or Use Alternate Drug.morphineMonitor Closely (2)duloxetine will increase the level or effect of morphine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. duloxetine and morphine both increase serotonin levels. Modify Therapy/Monitor Closely.nabumetoneMonitor Closely (1)duloxetine, nabumetone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.naproxenMonitor Closely (1)duloxetine, naproxen. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.naratriptanMonitor Closely (1)naratriptan and duloxetine both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)duloxetine, naratriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.nebivololMonitor Closely (1)duloxetine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.nefazodoneSerious - Use Alternative (1)duloxetine and nefazodone both increase serotonin levels. Avoid or Use Alternate Drug.netupitant/palonosetronSerious - Use Alternative (1)netupitant/palonosetron, duloxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.nilotinibMonitor Closely (1)nilotinib will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.nortriptylineMonitor Closely (1)duloxetine will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)duloxetine and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.oliceridineMonitor Closely (2)duloxetine will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal. duloxetine, oliceridine. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely.olopatadine intranasalSerious - Use Alternative (1)duloxetine 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. omeprazoleSerious - Use Alternative (1)omeprazole will decrease the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.ondansetronSerious - Use Alternative (1)ondansetron, duloxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.oxaprozinMonitor Closely (1)duloxetine, oxaprozin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.oxycodoneMonitor Closely (1)duloxetine will increase the level or effect of oxycodone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.oxymorphoneMonitor Closely (1)duloxetine will increase the level or effect of oxymorphone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.ozanimodSerious - Use Alternative (1)ozanimod increases toxicity of duloxetine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.palonosetronSerious - Use Alternative (1)palonosetron, duloxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.panax ginsengMinor (1)panax ginseng increases effects of duloxetine by pharmacodynamic synergism. Minor/Significance Unknown.parecoxibMonitor Closely (2)parecoxib will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. duloxetine, parecoxib. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.paroxetineSerious - Use Alternative (2)duloxetine and paroxetine both increase serotonin levels. Avoid or Use Alternate Drug. paroxetine will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.Minor (1)duloxetine will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.pefloxacinSerious - Use Alternative (1)pefloxacin will increase the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.peginterferon alfa 2aSerious - Use Alternative (1)peginterferon alfa 2a will increase the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.peginterferon alfa 2bMonitor Closely (1)peginterferon alfa 2b, duloxetine. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.pentazocineMonitor Closely (1)duloxetine and pentazocine both increase serotonin levels. Modify Therapy/Monitor Closely.pentobarbitalSerious - Use Alternative (1)pentobarbital will decrease the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.perhexilineMinor (1)duloxetine will increase the level or effect of perhexiline by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.perphenazineMonitor Closely (1)perphenazine will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Minor (1)duloxetine will increase the level or effect of perphenazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.phenelzineContraindicated (1)phenelzine and duloxetine both increase serotonin levels. Contraindicated.phenobarbitalSerious - Use Alternative (1)phenobarbital will decrease the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.phentermineSerious - Use Alternative (1)duloxetine, phentermine. Either increases toxicity of the other by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of serotonin syndrome.pipemidic acidSerious - Use Alternative (1)pipemidic acid will increase the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated.piroxicamMonitor Closely (1)duloxetine, piroxicam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.pleurisy rootMinor (1)pleurisy root decreases effects of duloxetine by unspecified interaction mechanism. Minor/Significance Unknown. Theoretical interaction.pregabalinMonitor Closely (1)pregabalin, duloxetine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.primidoneSerious - Use Alternative (1)primidone will decrease the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.procarbazineContraindicated (1)procarbazine and duloxetine both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.prochlorperazineMinor (1)duloxetine will increase the level or effect of prochlorperazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.promazineMinor (1)duloxetine will increase the level or effect of promazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.promethazineMinor (1)duloxetine will increase the level or effect of promethazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.propafenoneMonitor Closely (2)duloxetine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. propafenone will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.propranololMonitor Closely (1)duloxetine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.protriptylineSerious - Use Alternative (1)duloxetine and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.pseudoephedrineSerious - Use Alternative (1)duloxetine increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.quinacrineMonitor Closely (1)quinacrine will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.quinidineSerious - Use Alternative (1)quinidine will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.ranolazineMonitor Closely (1)ranolazine will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.rasagilineSerious - Use Alternative (1)rasagiline and duloxetine both increase serotonin levels. Avoid or Use Alternate Drug. Severe 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 increases toxicity of duloxetine by serotonin levels. Modify Therapy/Monitor Closely. Increases risk of serotonin syndrome.remimazolamMonitor Closely (1)remimazolam, duloxetine. 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.rifampinSerious - Use Alternative (1)rifampin will decrease the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated.risperidoneMonitor Closely (1)duloxetine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.ritlecitinibMonitor Closely (1)ritlecitinib will increase the level or effect of duloxetine 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 will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.rivaroxabanMonitor Closely (1)duloxetine increases toxicity of rivaroxaban by anticoagulation. Use Caution/Monitor. May enhance the antiplatelet effect of nonsteroidal anti-inflammatory agents.rizatriptanMonitor Closely (1)rizatriptan and duloxetine both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)duloxetine, rizatriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.rolapitantMonitor Closely (1)rolapitant will increase the level or effect of duloxetine 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.ropeginterferon alfa 2bSerious - Use Alternative (1)ropeginterferon alfa 2b and duloxetine both increase Other (see comment). Avoid or Use Alternate Drug. Narcotics, hypnotics or sedatives can produce additive neuropsychiatric side effects. Avoid use and monitor patients receiving the combination for effects of excessive CNS toxicity.rucaparibMonitor Closely (1)rucaparib will increase the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP1A2 substrates, if clinically indicated.safinamideContraindicated (1)duloxetine, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.salicylates (non-asa)Monitor Closely (1)duloxetine, 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.salsalateMonitor Closely (1)duloxetine, 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)duloxetine and SAMe both increase serotonin levels. Modify Therapy/Monitor Closely.secobarbitalSerious - Use Alternative (1)secobarbital will decrease the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.selegilineContraindicated (1)selegiline and duloxetine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of selegiline and initiation of treatment with a serotonergic drug.selegiline transdermalSerious - Use Alternative (1)selegiline transdermal and duloxetine both increase serotonin levels. Avoid or Use Alternate Drug.serdexmethylphenidate/dexmethylphenidateMinor (1)serdexmethylphenidate/dexmethylphenidate increases effects of duloxetine by decreasing metabolism. Minor/Significance Unknown.sertralineSerious - Use Alternative (2)duloxetine and sertraline both increase serotonin levels. Avoid or Use Alternate Drug. sertraline will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.smokingSerious - Use Alternative (1)smoking will decrease the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycolMonitor Closely (1)duloxetine, 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.somapacitanMonitor Closely (1)somapacitan will decrease the level or effect of duloxetine 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 duloxetine 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 duloxetine 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 substratesSt John's WortSerious - Use Alternative (1)duloxetine and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.stiripentolMonitor Closely (1)stiripentol, duloxetine. 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.sufentanil SLMonitor Closely (1)sufentanil SL, duloxetine. 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.sulfasalazineMonitor Closely (1)duloxetine, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by