Paxlovid® is contraindicated in people taking clozapine, with the risk of serious clozapine toxicity.
SSRIs for example:
fluvoxamine (very large effect)
sertraline (large doses)
some macrolide antibiotics including:
caffeine (large doses)
Potential to decrease Clozapine levels
St Johns Wort
Potential to depress bone marrow
Potential to depress respiration
Benzodiazepines, especially large parenteral doses or at start of therapy
Potential for anticholinergic side effects
For example constipation, urinary retention, delirium
Anticholinergic TCAs for example
Anticholinergic antipsychotics for example
EPSE medication for example
sedating antihistamines for example
gastrointestinal antispasmodics for example
Potential for hypotension
Some antipsychotics for example
Potential for changes due to smoking
Starting or stopping smoking can cause dramatic changes in clozapine blood levels
Prescription medications used for smoking cessation have been associated with destabilisation of mental state in some patients. Consider a strategic approach in consultation with a psychiatrist. Clozapine levels must be monitored in people ceasing smoking to avoid clozapine toxicity. Refer to the Clozapine Management Clinical Guideline (CMCG) (PDF 3.95MB) for required monitoring.
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