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.Serious - Use Alternative (1)lasmiditan increases levels of paliperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.lefamulinSerious - Use Alternative (1)lefamulin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.lemborexantMonitor Closely (1)lemborexant, paliperidone. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.lenvatinibMonitor Closely (1)paliperidone and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.leuprolideContraindicated (1)leuprolide increases toxicity of paliperidone by QTc interval. Contraindicated. Increases risk of torsades de pointes.levalbuterolMonitor Closely (1)paliperidone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.levodopaSerious - Use Alternative (1)paliperidone decreases effects of levodopa by pharmacodynamic antagonism. Avoid or Use Alternate Drug.levodopa inhaledSerious - Use Alternative (1)paliperidone decreases effects of levodopa inhaled by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Atypical (2nd generation) antipsychotics inhibit dopamine D2 receptors in varying degrees (clozapine and quetiapine are lower risk). .levofloxacinMonitor Closely (1)levofloxacin and paliperidone both increase QTc interval. Use Caution/Monitor.levoketoconazoleMonitor Closely (2)levoketoconazole will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. levoketoconazole and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.levomilnacipranMonitor Closely (1)levomilnacipran, 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).levorphanolMonitor Closely (1)levorphanol and paliperidone both increase sedation. Use Caution/Monitor.linezolidMonitor Closely (1)linezolid, 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).liraglutideMonitor Closely (1)paliperidone, liraglutide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.lisdexamfetamineMonitor Closely (1)paliperidone increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.lisurideSerious - Use Alternative (1)paliperidone decreases effects of lisuride by pharmacodynamic antagonism. Contraindicated.lithiumMonitor Closely (1)lithium, 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).Serious - Use Alternative (1)lithium and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.lofepramineMonitor Closely (2)lofepramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. paliperidone and lofepramine both increase sedation. Use Caution/Monitor.lofexidineMonitor Closely (2)paliperidone and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended. paliperidone and lofexidine both increase sedation. Use Caution/Monitor.lomitapideMonitor Closely (1)lomitapide increases levels of paliperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.lonafarnibMonitor Closely (1)lonafarnib will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.loprazolamMonitor Closely (1)loprazolam and paliperidone both increase sedation. Use Caution/Monitor.loratadineMonitor Closely (1)loratadine will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.lorazepamMonitor Closely (1)lorazepam and paliperidone both increase sedation. Use Caution/Monitor.lorcaserinMonitor Closely (1)lorcaserin, 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).lormetazepamMonitor Closely (1)lormetazepam and paliperidone both increase sedation. Use Caution/Monitor.lovastatinMonitor Closely (1)lovastatin will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.loxapineMonitor Closely (2)loxapine and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. loxapine and paliperidone both increase sedation. Use Caution/Monitor.loxapine inhaledMonitor Closely (2)loxapine inhaled and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. loxapine inhaled and paliperidone both increase sedation. Use Caution/Monitor.lumefantrineMonitor Closely (1)lumefantrine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.lurasidoneMonitor Closely (1)lurasidone, paliperidone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.macimorelinSerious - Use Alternative (1)macimorelin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.maprotilineMonitor Closely (2)maprotiline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. paliperidone and maprotiline both increase sedation. Use Caution/Monitor.maravirocMonitor Closely (1)maraviroc, paliperidone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.marijuanaMonitor Closely (1)paliperidone and marijuana both increase sedation. Use Caution/Monitor.meclizineMonitor Closely (3)meclizine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. meclizine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of meclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.mefloquineSerious - Use Alternative (1)mefloquine increases toxicity of paliperidone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.melatoninMonitor Closely (1)paliperidone and melatonin both increase sedation. Use Caution/Monitor.meperidineMonitor Closely (2)meperidine, 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). meperidine and paliperidone both increase sedation. Use Caution/Monitor.meprobamateMonitor Closely (1)paliperidone and meprobamate both increase sedation. Use Caution/Monitor.metaproterenolMonitor Closely (1)paliperidone increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.metaxaloneMonitor Closely (1)metaxalone and paliperidone both increase sedation. Use Caution/Monitor.metforminMonitor Closely (1)paliperidone, metformin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.methadoneMonitor Closely (3)methadone, 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). methadone and paliperidone both increase QTc interval. Use Caution/Monitor. methadone and paliperidone both increase sedation. Use Caution/Monitor.methamphetamineMonitor Closely (1)paliperidone increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.methocarbamolMonitor Closely (1)methocarbamol and paliperidone both increase sedation. Use Caution/Monitor.methscopolamineMonitor Closely (3)methscopolamine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. methscopolamine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. paliperidone increases effects of methscopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.methyldopaSerious - Use Alternative (1)paliperidone decreases effects of methyldopa by pharmacodynamic antagonism. Contraindicated.methylenedioxymethamphetamineMonitor Closely (1)paliperidone increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.methylergonovineMonitor Closely (1)methylergonovine, 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).methylphenidateMonitor Closely (1)paliperidone 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.metoclopramideMonitor Closely (1)paliperidone and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.metoclopramide intranasalSerious - Use Alternative (2)paliperidone, 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. paliperidone 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.midazolamMonitor Closely (1)midazolam and paliperidone both increase sedation. Use Caution/Monitor.midazolam intranasalMonitor Closely (1)midazolam intranasal, paliperidone. Either increases toxicity 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)paliperidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.mifepristoneMonitor Closely (1)mifepristone, paliperidone. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.miglitolMonitor Closely (1)paliperidone, 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, 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).mirtazapineMonitor Closely (1)paliperidone and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.mobocertinibSerious - Use Alternative (1)mobocertinib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.modafinilMonitor Closely (1)paliperidone increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.morphineMonitor Closely (1)morphine and paliperidone both increase sedation. Use Caution/Monitor.motherwortMonitor Closely (1)paliperidone and motherwort both increase sedation. Use Caution/Monitor.moxifloxacinMonitor Closely (1)moxifloxacin and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.moxonidineMonitor Closely (1)paliperidone and moxonidine both increase sedation. Use Caution/Monitor.nabiloneMonitor Closely (1)paliperidone and nabilone both increase sedation. Use Caution/Monitor.nalbuphineMonitor Closely (1)nalbuphine and paliperidone both increase sedation. Use Caution/Monitor.naldemedineMonitor Closely (1)paliperidone increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.naratriptanMonitor Closely (1)naratriptan, 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).nateglinideMonitor Closely (1)paliperidone, 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.nefazodoneMinor (1)nefazodone will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.nicardipineMonitor Closely (1)nicardipine will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.nifedipineMonitor Closely (1)nifedipine will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.nilotinibMonitor Closely (2)nilotinib will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. nilotinib and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.nintedanibMonitor Closely (1)paliperidone increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy.norepinephrineMonitor Closely (1)paliperidone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use