Do not use w/ strong CYP3A inhibitors including ketoconazole, itraconazole, clarithromycin, nefazodone, nelfinavir, ritonavir, indinavir & saquinavir. Increased ave steady-state plasma conc w/ ketoconazole (200 mg bid). Limit dose to 500 mg bid in patients on moderate CYP3A inhibitors including diltiazem, verapamil, aprepitant, erythromycin, fluconazole, & grapefruit juice or grapefruit-containing products. Increased steady-state plasma conc w/ diltiazem (180-360 mg daily) & verapamil (120 mg tid). Down-titrate dose in patients concomitantly treated w/ P-gp inhibitors eg, cyclosporine. Avoid co-administration w/ CYP3A inducers eg, rifampin, rifabutin, rifapentin, phenobarb, phenytoin, carbamazepine & St. John's wort. Decreased plasma conc w/ rifampin (600 mg once daily). Increased conc w/ paroxetine. Increased plasma levels of simvastatin. Elevated plasma conc of digoxin.
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