Yellow: Adjust dosing

If coadministering, initiate lowest starting dose. Monitor for excessive sedation.

If coadministering, monitor for cardiac medication adverse effects (e.g. hypotension)

If coadministering, avoid taking a second dose of ubrogepant within 24 hours

If used for local injections, monitor for corticosteroid-related adverse effects (e.g. Cushing's syndrome, adrenal insufficiency).

If coadministering, consider decreasing tramadol dose when coadministering. Titrate to clinical effect and monitor for sedation.

Pulmonary arterial hypertension: coadministration of lenacapavir with tadalafil is not recommended. Erectile dysfunction: When used on an "as needed" basis, tadalafil dose should not exceed 10 mg every 72 hours. If used once daily (chronic administration), tadalafil dose should not exceed 2.5 mg daily.

If coadministering, initiate dose at 5 mg daily. May increase to 10 mg daily if not effective. Monitor for excessive sedation.

Initiate simvastatin with the lowest starting dose and titrate to clinical effect. Monitor for adverse effects of lovastatin (e.g. myopathy, elevated transaminases).

Use with caution. Monitor for rivaroxaban adverse effects (e.g. bleeding). Avoid coadministration in persons with renal impairment (CrCL 15 - 80 ml/min) due to increased risk of bleeding.

If coadministering, do not exceed ranolazine dose of 500 mg twice daily.

Consider using alternative antiarrhythmic or ARV. If coadministering, monitor for propafenone adverse effects.

If co-administering, initiate with the lowest starting dose and titrate to clinical effect. Monitor for corticosteroid-related adverse effects (e.g. Cushing's syndrome, adrenal insufficiency).

If coadministering, monitor therapeutic effects and adverse reactions (e.g. sedation, respiratory depression)

Consider using alternative agents. If coadministration is unavoidable, decrease dose of naloxegol and monitor for adverse reactions.

If co-administering, monitor for excess sedation and adjust dose accordingly

If initiating methadone in a person already on lenacapavir, start with lowest feasible dose and titrate to clinical effect. If initiating lenacapavir in a person stable on methadone, dose adjustment of methadone may be required. Monitor for clinical efficacy and adverse effects (e.g. sedation, respiratory depression).

If initiating lenacapavir in patients stable on mavacamten, reduce mavacamten dose by one level (e.g. 15 mg to 10 mg, 10 mg to 5 mg, 5 mg to 2.5 mg). If initiating mavacamten in patients stable on lenacapavir, use typical starting dose (5 mg daily).

If coadministering, reduce lumateperone dose to 21 mg

Consider using alternative antiarrythmic or ARV. If coadministering, monitor for lidocaine adverse effects.

If coadministering, initiate lowest starting dose and titrate to clinical effect. Monitor for adverse effects such as adrenal insufficiency and Cushing's syndrome.

If coadministering, monitor for cardiac medication adverse effects (e.g. hypotension)

If coadministering monitor for ethosuximide-related adverse events.

If coadministering in the setting of post-MI heart failure, eplerenone dose not to exceed 25 mg daily. If coadministered for hypertension, initiate eplerenone at 25mg daily. Dose not to exceed 25 mg twice daily.

Consider using alternative cardiac medication or ARV. If coadministering, monitor for dronedarone adverse effects.

Use with caution and monitor digoxin therapeutic concentration

If co-administering, initiate with the lowest starting dose and titrate to clinical effect. Do not use doses of dexamethasone > 16 mg. Monitor for dexamethasone-related adverse effects.

Use with caution. Monitor for dabigatran adverse effects (e.g. bleeding)

If using for gout flare may coadminister a single dose of 1.2 mg. May not repeat dose for at least 3 days. If using for Familiar Mediterranean Fever do not exceed colchicine dose of 1.2 mg daily.

Consider using alternative ARV or antiplatelet agents. If coadministering, monitor for clopidogrel-related adverse events (e.g. bleeding)

If coadministering start with lowest dose and titrate to clinical effect. Monitor for buspirone-related adverse events.

If coadministering, initiate lowest starting dose and titrate to clinical effect. Monitor for adverse effects such as adrenal insufficiency and Cushing's syndrome.

If used for local injections, monitor for corticosteroid-related adverse effects (e.g. Cushing's syndrome, adrenal insufficiency).

If coadministering, avanafil dose should not exceed 50 mg in 24 hours

Use with caution.  Monitor for apixaban adverse effects (e.g. bleeding)

If coadministering, use lowest effective dose and monitor for alprazolam adverse effects

If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose

If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose

Initiate (and do not exceed) vardenafil 2.5 mg every 72 hours and monitor for adverse effects

Decrease trazodone dose or start low and titrate to effect

For erectile dysfunction initiate tadalafil 5 mg dose and do not exceed 10 mg every 72 hours. Monitor adverse effects. For patients taking a protease inhibitor (stable > 7 days) requiring tadalafil for pulmonary arterial hypertension initiate 20 mg once daily and increase to 40 mg once daily based on tolerability. Patients currently on tadalafil who require a PI should stop tadalafil ³24 hours before PI initiation, take the PI for 7 days, then resume tadalafil at 20 mg. Maximum recommended daily dose for treatment of BPH is 2.5 mg daily.

Decrease rifabutin to 150 mg every other day or 300 mg 3 times / week

Monitor closely, start with low dose and titrate to pain response as indicated

For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose should not be repeated earlier than 3 days after. For gout prophylaxis, reduce colchicine dose to 0.3 mg daily if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg every other day if on 0.6 mg daily prior to PI therapy. For treatment of familial Mediterranean fever do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment.

Start low and titrate bosentan to effect. If patient has been on protease inhibitor (other than unboosted atazanavir) for more than 10 days, start bosentan at 62.5 mg daily or every other day. If patient is currently on bosentan and requires a PI (other than unboosted atazanavir), stop bosentan for at least 36 hours prior to initiating ART. Wait 10 days and then resume bosentan starting with 62.5 mg daily or every other day.

Monitor clinical improvement and adjust olanzapine as indicated

If coadministering, monitor INR and adjust warfarin as indicated. Monitor for signs and symptons of bleeding.

Titrate paroxetine to effect; monitor for continued antidepressant response if darunavir / ritonavir initiated

If coadministering, do not exceed solifenacin 5 mg once daily

If coadministering, decrease dose of pimavanserin to 10 mg once daily

If coadministering, dose reduction may be necessary