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.