QTc interval. Minor/Significance Unknown.brimonidinebrimonidine increases effects of paliperidone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.chasteberrychasteberry decreases effects of paliperidone by pharmacodynamic antagonism. Minor/Significance Unknown. (Theoretical interaction).ethanolethanol, paliperidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.eucalyptuspaliperidone and eucalyptus both increase sedation. Minor/Significance Unknown.nefazodonenefazodone will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.pazopanibpaliperidone and pazopanib both increase QTc interval. Minor/Significance Unknown.sagepaliperidone and sage both increase sedation. Minor/Significance Unknown.abobotulinumtoxinAMonitor Closely (1)abobotulinumtoxinA increases effects of paliperidone by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.acarboseMonitor Closely (1)paliperidone, 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.aclidiniumMonitor Closely (2)aclidinium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.acrivastineMonitor Closely (1)acrivastine and paliperidone both increase sedation. Use Caution/Monitor.adagrasibSerious - Use Alternative (1)adagrasib, paliperidone. Either decreases toxicity 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.afatinibSerious - Use Alternative (1)paliperidone increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.albiglutideMonitor Closely (1)paliperidone, 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 (2)paliperidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. albuterol and paliperidone both increase QTc interval. Use Caution/Monitor.alfentanilMonitor Closely (1)alfentanil and paliperidone both increase sedation. Use Caution/Monitor.alfuzosinMonitor Closely (1)paliperidone and alfuzosin both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)alfuzosin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.almotriptanMonitor Closely (1)almotriptan, 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).alprazolamMonitor Closely (1)alprazolam and paliperidone both increase sedation. Use Caution/Monitor.amifostineMonitor Closely (1)amifostine, paliperidone. 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.amiodaroneMonitor Closely (1)amiodarone will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)amiodarone and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.amisulprideContraindicated (1)amisulpride, paliperidone. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndrome.Serious - Use Alternative (1)amisulpride and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.amitriptylineMonitor Closely (2)amitriptyline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. paliperidone and amitriptyline both increase sedation. Use Caution/Monitor.amobarbitalMonitor Closely (1)amobarbital and paliperidone both increase sedation. Use Caution/Monitor.amoxapineMonitor Closely (3)paliperidone and amoxapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. amoxapine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. paliperidone and amoxapine both increase sedation. Use Caution/Monitor.anagrelideSerious - Use Alternative (1)anagrelide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.anticholinergic/sedative combosMonitor Closely (3)anticholinergic/sedative combos decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. anticholinergic/sedative combos decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of anticholinergic/sedative combos by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.apomorphineMonitor Closely (1)paliperidone and apomorphine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (2)paliperidone decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug. apomorphine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.arformoterolMonitor Closely (2)paliperidone increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. arformoterol and paliperidone both increase QTc interval. Use Caution/Monitor.aripiprazoleMonitor Closely (2)aripiprazole and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. aripiprazole and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)aripiprazole and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.armodafinilMonitor Closely (1)paliperidone increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.arsenic trioxideSerious - Use Alternative (1)arsenic trioxide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.artemetherSerious - Use Alternative (1)artemether and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.artemether/lumefantrineMonitor Closely (1)artemether/lumefantrine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.asenapineMonitor Closely (1)asenapine and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)asenapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.asenapine transdermalMonitor Closely (1)asenapine transdermal and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)asenapine transdermal and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.atomoxetineSerious - Use Alternative (1)atomoxetine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.atorvastatinMonitor Closely (1)atorvastatin will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.atracuriumMonitor Closely (3)atracurium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. atracurium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.atropineMonitor Closely (3)atropine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. atropine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of atropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.atropine IV/IMMonitor Closely (3)paliperidone increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. atropine IV/IM decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. atropine IV/IM decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.avapritinibMonitor Closely (1)avapritinib and paliperidone both increase sedation. Use Caution/Monitor.azelastineMonitor Closely (1)azelastine and paliperidone both increase