enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.sufentanilMonitor Closely (1)sufentanil and thiothixene both increase sedation. Use Caution/Monitor.sufentanil SLSerious - Use Alternative (1)sufentanil SL, thiothixene. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. 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.sumatriptanMonitor Closely (1)sumatriptan, thiothixene. 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 intranasalMonitor Closely (1)sumatriptan intranasal, thiothixene. 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).tapentadolMonitor Closely (1)tapentadol and thiothixene both increase sedation. Use Caution/Monitor.teduglutideMonitor Closely (1)teduglutide increases levels of thiothixene by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.temazepamMonitor Closely (1)temazepam and thiothixene both increase sedation. Use Caution/Monitor.terbutalineMonitor Closely (1)thiothixene increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.teriflunomideMonitor Closely (1)teriflunomide decreases levels of thiothixene by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.tetrabenazineMonitor Closely (1)thiothixene and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)tetrabenazine and thiothixene both increase QTc interval. Avoid or Use Alternate Drug.thioridazineMonitor Closely (2)thioridazine and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. thioridazine and thiothixene both increase sedation. Use Caution/Monitor.tiotropiumMonitor Closely (3)tiotropium decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. tiotropium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor. thiothixene increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tolterodineMonitor Closely (3)tolterodine decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. tolterodine decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor. thiothixene increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.topiramateMonitor Closely (1)thiothixene and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolMonitor Closely (1)tramadol and thiothixene both increase sedation. Use Caution/Monitor.tranylcypromineMonitor Closely (1)tranylcypromine, thiothixene. 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).trazodoneMonitor Closely (1)thiothixene and trazodone both increase sedation. Use Caution/Monitor.triazolamMonitor Closely (1)triazolam and thiothixene both increase sedation. Use Caution/Monitor.triclofosMonitor Closely (1)triclofos and thiothixene both increase sedation. Use Caution/Monitor.trifluoperazineMonitor Closely (2)thiothixene and trifluoperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. thiothixene and trifluoperazine both increase sedation. Use Caution/Monitor.trihexyphenidylMonitor Closely (1)thiothixene increases effects of trihexyphenidyl by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive anticholinergic effects.trimipramineMonitor Closely (1)thiothixene and trimipramine both increase sedation. Use Caution/Monitor.triprolidineMonitor Closely (1)triprolidine and thiothixene both increase sedation. Use Caution/Monitor.trospium chlorideMonitor Closely (3)trospium chloride decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. trospium chloride decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor. thiothixene increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (1)thiothixene increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.vandetanibSerious - Use Alternative (1)thiothixene, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.vecuroniumMonitor Closely (3)vecuronium decreases levels of thiothixene by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. vecuronium decreases levels of thiothixene by pharmacodynamic antagonism. Use Caution/Monitor. thiothixene increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.vemurafenibSerious - Use Alternative (1)vemurafenib and thiothixene both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.venlafaxineMonitor Closely (1)venlafaxine, thiothixene. 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).vilanterol/fluticasone furoate inhaledSerious - Use Alternative (1)thiothixene increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.vilazodoneMonitor Closely (1)vilazodone, thiothixene. 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).voclosporinMonitor Closely (1)voclosporin, thiothixene. Either increases effects of the other by QTc interval. Use Caution/Monitor.xylometazolineMonitor Closely (1)thiothixene increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineMonitor Closely (1)thiothixene increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideMonitor Closely (1)thiothixene and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (2)thiothixene and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. thiothixene and ziprasidone both increase sedation. Use Caution/Monitor.zolmitriptanMonitor Closely (1)zolmitriptan, thiothixene. 