Selected Atypical Antipsychotics/CYP 3A4 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.
Medical warning:
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.
References:
1.Abilify (aripiprazole) US prescribing information. Otsuka America Pharmaceutical, Inc. February, 2012.
2.Seroquel (quetiapine fumarate) US prescribing information. AstraZeneca Pharmaceuticals LP July, 2011.
3.Risperdal Consta (risperidone long acting injection) US prescribing information. Janssen Pharmaceutical Ltd. September, 2011.
4.Mula M, Monaco F. Carbamazepine-risperidone interactions in patients with epilepsy. Clin Neuropharmacol 2002 Mar-Apr;25(2):97-100.
5.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.
6.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.
7.Hasselstrom J, Linnet K. Quetiapine serum concentrations in psychiatric patients: the influence of comedication. Ther Drug Monit 2004 Oct; 26(5):486-91.
8.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.
9.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.
10.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.
11.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.
12.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.
13.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.
14.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.
15.Abilify Maintena (aripiprazole ext-rel inj.) prescribing information. Otsuka Pharmaceuticals February, 2013.