sedation. Use Caution/Monitor.azithromycinMinor (1)azithromycin and paliperidone both increase QTc interval. Minor/Significance Unknown.baclofenMonitor Closely (1)baclofen and paliperidone both increase sedation. Use Caution/Monitor.bedaquilineMonitor Closely (1)paliperidone and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closelybelladonna alkaloidsMonitor Closely (3)belladonna alkaloids decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. belladonna alkaloids decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of belladonna alkaloids by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.belladonna and opiumMonitor Closely (4)belladonna and opium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. belladonna and opium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. belladonna and opium and paliperidone both increase sedation. Use Caution/Monitor.benazeprilMonitor Closely (2)paliperidone increases toxicity of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension. benazepril increases toxicity of paliperidone by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.benperidolMonitor Closely (2)benperidol and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. benperidol and paliperidone both increase sedation. Use Caution/Monitor.benzhydrocodone/acetaminophenMonitor Closely (1)benzhydrocodone/acetaminophen and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)benzhydrocodone/acetaminophen, paliperidone. 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.benzphetamineMonitor Closely (1)paliperidone increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.berotralstatMonitor Closely (1)berotralstat will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.betrixabanMonitor Closely (1)paliperidone increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.bosutinibMonitor Closely (1)bosutinib increases levels of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.brexanoloneMonitor Closely (1)brexanolone, paliperidone. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazoleMonitor Closely (1)brexpiprazole and paliperidone both increase sedation. Use Caution/Monitor.brimonidineMonitor Closely (1)brimonidine and paliperidone both increase sedation. Use Caution/Monitor.Minor (1)brimonidine increases effects of paliperidone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.brivaracetamMonitor Closely (1)brivaracetam and paliperidone both increase sedation. Use Caution/Monitor.bromocriptineSerious - Use Alternative (1)paliperidone decreases effects of bromocriptine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.brompheniramineMonitor Closely (1)brompheniramine and paliperidone both increase sedation. Use Caution/Monitor.buprenorphineMonitor Closely (1)buprenorphine and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine buccalMonitor Closely (1)buprenorphine buccal and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine buccal and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implantMonitor Closely (1)buprenorphine subdermal implant and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine subdermal implant and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine transdermalMonitor Closely (1)buprenorphine transdermal and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine transdermal and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine, long-acting injectionMonitor Closely (2)paliperidone 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. buprenorphine, long-acting injection and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine, long-acting injection and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.butabarbitalMonitor Closely (1)butabarbital and paliperidone both increase sedation. Use Caution/Monitor.butalbitalMonitor Closely (1)butalbital and paliperidone both increase sedation. Use Caution/Monitor.butorphanolMonitor Closely (1)butorphanol and paliperidone both increase sedation. Use Caution/Monitor.cabergolineSerious - Use Alternative (1)paliperidone decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.caffeineMonitor Closely (1)paliperidone increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.calcium/magnesium/potassium/sodium oxybatesSerious - Use Alternative (1)paliperidone, calcium/magnesium/potassium/sodium oxybates. Either increases effects 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.captoprilMonitor Closely (1)paliperidone, captopril. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.carbamazepineMonitor Closely (1)carbamazepine 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-gpcarbinoxamineMonitor Closely (1)carbinoxamine and paliperidone both increase sedation. Use Caution/Monitor.carisoprodolMonitor Closely (1)carisoprodol and paliperidone both increase sedation. Use Caution/Monitor.cenobamateMonitor Closely (1)cenobamate, paliperidone. Either increases effects of the other by sedation. Use Caution/Monitor.ceritinibMonitor Closely (1)paliperidone increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)ceritinib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.chasteberryMinor (1)chasteberry decreases effects of paliperidone by pharmacodynamic antagonism. Minor/Significance Unknown. (Theoretical interaction).chloral hydrateMonitor Closely (1)chloral hydrate and paliperidone both increase sedation. Use Caution/Monitor.chlordiazepoxideMonitor Closely (1)chlordiazepoxide and paliperidone both increase sedation. Use Caution/Monitor.chloroquineMonitor Closely (1)chloroquine increases toxicity of paliperidone by QTc interval. Use Caution/Monitor.chlorpheniramineMonitor Closely (1)chlorpheniramine and paliperidone both increase sedation. Use Caution/Monitor.chlorpromazineMonitor Closely (3)chlorpromazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. chlorpromazine and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. chlorpromazine and paliperidone both increase sedation. Use Caution/Monitor.chlorpropamideMonitor Closely (1)paliperidone, chlorpropamide. Other (see comment).