Abilify (aripiprazole) is a powerful atypical antipsychotic medication used to manage conditions like schizophrenia, bipolar I disorder, and major depressive disorder. While effective, Abilify is metabolized in the liver by specific enzymes, namely CYP2D6 and CYP3A4, which makes it highly susceptible to interactions with other substances. Taking Abilify with certain other drugs, supplements, or foods can alter its concentration in the body, leading to increased side effects or reduced therapeutic effect. It is crucial to be aware of these potential interactions and to discuss all substances you consume with your healthcare provider to ensure your safety.
Major substances to avoid
Several common substances can cause significant and potentially dangerous interactions with Abilify and should be avoided.
Alcohol
Combining Abilify with alcohol is strongly discouraged. Both substances are central nervous system (CNS) depressants, and their combined effect can significantly increase drowsiness, dizziness, and impairment of thinking and judgment. This heightens the risk of accidents, falls, and injuries. Alcohol can also exacerbate the psychiatric symptoms that Abilify is meant to treat, potentially worsening depression or manic episodes. The concurrent use places a higher strain on the liver, which can impact the metabolism of both substances.
Grapefruit and grapefruit juice
Grapefruit products contain compounds that inhibit the CYP3A4 enzyme, which plays a major role in breaking down aripiprazole. By blocking this enzyme, grapefruit can cause Abilify to build up in your system, leading to higher-than-intended medication levels and an increased risk of side effects such as tardive dyskinesia, sleepiness, and tremors. For this reason, healthcare providers generally advise patients to avoid grapefruit and its juice entirely while taking Abilify.
Cannabis (Marijuana) and CBD
Using cannabis, marijuana, or cannabis-derived products like cannabidiol (CBD) with Abilify can be risky. Both cannabis and Abilify can cause drowsiness and cognitive impairment. The combination can lead to extreme sleepiness, dizziness, confusion, and difficulty concentrating or reacting. The interaction can result in additive CNS depression, worsening the potential for falls and other accidents.
St. John's Wort
This popular herbal supplement, often used for depression, is a strong inducer of the CYP3A4 enzyme. When taken with Abilify, St. John's wort can speed up the drug's metabolism, causing its levels in the body to drop. This can make Abilify less effective at managing your condition. Always discuss the use of any herbal products with your doctor before starting them while on Abilify.
Medication interactions requiring caution
Abilify can interact with a wide range of prescription and over-the-counter medications. It is important to disclose all medications you are taking to your provider.
Other CNS depressants
- Benzodiazepines (e.g., Xanax, Ativan): Combining with Abilify significantly increases the risk of excessive sedation, low blood pressure, and impaired coordination.
- Opioids (e.g., oxycodone, morphine): Both Abilify and opioids can cause drowsiness and slow breathing. Their combined effect can be dangerous and lead to severe sedation or respiratory issues.
- Antihistamines (e.g., Benadryl): Sedating antihistamines can add to the drowsiness caused by Abilify. If you need to use an antihistamine, consult your doctor or pharmacist.
Medications that alter Abilify's metabolism
Abilify's metabolism is dependent on the CYP2D6 and CYP3A4 enzymes. Any medications that affect these enzymes can alter Abilify's concentration. For example:
- Strong CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine, bupropion): These can increase Abilify levels and the risk of side effects. Dose adjustment of Abilify is often required.
- Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir): These can also increase Abilify levels and require a dose reduction.
- Strong CYP3A4 inducers (e.g., carbamazepine, rifampin, phenytoin): These can decrease Abilify levels, making it less effective. Your doctor may need to increase your Abilify dose.
Comparison of medication interactions with Abilify
| Medication Category | Examples | Effect on Abilify | Clinical Concern |
|---|---|---|---|
| Antidepressants (CYP2D6 inhibitors) | Fluoxetine (Prozac), Paroxetine (Paxil), Bupropion (Wellbutrin) | Increases Abilify concentration | Heightened risk of side effects like akathisia and insomnia |
| Antifungals (CYP3A4 inhibitors) | Itraconazole, Ketoconazole | Increases Abilify concentration | Increased risk of typical antipsychotic side effects |
| Seizure Medications (CYP3A4 inducers) | Carbamazepine (Tegretol), Phenytoin (Dilantin) | Decreases Abilify concentration | Reduced therapeutic effectiveness; may require dose increase |
| Benzodiazepines | Lorazepam (Ativan), Alprazolam (Xanax) | Additive CNS depression | Exaggerated sedation, dizziness, low blood pressure |
| Blood Pressure Medications | Metoprolol, Prazosin | Additive blood pressure lowering | Increased risk of low blood pressure (orthostatic hypotension) upon standing |
| Opioid Pain Relievers | Oxycodone, Morphine | Additive CNS depression | Increased risk of excessive drowsiness and respiratory depression |
Essential precautions and consultation
To prevent potentially severe or life-threatening interactions, it is essential to follow your healthcare provider's instructions carefully. Always provide your doctor with a comprehensive list of all medications, supplements, vitamins, and herbal products you are currently taking, or plan to start. This includes both prescription and over-the-counter products. Never stop or alter your medication dose without consulting your physician first, as abrupt changes can cause withdrawal symptoms or worsening of your condition. Your doctor is the best resource for personalizing your treatment plan based on your specific health profile and metabolic factors.
Conclusion
Abilify is a vital medication for many mental health conditions, but its effectiveness and safety depend heavily on avoiding key interactions. From common substances like alcohol and grapefruit juice to certain prescription drugs and herbal supplements, a variety of items can significantly affect how Abilify works in your body. Understanding and proactively managing these interactions is a cornerstone of safe and effective treatment. Always maintain open communication with your healthcare team to ensure a safe and optimal outcome for your health.
What to do if an interaction is suspected
If you suspect an interaction has occurred, contact your doctor immediately. Symptoms can include unusual drowsiness, dizziness, confusion, or changes in mood or behavior. In severe cases, particularly involving excessive sedation or impaired breathing, seek emergency medical attention immediately. A list of your current medications and symptoms will be crucial for guiding the appropriate response.
