monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.sodium sulfate/potassium sulfate/magnesium sulfatesodium sulfate/potassium sulfate/magnesium sulfate increases effects of clozapine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.solifenacinsolifenacin decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.solifenacin decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.clozapine increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.clozapine and solifenacin both increase QTc interval. Use Caution/Monitor.somapacitansomapacitan will decrease the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratessomatrogonsomatrogon will decrease the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratessomatropinsomatropin will decrease the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratessorafenibsorafenib and clozapine both increase QTc interval. Use Caution/Monitor.stiripentolstiripentol, clozapine. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.sufentanilsufentanil and clozapine both increase sedation. Use Caution/Monitor.sulfamethoxypyridazinesulfamethoxypyridazine increases toxicity of clozapine by unspecified interaction mechanism. Use Caution/Monitor. Possibly increased neutropenic effects.sumatriptansumatriptan, 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).sumatriptan intranasalsumatriptan intranasal, 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).sunitinibclozapine and sunitinib both increase QTc interval. Use Caution/Monitor.suvorexantclozapine will increase the level or effect of suvorexant by affecting hepatic enzyme CYP2E1 metabolism. Modify Therapy/Monitor Closely. Decrease suvorexant starting dose to 5 mg HS if coadministered with moderate CYP3A4 inhibitorstacrolimusclozapine and tacrolimus both increase QTc interval. Use Caution/Monitor.tamsulosinclozapine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tapentadoltapentadol and clozapine both increase sedation. Use Caution/Monitor.telavancinclozapine and telavancin both increase QTc interval. Use Caution/Monitor.temazepamtemazepam and clozapine both increase sedation. Use Caution/Monitor.terbutalineclozapine increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.teriflunomideteriflunomide decreases levels of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.tetrabenazineclozapine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.thioridazineclozapine and thioridazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.clozapine and thioridazine both increase sedation. Use Caution/Monitor.thiothixeneclozapine and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.clozapine and thiothixene both increase sedation. Use Caution/Monitor.tiotropiumtiotropium decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.clozapine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tobacco usetobacco use will decrease the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.tolazamideclozapine, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.tolbutamideclozapine, tolbutamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.tolterodinetolterodine decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tolterodine decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.clozapine increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.topiramatetopiramate will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.clozapine and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadoltramadol and clozapine both increase sedation. Use Caution/Monitor.tranylcyprominetranylcypromine, 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).trazodoneclozapine and trazodone both increase sedation. Use Caution/Monitor.triazolamtriazolam and clozapine both increase sedation. Use Caution/Monitor.triclabendazoleclozapine and triclabendazole both increase QTc interval. Use Caution/Monitor.triclofostriclofos and clozapine both increase sedation. Use Caution/Monitor.trifluoperazineclozapine and trifluoperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.clozapine and trifluoperazine both increase sedation. Use Caution/Monitor.trihexyphenidylclozapine increases effects of trihexyphenidyl by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive anticholinergic effects.trimipramineclozapine and trimipramine both increase sedation. Use Caution/Monitor.clozapine and trimipramine both increase QTc interval. Use Caution/Monitor.triprolidinetriprolidine and clozapine both increase sedation. Use Caution/Monitor.triptorelintriptorelin increases toxicity of clozapine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.trospium chloridetrospium chloride decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.trospium chloride decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.clozapine increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.valbenazinevalbenazine and clozapine both increase QTc interval. Use Caution/Monitor.vardenafilclozapine and vardenafil both increase QTc interval. Use Caution/Monitor.vecuroniumvecuronium decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.vecuronium decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor.clozapine increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.venlafaxinevenlafaxine, 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).verapamilverapamil will increase the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.verapamil will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.vilazodonevilazodone, 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).voclosporinvoclosporin, clozapine. Either increases effects of the other by QTc interval. Use Caution/Monitor.voriconazolevoriconazole will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.xylometazolineclozapine increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineclozapine increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.zafirlukastzafirlukast will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ziconotideclozapine and ziconotide both increase sedation. Use Caution/Monitor.zileutonzileuton will increase the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.ziprasidoneclozapine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.clozapine and ziprasidone both increase sedation. Use Caution/Monitor.zolmitriptanzolmitriptan, 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).zotepineclozapine and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.clozapine and zotepine both increase sedation. Use Caution/Monitor.Minor (9)azithromycinazithromycin increases toxicity of clozapine by unspecified interaction mechanism. Minor/Significance Unknown. Enhanced CNS toxicity.brimonidinebrimonidine increases effects of clozapine by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.chasteberrychasteberry decreases effects of clozapine by pharmacodynamic antagonism. Minor/Significance Unknown. (Theoretical interaction).cilostazolclozapine increases levels of cilostazol by decreasing metabolism. Minor/Significance Unknown.eslicarbazepine acetateeslicarbazepine acetate will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ethanolethanol, clozapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.eucalyptusclozapine and eucalyptus both increase sedation. Minor/Significance Unknown.sageclozapine and sage both increase sedation. Minor/Significance Unknown.valproic acidvalproic acid decreases levels of clozapine by plasma protein binding competition. Minor/Significance Unknown.abametapirSerious - Use Alternative (1)abametapir will increase the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.abobotulinumtoxinAMonitor Closely (1)abobotulinumtoxinA 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.acalabrutinibMonitor Closely (1)acalabrutinib, clozapine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.acarboseMonitor Closely (1)acarbose, 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.aclidiniumMonitor Closely (2)aclidinium 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.acrivastineMonitor Closely (1)acrivastine and clozapine both increase sedation. Use Caution/Monitor.adagrasibSerious - Use Alternative (1)adagrasib, clozapine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.albiglutideMonitor Closely (1)clozapine, 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.albuterolMonitor Closely (2)clozapine 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.alfentanilMonitor Closely (1)alfentanil and clozapine both increase sedation. Use Caution/Monitor.alfuzosinMonitor Closely (2)clozapine and alfuzosin both increase QTc interval. Use Caution/Monitor. alfuzosin and clozapine both increase QTc interval. Use Caution/Monitor.almotriptanMonitor Closely (1)almotriptan, 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).alprazolamMonitor Closely (1)alprazolam and clozapine both increase sedation. Use Caution/Monitor.amifampridineMonitor Closely (1)clozapine 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.amifostineMonitor Closely (1)amifostine, 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.amiodaroneSerious - Use Alternative (1)clozapine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.amisulprideContraindicated (1)amisulpride, clozapine. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndromeIncreases risk of neuroleptic malignant syndrome.Serious - Use Alternative (1)clozapine and amisulpride both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.amitriptylineMonitor Closely (2)clozapine and amitriptyline both increase QTc interval. Use Caution/Monitor. clozapine and amitriptyline both increase sedation. Use Caution/Monitor.amobarbitalMonitor Closely (3)amobarbital 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.amoxapineMonitor Closely (3)clozapine 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.anagrelideMonitor Closely (1)clozapine and anagrelide both increase QTc interval.