If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.isofluraneclozapine and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.itraconazoleitraconazole will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.clozapine and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.ivosidenibivosidenib and clozapine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.ketoconazoleketoconazole will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.lefamulinlefamulin and clozapine both increase QTc interval. Avoid or Use Alternate Drug.leniolisibleniolisib will increase the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid leniolisib with CYP1A2 substrates that have a narrow therapeutic indexlevodopaclozapine decreases effects of levodopa by pharmacodynamic antagonism. Avoid or Use Alternate Drug.levodopa inhaledclozapine decreases effects of levodopa inhaled by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Atypical (2nd generation) antipsychotics inhibit dopamine D2 receptors in varying degrees (clozapine and quetiapine are lower risk). .levoketoconazolelevoketoconazole will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.lisurideclozapine decreases effects of lisuride by pharmacodynamic antagonism. Contraindicated.lithiumclozapine and lithium both increase QTc interval. Avoid or Use Alternate Drug.lofexidineclozapine and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.loperamideclozapine and loperamide both increase QTc interval. Avoid or Use Alternate Drug.lopinavirclozapine and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.macimorelinmacimorelin and clozapine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.maprotilineclozapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.methadoneclozapine and methadone both increase QTc interval. Avoid or Use Alternate Drug.methimazolemethimazole, clozapine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of agranulocytosis.methyldopaclozapine decreases effects of methyldopa by pharmacodynamic antagonism. Contraindicated.metoclopramide intranasalclozapine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.clozapine increases toxicity of metoclopramide intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive effects, including increased frequency and severity of tardive dyskinesia, other extrapyramidal symptoms, and neuroleptic malignant syndrome.midostaurinclozapine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.mobocertinibmobocertinib and clozapine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.moxifloxacinclozapine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.olanzapineclozapine and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesolopatadine intranasalclozapine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. ondansetronclozapine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.oxaliplatinclozapine and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.paliperidoneclozapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.panobinostatclozapine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.pazopanibclozapine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.pefloxacinpefloxacin will increase the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.pentamidineclozapine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.pimavanserinclozapine and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.pimozideclozapine and pimozide both increase QTc interval. Contraindicated.pitolisantclozapine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.ponesimodclozapine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.posaconazoleclozapine and posaconazole both increase QTc interval. Contraindicated.pramipexoleclozapine decreases effects of pramipexole by pharmacodynamic antagonism. Contraindicated.procainamideclozapine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.propafenoneclozapine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.propylthiouracilpropylthiouracil, clozapine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of agranulocytosis.quetiapineclozapine and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.quinidineclozapine and quinidine both increase QTc interval. Contraindicated.ranolazineclozapine and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.ribociclibribociclib will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.ribociclib increases toxicity of clozapine by QTc interval. Avoid or Use Alternate Drug.rifabutinrifabutin will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.rifampinrifampin will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.romidepsinclozapine and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.ropeginterferon alfa 2bropeginterferon alfa 2b, clozapine. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.ropiniroleclozapine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.safinamideclozapine decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.saquinavirsaquinavir increases levels of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Increased risk of QT prolongation and cardiac arrhythmias.selinexorselinexor, clozapine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.sevofluraneclozapine and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.siponimodclozapine and siponimod both increase QTc interval. Avoid or Use Alternate Drug.sodium oxybateclozapine, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.sotalolclozapine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.St John's WortSt John's Wort will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.sufentanil SLsufentanil SL, clozapine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.tetrabenazineclozapine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.thiothixeneclozapine and thiothixene both increase QTc interval. Avoid or Use Alternate Drug.toremifeneclozapine and toremifene both increase QTc interval. Avoid or Use Alternate Drug.trazodoneclozapine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.umeclidinium bromide/vilanterol inhaledclozapine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.vandetanibclozapine and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.vemurafenibclozapine and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.vilanterol/fluticasone furoate inhaledclozapine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.voriconazoleclozapine and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.vorinostatclozapine and vorinostat both increase QTc interval. Avoid or Use Alternate Drug.zidovudineclozapine, zidovudine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of myelosuppression.ziprasidoneclozapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.Monitor Closely (433)abobotulinumtoxinAabobotulinumtoxinA increases effects of clozapine by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.acalabrutinibacalabrutinib, clozapine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.acarboseacarbose, clozapine. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.aclidiniumaclidinium decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.clozapine increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.acrivastineacrivastine and clozapine both increase sedation. Use Caution/Monitor.albiglutideclozapine, albiglutide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.albuterolclozapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.albuterol and clozapine both increase QTc interval. Use Caution/Monitor.alfentanilalfentanil and clozapine both increase sedation. Use Caution/Monitor.alfuzosinclozapine and alfuzosin both increase QTc interval. Use Caution/Monitor.alfuzosin and clozapine both increase QTc interval. Use Caution/Monitor.almotriptanalmotriptan, clozapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).alprazolamalprazolam and clozapine both increase sedation. Use Caution/Monitor.amifampridineclozapine increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.amifostineamifostine, clozapine. Either increases effects of the other by anti-hypertensive channel blocking. Use Caution/Monitor. Due to its alpha adrenergic antagonism, atypical antipsychotic agents has the potential to enhance the effect of certain antihypertensive agents. Monitor blood pressure and adjust dose accordingly.amitriptylineclozapine and amitriptyline both increase sedation. Use Caution/Monitor.clozapine and amitriptyline both increase QTc interval. Use Caution/Monitor.amobarbitalamobarbital will decrease the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.amobarbital will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.amobarbital and clozapine both increase sedation. Use Caution/Monitor.amoxapineclozapine and amoxapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.clozapine and amoxapine both increase sedation. Use Caution/Monitor.clozapine and amoxapine both increase QTc interval. Use Caution/Monitor.anagrelideclozapine and anagrelide both increase QTc interval. Use Caution/Monitor.anticholinergic/sedative combosanticholinergic/sedative combos decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.anticholinergic/sedative combos decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.clozapine increases effects of anticholinergic/sedative combos by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.apomorphineclozapine and apomorphine both increase sedation. Use Caution/Monitor.apomorphine and clozapine both increase QTc interval. Use Caution/Monitor.aprepitantaprepitant will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.arformoterolclozapine increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.arformoterol and clozapine both increase QTc interval. Use Caution/Monitor.aripiprazolearipiprazole and clozapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.aripiprazole and clozapine both increase sedation. Use Caution/Monitor.armodafinilarmodafinil will decrease the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.armodafinil will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.clozapine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.artemether/lumefantrineartemether/lumefantrine will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.asenapineasenapine and clozapine both increase sedation. Use Caution/Monitor.asenapine transdermalasenapine transdermal and clozapine both increase sedation. Use Caution/Monitor.atazanaviratazanavir will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.atomoxetineatomoxetine and clozapine both increase QTc interval. Use Caution/Monitor.atracuriumatracurium decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.atracurium decreases levels of clozapine by pharmacodynamic antagonism. Use