Severe ARs w/ MAOIs. Serotonin syndrome w/ other serotonergic agents eg, triptans, SSRIs, other SNRIs, amphetamines, lithium, sibutramine, fentanyl & its analogues, tramadol, dextromethorphan, tapentadol, meperidine, methadone, pentazocine, St. John's wort; drugs impairing serotonin metabolism eg, linezolid & methylene blue or serotonin precursors eg, tryptophan supplements. Risk of QTc prolongation &/or ventricular arrhythmias w/ some antipsychotics & antibiotics. Decreased AUC & C
max of indinavir. Increased AUC & C
max of haloperidol. Increased AUC, C
max & C
min of desipramine. Increased plasma conc w/ ketoconazole, metoprolol. Increased AUC of risperidone. Reduced metabolism w/ CYP2D6 inhibitors. Increased levels w/ CYP3A4 inhibitors. False +ve urine immunoassay screening tests for PCP & amphetamine. Concomitant use w/ CNS-active drugs; ethanol.
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