Cariprazine and Clarithromycin: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 16, 2026 · Source data updated Jul 16, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Clarithromycin
Cariprazine
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Clarithromycin (Biaxin) can raise the level of cariprazine (Vraylar) in your body. Clarithromycin slows down the liver enzyme that normally breaks down cariprazine, so more of the medicine (and its active form) can build up. That can mean stronger side effects like restlessness, trouble sleeping, drowsiness, or feeling shaky.
The good news is this is very manageable. Your care team may lower your cariprazine dose or space it out further while you are on the antibiotic, and adjust it again once you finish the antibiotic. Please don't change either medicine on your own, just check in with your pharmacist or doctor so they can tailor your dose.
Mechanism: Clarithromycin is a strong CYP3A4 inhibitor; cariprazine is a CYP3A4 substrate. Inhibition reduces clearance of cariprazine and its active metabolite didesmethylcariprazine, increasing exposure.
- Magnitude: With ketoconazole, cariprazine AUC and Cmax rose ~100%.
- Evidence/onset: Probable; onset unspecified.
- Management (per labeling): Reduce/space cariprazine dosing. New start with a strong inhibitor: 1.5 mg every 3 days, may increase to 1.5 mg every other day per tolerability. Stable 1.5-3 mg/day, adjust to 1.5 mg every 3 days; stable 4.5-6 mg/day, adjust to 1.5 mg every other day. On inhibitor discontinuation, dose may need re-titration upward.
- Monitor for EPS, akathisia, sedation.
What happens
Increased exposure to cariprazine and its active metabolite, didesmethylcariprazine
Interaction Deep Dive
Giving cariprazine (which is metabolized by CYP3A4) together with a potent CYP3A4 inhibitor can raise the levels of both cariprazine and its active metabolite, didesmethylcariprazine. In interaction studies, combining cariprazine with ketoconazole (a strong CYP3A4 inhibitor) produced an increase of roughly 100% in both AUC and Cmax. Consequently, when starting cariprazine in a patient already receiving a strong CYP3A4 inhibitor (for schizophrenia or bipolar mania), begin with 1.5 mg orally every 3 days, and if warranted by clinical response and tolerability, raise the dose to 1.5 mg orally every other day. For those on a strong CYP3A4 inhibitor being treated for bipolar depression or receiving cariprazine as adjunctive therapy for MDD, the dose is 1.5 mg orally every 3 days. If a strong CYP3A4 inhibitor is added while the patient is already stable on cariprazine, dosage adjustments are needed: for patients taking 1.5 or 3 mg once daily, change cariprazine to 1.5 mg orally every 3 days when starting the inhibitor; for patients taking 4.5 or 6 mg once daily, change cariprazine to 1.5 mg orally every other day when starting the inhibitor. Once the strong CYP3A4 inhibitor is stopped, an increase in the cariprazine dose may be required, guided by clinical response and tolerability1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of cariprazine
How to manage this interaction
This interaction is well characterized and can be managed by adjusting your cariprazine. Keep taking both medicines exactly as prescribed unless your care team tells you otherwise.
- Your prescriber will typically lower your cariprazine dose or take it less often (for example, every 3 days or every other day) while you are on clarithromycin.
- When the clarithromycin course ends, your cariprazine dose may need to be increased again based on how you respond.
- Tell your pharmacist or doctor before starting the antibiotic, and report any new restlessness, tremor, stiffness, or heavy drowsiness.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In drug interaction studies, giving cariprazine 0.5 mg/day together with ketoconazole 400 mg/day led to an increase in total cariprazine AUC and Cmax of approximately 100% 1.
Common questions
Can I take Cariprazine and Clarithromycin together?
Clarithromycin can roughly double cariprazine exposure, so your care team will likely reduce or space out your cariprazine dose while you are on the antibiotic and readjust it afterward. Keep both as prescribed and check with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Cariprazine and Clarithromycin interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Cariprazine and Clarithromycin interaction managed?
This interaction is well characterized and can be managed by adjusting your cariprazine. Keep taking both medicines exactly as prescribed unless your care team tells you otherwise. Your prescriber will typically lower your cariprazine dose or take it less often (for example, every 3 days or every other day) while you are on clarithromycin. When the clarithromycin course ends, your cariprazine dose… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Cariprazine or Clarithromycin need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: VRAYLAR(R) oral capsules, cariprazine oral capsules. AbbVie Inc. (per FDA), North Chicago, IL, 2024. DailyMed
Keep reading about Clarithromycin
Keep reading about Cariprazine
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