Aripiprazole interactions to avoid

Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

Aripiprazole is approved by the U.S. Food and Drug Administration (FDA) to treat schizophrenia, bipolar disorder, Tourette’s syndrome, and irritability associated with autistic disorder (autism). Also known by its brand name Abilify, aripiprazole belongs to a class of drugs called atypical antipsychotics. It is thought to work by acting on certain dopamine and serotonin receptors. 

Although it’s an effective treatment option, aripiprazole has the potential to interact with several medications. Examples can include blood pressure medications, benzodiazepines, and certain antidepressants. Aripiprazole can also interact with grapefruit and alcohol. Being aware of aripiprazole interactions is important because they may affect the drug’s effectiveness or worsen the risk of side effects. 

Read on to learn more about potential aripiprazole interactions.

Aripiprazole drug interactions

Aripiprazole can interact with many medications. These interactions can increase the risk of side effects or affect the drug’s effectiveness. Here are some common drugs that may interact with aripiprazole.

Blood pressure medications

Blood pressure medications are used to control high blood pressure. There are many different types of blood pressure medications. Examples of blood pressure medications include: 

• Norvasc (amlodipine)
• Lopressor (metoprolol)
• Zestril (lisinopril) 
• Cozaar (losartan)
• Minipress (prazosin)

Aripiprazole may interact with blood pressure medications by increasing their blood pressure-lowering effects. This increases the risk of low blood pressure, which can cause symptoms such as dizziness, lightheadedness, and fainting. 

If you’re prescribed this combination of drugs, your healthcare provider will likely recommend routine monitoring of your blood pressure, and they may adjust the dosage of your blood pressure medication. 

Benzodiazepines

Benzodiazepines are drugs that doctors typically prescribe for anxiety, seizures, or sleep problems. This class of drugs may also interact with aripiprazole. When taken alone, each of these drugs may cause drowsiness and orthostatic hypotension (a sudden drop in blood pressure upon standing). Combining benzodiazepines with aripiprazole can worsen these side effects. Examples of benzodiazepines include: 

• Ativan (lorazepam)
• Xanax (alprazolam)
• Restoril (temazepam)
• Valium (diazepam)

If you’re taking a benzodiazepine with aripiprazole, your doctor might recommend monitoring your blood pressure at home. They may also adjust the dosages of your medications to minimize these side effects.

Opioids

Opioids are drugs that doctors prescribe to treat pain. They can cause serious side effects, including extreme sleepiness and slowed or shallow breathing. Examples of opioids include: 

• MS Contin (morphine)
• Oxycontin (oxycodone)
• Norco (hydrocodone/acetaminophen)

When taken together with aripiprazole, the sedative effects of opioids may increase. This interaction can cause symptoms such as extreme sleepiness or unresponsiveness. If this occurs, get emergency medical help right away. 

Certain antidepressants

Antidepressants may be prescribed by doctors alongside aripiprazole for individuals with major depressive disorder, also known as depression. However, certain antidepressants can interact with aripiprazole by slowing the breakdown of aripiprazole in the body. This interaction can increase the levels of aripiprazole in your system, which increases the risk of adverse effects. 

Examples of antidepressants include: 

• Prozac (fluoxetine) 
• Paxil (paroxetine)
• Wellbutrin SR (bupropion)
• Zoloft (sertraline)

To minimize the risk of side effects, doctors typically lower the dose of aripiprazole when administering these drugs together.

Certain antifungal medications

Antifungal drugs are prescribed to treat fungal infections, such as ringworm or yeast infections. Similar to some antidepressants, certain antifungals can block the breakdown of aripiprazole in the body. This interaction increases the risk of aripiprazole side effects. Examples of antifungals include:

• Ketoconazole
• Itraconazole
• Noxafil (posaconazole)

Due to this interaction, healthcare providers may reduce your aripiprazole dosage depending on your antifungal medications. 

Certain antibiotics

Antibiotics are drugs that are prescribed to treat bacterial infections. Many types of antibiotics are available, and each one works against different bacteria. 

