by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of cabozantinib with strong CYP3A4 inducers. If a strong CYP3A4 inducer is required, increase cabozantinib dose by 40 mg/day (Cometriq) or by 20 mg/day (Cabometyx). Resume previous dose 2-3 days after strong CYP3A4 inducer discontinued.caffeineMonitor Closely (1)armodafinil and caffeine both decrease sedation. Use Caution/Monitor.Minor (1)armodafinil will decrease the level or effect of caffeine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.cannabidiolMonitor Closely (1)armodafinil will increase the level or effect of cannabidiol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a moderate CYP2C19 inhibitor.carbamazepineMonitor Closely (2)armodafinil will decrease the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. carbamazepine will decrease the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.carbinoxamineMonitor Closely (1)carbinoxamine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.cenobamateMonitor Closely (1)cenobamate will decrease the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.ceritinibMinor (1)ceritinib will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.cevimelineMinor (1)armodafinil will decrease the level or effect of cevimeline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.chloral hydrateMonitor Closely (1)chloral hydrate increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.chlordiazepoxideMonitor Closely (1)chlordiazepoxide increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.chlorpheniramineMonitor Closely (1)chlorpheniramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.chlorpromazineMonitor Closely (1)chlorpromazine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.cilostazolMonitor Closely (2)armodafinil will decrease the level or effect of cilostazol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. armodafinil increases toxicity of cilostazol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider decreasing cilostazol dose; moderate CYP2C19 inhibitors may increase serum levels of 3,4-dehydrocilostazol (active metabolite).cimetidineMonitor Closely (1)cimetidine will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)armodafinil will increase the level or effect of cimetidine by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.cinacalcetMonitor Closely (1)armodafinil will decrease the level or effect of cinacalcet by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cinnarizineMonitor Closely (1)cinnarizine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.clarithromycinMonitor Closely (1)clarithromycin will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (2)armodafinil will decrease the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. clarithromycin will increase the level or effect of armodafinil by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.clemastineMonitor Closely (1)clemastine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.clobazamMonitor Closely (1)armodafinil will increase the level or effect of clobazam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Dosage adjustment may be required; CYP2C19 inhibitors may result in increased exposure to N-desmethylclobazam (active metabolite).clomipramineMonitor Closely (2)armodafinil will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. clomipramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)armodafinil will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.clonazepamMonitor Closely (1)clonazepam increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.clopidogrelMonitor Closely (2)armodafinil will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrel armodafinil decreases effects of clopidogrel by decreasing metabolism. Use Caution/Monitor. Cytochrome P450 2C19 inhibitors decrease the conversion of clopidogrel to its active form.clorazepateMonitor Closely (1)clorazepate increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.clotrimazoleMinor (1)clotrimazole will decrease the level or effect of armodafinil by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.clozapineMonitor Closely (3)armodafinil will decrease the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. armodafinil will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. clozapine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.cobicistatSerious - Use Alternative (1)cobicistat will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. May increase armotafinil concentration and decrease cobicistat as armodafinil is CYP3A4 inducer and cobicistat is CYP3A4 substratecobimetinibContraindicated (1)armodafinil will decrease the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Avoid coadministration. Strong or moderate CYP3A inducers may decrease cobimetinib systemic exposure by >80% and reduce its efficacy.cocaine topicalMinor (1)armodafinil will decrease the level or effect of cocaine topical by affecting hepatic enzyme CYP2B6 metabolism. Minor/Significance Unknown.codeineMonitor Closely (1)codeine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.colchicineMonitor Closely (1)armodafinil will decrease the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.conivaptanMonitor Closely (1)armodafinil will decrease the level or effect of conivaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)conivaptan will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.conjugated estrogensMonitor Closely (1)armodafinil will decrease the level or effect of conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.conjugated estrogens, vaginalMonitor Closely (1)armodafinil will decrease the level or effect of conjugated estrogens, vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cortisoneMonitor Closely (1)armodafinil will decrease the level or effect of cortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)cortisone will decrease the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.crizotinibMonitor Closely (1)crizotinib increases levels of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.crofelemerMonitor Closely (1)crofelemer increases levels of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.cyclizineMonitor Closely (1)cyclizine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.cyclophosphamideMinor (1)cyclophosphamide will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.cyclosporineMonitor