<unk>  is a moderate inhibitor of CYP2D6 and CYP2B6 in vitro. Accordingly, in human trials it caused increased blood levels of CYP2D6 substrates such as metoprolol, dextromethorphan, desipramine, imipramine and nortriptyline, as well as the CYP3A4/CYP2D6 substrate haloperidol. This effect is dose-dependent; for example, co-administration with 50 mg of<unk>  resulted in 20% greater exposure to desipramine, while 150 mg of<unk>  led to a 70% increase. In a placebo-controlled study, the concomitant administration of<unk>  and methadone caused a 40% increase in blood levels of the latter, which is primarily metabolized by CYP2B6.<unk>  had a slight inhibitory effect on the metabolism of diazepam, tolbutamide and warfarin, which are CYP2C9 or CYP2C19 substrates; the clinical relevance of this effect was unclear. As expected from in vitro data,<unk>  did not alter the human metabolism of the CYP3A4 substrates erythromycin, alprazolam, carbamazepine, clonazepam, and terfenadine; neither did it affect metabolism of the CYP1A2 substrate clozapine.<unk>  had no effect on the actions of digoxin and atenolol, which are not metabolized in the liver. Case reports suggest that taking<unk>  with phenytoin or zolpidem may induce<unk>  metabolism and decrease its efficacy, and that taking<unk>  with lamotrigine may increase the blood level of lamotrigine, possibly by inhibition of glucuronidation. CYP2C19 inhibitor esomeprazole increased<unk>  concentrations in blood plasma by approximately 40%. Clinical reports indicate that interaction between<unk>  and the MAOIs isocarboxazid and tranylcypromine may cause<unk> otonin syndrome. In a placebo-controlled study in which<unk>  was co-administered with lithium, 35% of the subjects experienced tremors, while none of those taking placebo did.<unk>  may interact with grapefruit juice—see "Grapefruit–drug interactions".
Sertraline
Citalopram
Escitalopram
Clomipramine
Trimipramine
Mirtazapine
Asenapine
Quetiapine