 50%. (Nintedanib label, Drug interactions)
- NorethindroneprogestinModerate
Oral Contraceptives Clinical Impact Co-administration of multiple-dose phentermine and topiramate extended-release capsules 15 mg/92 mg once daily with a single dose of oral contraceptive containing 35 µg ethinyl estradiol (estrogen component) and 1 mg norethindrone (progestin component), in obese otherwise healthy volunteers, decreased the exposure of ethinyl… (Phentermine and topiramate label, Drug interactions)
- Norgestimate and ethinyl estradioloral contraceptiveModerate
Oral Contraceptives Clinical Impact Co-administration of multiple-dose phentermine and topiramate extended-release capsules 15 mg/92 mg once daily with a single dose of oral contraceptive containing 35 µg ethinyl estradiol (estrogen component) and 1 mg norethindrone (progestin component), in obese otherwise healthy volunteers, decreased the exposure of ethinyl… (Phentermine and topiramate label, Drug interactions)
- Nortriptylinetricyclic antidepressantModerate
Close supervision and careful adjustment of the dosage are required when Pamelor is used with other anticholinergic drugs and sympathomimetic drugs. (Nortriptyline label, Drug interactions)
- OlanzapineantipsychoticModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- Omeprazoleproton pump inhibitorModerate
Table 4: Clinically Relevant Interactions Affecting Omeprazole When Co-Administered with Other Drugs CYP2C19 or CYP3A4 Inducers Clinical Impact: Decreased exposure of omeprazole when used concomitantly with strong inducers [see Clinical Pharmacology ( 12.3 )] . (Omeprazole label, Drug interactions)
- OndansetronQT-prolonging drugModerate
Phenytoin, Carbamazepine, and Rifampin In patients treated with potent inducers of CYP3A4 (i.e., phenytoin, carbamazepine, and rifampin), the clearance of ondansetron was significantly increased and ondansetron blood concentrations were decreased. (Ondansetron label, Drug interactions)
- OrlistatModerate
Drug Interactions and Decreased Vitamin Absorption ORLISTAT may interact with concomitant drugs including cyclosporine, levothyroxine, warfarin, amiodarone, antiepileptic drugs, and antiretroviral drugs [see Drug Interactions (7) ]. (Orlistat label, Warnings and precautions)
- OxcarbazepineanticonvulsantModerate
Therefore, if a patient develops a skin reaction while taking TRILEPTAL, consideration should be given to discontinuing TRILEPTAL use and prescribing another antiepileptic medication. (Oxcarbazepine label, Warnings and precautions)
- ParoxetineSSRIModerate
The risk is increased with concomitant use of other serotonergic agents (including triptans, tricyclic antidepressants, fentanyl, tramadol, meperidine, methadone, lithium, tryptophan, buspirone, amphetamines, and St. (Paroxetine label, Warnings and precautions)
- PerampanelanticonvulsantModerate
Patients should be carefully observed for signs of central nervous system (CNS) depression, such as somnolence and sedation, when FYCOMPA is used with other drugs with sedative properties because of potential additive effects. (Perampanel label, Warnings and precautions)
- PhenobarbitalbarbiturateModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- PhenytoinanticonvulsantModerate
Antiepileptic Drugs Clinical Impact Concomitant administration of phenytoin or carbamazepine with topiramate in patients with epilepsy, decreased plasma concentrations of topiramate by 48% and 40%, respectively, when compared to topiramate given alone [see Clinical Pharmacology (12.3) ] . (Phentermine and topiramate label, Drug interactions)
- PioglitazonethiazolidinedioneModerate
Pioglitazone Clinical Impact A decrease in the exposure of pioglitazone and its active metabolites were noted with the concurrent use of pioglitazone and topiramate in a clinical trial. (Phentermine and topiramate label, Drug interactions)
- PitolisantQT-prolonging drugModerate
Strong CYP3A4 Inducers: Decreased exposure of WAKIX; consider dosage adjustment of WAKIX ( 2.6 , 7.1 ) (Pitolisant label, Drug interactions)
