lorcaserin (Discontinued)

FDA Safety Communication

February 13, 2020: FDA requests lorcaserin be withdrawn from the market owing to a potential risk of cancer

For more information, see FDA Drug Safety Communication

Health care professionals should stop prescribing and dispensing lorcaserin to patients

Contact patients currently taking lorcaserin, inform them of the increased occurrence of cancer seen in the clinical trial, and ask them to stop taking the medicine

Discuss alternative weight-loss medicines or strategies

Obesity

Indicated as an adjunct to a reduced-calorie diet and exercise for chronic weight management with initial BMI ≥30 kg/m² (obese) or ≥27 kg/m² (overweight) with 1 weight-related comorbid condition (eg, hypertension, dyslipidemia, type 2 diabetes mellitus)

Tablets: 10 mg PO q12hr, OR

Extended-release tablets: 20 mg PO qDay

Dosage Modifications

Renal impairment

• Mild (CrCl >50 mL/min): No dosage adjustment required
• Moderate (CrCl 30-50 mL/min): Use caution
• Severe (CrCl <30 mL/min) or ESRD: Not recommended

Hepatic impairment

• Mild-to-moderate (Child-Pugh score 5-9): No dosage adjustment required
• Severe (Child-Pugh score >9): Use caution

Dravet Syndrome (Orphan)

Orphan designation for treatment of Dravet syndrome

Sponsor

• Epygenix Therapeutics, Inc; 140 East Ridgewood Avenue, Suite 415 South Tower; Paramus, New Jersey 07652

Safety and efficacy not established

Contraindicated (1)

• eliglustat

  lorcaserin increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.

Serious - Use Alternative (55)

• almotriptan

  almotriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• amitriptyline

  amitriptyline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• bupropion

  bupropion and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• buspirone

  buspirone and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• citalopram

  citalopram and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• clomipramine

  clomipramine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• cocaine topical

  cocaine topical and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• desipramine

  desipramine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• desvenlafaxine

  desvenlafaxine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• dextroamphetamine

  dextroamphetamine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• dextromethorphan

  dextromethorphan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxepin

  doxepin and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• duloxetine

  duloxetine and lorcaserin both increase sedation. Avoid or Use Alternate Drug.

• eletriptan

  eletriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• escitalopram

  escitalopram and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• fluoxetine

  fluoxetine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• fluvoxamine

  fluvoxamine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• frovatriptan

  frovatriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• imipramine

  imipramine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• iobenguane I 131

  lorcaserin will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

• isocarboxazid

  isocarboxazid and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• isoniazid

  isoniazid and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• L-tryptophan

  L-tryptophan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• levomilnacipran

  levomilnacipran and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• linezolid

  linezolid and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lisdexamfetamine

  lisdexamfetamine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lithium

  lithium and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• meperidine

  meperidine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• methamphetamine

  methamphetamine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• metoclopramide intranasal

  lorcaserin will increase the level or effect of metoclopramide intranasal by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Concurrent use of metoclopramide intranasal and strong CYP2D6 inhibitors is not recommended since the metoclopramide intranasal dose cannot be adjusted.

• milnacipran

  milnacipran and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• mirtazapine

  mirtazapine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• naratriptan

  naratriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• nefazodone

  nefazodone and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• nortriptyline

  nortriptyline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• paroxetine

  paroxetine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• perphenazine

  perphenazine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• phenelzine

  phenelzine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• protriptyline

  protriptyline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• rasagiline

  rasagiline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• rizatriptan

  rizatriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• selegiline

  selegiline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• selegiline transdermal

  selegiline transdermal and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• sertraline

  sertraline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• St John's Wort

  St John's Wort and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• sumatriptan

  sumatriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• sumatriptan intranasal

  sumatriptan intranasal and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• tramadol

  tramadol and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• tranylcypromine

  tranylcypromine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• trazodone

  trazodone and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• venlafaxine

  venlafaxine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• vilazodone

  vilazodone and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• vortioxetine

  lorcaserin increases levels of vortioxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Decrease vortioxetine dose by 50% when coadministered with strong CYP2D6 inhibitors.

