platelet activation; coadministration of SNRIs with clopidogrel may increase the risk of bleeding.cocaine topicalSerious - Use Alternative (1)cocaine topical and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.codeineMonitor Closely (1)desvenlafaxine will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgcyclobenzaprineSerious - Use Alternative (1)desvenlafaxine and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.cyproheptadineMonitor Closely (1)cyproheptadine decreases effects of desvenlafaxine by pharmacodynamic antagonism. Use Caution/Monitor. Cyproheptadine may diminish the serotonergic effect of SNRIs.daridorexantMonitor Closely (1)desvenlafaxine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. darunavirMonitor Closely (1)darunavir increases levels of desvenlafaxine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .desipramineMonitor Closely (1)desvenlafaxine will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)desipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.dexfenfluramineMonitor Closely (1)desvenlafaxine will increase the level or effect of dexfenfluramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)dexfenfluramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.dextroamphetamineMonitor Closely (1)desvenlafaxine will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)dextroamphetamine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.dextroamphetamine transdermalMonitor Closely (1)desvenlafaxine, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).dextromethorphanMonitor Closely (1)desvenlafaxine will increase the level or effect of dextromethorphan by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)dextromethorphan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.diazepam intranasalMonitor Closely (1)diazepam intranasal, desvenlafaxine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.difelikefalinMonitor Closely (1)difelikefalin and desvenlafaxine both increase sedation. Use Caution/Monitor.dihydroergotamineSerious - Use Alternative (1)dihydroergotamine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.dolasetronSerious - Use Alternative (1)dolasetron, desvenlafaxine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.donepezilMonitor Closely (1)desvenlafaxine will increase the level or effect of donepezil by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgdoxepinMonitor Closely (1)desvenlafaxine will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)doxepin and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.doxorubicinMonitor Closely (1)desvenlafaxine will increase the level or effect of doxorubicin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgdoxorubicin liposomalMonitor Closely (1)desvenlafaxine will increase the level or effect of doxorubicin liposomal by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgduloxetineMonitor Closely (1)desvenlafaxine will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)duloxetine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.eletriptanSerious - Use Alternative (1)eletriptan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.encainideMonitor Closely (1)desvenlafaxine will increase the level or effect of encainide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgergotamineSerious - Use Alternative (1)ergotamine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.escitalopramSerious - Use Alternative (1)escitalopram and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.fenfluramineMonitor Closely (1)fenfluramine, desvenlafaxine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.fentanylSerious - Use Alternative (1)desvenlafaxine and fentanyl both increase serotonin levels. Avoid or Use Alternate Drug. May cause serotonin syndromefesoterodineMonitor Closely (1)desvenlafaxine will increase the level or effect of fesoterodine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgfinerenoneMonitor Closely (1)desvenlafaxine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.fish oil triglyceridesMonitor Closely (1)fish oil triglycerides will increase the level or effect of desvenlafaxine by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.flecainideMonitor Closely (1)desvenlafaxine will increase the level or effect of flecainide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgflibanserinMonitor Closely (1)desvenlafaxine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.fluoxetineMonitor Closely (1)desvenlafaxine will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)fluoxetine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.fluphenazineMonitor Closely (1)desvenlafaxine will increase the level or effect of fluphenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgfluvoxamineMonitor Closely (1)desvenlafaxine will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. With higher desvenlafaxine doses (eg, 400 mg) decrease CYP2D6 substrate dose by up to 50%; dose adjustment not necessary with desvenlafaxine doses <100mgSerious - Use Alternative (1)fluvoxamine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.fosamprenavirMonitor Closely (1)fosamprenavir increases levels of desvenlafaxine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .frovatriptanSerious - Use Alternative (1)frovatriptan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.gabapentinMonitor Closely (1)gabapentin, desvenlafaxine. 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.gabapentin enacarbilMonitor Closely (1)gabapentin enacarbil, desvenlafaxine. 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.galantamineMonitor Closely (1)desvenlafaxine will increase the level or effect of galantamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgganaxoloneMonitor Closely (1)desvenlafaxine and ganaxolone both increase sedation. Use Caution/Monitor.granisetronSerious - Use Alternative (1)granisetron, desvenlafaxine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.haloperidolMonitor Closely (1)desvenlafaxine will increase the level or effect of haloperidol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mghydrocodoneMonitor Closely (2)hydrocodone, desvenlafaxine. 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. desvenlafaxine will increase the level or effect of hydrocodone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone) is mainly formed by CYP2D6 mediated O-demethylation of hydrocodone. Hydromorphone may contribute to the total analgesic effect of hydrocodone.hydromorphoneMonitor Closely (1)desvenlafaxine will increase the level or effect of hydromorphone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.ibrutinibMonitor Closely (1)ibrutinib will increase the level or effect of desvenlafaxine by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding. iloperidoneMonitor Closely (1)desvenlafaxine will increase the level or effect of iloperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgimipramineMonitor Closely (1)desvenlafaxine will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mgSerious - Use Alternative (1)imipramine and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.indinavirMonitor Closely (1)indinavir increases levels of desvenlafaxine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potential for increased toxicity. .iobenguane I 123Contraindicated (1)desvenlafaxine decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.iobenguane I 131Serious - Use Alternative (1)desvenlafaxine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.isavuconazonium sulfateMonitor Closely (1)desvenlafaxine will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.isocarboxazidContraindicated (1)isocarboxazid and desvenlafaxine both increase serotonin levels. Contraindicated. At least 14 days should elapse between discontinuation of MAOIs and initiation of treatment with a serotonergic drugisoniazidSerious - Use Alternative (1)isoniazid and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.ivacaftorMonitor Closely (1)desvenlafaxine increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .L-tryptophanSerious - Use Alternative (1)L-tryptophan and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.lasmiditanMonitor Closely (2)lasmiditan, desvenlafaxine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other