impairment. ondansetronasenapine 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.oxaliplatinoxaliplatin and asenapine both increase QTc interval. Avoid or Use Alternate Drug.oxycodoneasenapine and oxycodone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateoxymorphoneasenapine and oxymorphone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatepaliperidoneasenapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.panobinostatasenapine 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.paroxetineasenapine and paroxetine both increase QTc interval. Avoid or Use Alternate Drug.pazopanibasenapine and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.pentamidineasenapine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.pimavanserinpimavanserin and asenapine both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.pimozideasenapine and pimozide both increase QTc interval. Contraindicated.pitolisantasenapine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.ponesimodasenapine and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.primaquineprimaquine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.procainamideasenapine and procainamide both increase QTc interval. Avoid or Use Alternate Drug.promethazineasenapine and promethazine both decrease QTc interval. Avoid or Use Alternate Drug.propafenoneasenapine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.quinidineasenapine and quinidine both increase QTc interval. Avoid or Use Alternate Drug.ranolazineasenapine and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.remifentanilasenapine and remifentanil both increase sedation. Avoid or Use Alternate Drug.ribociclibribociclib and asenapine both increase QTc interval. Avoid or Use Alternate Drug.risperidoneasenapine and risperidone both increase QTc interval. Avoid or Use Alternate Drug.romidepsinasenapine and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.safinamideasenapine decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.saquinavirsaquinavir, asenapine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of QT prolongation and cardiac arrhythmias.asenapine and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.selinexorselinexor, asenapine. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.sertralinesertraline and asenapine both increase QTc interval. Avoid or Use Alternate Drug.sevofluranesevoflurane and asenapine both increase QTc interval. Avoid or Use Alternate Drug.sildenafilsildenafil increases effects of asenapine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypotension; separate sildenafil >25mg from alpha blocker by 4hr.siponimodsiponimod and asenapine both increase QTc interval. Avoid or Use Alternate Drug.solifenacinsolifenacin and asenapine both increase QTc interval. Avoid or Use Alternate Drug.sotalolasenapine and sotalol both increase QTc interval. Avoid or Use Alternate Drug.sufentanil SLsufentanil SL, asenapine. 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.sunitinibsunitinib and asenapine both increase QTc interval. Avoid or Use Alternate Drug.asenapine and sunitinib both increase QTc interval. Avoid or Use Alternate Drug.tacrolimustacrolimus and asenapine both increase QTc interval. Avoid or Use Alternate Drug.asenapine and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.telavancinasenapine and telavancin both increase QTc interval. Avoid or Use Alternate Drug.tetrabenazineasenapine and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.thioridazineasenapine will increase the level or effect of thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.thiothixeneasenapine and thiothixene both increase QTc interval. Avoid or Use Alternate Drug.toremifeneasenapine and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.trazodoneasenapine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.triptorelinasenapine and triptorelin both increase QTc interval. Avoid or Use Alternate Drug.umeclidinium bromide/vilanterol inhaledasenapine 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.vandetanibasenapine, 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.vardenafilasenapine and vardenafil both increase QTc interval. Avoid or Use Alternate Drug.vemurafenibvemurafenib and asenapine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.venlafaxineasenapine and venlafaxine both decrease QTc interval. Avoid or Use Alternate Drug.vilanterol/fluticasone furoate inhaledasenapine 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.voriconazoleasenapine and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.vorinostatasenapine and vorinostat both increase QTc interval. Avoid or Use Alternate Drug.vorinostat and asenapine both increase QTc interval. Avoid or Use Alternate Drug.yohimbeyohimbe increases effects of asenapine by pharmacodynamic synergism. Contraindicated.ziprasidoneasenapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.Monitor Closely (353)acarboseasenapine, 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.acebutololasenapine and acebutolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.aceclofenacaceclofenac decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.acemetacinacemetacin decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.acetaminophen/phenyltoloxamineasenapine and acetaminophen/phenyltoloxamine both increase sedation. Use Caution/Monitor.acrivastineacrivastine and asenapine both increase sedation. Use Caution/Monitor.albiglutideasenapine, 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.albuterolalbuterol and asenapine both increase QTc interval. Use Caution/Monitor.aldesleukinaldesleukin increases effects of asenapine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.alfuzosinalfuzosin and asenapine both increase anti-hypertensive channel blocking. Use Caution/Monitor.almotriptanalmotriptan, asenapine. 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).alprazolamasenapine and alprazolam both increase sedation. Use Caution/Monitor.amifostineamifostine, asenapine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.amifostine, asenapine. 