Certain antibiotics may interact with aripiprazole. Depending on the antibiotic, the interaction may increase the risk of side effects of aripiprazole or make aripiprazole less effective. Examples of antibiotics include: 

• Rifadin (rifampin)
• Clarithromycin

Certain seizure drugs

Combining aripiprazole with some seizure medications can make aripiprazole less effective than usual because they can speed up the breakdown of aripiprazole so it can’t reach as high levels in the body. As a result, your symptoms of schizophrenia, such as psychosis, may not be as controlled. Examples of seizure drugs include:

• Phenytoin 
• Tegretol (carbamazepine)

If prescribed a seizure drug that interacts with aripiprazole, your healthcare provider may increase your aripiprazole dosage.

Aripiprazole food interactions

Combining certain foods and beverages with aripiprazole may cause interactions. These foods include grapefruit and grapefruit juice.

Aripiprazole and grapefruit

Certain foods, such as grapefruit or grapefruit juice, can interact with aripiprazole. Grapefruit can slow the clearance of aripiprazole from the body and, therefore, can cause aripiprazole to reach higher levels in your body. The higher levels can increase the risk of side effects such as tardive dyskinesia (uncontrolled body movements), sleepiness, and tremor. 

Due to this interaction, it’s best to avoid grapefruit and grapefruit juice while on aripiprazole treatment. 

Other aripiprazole interactions

Aripiprazole may also interact with alcohol, some herbal supplements, cannabis, and certain health conditions. 

Aripiprazole and alcohol 

Aripiprazole and alcohol both cause similar side effects, including nausea, drowsiness, dizziness, and problems with coordination. Therefore, combining aripiprazole and alcohol may increase the risk of these side effects. An interaction can occur even if you have one or two drinks.

Due to this risk, healthcare providers typically recommend avoiding alcohol as much as possible while taking aripiprazole. If this interaction concerns you, talk to your provider about how much alcohol, if any, is safe to drink while on aripiprazole treatment. 

Aripiprazole and CBD

Cannabis, often called marijuana, can also interact with aripiprazole. Using cannabis or cannabis products, such as cannabidiol (CBD), with aripiprazole can increase the risk of certain side effects. These include extreme sleepiness, difficulty focusing or reacting, and dizziness. 

Aripiprazole and herbal supplements

Similar to its interaction with certain seizure medications, aripiprazole may also interact with an herbal supplement called St. John’s wort, according to PDR. St. John’s wort is used to help with symptoms of depression. However, it can interact with aripiprazole by speeding up its clearance from the body. This can result in lower-than-usual levels of aripiprazole in the body, which can make the drug less effective. 

Aripiprazole and disease

Certain medical conditions or health factors can increase the risk of side effects with aripiprazole. These include:

• History or family history of diabetes or high blood sugar
• Seizures
• Low or high blood pressure
• Heart problems, including stroke
• Low white blood cell count 
• Current pregnancy
• Currently breastfeeding

How to minimize aripiprazole interactions

Minimizing aripiprazole interactions can be done with careful planning and discussion with a healthcare professional. Here are some steps to take:

• Keep an updated medication and medical condition list: Include all over-the-counter and prescription drugs, vitamins, herbal supplements, and health conditions on the list. 
• Consult a healthcare provider before starting any new medications: Before you start any new medications, share your medication list with your provider so they can screen for potential interactions. 
• Watch out for warning signs: Warning signs of an aripiprazole interaction include new or worsening symptoms of your condition, changes in a drug’s effectiveness, or new or worsening side effects. If any of these occur, seek medical advice. 
• Read all drug information sheets before taking new medications: Be sure to read all drug information that comes with your medications. This includes product packaging, prescribing information, medication guides, and patient information sheets. 

When to talk to a healthcare provider about aripiprazole interactions

Consult with a healthcare provider about aripiprazole interactions when it’s first prescribed and before you start taking it. Doing so can help prevent interactions before they occur. Also, remember that aripiprazole comes in several forms, including injection, oral solution, tablet, and orally disintegrating tablet. All forms have a risk of interactions. 

This article does not contain a complete list of all aripiprazole interactions. There may be other interactions or drug information that isn’t discussed here. For this reason, it’s essential to consult a healthcare provider about potential interactions so they can properly manage and monitor your health.