• ziprasidone

  ziprasidone and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• zolmitriptan

  zolmitriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

Monitor Closely (82)

• amitriptyline

  lorcaserin will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• amoxapine

  lorcaserin will increase the level or effect of amoxapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• aripiprazole

  lorcaserin will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  lorcaserin, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• asenapine

  lorcaserin, asenapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• atomoxetine

  lorcaserin will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, lorcaserin. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• betaxolol

  lorcaserin will increase the level or effect of betaxolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• brexpiprazole

  lorcaserin will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer half of the usual brexpiprazole dose when coadministered with strong CYP2D6 inhibitors. If also administered with a strong/moderate CYP3A4 inhibitor, administer a quarter of brexpiprazole dose. NOTE: In MDD clinical trials, brexpiprazole dosage was not adjusted for strong CYP2D6 inhibitors (eg, paroxetine, fluoxetine); thus, CYP considerations are already factored into general dosing recommendations and brexpiprazole may be administered without dosage adjustment in patients with MDD.

• captopril

  lorcaserin will increase the level or effect of captopril by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• cariprazine

  lorcaserin, cariprazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• carvedilol

  lorcaserin will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• chloroquine

  lorcaserin will increase the level or effect of chloroquine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• chlorpromazine

  lorcaserin will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• cinacalcet

  lorcaserin will increase the level or effect of cinacalcet by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• citalopram

  lorcaserin will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• clomipramine

  lorcaserin will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• clozapine

  lorcaserin, clozapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• codeine

  lorcaserin will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• desipramine

  lorcaserin will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• deutetrabenazine

  lorcaserin will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.

• dextroamphetamine transdermal

  lorcaserin, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).
  
  lorcaserin will increase the level or effect of dextroamphetamine transdermal by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during dextroamphetamine initiation and after a dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and CYP2D6 inhibitor.

• doxepin

  lorcaserin will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• doxepin cream

  lorcaserin will increase the level or effect of doxepin cream by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• doxorubicin

  lorcaserin will increase the level or effect of doxorubicin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• doxorubicin liposomal

  lorcaserin will increase the level or effect of doxorubicin liposomal by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• duloxetine

  lorcaserin will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• eluxadoline

  lorcaserin increases levels of eluxadoline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. As a precautionary measure due to incomplete information on the metabolism of eluxadoline, use caution when coadministered with strong CYP2D6 inhibitors.

• epinephrine inhaled

  lorcaserin, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• flecainide

  lorcaserin will increase the level or effect of flecainide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• fluoxetine

  lorcaserin will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• fluphenazine

  lorcaserin will increase the level or effect of fluphenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  lorcaserin, fluphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• fluvoxamine

  lorcaserin will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• gepirone

  gepirone and lorcaserin both increase serotonin levels. Use Caution/Monitor. Monitor for symptoms of serotonin syndrome when gepirone is used gepirone with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinue gepirone and/or concomitant serotonergic drug.

• haloperidol

  lorcaserin will increase the level or effect of haloperidol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  lorcaserin, haloperidol. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• hydrocodone

  hydrocodone, lorcaserin. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• iloperidone

  lorcaserin will increase the level or effect of iloperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  lorcaserin, iloperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• imipramine

  lorcaserin will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• lofexidine

  lorcaserin will increase the level or effect of lofexidine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Concomitant use of lofexidine with strong CYP2D6 inhibitors may increase lofexidine plasma levels. Monitor for symptoms of orthostasis and bradycardia if coadministered with a CYP2D6 inhibitor. Consider lofexidine dose reduction.