- Posaconazoleazole antifungalModerate
Concomitant Use with Midazolam : Noxafil can prolong hypnotic/sedative effects. (Posaconazole label, Warnings and precautions)
- PrednisolonecorticosteroidModerate
CYP 3A4 inducers (e.g. barbiturates, phenytoin, carbamazepine, and rifampin): Drugs such as barbiturates, phenytoin, ephedrine, and rifampin, which induce hepatic microsomal drug metabolizing enzyme activity may enhance metabolism of prednisolone and require that the dosage of Orapred be increased. (Prednisolone label, Drug interactions)
- PrednisonecorticosteroidModerate
CYP 3A4 inducers and inhibitors: May, respectively, increase or decrease clearance of corticosteroids, necessitating dose adjustment. (Prednisone label, Drug interactions)
- PregabalinanticonvulsantModerate
When the decision is made to co-prescribe LYRICA CR with another CNS depressant, particularly an opioid, or to prescribe LYRICA CR to patients with underlying respiratory impairment, monitor patients for symptoms of respiratory depression and sedation, and consider initiating LYRICA CR at a low dose. (Pregabalin label, Warnings and precautions)
- PrimidoneanticonvulsantModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- ProchlorperazineantipsychoticModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- ProgesteroneprogestinModerate
Oral Contraceptives Clinical Impact Co-administration of multiple-dose phentermine and topiramate extended-release capsules 15 mg/92 mg once daily with a single dose of oral contraceptive containing 35 µg ethinyl estradiol (estrogen component) and 1 mg norethindrone (progestin component), in obese otherwise healthy volunteers, decreased the exposure of ethinyl… (Phentermine and topiramate label, Drug interactions)
- PromethazineantihistamineModerate
The impairment may be amplified by concomitant use 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 either be eliminated or given in reduced dosage in the presence of promethazine… (Promethazine label, Warnings)
- PropofolCNS depressantModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- Propranololbeta blockerModerate
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)
- QuetiapineantipsychoticModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- Ramelteonsedative-hypnoticModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- RepaglinidemeglitinideModerate
CYP2C8 and CYP3A4 Inducers Intervention: Repaglinide tablets dose increases and increased frequency of glucose monitoring may be required when co‑administered. (Repaglinide label, Drug interactions)
- RifampinantibioticModerate
…Hormonal Contraceptives Prevention or Management: Advise patients to change to non-hormonal methods of birth control during rifampin therapy Estrogens Decrease exposure Progestins Anticonvulsants Phenytoin Administered with rifampin 450 mg daily Decrease exposure Antiarrhythmics Disopyramide Decrease exposure Mexiletine Decrease exposure Quinidine Decrease exposure… (Rifampin label, Drug interactions)
- RisperidoneantipsychoticModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- RufinamideanticonvulsantModerate
Table 6: Summary of drug-drug interactions of BANZEL with other antiepileptic drugs AED Co-administered Influence of Rufinamide on AED concentration a) Influence of AED on Rufinamide concentration Carbamazepine Decrease by 7 to 13% b) Decrease by 19 to 26% Dependent on dose of carbamazepine Lamotrigine Decrease by 7 to 13% b) No Effect Phenobarbital Increase… (Rufinamide label, Drug interactions)
- ScopolamineanticholinergicModerate
Weigh this potential risk against the benefits before prescribing TRANSDERM SCŌP to patients with a history of seizures, including those receiving anti-epileptic medication or who have risk factors that can lower the seizure threshold. (Scopolamine label, Warnings and precautions)
- SertralineSSRIModerate
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. (Sertraline label, Warnings and precautions)
