Selected Antipsychotics/CYP3A4 Inducers
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Barbiturates, carbamazepine, glucocorticoids, phenytoin, rifampin, and St. John's wort may speed up how quickly your liver processes your antipsychotic medication.
What might happen:
The amount of medicine in your blood may decrease and it may not work as well.
What you should do about this interaction:
Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together and if you notice any change in your condition. Your doctor may want to change the dose of your medicine while you are taking barbiturates, carbamazepine, glucocorticoids, phenytoin, rifampin, or St. John's wort.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
1.Abilify (aripiprazole) US prescribing information. Otsuka America Pharmaceutical, Inc. February, 2012.
2.Haldol (haloperidol) US prescribing information. Ortho-McNeil-Janssen Pharmaceuticals, Inc. August, 2011.
3.Seroquel (quetiapine fumarate) US prescribing information. AstraZeneca Pharmaceuticals LP July, 2011.
4.Risperdal Consta (risperidone long acting injection) US prescribing information. Janssen Pharmaceutical Ltd. September, 2011.
5.Abilify Maintena (aripiprazole ext-rel inj.) prescribing information. Otsuka Pharmaceuticals February, 2013.
6.Mula M, Monaco F. Carbamazepine-risperidone interactions in patients with epilepsy. Clin Neuropharmacol 2002 Mar-Apr;25(2):97-100.
7.Grimm SW, Richtand NM, Winter HR, Stams KR, Reele SB. Effects of cytochrome P450 3A modulators ketoconazole and carbamazepine on quetiapine pharmacokinetics. Br J Clin Pharmacol 2006 Jan;61(1):58-69.
8.Castberg I, Skogvoll E, Spigset O. Quetiapine and drug interactions: evidence from a routine therapeutic drug monitoring service. J Clin Psychiatry 2007 Oct;68(10):1540-5.
9.Hasselstrom J, Linnet K. Quetiapine serum concentrations in psychiatric patients: the influence of comedication. Ther Drug Monit 2004 Oct; 26(5):486-91.
10.Nickl-Jockschat T, Paulzen M, Schneider F, Grozinger M. Drug interaction can lead to undetectable serum concentrations of quetiapine in the presence of carbamazepine. Clin Neuropharmacol 2009 Jan-Feb;32(1):55.
11.Wong YW, Yeh C, Thyrum PT. The effects of concomitant phenytoin administration on the steady-state pharmacokinetics of quetiapine. J Clin Psychopharmacol 2001 Feb;21(1):89-93.
12.Ono S, Mihara K, Suzuki A, Kondo T, Yasui-Furukori N, Furukori H, de Vries R, Kaneko S. Significant pharmacokinetic interaction between risperidone and carbamazepine: its relationship with CYP2D6 genotypes. Psychopharmacology (Berl) 2002 Jun;162(1):50-4.
13.Spina E, Avenoso A, Facciola G, Salemi M, Scordo MG, Giacobello T, Madia AG, Perucca E. Plasma concentrations of risperidone and 9-hydroxyrisperidone: effect of comedication with carbamazepine or valproate. Ther Drug Monit 2000 Aug;22(4):481-5.
14.Spina E, Scordo MG, Avenoso A, Perucca E. Adverse drug interaction between risperidone and carbamazepine in a patient with chronic schizophrenia and deficient CYP2D6 activity. J Clin Psychopharmacol 2001 Feb;21(1):108-9.
15.Mahatthanatrakul W, Nontaput T, Ridtitid W, Wongnawa M, Sunbhanich M. Rifampin, a cytochrome P450 3A inducer, decreases plasma concentrations of antipsychotic risperidone in healthy volunteers. J Clin Pharm Ther 2007 Apr;32(2):161-7.
16.Kim KA, Park PW, Liu KH, Kim KB, Lee HJ, Shin JG, Park JY. Effect of rifampin, an inducer of CYP3A and P-glycoprotein, on the pharmacokinetics of risperidone. J Clin Pharmacol 2008 Jan;48(1):66-72.
