OBJECT DRUGS
Antipsychotics, Atypical:
- Aripiprazole (Abilify, etc.)
- Brexpiprazole (Rexulti)
- Clozapine (Clozaril, etc.)
- Iloperidone (Fanapt)
- Olanzapine (Zyprexa, etc.)
- Paliperidone (Invega, etc.)
- Risperidone (Risperdal, etc.)
PRECIPITANT DRUGS
Antidepressants:
- Bupropion (Wellbutrin, etc.)
- Duloxetine (Cymbalta)
- Fluoxetine (Prozac, etc.)
- Fluvoxamine (Luvox, etc.)
- Paroxetine (Paxil, etc.)
Comment:
These antipsychotics are metabolized by CYP2D6. These antidepressants inhibit CYP2D6 and may lead to accumulation of the antipsychotics.
Class 3: Assess Risk & Take Action if Necessary
- Consider Alternative: Antidepressants with small or no effects on CYP2D6 include citalopram (Celexa), escitalopram (Lexapro), venlafaxine (Effexor), desvenlafaxine (Pristiq), and sertraline (Zoloft).
- Circumvent/Minimize: The manufacturer recommends that the dose of aripiprazole be reduced to one-half the usual dose if CYP2D6 inhibitors are added. If the inhibitor is then discontinued, they recommend that the aripiprazole dose be increased to the usual dosage.
- Monitor: Be alert for altered effect of the antipsychotics if CYP2D6 inhibitors are started, stopped, or changed in dosage. Due to the long half-lives of some of these drugs, the onset and offset of these interactions may take 1-2 weeks.