Drug interactions
Clozapine + Mexiletine
Severity: Major
Clozapine and Mexiletine: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Mexiletine inhibits CYP1A2, the main route of clozapine clearance, and can substantially raise clozapine levels. This may cause sedation, hypotension, seizures, myocarditis risk and QT effects.
What this interaction means in plain words
Clozapine and Mexiletine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Clozapine belongs to Central Nervous System; Mexiletine belongs to Cardiovascular.
Why it happens
Mexiletine inhibits CYP1A2-mediated clozapine metabolism.
What to do
Monitor clozapine levels and sedation, blood pressure and ECG; reduce the clozapine dose if levels rise.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Mexiletine
- Fezolinetant + Mexiletine Contraindicated
- Mexiletine + Pimozide Contraindicated
- Alosetron + Mexiletine Major
- Amiodarone + Mexiletine Major
- Cobicistat + Mexiletine Major
- Dofetilide + Mexiletine Major
Other interactions of Clozapine
- Clozapine + Deferiprone Contraindicated
- Clozapine + Irinotecan Contraindicated
- Clozapine + Pimozide Contraindicated
- Clozapine + Thioridazine Contraindicated
- Acalabrutinib + Clozapine Major
- Adagrasib + Clozapine Major
Frequently asked questions
Can I take Clozapine with Mexiletine?
MediHelp rates the interaction as major. Clozapine and Mexiletine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Mexiletine inhibits CYP1A2, the main route of clozapine clearance, and can substantially raise clozapine levels. This may cause sedation, hypotension, seizures, myocarditis risk and QT effects.
How serious is the interaction between Clozapine and Mexiletine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor clozapine levels and sedation, blood pressure and ECG; reduce the clozapine dose if levels rise.
What other medicines interact with Mexiletine?
MediHelp also lists interactions of Mexiletine with, for example, Fezolinetant, Pimozide, Alosetron. The full list is on the Mexiletine page.
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