- Sotalolbeta blockerModerate
Beta-2-Receptor Stimulants Beta-agonists such as albuterol, terbutaline and isoproterenol may have to be administered in increased dosages when used concomitantly with sotalol. (Sotalol label, Drug interactions)
- Spironolactonealdosterone antagonistModerate
In addition, when phentermine and topiramate extended-release capsules are used in conjunction with nonpotassium sparing diuretics this may further potentiate potassium-wasting. (Phentermine and topiramate label, Warnings and precautions)
- Spironolactone and hydrochlorothiazidealdosterone antagonistModerate
Concomitant administration of hydrochlorothiazide alone with topiramate alone has been shown to increase the C max and AUC of topiramate by 27% and 29%, respectively. (Phentermine and topiramate label, Drug interactions)
- Suvorexantsedative-hypnoticModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- TacrolimusimmunosuppressantModerate
Risk of Rejection with Strong CYP3A Inducers and Risk of Serious Adverse Reactions with Strong CYP3A Inhibitors The concomitant use of strong CYP3A inducers may increase the metabolism of tacrolimus, leading to lower whole blood trough concentrations and greater risk of rejection. (Tacrolimus label, Warnings and precautions)
- TadalafilPDE5 inhibitorModerate
CYP3A4 inhibitors (e.g. ketoconazole, ritonavir) increase CIALIS exposure ( 2.7 , 5.10 , 7.2 ) requiring dose adjustment: CIALIS for use as needed: no more than 10 mg every 72 hours CIALIS for once daily use: dose not to exceed 2.5 mg CYP3A4 inducers (e.g. rifampin) decrease CIALIS exposure ( 7.2 ). (Tadalafil label, Drug interactions)
- TemazepambenzodiazepineModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- TerbinafineantifungalModerate
Terbinafine clearance is increased 100% by rifampin, a CYP450 enzyme inducer, and decreased 33% by cimetidine, a CYP450 enzyme inhibitor. (Terbinafine label, Drug interactions)
- TetrabenazineVMAT2 inhibitorModerate
Alcohol or Other Sedating Drugs Concomitant use of alcohol or other sedating drugs may have additive effects and worsen sedation and somnolence [see Warnings and Precautions (5.7) ] . (Tetrabenazine label, Drug interactions)
- TheophyllinemethylxanthineModerate
25% increase Diazepam Benzodiazepines increase CNS concentrations of adenosine, a potent CNS depressant, while theophylline blocks adenosine receptors. (Theophylline label, Drug interactions)
- TiagabineanticonvulsantModerate
Use of tiagabine HCl without enzyme-inducing antiepileptic drugs results in blood levels about twice those attained in the studies on which current dosing recommendations are based (see DOSAGE AND ADMINISTRATION ). (Tiagabine label, Warnings)
- TinidazoleantibioticModerate
Phenytoin, fosphenytoin: Adjustment of anticonvulsant and/or tinidazole dose(s) may be needed ( 7.1, 7.2 ) (Tinidazole label, Drug interactions)
- TiotropiumanticholinergicModerate
Concomitant Respiratory Medications SPIRIVA RESPIMAT has been used concomitantly with short-acting and long-acting sympathomimetic (beta-agonists) bronchodilators, methylxanthines, oral and inhaled steroids, antihistamines, mucolytics, leukotriene modifiers, cromones, and anti-IgE treatment without increases in adverse reactions. (Tiotropium label, Drug interactions)
- Tizanidinemuscle relaxantModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
- TofacitinibimmunosuppressantModerate
…modification of XELJANZ/XELJANZ XR is recommended [see Dosage and Administration (2) , Clinical Pharmacology, Figure 3 (12.3) ] Moderate CYP3A4 Inhibitors Concomitantly Used with Strong CYP2C19 Inhibitors (e.g., fluconazole) Clinical Impact Increased exposure to tofacitinib Intervention Dosage modification of XELJANZ/XELJANZ XR is recommended [see Dosage and Administration… (Tofacitinib label, Drug interactions)
- TopiramateanticonvulsantModerate
