Potential serious reactions w/ MAOIs. Elevated levels of thioridazine. Risk of serotonin-associated effects w/ serotonergic medicinal/herbal products (including MAOIs, L-tryptophan, triptans, tramadol, linezolid, SSRIs, SNRIs, lithium & St. John's wort prep). Caution when co-administered w/ CNS-active medicinal products (eg, antiepileptics, antidepressants, antipsychotics, anxiolytics, sedative hypnotics). Possible reduction of clearance w/ CYP2D6, CYP3A4 & flavin monooxygenase 1 (FMO1) inhibitors. Increased exposure w/ potent CYP3A4 inhibitors (eg, ketoconazole, itraconazole, ritonavir, saquinavir, telithromycin, nefazodone, nelfinavir, atazanavir, grapefruit juice); moderate CYP3A4 inhibitors (eg, erythromycin, clarithromycin, fluconazole, amprenavir, fosamprenavir, aprepitant, verapamil, diltiazem); potent CYP2D6 inhibitors (eg, fluoxetine). Possible reduced orthostatic tolerance w/ PDE5 inhibitors & α-adrenergic receptor antagonists. Increased plasma conc of desipramine & other drugs metabolized by CYP2D6. Decreased AUCinf
of midazolam (CYP3A4 substrate). Caution w/ concomitant warfarin chronic therapy. Increased somnolence & decreased alertness w/ alcohol.