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).prochlorperazineMonitor Closely (5)olanzapine and prochlorperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. fluoxetine will increase the level or effect of prochlorperazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. olanzapine and prochlorperazine both decrease QTc interval. Use Caution/Monitor. olanzapine and prochlorperazine both increase sedation. Use Caution/Monitor. prochlorperazine and fluoxetine both increase QTc interval. Use Caution/Monitor.promazineMonitor Closely (2)promazine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely. fluoxetine will increase the level or effect of promazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.promethazineMonitor Closely (5)promethazine and olanzapine both increase sedation. Use Caution/Monitor. olanzapine and promethazine both decrease QTc interval. Use Caution/Monitor. promethazine and fluoxetine both increase QTc interval. Use Caution/Monitor. olanzapine and promethazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. promethazine, olanzapine. 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).Serious - Use Alternative (1)fluoxetine will increase the level or effect of promethazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.propafenoneSerious - Use Alternative (4)propafenone will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. fluoxetine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. olanzapine and propafenone both increase QTc interval. Avoid or Use Alternate Drug. propafenone and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.propanthelineMonitor Closely (3)propantheline decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. propantheline decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor. olanzapine increases effects of propantheline by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.propofolMonitor Closely (1)propofol and olanzapine both increase sedation. Use Caution/Monitor.propranololSerious - Use Alternative (1)fluoxetine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.propylhexedrineMonitor Closely (1)olanzapine increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protriptylineMonitor Closely (3)olanzapine and protriptyline both increase QTc interval. Use Caution/Monitor. olanzapine and protriptyline both increase sedation. Use Caution/Monitor. protriptyline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)fluoxetine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.quazepamMonitor Closely (1)quazepam and olanzapine both increase sedation. Use Caution/Monitor.quetiapineMonitor Closely (3)quetiapine, fluoxetine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT. olanzapine and quetiapine both increase sedation. Use Caution/Monitor. olanzapine and quetiapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.Serious - Use Alternative (1)olanzapine and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.quinacrineMinor (1)quinacrine will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.quinidineSerious - Use Alternative (3)olanzapine and quinidine both increase QTc interval. Avoid or Use Alternate Drug. quinidine will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. quinidine and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.quinineMonitor Closely (2)fluoxetine and quinine both increase QTc interval. Use Caution/Monitor. olanzapine and quinine both increase QTc interval. Use Caution/Monitor.rabeprazoleMinor (1)fluoxetine will increase the level or effect of rabeprazole by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.ramelteonMonitor Closely (2)fluoxetine will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. olanzapine and ramelteon both increase sedation. Use Caution/Monitor.ranolazineMonitor Closely (1)fluoxetine and ranolazine both increase QTc interval. Use Caution/Monitor.Minor (1)ranolazine will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.Serious - Use Alternative (1)olanzapine and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.rapacuroniumMonitor Closely (3)rapacuronium decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. rapacuronium decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor. olanzapine increases effects of rapacuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.rasagilineSerious - Use Alternative (1)rasagiline and fluoxetine both increase serotonin levels. Avoid or Use Alternate Drug. evere CNS toxicity associated with hyperpyrexia has been reported with the combined treatment of an antidepressant and rasagiline. Avoid combination within 14 days of MAOI use.remifentanilMonitor Closely (1)remifentanil, fluoxetine. Either increases toxicity of the other by serotonin levels. Modify Therapy/Monitor Closely.remimazolamMonitor Closely (2)remimazolam, fluoxetine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics. remimazolam, olanzapine. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.repaglinideMonitor Closely (1)olanzapine, repaglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.ribociclibSerious - Use Alternative (3)ribociclib increases toxicity of fluoxetine by QTc interval. Avoid or Use Alternate Drug. ribociclib will increase the level or effect of fluoxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. ribociclib increases toxicity of olanzapine by 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 instances.rifampinMonitor Closely (1)rifampin will decrease the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.rilpivirineMonitor Closely (2)olanzapine and rilpivirine both increase QTc interval. Use Caution/Monitor. rilpivirine increases toxicity of fluoxetine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.rimabotulinumtoxinBMonitor Closely (1)olanzapine, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Anticholinergics may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.risperidoneMonitor Closely (4)olanzapine and risperidone both increase QTc interval. Use Caution/Monitor. olanzapine and risperidone both increase sedation. Use Caution/Monitor. fluoxetine and risperidone both increase QTc interval. Use Caution/Monitor. olanzapine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.Serious - Use Alternative (1)fluoxetine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.ritlecitinibMonitor Closely (1)ritlecitinib will increase the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Ritlecitinib inhibits CYP1A2 substrates; coadministration increases AUC and peak plasma concentration sensitive substrates, which may increase risk of adverse reactions. Additional monitoring and dosage adjustment may be needed in accordance with product labeling of CYP1A2 substrates. ritonavirMonitor Closely (1)ritonavir decreases levels of olanzapine by increasing metabolism. Use Caution/Monitor.Minor (1)ritonavir will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.rivaroxabanMonitor Closely (1)fluoxetine increases effects of rivaroxaban by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.rizatriptanMonitor Closely (1)rizatriptan and fluoxetine both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)fluoxetine, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.rocuroniumMonitor Closely (3)rocuronium decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. rocuronium decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor. olanzapine increases effects of rocuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.rolapitantMonitor Closely (1)rolapitant will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.romidepsinMonitor Closely (2)olanzapine and romidepsin both increase QTc interval. Use Caution/Monitor. fluoxetine and romidepsin both increase QTc interval. Use Caution/Monitor.ropiniroleSerious - Use Alternative (1)olanzapine decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.rosiglitazoneMonitor Closely (1)olanzapine, rosiglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.rucaparibMonitor Closely (2)rucaparib will increase the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP1A2 substrates, if clinically indicated. rucaparib will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C9 substrates, if clinically indicated.ruxolitinibMinor (2)fluoxetine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. olanzapine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ruxolitinib topicalMinor (2)olanzapine will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. fluoxetine will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.safinamideMonitor Closely (1)fluoxetine, safinamide. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor patients for symptoms of serotonin syndrome if SSRIs are coadministered with safinamide.Serious - Use Alternative (1)olanzapine decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.sageMinor (1)olanzapine and sage both increase sedation. Minor/Significance Unknown.salicylates (non-asa)Monitor Closely (1)fluoxetine, salicylates (non-asa). Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.salmeterolMonitor Closely (2)fluoxetine and salmeterol both increase QTc interval. Modify Therapy/Monitor Closely. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular system olanzapine increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.salsalateMonitor Closely (1)fluoxetine, salsalate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.SAMeMonitor Closely (1)fluoxetine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.saquinavirMonitor Closely (1)saquinavir and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)olanzapine and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.saxagliptinMonitor Closely (1)olanzapine, saxagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.scopolamineMonitor Closely (3)scopolamine decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. scopolamine decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor. olanzapine increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.scullcapMonitor Closely (1)olanzapine and scullcap both increase sedation. Use Caution/Monitor.secobarbitalMonitor Closely (2)secobarbital will decrease the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. secobarbital and olanzapine both increase sedation. Use Caution/Monitor.selegilineContraindicated (1)selegiline and fluoxetine both increase serotonin levels. Contraindicated. At least 5 weeks should elapse between discontinuation of fluoxetine and initiation of selegiline.Monitor Closely (1)selegiline, olanzapine. 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).selegiline transdermalSerious - Use Alternative (1)selegiline transdermal and fluoxetine both decrease serotonin levels. Avoid or Use Alternate Drug.selinexorSerious - Use Alternative (2)selinexor, fluoxetine. 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. selinexor, olanzapine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor