<unk>  is metabolized primarily by the cytochrome P450 enzyme CYP2D6. Inhibitors and inducers of CYP2D6 may modify the pharmacokinetics of<unk>  and necessitate dosage adjustments. Bupropion, a strong CYP2D6 inhibitor, has been found to increase peak levels of<unk>  by 2.1-fold and total<unk>  levels by 2.3-fold (bupropion dosed at 300 mg/day and<unk>  dosed at 10 mg/day). The incidence of side effects with<unk> , like nausea, headache, vomiting, and insomnia, was correspondingly increased with the combination. Other strong CYP2D6 inhibitors, like fluoxetine, paroxetine, and quinidine, may have similar influences on the pharmacokinetics of<unk> , and it is recommended that the dosage of<unk>  be reduced by half when it is administered in combination with such medications. Lesser interactions have additionally been identified for<unk>  with the cytochrome P450 inhibitors ketoconazole and fluconazole. Rifampicin, a strong and broad cytochrome P450 inducer (though notably not of CYP2D6), has been found to decrease peak levels of<unk>  by 51% and total levels of<unk>  by 72% (rifampicin dosed at 600 mg/day and<unk>  at 20 mg/day). Similar influences on<unk>  pharmacokinetics may also occur with other strong cytochrome P450 inducers like carbamazepine and phenytoin. As such, it is recommended that increasing<unk>  dosage be considered when it is given in combination with strong cytochrome P450 inducers. The maximum recommended dose should not exceed three times the original<unk>  dose.<unk>  and its metabolites show no meaningful interactions with a variety of assessed cytochrome P450 enzymes and transporters (e.g., P-glycoprotein) and hence<unk>  is not expected to importantly influence the pharmacokinetics of other medications. The combination of<unk>  with MAOIs, including other MAOIs like linezolid and intravenous methylene blue, may cause serotonin syndrome and is contraindicated. The risk of serotonin syndrome may also be increased when<unk>  is combined with other serotonergic drugs, like SSRIs, SNRIs, tricyclic antidepressants (TCAs), triptans, tramadol, tryptophan, buspirone, St John's wort, fentanyl, and lithium, among others. However,<unk>  is not considered to be contraindicated with serotonergic medications besides MAOIs.
Vortioxetine
Atomoxetine
Edivoxetine
Dapoxetine
Duloxetine
Fluparoxan
Nabilone
Fluoxetine