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.amisulprideamisulpride and asenapine both increase sedation. Use Caution/Monitor.amitriptylineasenapine and amitriptyline both increase QTc interval. Use Caution/Monitor.asenapine and amitriptyline both increase sedation. Use Caution/Monitor.amlodipineasenapine and amlodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.amobarbitalasenapine and amobarbital both increase sedation. Use Caution/Monitor.amoxapineasenapine and amoxapine both increase QTc interval. Use Caution/Monitor.asenapine and amoxapine both increase sedation. Use Caution/Monitor.arformoterolarformoterol and asenapine both increase QTc interval. Use Caution/Monitor.aripiprazoleasenapine and aripiprazole both increase sedation. Use Caution/Monitor.asenapine transdermalasenapine and asenapine transdermal both increase sedation. Use Caution/Monitor.aspirinaspirin decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.aspirin rectalaspirin rectal decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.aspirin/citric acid/sodium bicarbonateaspirin/citric acid/sodium bicarbonate decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.atenololasenapine and atenolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.atomoxetineasenapine will increase the level or effect of atomoxetine by Other (see comment). Use Caution/Monitor. Potential for enhanced CNS depression. Monitor closely during conurrent use.avanafilavanafil increases effects of asenapine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.avapritinibasenapine and avapritinib both increase sedation. Use Caution/Monitor.azithromycinazithromycin increases toxicity of asenapine by QTc interval. Use Caution/Monitor.baclofenasenapine and baclofen both increase sedation. Use Caution/Monitor.bedaquilineasenapine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closelybenazeprilbenazepril increases effects of asenapine by pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.benzhydrocodone/acetaminophenasenapine will increase the level or effect of benzhydrocodone/acetaminophen by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone [benzhydrocodone is prodrug of hydrocodone]) is mainly formed by CYP2D6 mediated O-demethylation of hydrocodone. Hydromorphone may contribute to the total analgesic effect of hydrocodone.betaxololasenapine and betaxolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.bisoprololasenapine and bisoprolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.brexanolonebrexanolone, asenapine. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazoleasenapine and brexpiprazole both increase sedation. Use Caution/Monitor.brimonidineasenapine and brimonidine both increase sedation. Use Caution/Monitor.brivaracetamasenapine and brivaracetam both increase sedation. Use Caution/Monitor.brompheniramineasenapine and brompheniramine both increase sedation. Use Caution/Monitor.buprenorphine, long-acting injectionasenapine 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.butabarbitalasenapine and butabarbital both increase sedation. Use Caution/Monitor.butalbitalasenapine and butalbital both increase sedation. Use Caution/Monitor.butorphanolasenapine and butorphanol both increase sedation. Use Caution/Monitor.captoprilcaptopril, asenapine. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.carbidopacarbidopa increases effects of asenapine by pharmacodynamic synergism. Use Caution/Monitor. Monitor for hypotension.carbinoxamineasenapine and carbinoxamine both increase sedation. Use Caution/Monitor.cariprazineasenapine and cariprazine both increase sedation. Use Caution/Monitor.carisoprodolasenapine and carisoprodol both increase sedation. Use Caution/Monitor.carvedilolasenapine will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.asenapine and carvedilol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.celecoxibcelecoxib decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.celiprololasenapine and celiprolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.cenobamatecenobamate, asenapine. Either increases effects of the other by sedation. Use Caution/Monitor.cetirizineasenapine and cetirizine both increase sedation. Use Caution/Monitor.chlordiazepoxideasenapine and chlordiazepoxide both increase sedation. Use Caution/Monitor.chloroquinechloroquine increases toxicity of asenapine by QTc interval. Use Caution/Monitor.chlorpheniramineasenapine and chlorpheniramine both increase sedation. Use Caution/Monitor.chlorpromazineasenapine and chlorpromazine both increase sedation. Use Caution/Monitor.chlorpropamideasenapine, chlorpropamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.chlorzoxazoneasenapine and chlorzoxazone both increase sedation. Use Caution/Monitor.choline magnesium trisalicylatecholine magnesium trisalicylate decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.ciprofloxacinciprofloxacin will increase the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Asenapine has been associated with dose-related prolongation of the QT interval; asenapine should not be used with other agents also known to have this effect.ciprofloxacin and asenapine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.citalopramasenapine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.clemastineasenapine and clemastine both increase sedation. Use Caution/Monitor.clevidipineasenapine and clevidipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.clobazamasenapine, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).asenapine and clobazam both increase sedation. Use Caution/Monitor.clomipramineasenapine will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.asenapine and clomipramine both increase QTc interval. Use Caution/Monitor.asenapine and clomipramine both increase sedation. Use Caution/Monitor.clonazepamasenapine and clonazepam both increase sedation. Use