Key takeaways:
Ingrezza (valbenazine) is an oral medication that’s FDA approved to manage tardive dyskinesia and symptoms of Huntington’s disease. It has many interactions to be aware of.
Ingrezza interacts with antibiotics such as clarithromycin, antidepressants such as fluoxetine, and grapefruit juice. These interactions raise your risk of Ingrezza side effects.
Ingrezza also interacts with anti-seizure medications such as carbamazepine (Tegretol) and the supplement St. John’s wort. These interactions can cause Ingrezza to work less effectively.
Save on related medications
Ingrezza (valbenazine) is an oral medication that’s FDA approved to treat tardive dyskinesia in adults. It’s also approved to treat chorea (random or uncontrollable muscle movements) in adults with Huntington’s disease.
Certain medications, supplements, and foods interact with Ingrezza. So it’s important to know what to expect and how to avoid complications. Ingrezza interactions can change the amount of medication in your body. And this can change how well Ingrezza works or raise your risk of side effects.
Ingrezza interactions at a glance
Below is a list of notable Ingrezza interactions. This isn’t a complete list of all possible interactions. So it’s important to share your full medication list with your prescriber and pharmacist before starting Ingrezza. This list should include all over-the-counter (OTC) medications, vitamins, and supplements you take.
Notable Ingrezza interactions include:
Monoamine oxidase inhibitors (MAOIs), such as selegiline (Zelapar, Emsam)
Certain antibiotics, such as clarithromycin
Ritonavir (Norvir) and medications that contain it, such as Paxlovid (nirmatrelvir / ritonavir)
Grapefruit juice
Bupropion (Wellbutrin XL)
Certain selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and paroxetine (Paxil)
Anti-seizure medications, such as carbamazepine (Tegretol)
St. John’s wort
Digoxin (Lanoxin)
Here’s what to know about nine Ingrezza interactions and how to manage them.
1. MAOIs
You should avoid combining an MAOI with Ingrezza. MAOIs are a group of medications used to manage depression and symptoms of Parkinson’s disease. Examples include selegiline, phenelzine (Nardil), and rasagiline (Azilect).
Taking Ingrezza with an MAOI can raise your risk of serious side effects, such as serotonin syndrome. This is when there’s too much of the chemical messenger serotonin in your body. It can be life-threatening.
This interaction happens because MAOIs block an enzyme (protein) called monoamine oxidase. By blocking this protein, MAOIs raise the levels of serotonin and other chemicals in your brain. Ingrezza works by blocking a different protein, called vesicular monoamine transporter type 2 (VMAT2). This controls the release of the same brain chemicals that MAOIs affect. So taking Ingrezza and MAOIs together can raise your risk of side effects for both medications.
It’s recommended to avoid taking Ingrezza with an MAOI. Talk to a healthcare professional if you need to take an antidepressant or Parkinson’s disease treatment while taking Ingrezza. They can help you find a safer option. If you’re already taking an MAOI and need to start Ingrezza, you’ll need to wait at least 14 days after stopping the MAOI to start Ingrezza.
2. Clarithromycin
Not all antibiotics interact with Ingrezza, but clarithromycin is one to know about. Clarithromycin can increase the amount of Ingrezza in your body. This raises your risk of Ingrezza side effects, such as sleepiness and dry mouth.
In rare cases, Ingrezza can cause an irregular heart rhythm called long QT syndrome. Clarithromycin can make this serious side effect more likely to happen.
If you need to take clarithromycin, your prescriber may temporarily lower your Ingrezza dosage to help prevent side effects. The manufacturer’s recommended dosage is 40 mg once daily while you’re taking clarithromycin. But your prescriber may suggest something different. Be sure to follow your prescriber’s instructions.
3. Medications that contain ritonavir, such as Paxlovid
Ritonavir is an antiviral medication that’s found in several medications, including the COVID-19 treatment Paxlovid. This antiviral interacts with hundreds of medications, including Ingrezza. Ritonavir can increase the amount of Ingrezza in your body, making Ingrezza side effects more likely to happen.
Your prescriber may lower your Ingrezza dosage if you need to take a medication that contains ritonavir. The recommended dosage is 40 mg once daily while you’re taking ritonavir.
Some people take ritonavir-containing antivirals for only a few days (as with Paxlovid). In this case, your prescriber would raise your Ingrezza dosage back up after you finish treatment. But other people take ritonavir long term. In this case, your Ingrezza dosage may remain lower to help prevent side effects.
4. Grapefruit juice
A glass of grapefruit juice may seem harmless, but it can affect how some medications work. Grapefruit juice can cause Ingrezza to stay in your body longer. This raises your risk of side effects.
You may not need to completely avoid grapefruit juice while taking Ingrezza. But it’s a good idea to limit how much you consume. Ask your prescriber how much grapefruit juice would be OK for you to have while taking Ingrezza.
5. Bupropion
Bupropion is a medication that treats depression and can help you quit smoking. Bupropion can lead to higher levels of Ingrezza in your body. And this may make Ingrezza side effects more likely.
If you need to take bupropion while taking Ingrezza, your prescriber may need to adjust your dose. They may recommend lowering your Ingrezza dosage to 40 mg once daily to help keep the amount of Ingrezza in your body at a safe level.
6. Certain SSRIs
SSRIs are a commonly prescribed group of antidepressants. Not all SSRIs interact with Ingrezza. But fluoxetine and paroxetine do.
These SSRIs can increase the amount of Ingrezza in your body. This can lead to more Ingrezza side effects. Your prescriber may reduce your Ingrezza dosage to 40 mg daily if you need to take fluoxetine or paroxetine. This can help lower the risk of complications. Your prescriber may also suggest switching to an SSRI that doesn’t interact, such as citalopram (Celexa) or sertraline (Zoloft).
