Concurrent use with MAOIs ↑ risk of serious adverse reactions, including serotonin syndrome; MAOI use should be discontinued at least 14 days before/allow 14 days after discontinuing to start MAOIs.
↑ blood levels and risk of adverse reactions from desipramine and paroxetine ; ↓ dose of antidepressant and determine dose by clinical response.
Concurrent therapy with strong or moderate inhibitors of the CYP3A4 enzyme system including aprepitant , atazanavir , clarithromycin , diltiazem , erythromycin , fluconazole , fosamprenavir , indinavir , itraconazole , ketoconazole , nefazodone , nelfinavir , ritonavir , saquinavir , telithromycin and verapamil ↑ risk of QT prolongation; careful monitoring recommended.
Concurrent use with SSRIs or tricyclic antidepressants may result in serotonin syndrome.
Avoid concurrent use with drugs that prolong QT interval together with drugs that are metabolized by CYP 2D6 including thioridazine and pimozide .
When using with drugs that prolong QT interval and drugs that are moderate/strong inhibitors of CYP3A4 ECG monitoring is recommended.
Concurrent use of drugs that are metabolized by CYP2D6 , especially those with narrow therapeutic indeces should be undertaken with caution, dose modifications or choosing an alternative agent may be necessary, including codeine and hydrocodone .
↑ blood levels and risk of toxicity/adverse reactions from desipramine (daily dose should not exceed 40 mg/day) or paroxetine (dose should not exceed 35 mg/day.
↑ blood levels and the risk of toxicity from digoxin , careful monitoring recommended.
↑ CNS depressant with other CNS depressants including antihistamines , some antidepressants , sedative/hypnotics and alcohol .
dextromethorphan/quinidine has been found in Davis's Drug Guide
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