• loxapine

  lorcaserin, loxapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• loxapine inhaled

  lorcaserin, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• lurasidone

  lorcaserin, lurasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• maprotiline

  lorcaserin will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• metaxalone

  lorcaserin will increase the level or effect of metaxalone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• methamphetamine

  lorcaserin will increase the level or effect of methamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• metoprolol

  lorcaserin will increase the level or effect of metoprolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mirtazapine

  lorcaserin will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• molindone

  lorcaserin, molindone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• nebivolol

  lorcaserin will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• nefazodone

  lorcaserin will increase the level or effect of nefazodone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• nortriptyline

  lorcaserin will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• olanzapine

  lorcaserin, olanzapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• oliceridine

  lorcaserin will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.

• paliperidone

  lorcaserin, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• paroxetine

  lorcaserin will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• perphenazine

  lorcaserin will increase the level or effect of perphenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  lorcaserin, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• pimavanserin

  lorcaserin, pimavanserin. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• pimozide

  lorcaserin, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• pindolol

  lorcaserin will increase the level or effect of pindolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• pitolisant

  lorcaserin will increase the level or effect of pitolisant by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If coadministered with strong CYP2D6 inhibitors, initiate pitolisant at 8.9 mg/day and increase after 7 days to maximum of 17.8 mg/day. For patients currently taking pitolisant, reduce pitolisant dose by half upon initiating strong CYP2D6 inhibitors.

• procainamide

  lorcaserin will increase the level or effect of procainamide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• promethazine

  lorcaserin will increase the level or effect of promethazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• propafenone

  lorcaserin will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• propranolol

  lorcaserin will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• protriptyline

  lorcaserin will increase the level or effect of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• quetiapine

  lorcaserin, quetiapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• risperidone

  lorcaserin will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  lorcaserin, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• ritonavir

  lorcaserin will increase the level or effect of ritonavir by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• sertraline

  lorcaserin will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• sufentanil SL

  sufentanil SL, lorcaserin. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• tamoxifen

  lorcaserin will decrease the level or effect of tamoxifen by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tamsulosin

  lorcaserin increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• thioridazine

  lorcaserin will increase the level or effect of thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• thiothixene

  lorcaserin, thiothixene. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• timolol

  lorcaserin will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• timolol ophthalmic

  lorcaserin will increase the level or effect of timolol ophthalmic by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tolterodine

  lorcaserin will increase the level or effect of tolterodine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tramadol

  lorcaserin will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• trifluoperazine

  lorcaserin, trifluoperazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• trimipramine

  lorcaserin will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

• valbenazine

  lorcaserin will increase the level or effect of valbenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Consider reducing valbenazine dose based on tolerability if coadministered with a strong CYP2D6 inhibitor.

• venlafaxine

  lorcaserin will increase the level or effect of venlafaxine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• ziprasidone

  lorcaserin, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

Minor (0)

• almotriptan

  Serious - Use Alternative (1)almotriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• amitriptyline

  Monitor Closely (1)lorcaserin will increase the level or effect of amitriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• amoxapine

  Monitor Closely (1)lorcaserin will increase the level or effect of amoxapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• aripiprazole

  Monitor Closely (2)lorcaserin will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  lorcaserin, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• asenapine

  Monitor Closely (1)lorcaserin, asenapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• atomoxetine

  Monitor Closely (1)lorcaserin will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  Monitor Closely (1)benzhydrocodone/acetaminophen, lorcaserin. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• betaxolol

  Monitor Closely (1)lorcaserin will increase the level or effect of betaxolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• brexpiprazole

  Monitor Closely (1)lorcaserin will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer half of the usual brexpiprazole dose when coadministered with strong CYP2D6 inhibitors. If also administered with a strong/moderate CYP3A4 inhibitor, administer a quarter of brexpiprazole dose. NOTE: In MDD clinical trials, brexpiprazole dosage was not adjusted for strong CYP2D6 inhibitors (eg, paroxetine, fluoxetine); thus, CYP considerations are already factored into general dosing recommendations and brexpiprazole may be administered without dosage adjustment in patients with MDD.

