may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.selpercatinibMonitor Closely (2)selpercatinib increases toxicity of olanzapine by QTc interval. Use Caution/Monitor. selpercatinib increases toxicity of fluoxetine by QTc interval. Use Caution/Monitor.serdexmethylphenidate/dexmethylphenidateMinor (1)serdexmethylphenidate/dexmethylphenidate increases effects of fluoxetine by decreasing metabolism. Minor/Significance Unknown.sertralineMonitor Closely (2)olanzapine and sertraline both increase QTc interval. Use Caution/Monitor. sertraline and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)sertraline will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. fluoxetine and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.sevofluraneSerious - Use Alternative (2)sevoflurane and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug. sevoflurane 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 instancesshepherd's purseMonitor Closely (1)olanzapine and shepherd's purse both increase sedation. Use Caution/Monitor.siponimodSerious - Use Alternative (3)siponimod and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug. olanzapine and siponimod both increase QTc interval. Avoid or Use Alternate Drug. olanzapine will increase the level or effect of siponimod by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with drugs that cause moderate CYP2C9 AND a moderate or strong CYP3A4 inhibition is not recommended. Caution if siponimod coadministered with moderate CYP2C9 inhibitors alone.sitagliptinMonitor Closely (1)olanzapine, sitagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.smokingMonitor Closely (1)smoking will decrease the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.sodium oxybateSerious - Use Alternative (1)olanzapine, 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.sodium sulfate/?magnesium sulfate/potassium chlorideMonitor Closely (2)sodium sulfate/?magnesium sulfate/potassium chloride increases effects of olanzapine 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. sodium sulfate/?magnesium sulfate/potassium chloride increases effects of fluoxetine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold.sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycolMonitor Closely (1)fluoxetine, sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.sodium sulfate/potassium sulfate/magnesium sulfateMonitor Closely (2)sodium sulfate/potassium sulfate/magnesium sulfate increases effects of fluoxetine by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of seizures when using bowel preps together with drugs that lower the seizure threshold. sodium sulfate/potassium sulfate/magnesium sulfate increases effects of olanzapine 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.solifenacinMonitor Closely (5)solifenacin decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. olanzapine increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. solifenacin and fluoxetine both increase QTc interval. Use Caution/Monitor. solifenacin decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor. olanzapine and solifenacin both increase QTc interval. Use Caution/Monitor.somapacitanMonitor Closely (1)somapacitan will decrease the level or effect of olanzapine 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 substratessomatrogonMonitor Closely (1)somatrogon will decrease the level or effect of olanzapine 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 substratessomatropinMonitor Closely (1)somatropin will decrease the level or effect of olanzapine 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 substratessorafenibMonitor Closely (2)sorafenib and fluoxetine both increase QTc interval. Use Caution/Monitor. sorafenib and olanzapine both increase QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancessotalolSerious - Use Alternative (2)fluoxetine and sotalol both increase QTc interval. Avoid or Use Alternate Drug. olanzapine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.sparsentanMonitor Closely (1)sparsentan will decrease the level or effect of fluoxetine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C9 inducer) decreases exposure of CYP2C9 substrates and reduces efficacy related to these substrates. St John's WortSerious - Use Alternative (1)fluoxetine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.stiripentolMonitor Closely (2)stiripentol, olanzapine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence. stiripentol, olanzapine. 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.sufentanilMonitor Closely (1)sufentanil and olanzapine both increase sedation. Use Caution/Monitor.sufentanil SLMonitor Closely (1)sufentanil SL, fluoxetine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.Serious - Use Alternative (1)sufentanil SL, olanzapine. 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.sulfamethoxazoleMonitor Closely (1)fluoxetine will increase the level or effect of sulfamethoxazole by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.sulfasalazineMonitor Closely (1)fluoxetine, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.sulindacMonitor Closely (1)fluoxetine, sulindac. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.sumatriptanMonitor Closely (2)sumatriptan, 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). sumatriptan and fluoxetine both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)fluoxetine, sumatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.sumatriptan intranasalMonitor Closely (2)sumatriptan intranasal, 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). sumatriptan intranasal and fluoxetine both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)fluoxetine, sumatriptan intranasal. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.sunitinibMonitor Closely (2)olanzapine and sunitinib both increase QTc interval. Use Caution/Monitor. sunitinib and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.tacrolimusMonitor Closely (2)tacrolimus and fluoxetine both increase QTc interval. Use Caution/Monitor. olanzapine and tacrolimus both increase QTc interval. Use Caution/Monitor.tamoxifenMonitor Closely (1)fluoxetine will decrease the level or effect of tamoxifen by decreasing metabolism. Use Caution/Monitor. Inhibition of CYP2D6 metabolism to tamoxifen's active metabolite, endoxifen.tamsulosinMonitor Closely (1)fluoxetine increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.tapentadolMonitor Closely (2)fluoxetine and tapentadol both increase serotonin levels. Modify Therapy/Monitor Closely. tapentadol and olanzapine both increase sedation. Use Caution/Monitor.tazemetostatMonitor Closely (2)olanzapine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. fluoxetine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tedizolidSerious - Use Alternative (1)tedizolid, fluoxetine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.telavancinMonitor Closely (2)fluoxetine and telavancin both increase QTc interval. Use Caution/Monitor. olanzapine and telavancin both increase QTc interval. Use Caution/Monitor.temazepamMonitor Closely (1)temazepam and olanzapine both increase sedation. Use Caution/Monitor.terbinafineMonitor Closely (1)terbinafine will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.terbutalineMonitor Closely (2)fluoxetine and terbutaline 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 terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.teriflunomideMonitor Closely (1)teriflunomide decreases levels of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.tetrabenazineMonitor Closely (2)fluoxetine increases effects of tetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decrease tetrabenazine dose by 50% when coadministered with strong CYP2D6 inhibitors. olanzapine and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)olanzapine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug. tetrabenazine and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.thioridazineContraindicated (4)olanzapine and thioridazine both increase QTc interval. Contraindicated. fluoxetine increases levels of thioridazine by decreasing metabolism. Contraindicated. Risk of long QT syndrome. thioridazine will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. thioridazine and fluoxetine both increase QTc interval. Contraindicated.Monitor Closely (2)olanzapine and thioridazine both increase sedation. Use Caution/Monitor. olanzapine and thioridazine 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 thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.thiothixeneMonitor Closely (3)olanzapine and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. thiothixene and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely. olanzapine and thiothixene both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)olanzapine and thiothixene both increase QTc interval. Avoid or Use Alternate Drug.timololSerious - Use Alternative (1)fluoxetine will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.tinidazoleMonitor Closely (2)fluoxetine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. olanzapine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tiotropiumMonitor Closely (3)tiotropium decreases levels of olanzapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. tiotropium decreases levels of olanzapine by pharmacodynamic antagonism. Use Caution/Monitor. olanzapine increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tipranavirSerious - Use Alternative (1)tipranavir will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.tobacco useMonitor Closely (1)tobacco use will decrease the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.tolazamideMonitor Closely (2)fluoxetine increases effects of tolazamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia. olanzapine, 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.tolbutamideMonitor Closely (3)fluoxetine increases effects of tolbutamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia. fluoxetine will increase the level or effect of tolbutamide by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. olanzapine, 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.tolfenamic acidMonitor Closely (1)fluoxetine, tolfenamic acid. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.tolmetinMonitor Closely (1)fluoxetine, tolmetin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor.