Interaction examples

Absorption (acid suppression ↓) Absorption (acidic gastric pH required) Absorption (adsorption/binding ↓) Absorption (aluminum interaction) Absorption (bile-acid sequestrant interaction) Absorption (calcium interaction) Absorption (chelation) Absorption (enteral feeding interaction) Absorption (food ↑) Absorption (food ↓) Absorption (gastric emptying interaction) Absorption (high-fat meal interaction) Absorption (iron interaction) Absorption (magnesium interaction) Absorption (pH-dependent) Absorption (polyvalent-cation interaction) Alcohol interaction ALDH inhibitor Allopurinol + azathioprine/mercaptopurine — myelosuppression Amiloride/spironolactone + ACEi/ARB — hyperkalemia Antimuscarinic burden Aripiprazole + bupropion/fluoxetine/paroxetine — CYP2D6 Atomoxetine + bupropion — CYP2D6 Atomoxetine + fluoxetine/paroxetine — CYP2D6 BBB: crosses freely BBB: excluded BBB: largely crosses BBB: limited entry BBB: P-gp substrate BBB: transporter-sensitive CNS exposure BCRP inhibitor BCRP substrate Bleeding risk Bradycardia Caffeine + fluvoxamine — CYP1A2 Caffeine interaction Carbamazepine + oral contraceptive — enzyme induction Clopidogrel + omeprazole — CYP2C19 Clozapine + bulk-forming laxatives — obstruction/perforation Clozapine + fluvoxamine — CYP1A2 CNS depression Codeine + bupropion/fluoxetine/paroxetine — ↓ activation Cognitive impairment Colchicine + CYP3A/P-gp inhibitor COMT substrate CYP inhibition (mechanism-based) CYP inhibition (time-dependent) CYP metabolism (autoinduction) CYP metabolism (autoinhibition) CYP metabolism (high first-pass) CYP1A2 inducer CYP1A2 inhibitor CYP1A2 substrate CYP2B6 inducer CYP2B6 inhibitor CYP2B6 substrate CYP2C19 inducer CYP2C19 inhibitor CYP2C19 phenotype-sensitive CYP2C19 substrate CYP2C8 inducer CYP2C8 inhibitor CYP2C8 substrate CYP2C9 inducer CYP2C9 inhibitor CYP2C9 phenotype-sensitive CYP2C9 substrate CYP2D6 inhibitor CYP2D6 phenotype-sensitive CYP2D6 substrate CYP2E1 inducer CYP2E1 inhibitor CYP2E1 substrate CYP3A4 inducer CYP3A4 inhibitor CYP3A4 substrate CYP3A5 phenotype-sensitive substrate Dialyzable Digoxin + P-gp inhibitor Distribution (fat sequestration) Distribution (large Vd) Distribution (small Vd) Distribution (tissue sequestration) DOAC + CYP3A/P-gp inhibitor DOAC + NSAID/antiplatelet — bleeding DOAC + strong CYP3A/P-gp inducer — ↓ anticoagulation DPYD phenotype-sensitive DPYD substrate Esterase-metabolized GI-restricted (minimal systemic absorption) Grapefruit interaction Half-life (very long) Half-life (very short) Hepatic clearance (predominant) Hepatotoxicity Hyperglycemia Hyperkalemia Hypertension Hypoglycemia Hypokalemia Hyponatremia Hypotension Ionization (amphoteric) Ionization (permanently charged) Ionization (weak acid) Ionization (weak base) Lamotrigine + level-altering drugs Lithium + level-lowering drugs Lithium + level-raising drugs Lumateperone/lurasidone + strong CYP3A inhibitor MAO-A inhibitor MAO-A substrate MAO-B inhibitor MAO-B substrate MAOI + not potentially fatal combinations (Gillman) MAOI + potentially fatal combinations (Gillman) MATE1 inhibitor MATE1 substrate MATE2-K inhibitor MATE2-K substrate Metabolism (active-metabolite dependent) Metabolism (CYP-independent) Mirtazapine + clonidine/guanfacine — alpha-2 opposition Myelosuppression NAT2 substrate Nephrotoxicity Neutropenia/agranulocytosis Nitrate + PDE5 inhibitor NUDT15 phenotype-sensitive OAT1 inhibitor OAT1 substrate OAT3 inhibitor OAT3 substrate OATP1B1 inhibitor OATP1B1 substrate OATP1B3 inhibitor OATP1B3 substrate OCT1 substrate OCT2 inhibitor OCT2 substrate Opioid + benzodiazepine Opioid + gabapentinoid Orthostasis Ototoxicity P-gp inducer P-gp inhibitor P-gp substrate Pancreatitis Poorly dialyzable Prolactin elevation Protein binding (albumin) Protein binding (alpha-1-acid glycoprotein / AAG) Protein bound (highly) Protein bound (very highly) QRS widening / NaV1.5 QTc prolongation Quetiapine + strong CYP3A inhibitor Renal clearance (active secretion) Renal clearance (glomerular filtration) Renal clearance (predominant) Renal clearance (tubular competition) Respiratory depression Rhabdomyolysis/myopathy Sedation Seizure-threshold lowering Seville orange interaction Simvastatin + clarithromycin SLCO1B1 phenotype-sensitive Smoking interaction (CYP1A2 induction/de-induction) St John's wort interaction Sympathomimetic Tacrolimus + CYP3A inducer/inhibitor Tamoxifen + bupropion/fluoxetine/paroxetine — ↓ activation Thrombocytopenia Tizanidine + fluvoxamine/viloxazine/ciprofloxacin — CYP1A2 TMP-SMX + methotrexate — marrow suppression TMP-SMX + spironolactone/ACEi/ARB — hyperkalemia TPMT phenotype-sensitive TPMT substrate Tramadol + bupropion/fluoxetine/paroxetine — ↓ activation Triple whammy — ACEi/ARB + diuretic + NSAID Tyramine interaction UGT inducer UGT substrate (isoform uncertain) UGT1A1 inhibitor UGT1A1 phenotype-sensitive UGT1A1 substrate UGT1A4 inhibitor UGT1A4 substrate UGT2B7 inhibitor UGT2B7 substrate Urinary pH (acidification ↑ clearance) Urinary pH (alkalinization ↑ clearance) Urinary pH-sensitive clearance Verapamil/diltiazem + beta blocker — bradycardia/AV block Verapamil/diltiazem + digoxin — ↑ digoxin Vitamin K food interaction Warfarin + amiodarone — ↑ anticoagulation Warfarin + TMP-SMX/metronidazole — ↑ anticoagulation Xanthine oxidase inhibitor Xanthine oxidase substrate