caution. Use Caution/Monitor.nortriptylineMonitor Closely (2)nortriptyline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. paliperidone and nortriptyline both increase sedation. Use Caution/Monitor.octreotideMonitor Closely (1)octreotide and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.octreotide (Antidote)Monitor Closely (1)octreotide (Antidote) and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.ofloxacinMonitor Closely (1)ofloxacin and paliperidone both increase QTc interval. Use Caution/Monitor.olanzapineMonitor Closely (2)olanzapine and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. olanzapine and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)olanzapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.oliceridineMonitor Closely (1)oliceridine, paliperidone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. 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.olodaterol inhaledMonitor Closely (1)paliperidone and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmiasolopatadine intranasalSerious - Use Alternative (1)paliperidone 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. onabotulinumtoxinAMonitor Closely (3)onabotulinumtoxinA decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. onabotulinumtoxinA decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.ondansetronSerious - Use Alternative (1)paliperidone and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.opium tinctureMonitor Closely (1)opium tincture and paliperidone both increase sedation. Use Caution/Monitor.orphenadrineMonitor Closely (1)orphenadrine and paliperidone both increase sedation. Use Caution/Monitor.osilodrostatMonitor Closely (1)osilodrostat and paliperidone both increase QTc interval. Use Caution/Monitor.osimertinibMonitor Closely (1)osimertinib and paliperidone both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.oxaliplatinSerious - Use Alternative (2)oxaliplatin will increase the level or effect of paliperidone by Other (see comment). Avoid or Use Alternate Drug. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval. oxaliplatin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.oxazepamMonitor Closely (1)oxazepam and paliperidone both increase sedation. Use Caution/Monitor.oxybutyninMonitor Closely (3)oxybutynin decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. oxybutynin decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of oxybutynin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.oxybutynin topicalMonitor Closely (3)oxybutynin topical decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. oxybutynin topical decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of oxybutynin topical by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.oxybutynin transdermalMonitor Closely (3)oxybutynin transdermal decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. oxybutynin transdermal decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of oxybutynin transdermal by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.oxycodoneMonitor Closely (1)oxycodone and paliperidone both increase sedation. Use Caution/Monitor.oxymorphoneMonitor Closely (1)oxymorphone and paliperidone both increase sedation. Use Caution/Monitor.ozanimodMonitor Closely (1)ozanimod and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.pancuroniumMonitor Closely (3)pancuronium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. pancuronium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of pancuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.panobinostatSerious - Use Alternative (1)paliperidone and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.papaveretumMonitor Closely (1)papaveretum and paliperidone both increase sedation. Use Caution/Monitor.papaverineMonitor Closely (1)paliperidone and papaverine both increase sedation. Use Caution/Monitor.paroxetineMonitor Closely (2)paroxetine, 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). paliperidone and paroxetine both increase QTc interval. Use Caution/Monitor.pasireotideMonitor Closely (1)paliperidone and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.pazopanibMinor (1)paliperidone and pazopanib both increase QTc interval. Minor/Significance Unknown.pentamidineSerious - Use Alternative (1)paliperidone and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.pentazocineMonitor Closely (1)pentazocine and paliperidone both increase sedation. Use Caution/Monitor.pentobarbitalMonitor Closely (1)pentobarbital and paliperidone both increase sedation. Use Caution/Monitor.perphenazineMonitor Closely (3)perphenazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. paliperidone and perphenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. paliperidone and perphenazine both increase sedation. Use Caution/Monitor.phendimetrazineMonitor Closely (1)paliperidone increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenelzineMonitor Closely (1)phenelzine, 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).phenobarbitalMonitor Closely (2)phenobarbital will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. phenobarbital and paliperidone both increase sedation. Use Caution/Monitor.phentermineMonitor Closely (1)paliperidone increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrineMonitor Closely (1)paliperidone increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrine POMonitor Closely (1)paliperidone increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .phenytoinMonitor Closely (1)phenytoin will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.pholcodineMonitor Closely (1)paliperidone and pholcodine both increase sedation. Use Caution/Monitor.pimavanserinSerious - Use Alternative (1)paliperidone and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.pimozideMonitor Closely (2)paliperidone and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. paliperidone and pimozide both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)paliperidone and pimozide both increase QTc interval. Avoid or Use Alternate Drug.pioglitazoneMonitor Closely (1)paliperidone, pioglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.pirbuterolMonitor Closely (1)paliperidone increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.pitolisantSerious - Use Alternative (1)paliperidone and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.pomalidomideSerious - Use Alternative (1)paliperidone increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.posaconazoleMonitor Closely (1)paliperidone and posaconazole both increase QTc interval. Use Caution/Monitor.pralidoximeMonitor Closely (3)pralidoxime decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. pralidoxime decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.pramipexoleSerious - Use Alternative (1)paliperidone decreases effects of pramipexole by pharmacodynamic antagonism. Contraindicated.pramlintideMonitor Closely (1)paliperidone, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.primaquineSerious - Use Alternative (1)primaquine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.primidoneMonitor Closely (1)primidone and paliperidone both increase sedation. Use Caution/Monitor.procainamideSerious - Use Alternative (1)paliperidone and procainamide both increase QTc interval. Avoid or Use Alternate Drug.procarbazineMonitor Closely (1)procarbazine, 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).prochlorperazineMonitor Closely (3)prochlorperazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. paliperidone and prochlorperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. paliperidone and prochlorperazine both increase sedation. Use Caution/Monitor.promazineMonitor Closely (1)promazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.promethazineMonitor Closely (4)promethazine, 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). promethazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. paliperidone and promethazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. promethazine and paliperidone both increase sedation. Use Caution/Monitor.propanthelineMonitor Closely (3)propantheline decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. propantheline decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of propantheline by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.propofolMonitor Closely (1)propofol and paliperidone both increase sedation. Use Caution/Monitor.propylhexedrineMonitor Closely (1)paliperidone increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protriptylineMonitor Closely (2)protriptyline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. paliperidone and protriptyline both increase sedation. Use Caution/Monitor.quazepamMonitor Closely (1)quazepam and paliperidone both increase sedation. Use Caution/Monitor.quercetinMonitor Closely (1)quercetin will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.quetiapineMonitor Closely (3)paliperidone 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.quinidineSerious - Use Alternative (2)quinidine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. quinidine will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.quinineMonitor Closely (1)paliperidone and quinine both increase QTc interval. Use Caution/Monitor.ramelteonMonitor Closely (1)paliperidone and ramelteon both increase sedation. Use Caution/Monitor.ranolazineMonitor Closely (2)ranolazine 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.rapacuroniumMonitor Closely (3)rapacuronium 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.remimazolamMonitor Closely (1)remimazolam, 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.repaglinideMonitor Closely (1)paliperidone, 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.ribociclibSerious - Use Alternative (1)ribociclib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.rifampinMonitor Closely (1)rifampin 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-gprifaximinMonitor Closely (1)paliperidone increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.rilpivirineMonitor Closely (1)rilpivirine 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.riociguatSerious - Use Alternative (1)paliperidone will increase the level or effect of riociguat by decreasing metabolism. Avoid