10 Aripiprazole Interactions to Watch Out for

Aripiprazole (Abilify) is an atypical antipsychotic. It can help treat symptoms of schizophrenia and bipolar 1 disorder. It’s also used along with antidepressants to treat major depressive disorder (depression). Aripiprazole works by balancing dopamine and serotonin levels in the brain. These chemical messengers help regulate thinking, mood, and behavior.

After taking aripiprazole, your body breaks it down using two enzymes (proteins). Unfortunately, many other medications and supplements can affect how these enzymes work. Combining them with aripiprazole means an interaction can happen. And it can change how this medication works.

So which medications interfere with aripiprazole? Let’s take a look at 10 common interactions.

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1. Carbamazepine

Carbamazepine (Tegretol, Tegretol XR, Equetro) is an anti-seizure medication. It’s also prescribed for people living with bipolar disorder. Carbmazepine speeds up one of the enzymes that breaks down aripiprazole. This means there’s less aripiprazole available than there should be. This interaction can cause aripiprazole to be less effective.

It’s possible your healthcare provider may feel you could benefit from both medications. If you’re taking carbamazepine, you may need a higher dose of aripiprazole for it to work effectively. 

2. St. John’s wort

St. John’s wort is an over-the-counter (OTC) supplement. It’s commonly taken for symptoms of mild depression. It can speed up one of the enzymes that breaks down aripiprazole. This can cause it to leave the body faster than it should. And it can make aripiprazole less effective.

Let your healthcare provider know if you take St. John’s wort when starting aripiprazole. They may suggest stopping St. John’s wort to avoid this interaction. And they may recommend different depression treatment options.

3. Some medications for Parkinson’s disease

Dopamine agonists are a class of medications that are commonly prescribed to treat Parkinson’s disease (PD). They work by raising dopamine levels in the brain. Aripiprazole has the opposite effect — it lowers dopamine levels. Taking these medications together can make them both less effective.

It’s unlikely that your healthcare provider would prescribe this combination. They would probably choose an alternative for either aripiprazole or the dopamine agonist to avoid this interaction.

4. Clarithromycin

Clarithromycin is an antibiotic that can treat certain kinds of bacterial infections. It can slow down one of the enzymes that break down aripiprazole. This means there will be too much aripiprazole in the body. So your risk of side effects can go up.

There may be times when you need to take both of these medications together. Your healthcare provider may lower your dose of aripiprazole to prevent side effects. This is especially true if you’ll be taking clarithromycin for a while.

5. Certain antidepressants

Fluoxetine (Prozac) and paroxetine (Paxil, Brisdelle) can be prescribed to treat depression and menopausal hot flashes. They’re known as selective serotonin reuptake inhibitors (SSRIs). These two SSRIs can interact with aripiprazole. They slow down one of the enzymes that breaks it down. This means aripiprazole may be more likely to cause side effects.

Some people living with depression take both aripiprazole and an SSRI. In this case, the benefits of both likely outweigh the risks of interactions.

If you take an SSRI, you might be able to take aripiprazole with it. Your healthcare provider may recommend an antidepressant that doesn’t interact with aripiprazole. Or, they may just have you watch for more side effects. This could include nausea, dizziness, or uncontrollable body movements. If you notice these, your provider may lower your aripiprazole dose.

6. Azole antifungal medications

Ketoconazole and fluconazole (Diflucan) are azole antifungals. They’re used to treat certain fungal infections. These medications can slow an enzyme that breaks down aripiprazole. This interaction can increase your risk of aripiprazole side effects.

Depending on how long you’ll be taking fluconazole, you may need a lower dose of aripiprazole. Short courses — like one-day fluconazole for yeast infections — may not be as much of a concern. Your healthcare provider will determine if aripiprazole dosage changes are needed.

Oral ketoconazole causes a more worrying interaction. It greatly increases the amount of aripiprazole in the body. It’s recommended that a person’s aripiprazole dose be cut in half if they need to take ketoconazole.

Keep in mind that this interaction doesn’t apply to topical ketoconazole (applied to the skin). Very little of the medication is absorbed compared to oral ketoconazole tablets. So interactions are unlikely.

7. Benzodiazepines

Benzodiazepines (BZDs), such as lorazepam (Ativan), are a common short-term treatment for anxiety. Combining BZDs and aripiprazole can raise the risk of certain side effects. Both of these medications can cause drowsiness and a drop in blood pressure. Blood pressure changes may be more likely to happen when changing positions quickly.

If you’re taking both aripiprazole and a BZD, ask your healthcare provider if you should check your blood pressure at home. And let your provider know if you’re experiencing excessive drowsiness. They may suggest changes to one or both medications. Don’t drive until you know how you react to taking these medications together. 

8. Blood pressure medications

Aripiprazole can interact with blood pressure medications. As mentioned above, this medication can cause low blood pressure upon changing positions. This side effect can worsen if you’re also taking blood pressure medications. The combination can cause your blood pressure to suddenly drop too low.

Discuss how often you should check your blood pressure with your healthcare provider. Let them know if you’re experiencing any symptoms of low blood pressure (hypotension). These may include light-headedness, blurry vision, dizziness.

9. Opioids

Opioids are a group of medications prescribed to treat pain. They carry a risk of serious side effects, including slowed breathing and severe drowsiness. When taken with other medications that have the same side effects, the risk of experiencing them goes up. In some cases, it can lead to severe complications or even death.

In 2016, the FDA issued a warning about how serious these interactions are. They recommend avoiding the combination of opioids with many other medications, including aripiprazole. If you do need to take both aripiprazole and an opioid, the FDA suggests taking the lowest doses needed to treat symptoms.

If you’re taking both medications and experience severe drowsiness or breathing difficulties, call 911 or seek immediate medical care.

10. Alcohol

Drinking alcohol can affect the body in many ways. Two well-known effects are its ability to impair coordination and make you sleepy. There are many medications that shouldn’t be mixed with alcohol. Aripiprazole is one of them.

As mentioned above, aripiprazole can make you drowsy. It can also affect your balance and coordination. Drinking alcohol while taking aripiprazole can worsen these side effects. This can happen even if you’re only having a drink or two. There’s also concern that alcohol can make medications like aripiprazole less effective.

So it’s best to avoid this combination as much as possible. And be sure to ask your healthcare provider if there’s a safe amount for you to drink before combining alcohol and aripiprazole.

When should I contact my healthcare provider about an aripiprazole interaction?

Provide a medication list to your healthcare provider and pharmacist before starting aripiprazole. You should also share this list any time medication changes occur. Be sure to include prescription and OTC medications, as well as dietary supplements. This information can help your healthcare team spot potential interactions before they happen.

Contact your healthcare provider if you develop new or worse aripiprazole side effects. You should also reach out if your health condition’s symptoms are getting worse. These can be symptoms of a potential interaction. And you may need a change to your aripiprazole dosage.

If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.

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Written by:

Kristine Foley, PharmD

Kristine Foley is a licensed pharmacist with over 13 years of community pharmacy experience. She earned her Doctor of Pharmacy degree from Rutgers University.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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