Modafinil Clozapine

Albuterol Salbutamol Clenbuterol Fenoterol Adrafanil Fluparoxan Modafinil Idazoxan Mirtazapine [also 5-HT2] Yohimbine Clozapine Bupropion... 

Clozapine toxicity occurred in a 42-year-old man after he was given modafinil 300 mg/day, a central stimulant, to combat sedation associated with clozapine (450 mg/day) (260). He complained of dizziness, had an unsteady gait, and fell twice. His serum clozapine concentration was 1400 ng/ml, which suggested a metabolic interaction between clozapine and modafinil. The authors suspected that inhibition of CYP2C19 by modafinil had reduced clozapine clearance. 

Dequardo JR. Modafinil-associated clozapine toxicity. Am J Psychiatry 2002 15917) 1243—4. 

Clozapine toxicity occurred after modafinil administration to reverse sedation associated with clozapine (10). 

It is possible that inhibition of CYP2C19 by modafinil interfered with clozapine clearance in this case (11). Despite the potential of modafinil for reversing clozapine-associated sedation (12), caution is required when prescribing this drug combination. 

CLOZAPINE, HALOPERIDOL, OLANZAPINE CNS STIMULANTS-MODAEINIL May cause X plasma concentrations of these substrates if CYPl A2 is the predominant metabolic pathway and alternative metabolic pathways are either genetically deficient or affected Modafinil is a moderate inducer of CYPl A2 in a concentration-dependent manner Be aware. Patients who are using oestrogen-containing contraceptives should be warned to use alternative forms of contraception during and for at least 1 month after cessation of modafinil... 

There are isolated cases of apparent interactions between clozapine, and ampicillin, buspirone, caffeine, haloperidol, loperamide, modafinil, nefazodone, nicotinic acid, tryptophan, or vitamin C. Grapefruit juice, influenza vaccine mirtazapine, reboxetine, or venlafaxine do not appear to interact Cocaine levels may increase when taken with clozapine. 

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