Modify Therapy/Monitor Closely.paliperidone and protriptyline both increase sedation. Use Caution/Monitor.quazepamquazepam and paliperidone both increase sedation. Use Caution/Monitor.quercetinquercetin will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.quetiapinepaliperidone and quetiapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.paliperidone and quetiapine both increase sedation. Use Caution/Monitor.quetiapine, paliperidone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.quininepaliperidone and quinine both increase QTc interval. Use Caution/Monitor.ramelteonpaliperidone and ramelteon both increase sedation. Use Caution/Monitor.ranolazineranolazine will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.paliperidone and ranolazine both increase QTc interval. Use Caution/Monitor.rapacuroniumrapacuronium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.rapacuronium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.paliperidone increases effects of rapacuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.remimazolamremimazolam, paliperidone. 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.repaglinidepaliperidone, repaglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.rifampinrifampin will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Paliperidone dose may need to be increased when coadministered with strong inducers of both CYP3A4 and P-gprifaximinpaliperidone increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.rilpivirinerilpivirine increases toxicity of paliperidone by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.risperidonepaliperidone and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.paliperidone and risperidone both increase QTc interval. Use Caution/Monitor.paliperidone and risperidone both increase sedation. Use Caution/Monitor.paliperidone, risperidone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Paliperidone is the major active metabolite of risperidone, consideration should be given to the additive paliperidone exposure if any of these medications are coadministered.ritonavirritonavir will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.rocuroniumrocuronium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.rocuronium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.paliperidone increases effects of rocuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.rosiglitazonepaliperidone, rosiglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.salmeterolpaliperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.sarecyclinesarecycline will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.saxagliptinpaliperidone, saxagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.scopolaminescopolamine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.scopolamine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.paliperidone increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.scullcappaliperidone and scullcap both increase sedation. Use Caution/Monitor.secobarbitalsecobarbital and paliperidone both increase sedation. Use Caution/Monitor.selegilineselegiline, paliperidone. 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).selpercatinibselpercatinib increases toxicity of paliperidone by QTc interval. Use Caution/Monitor.shepherd's pursepaliperidone and shepherd's purse both increase sedation. Use Caution/Monitor.simvastatinsimvastatin will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.sirolimussirolimus will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.sitagliptinpaliperidone, 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.sodium sulfate/?magnesium sulfate/potassium chloridesodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of paliperidone by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .sodium sulfate/?magnesium sulfate/potassium chloride increases effects of paliperidone 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/potassium sulfate/magnesium sulfatesodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of paliperidone by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .sodium sulfate/potassium sulfate/magnesium sulfate increases effects of paliperidone 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.solifenacinsolifenacin decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.solifenacin decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.paliperidone increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.sorafenibsorafenib and paliperidone both increase QTc interval. Use Caution/Monitor.St John's WortSt John's Wort will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Paliperidone dose may need to be increased when coadministered with strong inducers of both CYP3A4 and P-gpstiripentolstiripentol will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.stiripentol, paliperidone. 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.sufentanilsufentanil and paliperidone both increase sedation. Use Caution/Monitor.sulfamethoxazolesulfamethoxazole and paliperidone both increase QTc interval. Use Caution/Monitor.sumatriptansumatriptan, paliperidone. 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 intranasalsumatriptan intranasal, paliperidone. 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).tacrolimustacrolimus will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.tapentadoltapentadol and paliperidone both increase sedation. Use Caution/Monitor.telavancinpaliperidone and telavancin both increase QTc interval. Use Caution/Monitor.temazepamtemazepam and paliperidone both increase sedation. Use Caution/Monitor.terbutalinepaliperidone increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.tetrabenazinepaliperidone and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.thioridazinepaliperidone and thioridazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.thioridazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.paliperidone and thioridazine both increase sedation. Use Caution/Monitor.thiothixenepaliperidone and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.paliperidone and thiothixene both increase sedation. Use Caution/Monitor.tiotropiumtiotropium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tiotropium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.paliperidone increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tolazamidepaliperidone, 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.tolbutamidepaliperidone, 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.tolterodinetolterodine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.tolterodine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.paliperidone increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tolvaptantolvaptan will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.topiramatepaliperidone and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadoltramadol and paliperidone both increase sedation. Use Caution/Monitor.tranylcyprominetranylcypromine, paliperidone. 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).trazodonetrazodone will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.trazodone and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.paliperidone and trazodone both increase sedation. Use Caution/Monitor.triazolamtriazolam and paliperidone both increase sedation. Use Caution/Monitor.triclabendazoletriclabendazole and paliperidone both increase QTc interval. Use Caution/Monitor.triclofostriclofos and paliperidone both increase sedation. Use Caution/Monitor.trifluoperazinepaliperidone and trifluoperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.trifluoperazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.paliperidone and trifluoperazine both increase sedation. Use Caution/Monitor.trimethoprimpaliperidone and trimethoprim both increase QTc interval. Use Caution/Monitor.trimipraminetrimipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.paliperidone and trimipramine both increase sedation. Use Caution/Monitor.triprolidinetriprolidine and paliperidone both increase sedation. Use Caution/Monitor.tropisetronpaliperidone and tropisetron both increase QTc interval. Use Caution/Monitor.trospium chloridetrospium chloride decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.trospium chloride decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.paliperidone increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tucatinibtucatinib will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.valbenazinevalbenazine and paliperidone both increase QTc interval. Use Caution/Monitor.vecuroniumvecuronium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.vecuronium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.paliperidone increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.venlafaxinepaliperidone and venlafaxine both increase QTc interval. Use Caution/Monitor.venlafaxine, paliperidone. 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).verapamilverapamil will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.vilazodonevilazodone, paliperidone. 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).voclosporinvoclosporin, paliperidone. Either increases effects of the other by QTc interval. Use Caution/Monitor.voriconazolepaliperidone and voriconazole both increase QTc interval. Use Caution/Monitor.xylometazolinepaliperidone increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbinepaliperidone increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotidepaliperidone and ziconotide both increase sedation. Use Caution/Monitor.ziprasidonepaliperidone and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.paliperidone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.paliperidone and ziprasidone both increase sedation. Use Caution/Monitor.zolmitriptanzolmitriptan, paliperidone. 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).zotepinepaliperidone and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.paliperidone and zotepine both increase sedation. Use Caution/Monitor.Minor (8)azithromycinazithromycin and paliperidone both increase