Drug interactions
Isoniazid + Levomilnacipran
Severity: Moderate
Isoniazid and Levomilnacipran: moderate 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
Levomilnacipran is partly cleared by CYP3A4, so its levels may rise with isoniazid. Isoniazid's weak MAO inhibition could also add to the serotonergic effects of this SNRI, although serious serotonin syndrome is uncommon with this combination.
What this interaction means in plain words
Isoniazid and Levomilnacipran can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Isoniazid belongs to Anti Bacterial; Levomilnacipran belongs to Central Nervous System.
Why it happens
Isoniazid inhibits CYP3A4 and weakly inhibits MAO, which may increase levomilnacipran exposure and serotonergic activity.
What to do
Monitor for serotonin toxicity (tremor, agitation, hyperthermia, clonus) and increased blood pressure or heart rate. Keep the levomilnacipran dose at or below 80 mg daily if a strong CYP3A4 inhibitor effect is suspected.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Isoniazid
Other interactions of Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Isoniazid with Levomilnacipran?
MediHelp rates the interaction as moderate. Isoniazid and Levomilnacipran can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Levomilnacipran is partly cleared by CYP3A4, so its levels may rise with isoniazid. Isoniazid's weak MAO inhibition could also add to the serotonergic effects of this SNRI, although serious serotonin syndrome is uncommon with this combination.
How serious is the interaction between Isoniazid and Levomilnacipran?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for serotonin toxicity (tremor, agitation, hyperthermia, clonus) and increased blood pressure or heart rate. Keep the levomilnacipran dose at or below 80 mg daily if a strong CYP3A4 inhibitor effect is suspected.
What other medicines interact with Isoniazid?
MediHelp also lists interactions of Isoniazid with, for example, Bacillus calmette-guerin substrain tice, Benzhydrocodone / acetaminophen, Carbamazepine. The full list is on the Isoniazid page.
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