Nilotinib and Cariprazine: 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
Nilotinib
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.
These two medicines can interact. Nilotinib slows down a liver enzyme (called CYP3A4) that normally breaks down cariprazine (Vraylar). When that enzyme is slowed, more cariprazine and its active byproduct build up in your body. That extra buildup can lead to stronger side effects, like restlessness, drowsiness, muscle stiffness, or feeling shaky.
The good news is this is very manageable. Your care team knows to use a lower cariprazine dose when it is taken with a medicine like nilotinib, and they will watch how you respond. Keep taking both exactly as prescribed, and let your pharmacist or doctor know you are on both so they can tailor your dose.
Mechanism: Nilotinib is a moderate CYP3A4 inhibitor; cariprazine is a CYP3A4 substrate. Inhibition reduces cariprazine metabolism, increasing exposure of cariprazine and its active metabolite didesmethylcariprazine (DDCAR).
Direction/severity: Increased cariprazine effect; major, probable evidence. Onset unspecified but DDCAR has a long half-life, so effects accumulate.
Management (per labeling):
- Initiating cariprazine on a moderate inhibitor (schizophrenia/bipolar mania): 1.5 mg every other day.
- Bipolar depression / adjunctive MDD: 1.5 mg every other day.
- On stable 1.5 or 3 mg daily: reduce to 1.5 mg every other day.
- On 4.5 or 6 mg daily: reduce to 1.5 mg daily.
- On inhibitor discontinuation, re-titrate upward per response/tolerability. Monitor for EPS, akathisia, sedation.
What happens
Increased cariprazine and its major active metabolite (didesmethylcariprazine (DDCAR)) exposure
Interaction Deep Dive
Because cariprazine is metabolized by CYP3A4, giving it together with a moderate CYP3A4 inhibitor can raise levels of both cariprazine and its active metabolite, didesmethylcariprazine. If cariprazine is being started in a patient already receiving a moderate CYP3A4 inhibitor for schizophrenia or bipolar mania, begin with 1.5 mg orally every other day, and if warranted by clinical response and tolerability, increase to 1.5 mg orally every other day. For patients on a moderate CYP3A4 inhibitor being treated for bipolar depression or receiving adjunctive therapy for MDD, the dose is 1.5 mg orally every other day. When a moderate CYP3A4 inhibitor is added to an established cariprazine regimen, the cariprazine dose should be modified as follows: patients currently taking 1.5 or 3 mg once daily should be switched to 1.5 mg orally every other day, while those currently taking 4.5 or 6 mg once daily should be switched to 1.5 mg orally once daily. Upon discontinuation of the moderate CYP3A4 inhibitor, an increase in the cariprazine dose may be warranted according to clinical response and tolerability1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of cariprazine
How to manage this interaction
This interaction is well understood and your care team has clear ways to handle it. Because nilotinib raises cariprazine levels, the usual approach is to use a lower cariprazine dose while the two are combined, and to monitor how you feel.
- Keep taking both as prescribed unless your prescriber tells you otherwise.
- Your cariprazine dose may be adjusted and individualized (often to a lower dose or less frequent dosing) by your team.
- Watch for stronger side effects like restlessness, stiffness, tremor, or drowsiness, and report them.
- Tell your doctor or pharmacist whenever either medicine is started or stopped, since the dose may need to change again.
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 1.5 mg/day together with erythromycin (a moderate CYP3A4 inhibitor) 500 mg twice daily for 21 days led to an increase in cariprazine AUC (0 to 24 hours) and Cmax of roughly 50% 1. In one study that enrolled only White males receiving cariprazine 1.5 mg/day and erythromycin 500 mg twice daily (n=40), AUCs rose by 38% (cariprazine), 11% (desmethylcariprazine, an active metabolite), and 60% (didesmethylcariprazine, an active metabolite), while Cmax increased by 34%, 16%, and 62%, respectively. Tmax was unchanged by coadministration with erythromycin 2.
Common questions
Can I take Nilotinib and Cariprazine together?
Nilotinib can raise cariprazine levels and increase its side effects, so your care team will usually lower the cariprazine dose and monitor you. Keep taking both as prescribed and confirm your dosing with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Nilotinib and Cariprazine 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 Nilotinib and Cariprazine interaction managed?
This interaction is well understood and your care team has clear ways to handle it. Because nilotinib raises cariprazine levels, the usual approach is to use a lower cariprazine dose while the two are combined, and to monitor how you feel. Keep taking both as prescribed unless your prescriber tells you otherwise. Your cariprazine dose may be adjusted and individualized (often to a lower dose or le… 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.
Questions for your pharmacist
- Does my dose of Nilotinib or Cariprazine 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 (2)
- Product Information: VRAYLAR(R) oral capsules, cariprazine oral capsules. AbbVie Inc. (per FDA), North Chicago, IL, 2024. DailyMed
- Szabo M, Hujber Z, Harsanyi J, et al: Coadministration of cariprazine with a moderate CYP3A4 inhibitor in patients with schizophrenia: implications for dose adjustment and safety monitoring. Clin Pharmacokinet 2024; 63(10):1501-1510. PubMed
Keep reading about Nilotinib
Keep reading about Cariprazine
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