• bupropion

  Serious - Use Alternative (1)bupropion and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• buspirone

  Serious - Use Alternative (1)buspirone and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• captopril

  Monitor Closely (1)lorcaserin will increase the level or effect of captopril by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• cariprazine

  Monitor Closely (1)lorcaserin, cariprazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• carvedilol

  Monitor Closely (1)lorcaserin will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• chloroquine

  Monitor Closely (1)lorcaserin will increase the level or effect of chloroquine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• chlorpromazine

  Monitor Closely (1)lorcaserin will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• cinacalcet

  Monitor Closely (1)lorcaserin will increase the level or effect of cinacalcet by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• citalopram

  Monitor Closely (1)lorcaserin will increase the level or effect of citalopram by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)citalopram and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• clomipramine

  Monitor Closely (1)lorcaserin will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• clozapine

  Monitor Closely (1)lorcaserin, clozapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• cocaine topical

  Serious - Use Alternative (1)cocaine topical and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• codeine

  Monitor Closely (1)lorcaserin will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Prevents conversion of codeine to its active metabolite morphine.

• desipramine

  Monitor Closely (1)lorcaserin will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)desipramine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• desvenlafaxine

  Serious - Use Alternative (1)desvenlafaxine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (1)lorcaserin will increase the level or effect of deutetrabenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Strong CYP2D6 inhibitors increase the systemic exposure to the active dihydro-metabolites of deutetrabenazine by approximately 3-fold. Do not exceed 18 mg/dose and 36 mg/day of deutetrabenazine if coadministered with strong CYP2D6 inhibitors.

• dextroamphetamine

  Serious - Use Alternative (1)dextroamphetamine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• dextroamphetamine transdermal

  Monitor Closely (2)lorcaserin, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).
  
  lorcaserin will increase the level or effect of dextroamphetamine transdermal by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor patients for signs and symptoms of serotonin syndrome, particularly during dextroamphetamine initiation and after a dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and CYP2D6 inhibitor.

• dextromethorphan

  Serious - Use Alternative (1)dextromethorphan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxepin

  Monitor Closely (1)lorcaserin will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)doxepin and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• doxepin cream

  Monitor Closely (1)lorcaserin will increase the level or effect of doxepin cream by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• doxorubicin

  Monitor Closely (1)lorcaserin will increase the level or effect of doxorubicin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• doxorubicin liposomal

  Monitor Closely (1)lorcaserin will increase the level or effect of doxorubicin liposomal by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• duloxetine

  Monitor Closely (1)lorcaserin will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)duloxetine and lorcaserin both increase sedation. Avoid or Use Alternate Drug.

• eletriptan

  Serious - Use Alternative (1)eletriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• eliglustat

  Contraindicated (1)lorcaserin increases levels of eliglustat by affecting hepatic enzyme CYP2D6 metabolism. Contraindicated. If coadministered with strong or moderate CYP2D6 inhibitors, reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive and intermediate metabolizers; eliglustat is contraindiated if strong or moderate CYP2D6 inhibitors are given concomitantly with strong or moderate CYP3A inhibitors.

• eluxadoline

  Monitor Closely (1)lorcaserin increases levels of eluxadoline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. As a precautionary measure due to incomplete information on the metabolism of eluxadoline, use caution when coadministered with strong CYP2D6 inhibitors.

• epinephrine inhaled

  Monitor Closely (1)lorcaserin, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

• escitalopram

  Serious - Use Alternative (1)escitalopram and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• flecainide

  Monitor Closely (1)lorcaserin will increase the level or effect of flecainide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• fluoxetine

  Monitor Closely (1)lorcaserin will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)fluoxetine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• fluphenazine

  Monitor Closely (2)lorcaserin will increase the level or effect of fluphenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  lorcaserin, fluphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• fluvoxamine

  Monitor Closely (1)lorcaserin will increase the level or effect of fluvoxamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)fluvoxamine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• frovatriptan

  Serious - Use Alternative (1)frovatriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• gepirone

  Monitor Closely (1)gepirone and lorcaserin both increase serotonin levels. Use Caution/Monitor. Monitor for symptoms of serotonin syndrome when gepirone is used gepirone with other drugs that may affect the serotonergic neurotransmitter systems. If serotonin syndrome occurs, consider discontinue gepirone and/or concomitant serotonergic drug.

• haloperidol

  Monitor Closely (2)lorcaserin will increase the level or effect of haloperidol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  lorcaserin, haloperidol. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• hydrocodone

  Monitor Closely (1)hydrocodone, lorcaserin. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• iloperidone

  Monitor Closely (2)lorcaserin will increase the level or effect of iloperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  lorcaserin, iloperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• imipramine

  Monitor Closely (1)lorcaserin will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)imipramine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• iobenguane I 131

  Serious - Use Alternative (1)lorcaserin will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

• isocarboxazid

  Serious - Use Alternative (1)isocarboxazid and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• isoniazid

  Serious - Use Alternative (1)isoniazid and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• L-tryptophan

  Serious - Use Alternative (1)L-tryptophan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• levomilnacipran

  Serious - Use Alternative (1)levomilnacipran and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• linezolid

  Serious - Use Alternative (1)linezolid and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lisdexamfetamine

  Serious - Use Alternative (1)lisdexamfetamine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lithium

  Serious - Use Alternative (1)lithium and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lofexidine

  Monitor Closely (1)lorcaserin will increase the level or effect of lofexidine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Concomitant use of lofexidine with strong CYP2D6 inhibitors may increase lofexidine plasma levels. Monitor for symptoms of orthostasis and bradycardia if coadministered with a CYP2D6 inhibitor. Consider lofexidine dose reduction.

• loxapine

  Monitor Closely (1)lorcaserin, loxapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• loxapine inhaled

  Monitor Closely (1)lorcaserin, loxapine inhaled. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• lurasidone

  Monitor Closely (1)lorcaserin, lurasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• maprotiline

  Monitor Closely (1)lorcaserin will increase the level or effect of maprotiline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• meperidine

  Serious - Use Alternative (1)meperidine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• metaxalone

  Monitor Closely (1)lorcaserin will increase the level or effect of metaxalone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• methamphetamine

  Monitor Closely (1)lorcaserin will increase the level or effect of methamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)methamphetamine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• metoclopramide intranasal

  Serious - Use Alternative (1)lorcaserin will increase the level or effect of metoclopramide intranasal by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Concurrent use of metoclopramide intranasal and strong CYP2D6 inhibitors is not recommended since the metoclopramide intranasal dose cannot be adjusted.

• metoprolol

  Monitor Closely (1)lorcaserin will increase the level or effect of metoprolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• milnacipran

  Serious - Use Alternative (1)milnacipran and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• mirtazapine

  Monitor Closely (1)lorcaserin will increase the level or effect of mirtazapine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• molindone

  Monitor Closely (1)lorcaserin, molindone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• naratriptan

  Serious - Use Alternative (1)naratriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• nebivolol

  Monitor Closely (1)lorcaserin will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• nefazodone

  Monitor Closely (1)lorcaserin will increase the level or effect of nefazodone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)nefazodone and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• nortriptyline

  Monitor Closely (1)lorcaserin will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)nortriptyline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• olanzapine

  Monitor Closely (1)lorcaserin, olanzapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• oliceridine

  Monitor Closely (1)lorcaserin will increase the level or effect of oliceridine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.

