Apalutamide with Aripiprazole Interaction Details
Brand Names Associated with Apalutamide
- Apalutamide
- Erleada®
Brand Names Associated with Aripiprazole
- Abilify Mycite®
- Abilify®
- Aripiprazole
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Mar 04, 2024
Interaction Effect
Reduced ARIPiprazole exposure
Interaction Summary
Coadministration of ARIPiprazole and this drug, a strong CYP3A4 inducer, may result in decreased ARIPiprazole plasma levels. Avoid coadministration of long-acting ARIPiprazole injection with strong CYP3A4 inducers for more than 14 days. Dosage adjustments are not recommended for patients with concomitant use of CYP3A4 inducers for less than 14 days[1][2]. Double the normal immediate-release ARIPiprazole dose over 1 to 2 weeks when these agents are coadministered. No dose adjustments are necessary for patients being treated for major depressive disorder. If the CYP3A4 inducer is discontinued, the ARIPiprazole dose should be decreased over 1 to 2 weeks to the original level [3][4][5].
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Coadministration of ARIPiprazole and a strong CYP3A4 inducer may result in decreased ARIPiprazole plasma levels. Avoid coadministration of long-acting ARIPiprazole injection with strong CYP3A4 inducers for more than 14 days. Dosage adjustments are not recommended for patients with concomitant use of CYP3A4 inducers for less than 14 days[1][2]. Double the normal ARIPiprazole dose over 1 to 2 weeks when these agents are coadministered. No dose adjustments are necessary for patients being treated for major depressive disorder. If the CYP3A4 inducer is discontinued, the ARIPiprazole dose should be decreased over 1 to 2 weeks to the original level [3][4][5].
Mechanism Of Interaction
Induction of CYP3A4-mediated metabolism of ARIPiprazole
Literature Reports
A) During drug interaction studies, coadministration of ARIPiprazole 30 mg/day and carbamazepine 200 mg twice daily resulted in a 70% decrease in the AUC and Cmax of both ARIPiprazole and its active metabolite [6].
B) Coadministration of carbamazepine, a strong CYP3A4 inducer, twice daily with ARIPiprazole once daily decreased plasma concentrations of ARIPiprazole and its active metabolite, dehydro-ARIPiprazole by 64% and 68%, respectively. In this pharmacokinetic study, 18 patients with schizophrenia (mean age 35.8 years) on a fixed dose of ARIPiprazole (12 mg (n=3) or 24 mg (n=18)) once daily for 3 to 5 weeks were started on carbamazepine 200 mg twice daily for 1 week. Blood samples were analyzed before carbamazepine initiation and 1 week after completion. The mean carbamazepine plasma concentration achieved was 9.3 mcg/mL. A review of CYP2D6 genotypes showed no association between genotypes and changes in ARIPiprazole and dehydro-ARIPiprazole plasma concentrations. The concentration ratio of ARIPiprazole to dehydro-ARIPiprazole did not change during the study. Because carbamazepine is a potent inducer of CYP3A4, the most likely mechanism for this interaction is CYP3A4 induction [7].
References
1 ) Product Information: ABILIFY MAINTENA(R) intramuscular extended-release injection, aripiprazole intramuscular extended-release injection. Otsuka America Pharmaceutical, Inc (per manufacturer), Rockville, MD, 2017.
2 ) Product Information: ABILIFY ASIMTUFII(R) intramuscular extended-release suspension, aripiprazole intramuscular extended-release suspension. Otsuka America Pharmaceutical Inc (per FDA), Rockville, MD, 2023.
3 ) Product Information: ABILIFY(R) oral tablets, oral solution, intramuscular injection, aripiprazole oral tablets, oral solution, intramuscular injection. Otsuka America Pharmaceutical Inc (per FDA), Rockville, MD, 2017.
4 ) Product Information: ABILIFY DISCMELT(R) oral disintegrating tablets, aripiprazole oral disintegrating tablets. Otsuka America Pharmaceutical Inc (per FDA), Rockville, MD, 2017.
5 ) Product Information: ABILIFY MYCITE(R) oral tablets with sensor, aripiprazole oral tablets with sensor. Otsuka America Pharmaceutical, Inc (per FDA), Rockville, MD, 2017.
6 ) Product Information: ABILIFY(R) oral tablets, oral solution, intramuscular injection, aripiprazole oral tablets, oral solution, intramuscular injection. Otsuka America Pharmaceutical, Inc. (per FDA), Rockville, MD, 2014.
7 ) Nakamura A, Mihara K, Nagai G, et al: Pharmacokinetic and pharmacodynamic interactions between carbamazepine and aripiprazole in patients with schizophrenia. Ther Drug Monit 2009; 31(5):575-578.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...
Apalutamide Overview
-
Apalutamide is used to treat certain types of prostate cancer (cancer in men that begins in the prostate [a male reproductive gland]) and has spread to other parts of the body or that has not spread to other parts of the body but has not been helped by other medical treatments. Apalutamide is in a class of medications called androgen receptor inhibitors. It works by blocking the effects of androgen (a male reproductive hormone) to stop the growth and spread of cancer cells.
Aripiprazole Overview
-
Aripiprazole is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used alone or with other medications to treat episodes of mania or mixed episodes (symptoms of mania and depression that happen together) in adults, teenagers, and children 10 years of age and older with bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Aripiprazole is also used with an antidepressant to treat depression when symptoms cannot be controlled by the antidepressant alone. Aripiprazole is also used to treat children 6 to 17 years of age who have autistic disorder (a developmental problem that causes difficulty communicating and interacting with others). Aripiprazole may help control irritable behavior such as aggression, temper tantrums, and frequent mood changes in these children. Aripiprazole is also used to treat children 6 to 18 years of age who have Tourette's disorder (a condition characterized by the need to perform repeated motions or to repeat sounds or words). Aripiprazole is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.
Return To Our Drug Interaction Homepage
Feedback, Question Or Comment About This Information?
Ask Dr. Brian Staiger, PharmD, our medical editor, directly! He's always more than happy to assist.
Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.