Oral Contraceptives Clinical Impact Co-administration of multiple-dose phentermine and topiramate extended-release capsules 15 mg/92 mg once daily with a single dose of oral contraceptive containing 35 µg ethinyl estradiol (estrogen component) and 1 mg norethindrone (progestin component), in obese otherwise healthy volunteers, decreased the exposure of ethinyl… (Phentermine and topiramate label, Drug interactions)
- Torsemideloop diureticModerate
In addition, when phentermine and topiramate extended-release capsules are used in conjunction with nonpotassium sparing diuretics this may further potentiate potassium-wasting. (Phentermine and topiramate label, Warnings and precautions)
- TrazodoneantidepressantModerate
CYP3A4 Inducers: Increase in RALDESY dosage may be necessary ( 2.5 , 7 ). (Trazodone label, Drug interactions)
- Treprostinilprostaglandin analogModerate
Co-administration of a CYP2C8 enzyme inducer (e.g., rifampin) may decrease exposure to treprostinil. (Treprostinil label, Warnings and precautions)
- TriamcinolonecorticosteroidModerate
Hepatic enzyme inducers (e.g., barbiturates, phenytoin, carbamazepine, rifampin): Drugs which induce hepatic microsomal drug metabolizing enzyme activity may enhance the metabolism of corticosteroids and require that the dosage of the corticosteroid be increased. (Triamcinolone label, Drug interactions)
- Triamterenepotassium-sparing diureticModerate
In addition, when phentermine and topiramate extended-release capsules are used in conjunction with nonpotassium sparing diuretics this may further potentiate potassium-wasting. (Phentermine and topiramate label, Warnings and precautions)
- Triamterene and hydrochlorothiazidepotassium-sparing diureticModerate
Concomitant administration of hydrochlorothiazide alone with topiramate alone has been shown to increase the C max and AUC of topiramate by 27% and 29%, respectively. (Phentermine and topiramate label, Drug interactions)
- TrihexyphenidylanticholinergicModerate
Concurrent use of alcohol or other CNS depressants with trihexyphenidyl HCl may cause increased sedative effects. (Trihexyphenidyl label, Drug interactions)
- Valsartan and hydrochlorothiazideangiotensin II receptor blocker (ARB)Moderate
Concomitant administration of hydrochlorothiazide alone with topiramate alone has been shown to increase the C max and AUC of topiramate by 27% and 29%, respectively. (Phentermine and topiramate label, Drug interactions)
- VenlafaxineSNRIModerate
The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, meperidine, methadone, busipirone, amphetamines, and St. (Venlafaxine label, Warnings and precautions)
- Verapamilcalcium channel blockerModerate
CYP3A4 inducers decrease verapamil levels ( 7.1 ) (Verapamil label, Drug interactions)
- VilazodoneSSRIModerate
The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, meperidine, methadone, lithium, tramadol, tryptophan, buspirone, amphetamines, and St. (Vilazodone label, Warnings and precautions)
- Voriconazoleazole antifungalModerate
Eszopiclone (CYP3A4 Inhibition) Not Studied In Vivo or In Vitro , but Drug Plasma Exposure Likely to be Increased which may Increase the Sedative Effect of Eszopiclone Dose reduction of eszopiclone is recommended. (Voriconazole label, Drug interactions)
- VortioxetineantidepressantModerate
The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, meperidine, methadone, buspirone, amphetamines, and St. (Vortioxetine label, Warnings and precautions)
- ZiprasidoneantipsychoticModerate
The concomitant use of alcohol or central nervous system (CNS) depressant drugs with phentermine and topiramate extended-release capsules may potentiate CNS depression or other centrally mediated effects of these agents, such as dizziness, cognitive adverse reactions, drowsiness, light-headedness, impaired coordination, and somnolence. (Phentermine and topiramate label, Warnings and precautions)
Minor mentions (14)
- AcarboseantidiabeticMinor
These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel-blocking drugs, and isoniazid. (Acarbose label, Drug interactions)
- AspirinNSAIDMinor