Closely (1)armodafinil will decrease the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (2)cyclosporine will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. cyclosporine will increase the level or effect of armodafinil by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.cyproheptadineMonitor Closely (1)cyproheptadine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dabrafenibMonitor Closely (1)dabrafenib will decrease the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.dapsoneMinor (1)armodafinil will decrease the level or effect of dapsone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.daridorexantSerious - Use Alternative (1)armodafinil will decrease the level or effect of daridorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.darifenacinMonitor Closely (1)armodafinil will decrease the level or effect of darifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)darifenacin will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.darunavirMonitor Closely (1)armodafinil will decrease the level or effect of darunavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)darunavir will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.dasatinibMonitor Closely (1)armodafinil will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)dasatinib will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.deferasiroxMonitor Closely (1)deferasirox will decrease the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.deflazacortSerious - Use Alternative (1)armodafinil will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.desipramineMonitor Closely (1)desipramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dexamethasoneMonitor Closely (1)armodafinil will decrease the level or effect of dexamethasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)dexamethasone will decrease the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.dexchlorpheniramineMonitor Closely (1)dexchlorpheniramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dexfenfluramineMonitor Closely (1)armodafinil and dexfenfluramine both decrease sedation. Use Caution/Monitor.dexmedetomidineMonitor Closely (1)dexmedetomidine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dexmethylphenidateMonitor Closely (1)armodafinil and dexmethylphenidate both decrease sedation. Use Caution/Monitor.dextroamphetamineMonitor Closely (1)armodafinil and dextroamphetamine both decrease sedation. Use Caution/Monitor.dextromoramideMonitor Closely (1)dextromoramide increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.DHEA, herbalMinor (1)DHEA, herbal will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.diamorphineMonitor Closely (1)diamorphine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.diazepamMonitor Closely (1)armodafinil will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)armodafinil will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.diazepam intranasalMonitor Closely (2)armodafinil will decrease the level or effect of diazepam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong or moderate CYP3A4 inducers may increase rate of diazepam elimination; therefore, efficacy of diazepam may be decreased. armodafinil will increase the level or effect of diazepam intranasal by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Strong or moderate CYP2C19 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.dienogest/estradiol valerateMonitor Closely (1)armodafinil will decrease the level or effect of dienogest/estradiol valerate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Advise women to use alternative method of contraception or back-up method when moderate or weak enzyme inducer is used with combination contraceptives. Back-up contraception should be continued for 28 days after discontinuing medication to ensure contraceptive reliability. diethylpropionMonitor Closely (1)armodafinil and diethylpropion both decrease sedation. Use Caution/Monitor.difenoxin hclMonitor Closely (1)difenoxin hcl increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dihydroergotamineSerious - Use Alternative (1)armodafinil will decrease the level or effect of dihydroergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.dihydroergotamine intranasalSerious - Use Alternative (1)armodafinil will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.diltiazemMonitor Closely (2)diltiazem will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. armodafinil will decrease the level or effect of diltiazem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dimenhydrinateMonitor Closely (1)dimenhydrinate increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.diphenhydramineMonitor Closely (1)diphenhydramine increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.diphenoxylate hclMonitor Closely (1)diphenoxylate hcl increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dipipanoneMonitor Closely (1)dipipanone increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.disopyramideMinor (1)armodafinil will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.dobutamineMonitor Closely (1)dobutamine and armodafinil both decrease sedation. Use Caution/Monitor.docetaxelMinor (1)armodafinil will decrease the level or effect of docetaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.donepezilMinor (1)armodafinil will decrease the level or effect of donepezil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.dopamineMonitor Closely (1)armodafinil and dopamine both decrease sedation. Use Caution/Monitor.dopexamineMonitor Closely (1)dopexamine and armodafinil both decrease sedation. Use Caution/Monitor.doravirineContraindicated (1)armodafinil will decrease the level or effect of doravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of doravirine with a CYP3A inducer may decrease doravirine plasma concentrations and/or effects. Potential for loss of virologic response and possible resistance to doravirine. doxepinMonitor Closely (1)doxepin increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.doxorubicin liposomalMinor (1)armodafinil will decrease the level or effect of doxorubicin liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.dronedaroneSerious - Use Alternative (1)armodafinil will decrease the level or effect of dronedarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (2)dronedarone will increase the level