risk of agranulocytosis.methocarbamolMonitor Closely (1)methocarbamol and clozapine both increase sedation. Use Caution/Monitor.methscopolamineMonitor Closely (3)methscopolamine decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. methscopolamine decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor. clozapine increases effects of methscopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.methyldopaSerious - Use Alternative (1)clozapine decreases effects of methyldopa by pharmacodynamic antagonism. Contraindicated.methylenedioxymethamphetamineMonitor Closely (1)clozapine increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.methylergonovineMonitor Closely (1)methylergonovine, clozapine. 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).methylphenidateMonitor Closely (1)clozapine increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.methylprednisoloneMonitor Closely (1)methylprednisolone will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.metoclopramideMonitor Closely (1)clozapine and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.metoclopramide intranasalSerious - Use Alternative (2)clozapine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient. clozapine increases toxicity of metoclopramide intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive effects, including increased frequency and severity of tardive dyskinesia, other extrapyramidal symptoms, and neuroleptic malignant syndrome.metronidazoleMonitor Closely (1)metronidazole will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.mexiletineMonitor Closely (1)mexiletine will increase the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.miconazole vaginalMonitor Closely (1)miconazole vaginal will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.midazolamMonitor Closely (1)midazolam and clozapine both increase sedation. Use Caution/Monitor.midazolam intranasalMonitor Closely (1)midazolam intranasal, clozapine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.midodrineMonitor Closely (1)clozapine increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.midostaurinSerious - Use Alternative (1)clozapine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.mifepristoneMonitor Closely (1)mifepristone, clozapine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.miglitolMonitor Closely (1)clozapine, miglitol. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.milnacipranMonitor Closely (1)milnacipran, clozapine. 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).mirtazapineMonitor Closely (2)clozapine and mirtazapine both increase QTc interval. Use Caution/Monitor. clozapine and mirtazapine both increase sedation. Use Caution/Monitor.mobocertinibSerious - Use Alternative (1)mobocertinib and clozapine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.modafinilMonitor Closely (2)modafinil will decrease the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. clozapine increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.morphineMonitor Closely (1)morphine and clozapine both increase sedation. Use Caution/Monitor.motherwortMonitor Closely (1)clozapine and motherwort both increase sedation. Use Caution/Monitor.moxifloxacinSerious - Use Alternative (1)clozapine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.moxonidineMonitor Closely (1)clozapine and moxonidine both increase sedation. Use Caution/Monitor.nabiloneMonitor Closely (1)clozapine and nabilone both increase sedation. Use Caution/Monitor.nalbuphineMonitor Closely (1)nalbuphine and clozapine both increase sedation. Use Caution/Monitor.naratriptanMonitor Closely (1)naratriptan, clozapine. 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).nateglinideMonitor Closely (1)clozapine, nateglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.nefazodoneMonitor Closely (1)nefazodone will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nelfinavirMonitor Closely (1)nelfinavir will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nevirapineMonitor Closely (1)nevirapine will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nifedipineMonitor Closely (1)nifedipine will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nilotinibMonitor Closely (2)nilotinib will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. clozapine and nilotinib both increase QTc interval. Use Caution/Monitor.nirmatrelvirContraindicated (1)nirmatrelvir will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.nirmatrelvir/ritonavirContraindicated (1)nirmatrelvir/ritonavir will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.norepinephrineMonitor Closely (1)clozapine increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptylineMonitor Closely (2)clozapine and nortriptyline both increase QTc interval. Use Caution/Monitor. clozapine and nortriptyline both increase sedation. Use Caution/Monitor.octreotideMonitor Closely (1)clozapine and octreotide both increase QTc interval. Use Caution/Monitor.ofloxacinMonitor Closely (1)clozapine and ofloxacin both increase QTc interval. Use Caution/Monitor.olanzapineMonitor Closely (2)clozapine and olanzapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. clozapine and olanzapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clozapine and olanzapine both increase QTc interval. Avoid or Use Alternate Drug. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instancesoliceridineMonitor Closely (2)clozapine will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal. oliceridine, clozapine. 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)clozapine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor.olopatadine intranasalSerious - Use Alternative (1)clozapine 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. omeprazoleMonitor Closely (1)omeprazole will decrease the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.onabotulinumtoxinAMonitor Closely (3)onabotulinumtoxinA decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. onabotulinumtoxinA decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor. clozapine increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.ondansetronSerious - Use Alternative (1)clozapine 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 clozapine both increase sedation. Use Caution/Monitor.orphenadrineMonitor Closely (1)orphenadrine and clozapine both increase sedation. Use Caution/Monitor.osilodrostatMonitor Closely (1)osilodrostat and clozapine both increase QTc interval. Use Caution/Monitor.osimertinibMonitor Closely (1)osimertinib and clozapine both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.oxaliplatinMonitor Closely (2)oxaliplatin and clozapine both increase immunosuppressive effects; risk of infection. Use Caution/Monitor. Use of oxaliplatin with concomitant immunosuppressants or with impaired immune systems may increased risk for serious infections. oxaliplatin will increase the level or effect of clozapine by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.Serious - Use Alternative (1)clozapine and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.oxazepamMonitor Closely (1)oxazepam and clozapine both increase sedation. Use Caution/Monitor.oxcarbazepineMonitor Closely (1)oxcarbazepine will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.oxybutyninMonitor Closely (3)oxybutynin decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. oxybutynin decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor. clozapine increases effects of oxybutynin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.oxybutynin topicalMonitor Closely (3)oxybutynin topical decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. oxybutynin topical decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor. clozapine 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 clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. oxybutynin transdermal decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor. clozapine increases effects of oxybutynin transdermal by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.oxycodoneMonitor Closely (1)oxycodone and clozapine both increase sedation. Use Caution/Monitor.oxymorphoneMonitor Closely (1)oxymorphone and clozapine both increase sedation. Use Caution/Monitor.ozanimodMonitor Closely (1)ozanimod and clozapine 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.paliperidoneMonitor Closely (2)clozapine and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. clozapine and paliperidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clozapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.pancuroniumMonitor Closely (3)pancuronium decreases levels of clozapine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. pancuronium decreases levels of clozapine by pharmacodynamic antagonism. Use Caution/Monitor. clozapine increases effects of pancuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.panobinostatSerious - Use Alternative (1)clozapine 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 clozapine both increase sedation. Use Caution/Monitor.papaverineMonitor Closely (1)clozapine and papaverine both increase sedation. Use Caution/Monitor.paroxetineMonitor Closely (2)paroxetine increases levels of clozapine by decreasing metabolism. Use Caution/Monitor. Plasma levels of clozapine may be increased, resulting in increased pharmacologic and toxic effects. Adjust clozapine dose as needed when initiating or discontinuing certain SSRIs. . paroxetine, clozapine. 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).pasireotideMonitor Closely (1)clozapine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.pazopanibSerious - Use Alternative (1)clozapine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.pefloxacinSerious - Use Alternative (1)pefloxacin will increase the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.peginterferon alfa 2aMonitor Closely (1)peginterferon alfa 2a will increase the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.pentamidineSerious - Use Alternative (1)clozapine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.pentazocineMonitor Closely (1)pentazocine and clozapine both increase sedation. Use Caution/Monitor.pentobarbitalMonitor Closely (3)pentobarbital will decrease the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. pentobarbital will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme