ginkgo + lamotrigine

if seizure disorder use, avoid consumption of ginkgo seeds; otherwise, caution advised: combo may alter seizure control (antagonistic effects, ginkgotoxin may decr. seizure threshold)

ginkgo + dabigatran

monitor bleeding s/sx; ATRIAL FIBRILLATION: avoid combo if CrCl <30 mL/min; OTHER INDICATIONS: avoid combo if CrCl <50 mL/min; if dabigatran use for DVT/PE prophylaxis post-hip replacement and CrCl >50 mL/min, consider separating admin. at least 2h apart: combo may incr. dabigatran levels, risk of bleeding (incl. life-threatening), other adverse effects (P-gp-mediated transport inhibited, additive effects)

amitriptyline + sertraline

use alternative or monitor serotonin syndrome sx, especially during initiation/titration: combo may incr. risk of serotonin syndrome, CNS depression, psychomotor impairment (additive effects)

perphenazine + sertraline

consider decr. perphenazine dose: combo may incr. perphenazine levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, additive effects)

asenapine + sertraline

use alternative or monitor ECG: combo may incr. risk of QT prolongation, cardiac arrhythmias, CNS depression, psychomotor impairment (additive effects)

ginkgo + fenugreek

monitor bleeding s/sx: combo may incr. risk of bleeding, incl. life-threatening (additive effects)

ginkgo + sertraline

monitor bleeding s/sx: combo may incr. risk of bleeding, incl. life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

valsartan + amitriptyline

monitor BP: combo may incr. risk of hypotension, incl. orthostasis (additive effects)

valsartan + perphenazine

monitor BP: combo may incr. risk of severe hypotension, incl. orthostasis, syncope (additive effects)

valsartan + asenapine

monitor BP: combo may incr. risk of hypotension, incl. orthostasis, syncope (additive effects)

fenugreek + dabigatran

monitor bleeding s/sx: combo may incr. risk of bleeding, incl. life-threatening (additive effects)

fenugreek + sertraline

monitor bleeding s/sx: combo may incr. risk of bleeding, incl. life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

lamotrigine + perphenazine

consider decr. dose of one or both drugs: combo may incr. risk of CNS depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, perphenazine may decr. seizure threshold)

lamotrigine + amitriptyline

caution advised: combo may incr. risk of CNS depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, amitriptyline may decr. seizure threshold)

lamotrigine + neostigmine

monitor HR: combo may incr. risk of bradycardia (additive effects)

lamotrigine + glycopyrrolate

caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

amitriptyline + glycopyrrolate

monitor HR; consider decr. dose of one or both drugs: combo may incr. risk of tachycardia, CNS depression, psychomotor impairment, hyperthermia, anticholinergic adverse effects (additive effects)

perphenazine + glycopyrrolate

consider decr. dose of one or both drugs: combo may incr. risk of CNS depression, psychomotor impairment, anticholinergic adverse effects (additive effects)

amitriptyline + neostigmine

caution advised: combo may decr. efficacy of both drugs (antagonistic effects)

perphenazine + neostigmine

caution advised: combo may decr. efficacy of both drugs (antagonistic effects)

amitriptyline + dexchlorpheniramine

consider decr. dose of one or both drugs: combo may incr. risk of CNS depression, psychomotor impairment, hyperthermia, anticholinergic adverse effects (additive effects)

perphenazine + dexchlorpheniramine

consider decr. dose of one or both drugs: combo may incr. risk of CNS depression, psychomotor impairment, anticholinergic adverse effects (additive effects)

amitriptyline + asenapine

monitor ECG, BP: combo may incr. risk of QT prolongation, cardiac arrhythmias, CNS depression, psychomotor impairment, hypotension (incl. orthostasis, syncope), hyperthermia (additive effects)

perphenazine + asenapine

monitor BP; consider decr. dose of one or both drugs: combo may incr. perphenazine levels, risk of CNS depression, psychomotor impairment, severe hypotension (orthostasis, syncope), extrapyramidal symptoms, hyperthermia, other adverse effects (hepatic metab. inhibited, additive effects)

dabigatran + sertraline

monitor bleeding s/sx: combo may incr. risk of bleeding, incl. life-threatening (additive effects, antiplatelet effects augmented by inhibition of platelet serotonin uptake)

ginkgo + tamoxifen

caution advised: combo may decr. tamoxifen and active metabolite levels, efficacy (hepatic metab. induced)

lamotrigine + imipenem

caution advised if seizure disorder use: combo may alter seizure control (antagonistic effects, imipenem may decr. seizure threshold)

lamotrigine + dexchlorpheniramine

caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

lamotrigine + asenapine

caution advised: combo may incr. risk of CNS depression, psychomotor impairment; may alter seizure control (additive effects; antagonistic effects, asenapine may decr. seizure threshold)

lamotrigine + sertraline

caution advised: combo may incr. lamotrigine levels, risk of adverse effects; may incr. risk of CNS depression, psychomotor impairment; may alter seizure control (mechanism unknown, hepatic metab. possibly inhibited; additive effects; antagonistic effects, sertraline may decr. seizure threshold)

glycopyrrolate + dexchlorpheniramine

caution advised: combo may incr. risk of CNS depression, psychomotor impairment, anticholinergic adverse effects (additive effects)

neostigmine + dexchlorpheniramine

caution advised: combo may decr. efficacy of both drugs (antagonistic effects)

glycopyrrolate + asenapine

caution advised: combo may incr. risk of CNS depression, psychomotor impairment, hyperthermia (additive effects)

glycopyrrolate + sertraline

caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)

dexchlorpheniramine + asenapine

caution advised: combo may incr. risk of CNS depression, psychomotor impairment, hyperthermia (additive effects)

dexchlorpheniramine + sertraline

caution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)