St John's Wort and Aripiprazole Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
St John's Wort
No brand names on recordAripiprazole Injection
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.
What happens
Reduced ARIPiprazole exposure
Interaction Deep Dive
Coadministration of ARIPiprazole and strong CYP3A inducers may reduce ARIPiprazole exposure. Avoid coadministration of extended release ARIPiprazole with strong CYP3A inducers for more than 14 days. No dosage adjustment required with concomitant use for less than 14 days41. Double the normal ARIPiprazole dose over 1 to 2 weeks when these agents are coadministered. Reduce ARIPiprazole dose to normal, if the CYP3A inducer is discontinued 32. If coadministration for more than 2 weeks is needed, increase the Aristada(R) dosage for patients receiving 441 mg IM monthly to 662 mg monthly 5. Avoid the concomitant use as Aristada Initio(TM) dose cannot be modified 6.
Why it happens (mechanism)
Induction of CYP3A-mediated metabolism of ARIPiprazole
Literature reports
2 reports — tap to read
a) Coadministration of carBAMazepine, a strong CYP3A 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 CYP3A, the most likely mechanism for this interaction is CYP3A induction 7.
b) Concomitant use of ARIPiprazole with carBAMazepine resulted in increased AUC and Cmax of ARIPiprazole by 0.1-fold and 0.2-fold, respectively. Concomitant use also increased the AUC and Cmax of dehydro-ARIPiprazole by 0.2-fold 41.
Common questions
Can I take St John's Wort and Aripiprazole Injection together?
Reduced ARIPiprazole exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the St John's Wort and Aripiprazole Injection 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 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 St John's Wort or Aripiprazole Injection 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 (7)
- Product Information: ABILIFY ASIMTUFII(R) intramuscular extended-release suspension, aripiprazole intramuscular extended-release suspension. Otsuka America Pharmaceutical Inc (per FDA), Rockville, MD, 2023.
- Product Information: ABILIFY MYCITE(R) oral tablets with sensor, aripiprazole oral tablets with sensor. Otsuka America Pharmaceutical Inc (per FDA), Rockville, MD, 2022. DailyMed
- 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, 2022. DailyMed
- Product Information: ABILIFY MAINTENA(R) intramuscular extended-release injection, aripiprazole intramuscular extended-release injection. Otsuka America Pharmaceutical Inc (per FDA), Rockville, MD, 2020.
- Product Information: ARISTADA(R) intramuscular extended-release injection, aripiprazole lauroxil intramuscular extended-release injection. