substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.zolmitriptanzolmitriptan, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.Monitor Closely (107)abciximababciximab, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.alteplasealteplase, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.anagrelideanagrelide, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.antithrombin IIIvortioxetine and antithrombin III both increase anticoagulation. Use Caution/Monitor.apixabanvortioxetine and apixaban both increase anticoagulation. Use Caution/Monitor.argatrobanvortioxetine and argatroban both increase anticoagulation. Use Caution/Monitor.aspirinaspirin, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Risk minimal with low-dose aspirin.aspirin rectalaspirin rectal, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Risk minimal with low-dose aspirin.betrixabanvortioxetine, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.bivalirudinvortioxetine and bivalirudin both increase anticoagulation. Use Caution/Monitor.bosentanbosentan decreases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.bosentan will decrease the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.carbamazepinecarbamazepine decreases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.celecoxibcelecoxib, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.choline magnesium trisalicylatecholine magnesium trisalicylate, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.cilostazolcilostazol, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.cinacalcetcinacalcet increases levels of vortioxetine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Decrease vortioxetine dose by 50% when coadministered with strong CYP2D6 inhibitors.clonidineclonidine, vortioxetine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.clopidogrelclopidogrel, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.dabrafenibdabrafenib decreases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.dabrafenib will decrease the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.daridorexantvortioxetine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. darunavirdarunavir will increase the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.desirudindesirudin, vortioxetine. Either increases effects of the other by serotonin levels. Use Caution/Monitor.dexamethasonedexamethasone decreases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.diazepam intranasaldiazepam intranasal, vortioxetine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.diclofenacdiclofenac, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.difelikefalindifelikefalin and vortioxetine both increase sedation. Use Caution/Monitor.diflunisaldiflunisal, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.dipyridamoledipyridamole increases effects of vortioxetine by anticoagulation. Use Caution/Monitor.efavirenzefavirenz decreases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.elagolixelagolix decreases levels of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.eliglustateliglustat increases levels of vortioxetine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.encorafenibencorafenib, vortioxetine. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.enoxaparinvortioxetine and enoxaparin both increase anticoagulation. Use Caution/Monitor.enzalutamideenzalutamide decreases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.eptifibatideeptifibatide increases effects of vortioxetine by anticoagulation. Use Caution/Monitor.eslicarbazepine acetateeslicarbazepine acetate increases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.etodolacetodolac, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.etravirineetravirine decreases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.etravirine will decrease the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.fedratinibfedratinib will increase the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.fedratinib will increase the level or effect of vortioxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.fenfluraminefenfluramine, vortioxetine. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration with drugs that increase serotoninergic effects may increase the risk of serotonin syndrome.fenoprofenfenoprofen, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.fish oilfish oil, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.fish oil triglyceridesfish oil triglycerides will increase the level or effect of vortioxetine by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.flurbiprofenflurbiprofen, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.fondaparinuxvortioxetine and fondaparinux both increase anticoagulation. Use Caution/Monitor.fosphenytoinfosphenytoin decreases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.gabapentingabapentin, vortioxetine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.gabapentin enacarbilgabapentin enacarbil, vortioxetine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.ganaxolonevortioxetine and ganaxolone both increase sedation. Use Caution/Monitor.garlicgarlic, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.heparinvortioxetine and heparin both increase anticoagulation. Use Caution/Monitor.ibrutinibibrutinib will increase the level or effect of vortioxetine by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding. ibuprofenibuprofen, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.ibuprofen IVibuprofen IV, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.indinavirindinavir will increase the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.indomethacinindomethacin, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.istradefyllineistradefylline will increase the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.ketoprofenketoprofen, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.ketorolacketorolac, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.ketorolac intranasalketorolac intranasal, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.lasmiditanlasmiditan, vortioxetine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.lenacapavirlenacapavir will increase the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.lorlatiniblorlatinib will decrease the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.meclofenamatemeclofenamate, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.mefenamic acidmefenamic acid, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.meloxicammeloxicam, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.metforminvortioxetine increases effects of metformin by pharmacodynamic synergism. Use Caution/Monitor.mifepristonemifepristone will increase the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.mitotanemitotane decreases levels of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.nabumetonenabumetone, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.nafcillinnafcillin decreases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.nafcillin will decrease the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.naproxennaproxen, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.nevirapinenevirapine decreases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.omega 3 carboxylic acidsomega 3 carboxylic acids, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.omega 3 fatty acidsomega 3 fatty acids, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.oxaprozinoxaprozin, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.oxcarbazepineoxcarbazepine increases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.pentobarbitalpentobarbital increases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.pentosan polysulfate sodiumpentosan polysulfate sodium, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.phenobarbitalphenobarbital increases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.phenytoinphenytoin increases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.piroxicampiroxicam, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.prasugrelprasugrel increases effects of vortioxetine by anticoagulation. Use Caution/Monitor.pregabalinpregabalin, vortioxetine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.primidoneprimidone increases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.protein C concentrateprotein C concentrate, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.remimazolamremimazolam, vortioxetine. 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.reteplasereteplase, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.rifabutinrifabutin decreases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.rifabutin will decrease the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifampinrifampin decreases levels of vortioxetine by increasing metabolism. Modify Therapy/Monitor Closely. Consider increasing the vortioxetine dose when coadministered with strong CYP inducers for >14 days; not to exceed 3 times original vortioxetine dose.rifampin will decrease the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider increasing vortioxetine dose when coadministered with a strong CYP inducer for >14 days. Do not exceed 3x the original dose. Reduce vortioxetine dose to original level within 14 days, when