Cariprazine and Mavacamten: 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
Mavacamten
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.
You've been prescribed Camzyos (mavacamten) for your heart along with Vraylar (cariprazine). Here's the plain-English version: mavacamten can gently speed up how your body breaks down cariprazine. That means the level of cariprazine in your blood may drop a bit, and it could work a little less well over time.
The good news is this is based on theory and lab predictions, not strong real-world reports, so it may be mild. Your care team can handle it easily by keeping an eye on how you're feeling and adjusting your dose if needed. Keep taking both as prescribed and let your doctor or pharmacist know if your mood symptoms seem to come back.
Mechanism: Mavacamten is a moderate CYP3A4 inducer. Cariprazine is a CYP3A4 substrate (not a prodrug), so induction increases its clearance, lowering exposure (AUC/Cmax) and potentially reducing antipsychotic efficacy.
Magnitude/evidence: Theoretical. Extrapolated from a midazolam probe study: AUC decreased 13% (up to a predicted 45% at upper therapeutic mavacamten doses in HCM patients). Onset unspecified; effect develops over days as enzyme induction establishes.
- Monitor for loss of cariprazine efficacy (return of psychiatric symptoms).
- Cariprazine dose may be adjusted and individualized by the care team.
- No absolute contraindication; manageable with clinical monitoring.
What happens
Reduced CYP3A4 substrate exposure and reduced efficacy of CYP3A4 substrate
Interaction Deep Dive
When mavacamten is given together with CYP3A4 substrates, the exposure of those substrates may fall, which can in turn diminish their effectiveness. For this reason, careful monitoring is warranted whenever mavacamten is combined with CYP3A4 substrates. A drug interaction study in healthy subjects showed that a 16 day regimen of mavacamten (25 mg on days 1 and 2, then 15 mg for the next 14 days) lowered midazolam AUC(inf) by 13% and Cmax by 7%. In symptomatic obstructive hypertrophic cardiomyopathy (HCM) patients receiving once daily mavacamten at the higher end of the therapeutic range, midazolam AUC(inf) and Cmax are projected to fall by as much as 45% and 24%, respectively1.
Why it happens (mechanism)
Induction of CYP3A4-substrate metabolism by mavacamten
How to manage this interaction
This interaction is generally manageable, and you should keep taking both medications as prescribed unless your care team tells you otherwise.
- Your team may monitor you more closely for any return of the symptoms cariprazine treats (such as mood or psychotic symptoms).
- Your cariprazine dose may be adjusted and individualized if needed.
- Tell your pharmacist or prescriber if you notice your psychiatric symptoms coming back or worsening after starting mavacamten.
Because this is based on theoretical data, the effect may be small, but reporting changes helps your team keep things on track.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a drug interaction study, giving a 16 day regimen of mavacamten (25 mg on days 1 and 2, then 15 mg for 14 days) together with midazolam lowered midazolam AUC(inf) by 13% and Cmax by 7% in healthy subjects. When mavacamten is given once daily to symptomatic obstructive hypertrophic cardiomyopathy (HCM) patients at the top of the therapeutic range, midazolam AUC(inf) and Cmax are projected to fall by up to 45% and 24%, respectively 1.
Common questions
Can I take Cariprazine and Mavacamten together?
Mavacamten may modestly lower cariprazine levels and could reduce how well it works, so watch for returning symptoms and report them; your care team can adjust the dose if needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Cariprazine and Mavacamten interaction?
It is rated moderate. Can be significant — usually manageable with 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 Mavacamten interaction managed?
This interaction is generally manageable, and you should keep taking both medications as prescribed unless your care team tells you otherwise. Your team may monitor you more closely for any return of the symptoms cariprazine treats (such as mood or psychotic symptoms). Your cariprazine dose may be adjusted and individualized if needed. Tell your pharmacist or prescriber if you notice your psychiat… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Cariprazine or Mavacamten 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 anything you'd monitor while I'm on both?
References (1)
- Product Information: CAMZYOS(R) oral capsules, mavacamten oral capsules. Bristol-Myers Squibb Company (per Manufacturer), Princeton, NJ, 2025. DailyMed
Keep reading about Mavacamten
Keep reading about Cariprazine
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