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).zotepineMonitor Closely (2)thiothixene and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. thiothixene and zotepine both increase sedation. Use Caution/Monitor. Frequency Not Defined Constipation Decr sweating Drowsiness EPS ( muscle stiffness, dystonia, Parkinsonism, tardive dyskinesia, akathisia) (60%) Incr appetite Orthostatic hypotension Photosensitivity Wt gain Xerostomia Agitation Allergic dermatitis Allergic reactions Anorexia Anticholinergic effects Anxiety Cerebral edema Depression Dizziness Erectile dysfunction Euphoria Headache Ileus Insomnia Irregular menses Lens opacities (prolonged use) Poikilothermia Rash Restlessness Sedation Tachycardia Weakness Agranulocytosis, blood dyscrasias (rare) Galactorrhea (rare) Heat stroke (rare) NMS (infrequent but serious) Obstructive hyperbilirubinemia (rare) Cholestatic jaundice Confusion Decr gag reflex Gynecomastia Hyperpyrexia Peripheral edema Black Box Warnings Patients with dementia-related psychosis who are treated with antipsychotic drugs are at an increased risk of death as shown in short-term controlled trials. The deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. This drug is not approved for the treatment of patients with dementia-related psychosis.Contraindications Documented hypersensitivity Blood dyscrasias Coma Circulatory collapse CNS depression (including coma) Cautions Potential cross-sensitivity between thioxanthenes & phenothiazine derivative Not for use for dementia in elderly Antiemetic effect observed in animal studies; since this effect may also occur in man, it is possible that this drug may mask signs of overdosage of toxic drugs and may obscure conditions such as intestinal obstruction and brain tumor Consider known capability of this drug and certain other psychotropic drugs to precipitate convulsions, use extreme caution in patients with history of convulsive disorders or those in a state of alcohol withdrawal; it may lower convulsive threshold; although this drug potentiates the actions of the barbiturates, the dosage of the anticonvulsant therapy should not be reduced when this drug is administered concurrently Exhibits rather weak anticholinergic properties; use with caution in patients who might be exposed to extreme heat or who are receiving atropine or related drugs Use with caution in patients with cardiovascular disease Use caution and adjust dose when used in conjunction with other CNS depressants Carefully observe for pigmentary retinopathy and lenticular pigmentation (fine lenticular pigmentation has been noted in a small number of patients treated with this drug for prolonged periods); blood dyscrasias (agranulocytosis, pancytopenia, thrombocytopenic purpura), and liver damage (jaundice, biliary stasis) reported with related drugs Prolactin Therapy may elevate prolactin levels; the elevation persists during chronic administration; tissue culture experiments indicate that approximately one-third of human breast cancers are prolactin dependent in vitro, a factor of potential importance if prescription of this drug is contemplated in a patient with a previously detected breast cancer Although disturbances such as galactorrhea, amenorrhea, gynecomastia, and impotence reported, the clinical significance of elevated serum prolactin levels is unknown for most patients; an increase in mammary neoplasms has been found in rodents after chronic administration of antipsychotic drugs Neither clinical studies nor epidemiologic studies conducted to date, however, have shown association between chronic administration of these drugs and mammary tumorigenesis; the available evidence is considered too limited to be conclusive Leukopenia, neutropenia, and agranulocytosis In clinical trial and/or postmarketing experience, events of leukopenia/neutropenia and agranulocytosis reported temporally related to antipsychotic agents Possible risk factors for leukopenia/neutropenia include preexisting low white blood cell count (WBC) and history of drug-induced leukopenia/neutropenia Patients with a history of a clinically significant low WBC or drug-induced leukopenia/neutropenia should have their complete blood count (CBC) monitored frequently during the first few months of therapy and discontinuation of this drug should be considered at first sign of a clinically significant decline in WBC in absence of other causative factors Patients with clinically significant neutropenia should be carefully monitored for fever or other symptoms or signs of infection and treated promptly if such symptoms or signs occur; patients with severe neutropenia (absolute neutrophil count <1000/mm3) should discontinue therapy and have their WBC followed until recovery Tardive dyskinesia Tardive dyskinesia, a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements may develop; although prevalence of the syndrome appears to be highest among elderly, especially elderly women, it is impossible to rely upon prevalence estimates to predict, at inception of antipsychotic treatment, which patients are likely to develop the syndrome; whether antipsychotic drug products differ in their potential to cause tardive dyskinesia is unknown Both the risk of developing the syndrome and likelihood that it will become irreversible are believed to increase as the duration of treatment and total cumulative dose of antipsychotic drugs administered to patient increase; however, the syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses There is no known treatment for established cases of tardive dyskinesia, although the syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn; antipsychotic treatment, itself, however, may suppress (or partially suppress) the signs and symptoms of the syndrome and thereby may possibly mask the underlying disease process The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown; given these considerations, antipsychotics should be prescribed in a manner that is most likely to minimize the occurrence of tardive dyskinesia; chronic antipsychotic treatment should generally be reserved for patients who suffer from a chronic illness that, is known to respond to antipsychotic drugs, and, for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate In patients who do require chronic treatment, the smallest dose and shortest duration of treatment producing a satisfactory clinical response