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Increased Sedative effects with benzodiazepines (e.g. Alprazolam, Clonazepam, Diazepam).
Increased risk of serotonin syndrome with SSRIs (e.g. escitalopram, fluoxetine, sertraline), serotonin-norepinephrine reuptake inhibitors (e.g. venlafaxine, duloxetine, sibutramine), TCAs (e.g. amitriptyline, clomipramine, imipramine), triptans (e.g. sumatriptan, zolmitriptan, almotriptan), amphetamine, buspirone, fentanyl, lithium, tramadol and tryptophan.
Increased serum plasma concentration with potent CYP3A4 inhibitors such as HIV-protease inhibitors (e.g. ritonavir), azole antifungals (e.g. itraconazole, ketoconazole), erythromycin and nefazodone.
Decreased serum plasma concentration with potent CYP3A4 inducers (e.g. carbamazepine, phenytoin, rifampin).
Increased serum plasma concentration when concurrently administered with cimetidine.
Increased risk of QT prolongation with drugs concurrently administered with QTc interval prolonging drugs (e.g. azithromycin, fluconazole, chloroquine).
May diminish antihypertensive effect of α2-agonist (e.g. clonidine, methyldopa).
May enhance the anticoagulant of warfarin.
Potentially Fatal: Increased risk of serotonin syndrome when concurrently administered with or within 14 days of discontinuing MAOIs (e.g. isocarboxazid, linezolid, IV methylene blue, phenelzine, selegiline, tranylcypromine).
Food Interaction: Increased sedative effect with alcohol. Increased risk of serotonin syndrome with St. John's wort.
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