Before starting Ingrezza, tell your healthcare team if you’re already taking an SSRI. They can help you determine if you can safely take it with Ingrezza.
7. Anti-seizure medications, such as carbamazepine
Carbamazepine and phenytoin (Dilantin) are anti-seizure medications. Unlike the interactions already discussed, they lower the levels of Ingrezza in your body. This can make Ingrezza less effective.
It’s recommended to avoid taking Ingrezza with carbamazepine or phenytoin. If you’re already taking one of these anti-seizure medications, your prescriber might recommend an alternative to Ingrezza. If you’re already taking Ingrezza and need to start an anti-seizure medication, your prescriber can recommend an option that’s safer to combine.
8. St. John’s wort
St. John’s wort is a dietary supplement that some people use for depression symptoms. But “natural” doesn’t mean it’s free of risks. St. John’s wort interacts with many medications, including Ingrezza.
St. John’s wort can cause your body to break down Ingrezza faster than normal. This can lower the amount of Ingrezza in your body and make it less effective.
It’s best to avoid St. John’s wort while taking Ingrezza. If you’re considering a supplement or medication to support your mental health, talk to a healthcare professional. They can help you find a treatment that works with your lifestyle and doesn’t interact with Ingrezza.
9. Digoxin
Digoxin is a medication that’s used to treat certain heart conditions. Ingrezza can increase the amount of digoxin in your body. This can raise your risk of side effects, including digoxin toxicity. This is when there’s too much digoxin in your body. It can lead to life-threatening problems, such as abnormal heart rhythms and heart failure.
This Ingrezza interaction doesn’t always mean you can’t take digoxin. But your prescriber might want to monitor your digoxin levels more closely to help keep you safe. They might also adjust your digoxin dosage if needed.
Frequently asked questions
You shouldn’t take Ingrezza if you’re allergic to any of its active or inactive ingredients. Also, Ingrezza may not be a good fit if you have certain heart rhythm problems, such as inherited long QT syndrome. This is because it has a rare risk of causing this abnormal heart rhythm. People with this condition may have a higher risk of developing this serious Ingrezza side effect.
Austedo (deutetrabenazine) is a medication that’s similar to Ingrezza. Both belong to the same medication class and are approved to treat tardive dyskinesia and Huntington’s disease.
Another medication in the same class as Ingrezza is Xenazine (tetrabenazine). It’s approved to manage Huntington’s disease symptoms. It’s not approved for tardive dyskinesia, but some healthcare professionals prescribe it off-label for this use.
No new medications have been approved to treat tardive dyskinesia in recent years. But new formulations of existing medications have become available. Austedo XR was approved in 2023 as a once-daily, extended-release version of Austedo. The FDA also approved Ingrezza Sprinkle capsules in 2024. Ingrezza Sprinkle capsules can be opened and sprinkled onto soft foods. This version may be helpful for people who have trouble swallowing pills.
You shouldn’t take Ingrezza if you’re allergic to any of its active or inactive ingredients. Also, Ingrezza may not be a good fit if you have certain heart rhythm problems, such as inherited long QT syndrome. This is because it has a rare risk of causing this abnormal heart rhythm. People with this condition may have a higher risk of developing this serious Ingrezza side effect.
Austedo (deutetrabenazine) is a medication that’s similar to Ingrezza. Both belong to the same medication class and are approved to treat tardive dyskinesia and Huntington’s disease.
Another medication in the same class as Ingrezza is Xenazine (tetrabenazine). It’s approved to manage Huntington’s disease symptoms. It’s not approved for tardive dyskinesia, but some healthcare professionals prescribe it off-label for this use.
No new medications have been approved to treat tardive dyskinesia in recent years. But new formulations of existing medications have become available. Austedo XR was approved in 2023 as a once-daily, extended-release version of Austedo. The FDA also approved Ingrezza Sprinkle capsules in 2024. Ingrezza Sprinkle capsules can be opened and sprinkled onto soft foods. This version may be helpful for people who have trouble swallowing pills.
The bottom line
Ingrezza (valbenazine) is an oral medication that’s FDA approved to treat tardive dyskinesia and symptoms of Huntington’s disease. Ingrezza interacts with a number of medications, foods, and supplements.
Some interactions, such as clarithromycin and grapefruit juice, can raise Ingrezza levels in your body. This raises your risk of side effects. Other interactions, such as carbamazepine (Tegretol) and St. John’s wort, can make Ingrezza less effective.
Before starting treatment with Ingrezza, share a list of your medications with your prescriber and pharmacist. They can review your medication list for potential interactions.
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References
Chen, M. A. (2025). Digitalis toxicity. MedlinePlus.
Gupta, H., et al. (2021). Valbenazine for the treatment of adults with tardive dyskinesia. Health Psychology Research.
National Heart, Lung, and Blood Institute. (2022). Long QT syndrome. National Institutes of Health.
Neurocrine Biosciences. (2024). Neurocrine Biosciences announces U.S. FDA approval of Ingrezza Sprinkle (valbenazine) capsules.
Neurocrine Biosciences. (2026). Ingrezza- valbenazine capsule [package insert]. DailyMed.
Patel, P., et al. (2025). Monoamine oxidase inhibitors (MAOIs). StatPearls.
Teva Neuroscience. (2025). Austedo- deutetrabenazine tablet, coated. DailyMed.
Teva Pharmaceutical Industries. (2023). Teva announces FDA approval of Austedo XR (deutetrabenazine) extended-release tablets, a new once-daily formulation of Austedo (deutetrabenazine) tablets.
U.S. Food and Drug Administration. (2021). Grapefruit and some drugs don’t mix.