17.Yasui-Furukori N, Kondo T, Mihara K, Suzuki A, Inoue Y, Kaneko S. Significant dose effect of carbamazepine on reduction of steady-state plasma concentration of haloperidol in schizophrenic patients. J Clin Psychopharmacol 2003 Oct;23(5):435-40.
18.Hesslinger B, Normann C, Langosch JM, Klose P, Berger M, Walden J. Effects of carbamazepine and valproate on haloperidol plasma levels and on psychopathologic outcome in schizophrenic patients. J Clin Psychopharmacol 1999 Aug;19(4):310-5.
19.Iwahashi K, Miyatake R, Suwaki H, Hosokawa K, Ichikawa Y. The drug-drug interaction effects of haloperidol on plasma carbamazepine levels. Clin Neuropharmacol 1995 Jun;18(3):233-6.
20.Arana GW, Goff DC, Friedman H, Ornsteen M, Greenblatt DJ, Black B, Shader RI. Does carbamazepine-induced reduction of plasma haloperidol levels worsen psychotic symptoms?. Am J Psychiatry 1986 May;143(5):650-1.
21.Klein E, Bental E, Lerer B, Belmaker RH. Carbamazepine and haloperidol v placebo and haloperidol in excited psychoses. A controlled study. Arch Gen Psychiatry 1984 Feb;41(2):165-70.
22.Hirokane G, Someya T, Takahashi S, Morita S, Shimoda K. Interindividual variation of plasma haloperidol concentrations and the impact of concomitant medications: the analysis of therapeutic drug monitoring data. Ther Drug Monit 1999 Feb;21(1):82-6.
23.Raitasuo V, Lehtovaara R, Huttunen MO. Effect of switching carbamazepine to oxcarbazepine on the plasma levels of neuroleptics. A case report. Psychopharmacology (Berl) 1994 Sep;116(1):115-6.
24.Kahn EM, Schulz SC, Perel JM, Alexander JE. Change in haloperidol level due to carbamazepine--a complicating factor in combined medication for schizophrenia. J Clin Psychopharmacol 1990 Feb;10(1):54-7.
25.Fast DK, Jones BD, Kusalic M, Erickson M. Effect of carbamazepine on neuroleptic plasma levels and efficacy. Am J Psychiatry 1986 Jan; 143(1):117-8.
26.Jann MW, Ereshefsky L, Saklad SR, Seidel DR, Davis CM, Burch NR, Bowden CL. Effects of carbamazepine on plasma haloperidol levels. J Clin Psychopharmacol 1985 Apr;5(2):106-9.
27.Cohen D, Diemont WL. Deterioration of schizoaffective disorder due to an interaction between haloperidol and carbamazepine. Ned Tijdschr Geneeskd 2002 Oct 12;146(41):1942-4.
28.Kanter GL, Yerevanian BI, Ciccone JR. Case report of a possible interaction between neuroleptics and carbamazepine. Am J Psychiatry 1984 Sep;141(9):1101-2.
29.Brayley J, Yellowlees P. An interaction between haloperidol and carbamazepine in a patient with cerebral palsy. Aust N Z J Psychiatry 1987 Dec;21(4):605-7.
30.Kim YH, Cha IJ, Shim JC, Shin JG, Yoon YR, Kim YK, Kim JI, Park GH, Jang IJ, Woo JI, Shin SG. Effect of rifampin on the plasma concentration and the clinical effect of haloperidol concomitantly administered to schizophrenic patients. J Clin Psychopharmacol 1996 Jun;16(3):247-52.
31.Takeda M, Nishinuma K, Yamashita S, Matsubayashi T, Tanino S, Nishimura T. Serum haloperidol levels of schizophrenics receiving treatment for tuberculosis. Clin Neuropharmacol 1986;9(4):386-97.
32.US Food and Drug Administration (FDA). Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. Available at: http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/ DrugInteractionsLabeling/ucm093664.htm. Updated 08/05/2011.