• paliperidone

  Monitor Closely (1)lorcaserin, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• paroxetine

  Monitor Closely (1)lorcaserin will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)paroxetine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• perphenazine

  Monitor Closely (2)lorcaserin will increase the level or effect of perphenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  lorcaserin, perphenazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).Serious - Use Alternative (1)perphenazine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• phenelzine

  Serious - Use Alternative (1)phenelzine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• pimavanserin

  Monitor Closely (1)lorcaserin, pimavanserin. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• pimozide

  Monitor Closely (1)lorcaserin, pimozide. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• pindolol

  Monitor Closely (1)lorcaserin will increase the level or effect of pindolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• pitolisant

  Monitor Closely (1)lorcaserin will increase the level or effect of pitolisant by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. If coadministered with strong CYP2D6 inhibitors, initiate pitolisant at 8.9 mg/day and increase after 7 days to maximum of 17.8 mg/day. For patients currently taking pitolisant, reduce pitolisant dose by half upon initiating strong CYP2D6 inhibitors.

• procainamide

  Monitor Closely (1)lorcaserin will increase the level or effect of procainamide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• promethazine

  Monitor Closely (1)lorcaserin will increase the level or effect of promethazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• propafenone

  Monitor Closely (1)lorcaserin will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• propranolol

  Monitor Closely (1)lorcaserin will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• protriptyline

  Monitor Closely (1)lorcaserin will increase the level or effect of protriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)protriptyline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• quetiapine

  Monitor Closely (1)lorcaserin, quetiapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• rasagiline

  Serious - Use Alternative (1)rasagiline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• risperidone

  Monitor Closely (2)lorcaserin will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  lorcaserin, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• ritonavir

  Monitor Closely (1)lorcaserin will increase the level or effect of ritonavir by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• rizatriptan

  Serious - Use Alternative (1)rizatriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• selegiline

  Serious - Use Alternative (1)selegiline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• selegiline transdermal

  Serious - Use Alternative (1)selegiline transdermal and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• sertraline

  Monitor Closely (1)lorcaserin will increase the level or effect of sertraline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)sertraline and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• St John's Wort

  Serious - Use Alternative (1)St John's Wort and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• sufentanil SL

  Monitor Closely (1)sufentanil SL, lorcaserin. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter system may result in serotonin syndrome. If concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment.

• sumatriptan

  Serious - Use Alternative (1)sumatriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• sumatriptan intranasal

  Serious - Use Alternative (1)sumatriptan intranasal and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• tamoxifen

  Monitor Closely (1)lorcaserin will decrease the level or effect of tamoxifen by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tamsulosin

  Monitor Closely (1)lorcaserin increases levels of tamsulosin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• thioridazine

  Monitor Closely (1)lorcaserin will increase the level or effect of thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• thiothixene

  Monitor Closely (1)lorcaserin, thiothixene. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• timolol

  Monitor Closely (1)lorcaserin will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• timolol ophthalmic

  Monitor Closely (1)lorcaserin will increase the level or effect of timolol ophthalmic by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tolterodine

  Monitor Closely (1)lorcaserin will increase the level or effect of tolterodine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tramadol

  Monitor Closely (1)lorcaserin will increase the level or effect of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)tramadol and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• tranylcypromine

  Serious - Use Alternative (1)tranylcypromine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• trazodone

  Serious - Use Alternative (1)trazodone and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• trifluoperazine

  Monitor Closely (1)lorcaserin, trifluoperazine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• trimipramine

  Monitor Closely (1)lorcaserin will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

• valbenazine

  Monitor Closely (1)lorcaserin will increase the level or effect of valbenazine by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Consider reducing valbenazine dose based on tolerability if coadministered with a strong CYP2D6 inhibitor.

• venlafaxine

  Monitor Closely (1)lorcaserin will increase the level or effect of venlafaxine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)venlafaxine and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• vilazodone

  Serious - Use Alternative (1)vilazodone and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• vortioxetine

  Serious - Use Alternative (1)lorcaserin increases levels of vortioxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Decrease vortioxetine dose by 50% when coadministered with strong CYP2D6 inhibitors.

• ziprasidone

  Monitor Closely (1)lorcaserin, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).Serious - Use Alternative (1)ziprasidone and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• zolmitriptan

  Serious - Use Alternative (1)zolmitriptan and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.