Cariprazine and St John's Wort: 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
St John's Wort
No brand names on recordCariprazine
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.
St. John's Wort and Vraylar (cariprazine) can interact. St. John's Wort is a herbal product that can speed up an enzyme in your body called CYP3A4. That same enzyme handles cariprazine, the medicine that helps steady your mood and thinking. Here is the tricky part: this enzyme both builds up and clears away cariprazine's active forms, so speeding it up could throw off your levels either way. Because of that, the combination is not recommended.
The good news is this is very manageable. Please don't start or stop anything on your own. Just let your doctor or pharmacist know you're taking (or thinking about taking) St. John's Wort, and they can guide you.
Mechanism: St. John's Wort is a potent CYP3A4 inducer; cariprazine is a CYP3A4 substrate whose active metabolites (desmethyl- and didesmethyl-cariprazine) are both formed and eliminated via CYP3A4.
- Direction/magnitude: Net effect on total active-moiety exposure is unpredictable because induction affects both formation and clearance. Not formally evaluated.
- Evidence: Theoretical.
- Onset: Unspecified (enzyme induction is typically delayed, over days to weeks).
- Management: Coadministration is not recommended. Avoid the combination; if unavoidable, monitor closely for loss of efficacy or altered tolerability and individualize therapy.
What happens
Effects on the cariprazine exposure has not been evaluated and the net effect is unclear
Interaction Deep Dive
It is advised against giving cariprazine (which is metabolized by CYP3A4) together with a CYP3A4 inducer. The generation as well as the clearance of cariprazine's active metabolites depend on CYP3A4. How CYP3A4 inducers influence cariprazine exposure has not been studied, so the overall outcome remains uncertain1.
Why it happens (mechanism)
Induction of CYP3A4-mediated metabolism of cariprazine
How to manage this interaction
What your care team may do:
- Because the net effect on cariprazine is unpredictable, the combination is generally not recommended, so your team may suggest avoiding St. John's Wort or choosing a different option.
- If both are used, they may watch you more closely for symptoms returning or for new side effects, and tailor your plan to you.
What you should do: Keep taking your Vraylar exactly as prescribed. Tell your pharmacist or prescriber about any herbal products or supplements, including St. John's Wort, before starting or stopping them so they can guide you safely.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Cariprazine and St John's Wort together?
Combining St. John's Wort with cariprazine (Vraylar) is not recommended because it may unpredictably change cariprazine levels. Don't change anything on your own; talk with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Cariprazine and St John's Wort 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 St John's Wort interaction managed?
What your care team may do: Because the net effect on cariprazine is unpredictable, the combination is generally not recommended, so your team may suggest avoiding St. John's Wort or choosing a different option. If both are used, they may watch you more closely for symptoms returning or for new side effects, and tailor your plan to you. What you should do: Keep taking your Vraylar exactly as presc… 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 St John's Wort 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
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