decrease the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.prochlorperazineasenapine will increase the level or effect of prochlorperazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.promazineasenapine will increase the level or effect of promazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.promethazineasenapine will increase the level or effect of promethazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.risperidoneasenapine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.secobarbitalsecobarbital will decrease the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.smokingsmoking will decrease the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.tizanidinetizanidine increases effects of asenapine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.tobacco usetobacco use will decrease the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.tolterodineasenapine will increase the level or effect of tolterodine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.tramadolasenapine will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.treprostiniltreprostinil increases effects of asenapine by pharmacodynamic synergism. Minor/Significance Unknown.trifluoperazineasenapine will increase the level or effect of trifluoperazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.tropisetronasenapine will increase the level or effect of tropisetron by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.verapamilverapamil will increase the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.zileutonzileuton will increase the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.acarboseMonitor Closely (1)asenapine, acarbose. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.acebutololMonitor Closely (1)asenapine and acebutolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.aceclofenacMonitor Closely (1)aceclofenac decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.acemetacinMonitor Closely (1)acemetacin decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.acetaminophen/phenyltoloxamineMonitor Closely (1)asenapine and acetaminophen/phenyltoloxamine both increase sedation. Use Caution/Monitor.acrivastineMonitor Closely (1)acrivastine and asenapine both increase sedation. Use Caution/Monitor.adagrasibSerious - Use Alternative (1)adagrasib, asenapine. 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)asenapine, 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 (1)albuterol and asenapine both increase QTc interval. Use Caution/Monitor.aldesleukinMonitor Closely (1)aldesleukin increases effects of asenapine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.alfentanilSerious - Use Alternative (1)asenapine and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatealfuzosinMonitor Closely (1)alfuzosin and asenapine both increase anti-hypertensive channel blocking. Use Caution/Monitor.Serious - Use Alternative (1)alfuzosin and asenapine both increase QTc interval. Avoid or Use Alternate Drug.almotriptanMonitor Closely (1)almotriptan, asenapine. 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)asenapine and alprazolam both increase sedation. Use Caution/Monitor.amifostineMonitor Closely (2)amifostine, asenapine. 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. amifostine, asenapine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.amiodaroneSerious - Use Alternative (1)asenapine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.amisulprideContraindicated (1)amisulpride, asenapine. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndrome.Monitor Closely (1)amisulpride and asenapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amisulpride and asenapine both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.amitriptylineMonitor Closely (2)asenapine and amitriptyline both increase QTc interval. Use Caution/Monitor. asenapine and amitriptyline both increase sedation. Use Caution/Monitor.amlodipineMonitor Closely (1)asenapine and amlodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.amobarbitalMonitor Closely (1)asenapine and amobarbital both increase sedation. Use Caution/Monitor.Minor (1)amobarbital will decrease the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.amoxapineMonitor Closely (2)asenapine and amoxapine both increase QTc interval. Use Caution/Monitor. asenapine and amoxapine both increase sedation. Use Caution/Monitor.anagrelideSerious - Use Alternative (2)anagrelide and asenapine both increase QTc interval. Avoid or Use Alternate Drug. asenapine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.apomorphineSerious - Use Alternative (1)apomorphine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.arformoterolMonitor Closely (1)arformoterol and asenapine both increase QTc interval. Use Caution/Monitor.aripiprazoleMonitor Closely (1)asenapine and aripiprazole both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)aripiprazole and asenapine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)asenapine will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.armodafinilMinor (1)armodafinil will decrease the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.arsenic trioxideSerious - Use Alternative (1)asenapine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.artemetherSerious - Use Alternative (1)artemether and asenapine both increase QTc interval. Avoid or Use Alternate Drug.artemether/lumefantrineSerious - Use Alternative (1)asenapine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.asenapine transdermalMonitor Closely (1)asenapine and asenapine transdermal both increase sedation. Use Caution/Monitor.aspirinMonitor Closely (1)aspirin decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.aspirin rectalMonitor Closely (1)aspirin rectal decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.aspirin/citric acid/sodium bicarbonateMonitor Closely (1)aspirin/citric acid/sodium bicarbonate decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.atenololMonitor Closely (1)asenapine and atenolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.atomoxetineMonitor Closely (1)asenapine will increase the level or effect of atomoxetine by Other (see comment). Use Caution/Monitor. Potential for enhanced CNS depression. Monitor closely during conurrent use.Serious - Use Alternative (1)atomoxetine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.avanafilMonitor Closely (1)avanafil