(tartrazine) sensitivity in the general population is low, it is frequently seen in patients who also have aspirin hypersensitivity. (Phentermine and topiramate label, Warnings and precautions)
- CephalexincephalosporinMinor
Anticonvulsant therapy can be given if clinically indicated. (Cephalexin label, Warnings and precautions)
- Epoetin alfaMinor
The “gasping syndrome” is characterized by central nervous system (CNS) depression, metabolic acidosis, and gasping respirations. (Epoetin alfa label, Warnings and precautions)
- GlyburidesulfonylureaMinor
These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid. (Glyburide label, Drug interactions)
- HydroxychloroquineQT-prolonging drugMinor
Antiepileptics The activity of antiepileptic drugs might be impaired if co-administered with PLAQUENIL. (Hydroxychloroquine label, Drug interactions)
- Insulin regular (human)insulinMinor
Atypical Antipsychotics (e.g., olanzapine and clozapine), Corticosteroids, Danazol, Diuretics, Estrogens, Glucagon, Isoniazid, Niacin, Oral Contraceptives, Phenothiazines, Progestogens (e.g., in oral contraceptives), Protease inhibitors, Somatropin, Sympathomimetic Agents (e.g., albuterol, epinephrine, terbutaline) and Thyroid Hormones. (Insulin regular (human) label, Drug interactions)
- IpratropiumanticholinergicMinor
ATROVENT HFA has been used concomitantly with other drugs, including sympathomimetic bronchodilators, methylxanthines, oral and inhaled steroids commonly used in the treatment of COPD. (Ipratropium label, Drug interactions)
- KetorolacNSAIDMinor
Antiepileptic Drugs Sporadic cases of seizures have been reported during concomitant use of ketorolac tromethamine and antiepileptic drugs (phenytoin, carbamazepine). (Ketorolac label, Drug interactions)
- Labetalolbeta blockerMinor
Labetalol has also been reported to produce a false-positive test for amphetamine when screening urine for the presence of drugs using the commercially available assay methods. (Labetalol label, Drug interactions)
- LevetiracetamanticonvulsantMinor
Other Antiepileptic Drugs Potential drug interactions between levetiracetam and other AEDs (carbamazepine, gabapentin, lamotrigine, phenobarbital, phenytoin, primidone and valproate) were also assessed by evaluating the serum concentrations of levetiracetam and these AEDs during placebo-controlled clinical studies. (Levetiracetam label, Drug interactions)
- Prazosinalpha blockerMinor
…to date with the following: (1) cardiac glycosides– digitalis and digoxin; (2) hypoglycemics–insulin, chlorpropamide, phenformin, tolazamide, and tolbutamide; (3) tranquilizers and sedatives–chlordiazepoxide, diazepam, and phenobarbital; (4) antigout–allopurinol, colchicine, and probenecid; (5) antiarrhythmics–procainamide, propranolol (see WARNINGS however),… (Prazosin label, Drug interactions)
- RifaximinantibioticMinor
CYP3A4 Substrates An in vitro study has suggested that rifaximin induces CYP3A4 [see Clinical Pharmacology ( 12.3 )] . (Rifaximin label, Drug interactions)
- RiociguatvasodilatorMinor
Strong CYP3A inducers: Strong inducers of CYP3A (for example, rifampin, phenytoin, carbamazepine, phenobarbital or St. (Riociguat label, Drug interactions)
No significant interaction reported (1)
- Montelukastleukotriene receptor antagonistNo interaction
…adjustment is needed when SINGULAIR is co-administered with theophylline, prednisone, prednisolone, oral contraceptives, fexofenadine, digoxin, warfarin, gemfibrozil, itraconazole, thyroid hormones, sedative hypnotics, non-steroidal anti-inflammatory agents, benzodiazepines, decongestants, and Cytochrome P450 (CYP) enzyme inducers [see Clinical Pharmacology (12.3) ]. (Montelukast label, Drug interactions)
Check Phentermine and topiramate against everything you take. Add your full list; every pair is checked at once.
Open in the checkerNot medical advice. Severity reflects the label's wording, not your circumstances. A "major" flag can be routine under supervision and a "minor" one can matter at high doses. Ask a pharmacist.