increases effects of asenapine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.avapritinibMonitor Closely (1)asenapine and avapritinib both increase sedation. Use Caution/Monitor.azithromycinMonitor Closely (1)azithromycin increases toxicity of asenapine by QTc interval. Use Caution/Monitor.baclofenMonitor Closely (1)asenapine and baclofen both increase sedation. Use Caution/Monitor.bedaquilineMonitor Closely (1)asenapine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closelybenazeprilMonitor Closely (1)benazepril increases effects of asenapine by pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.benzhydrocodone/acetaminophenMonitor Closely (1)asenapine will increase the level or effect of benzhydrocodone/acetaminophen by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone [benzhydrocodone is prodrug of hydrocodone]) is mainly formed by CYP2D6 mediated O-demethylation of hydrocodone. Hydromorphone may contribute to the total analgesic effect of hydrocodone.Serious - Use Alternative (2)benzhydrocodone/acetaminophen, asenapine. Either increases toxicity 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. asenapine and benzhydrocodone/acetaminophen both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebetaxololMonitor Closely (1)asenapine and betaxolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.bisoprololMonitor Closely (1)asenapine and bisoprolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.brexanoloneMonitor Closely (1)brexanolone, asenapine. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazoleMonitor Closely (1)asenapine and brexpiprazole both increase sedation. Use Caution/Monitor.brimonidineMonitor Closely (1)asenapine and brimonidine both increase sedation. Use Caution/Monitor.Minor (1)brimonidine increases effects of asenapine by pharmacodynamic synergism. Minor/Significance Unknown.brivaracetamMonitor Closely (1)asenapine and brivaracetam both increase sedation. Use Caution/Monitor.brompheniramineMonitor Closely (1)asenapine and brompheniramine both increase sedation. Use Caution/Monitor.buprenorphineSerious - Use Alternative (3)asenapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug. buprenorphine and asenapine both increase QTc interval. Avoid or Use Alternate Drug. asenapine and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine buccalSerious - Use Alternative (2)buprenorphine buccal and asenapine both increase QTc interval. Avoid or Use Alternate Drug. asenapine and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine subdermal implantSerious - Use Alternative (2)buprenorphine subdermal implant and asenapine both increase QTc interval. Avoid or Use Alternate Drug. asenapine and buprenorphine subdermal implant both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine transdermalSerious - Use Alternative (2)buprenorphine transdermal and asenapine both increase QTc interval. Avoid or Use Alternate Drug. asenapine and buprenorphine transdermal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine, long-acting injectionMonitor Closely (1)asenapine increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.Serious - Use Alternative (2)buprenorphine, long-acting injection and asenapine both increase QTc interval. Avoid or Use Alternate Drug. asenapine and buprenorphine, long-acting injection both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebutabarbitalMonitor Closely (1)asenapine and butabarbital both increase sedation. Use Caution/Monitor.Minor (1)butabarbital will decrease the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.butalbitalMonitor Closely (1)asenapine and butalbital both increase sedation. Use Caution/Monitor.Minor (1)butalbital will decrease the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.butcher's broomMinor (1)asenapine, butcher's broom. Either decreases effects of the other by Mechanism: pharmacodynamic antagonism. Minor/Significance Unknown.butorphanolMonitor Closely (1)asenapine and butorphanol both increase sedation. Use Caution/Monitor.captoprilMonitor Closely (1)captopril, asenapine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.carbamazepineMinor (1)carbamazepine will decrease the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.carbidopaMonitor Closely (1)carbidopa increases effects of asenapine by pharmacodynamic synergism. Use Caution/Monitor. Monitor for hypotension.carbinoxamineMonitor Closely (1)asenapine and carbinoxamine both increase sedation. Use Caution/Monitor.cariprazineMonitor Closely (1)asenapine and cariprazine both increase sedation. Use Caution/Monitor.carisoprodolMonitor Closely (1)asenapine and carisoprodol both increase sedation. Use Caution/Monitor.carvedilolMonitor Closely (2)asenapine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. asenapine and carvedilol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.celecoxibMonitor Closely (1)celecoxib decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.celiprololMonitor Closely (1)asenapine and celiprolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.cenobamateMonitor Closely (1)cenobamate, asenapine. Either increases effects of the other by sedation. Use Caution/Monitor.ceritinibSerious - Use Alternative (1)ceritinib and asenapine both increase QTc interval. Avoid or Use Alternate Drug.cetirizineMonitor Closely (1)asenapine and cetirizine both increase sedation. Use Caution/Monitor.chlordiazepoxideMonitor Closely (1)asenapine and chlordiazepoxide both increase sedation. Use Caution/Monitor.chloroquineMonitor Closely (1)chloroquine increases toxicity of asenapine by QTc interval. Use Caution/Monitor.chlorpheniramineMonitor Closely (1)asenapine and chlorpheniramine both increase sedation. Use Caution/Monitor.chlorpromazineMonitor Closely (1)asenapine and chlorpromazine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)asenapine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)asenapine will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.chlorpropamideMonitor Closely (1)asenapine, chlorpropamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.chlorzoxazoneMonitor Closely (1)asenapine and chlorzoxazone both increase sedation. Use Caution/Monitor.choline magnesium trisalicylateMonitor Closely (1)choline magnesium trisalicylate decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.cigarette smokingMinor (1)cigarette smoking will decrease the level or effect of asenapine by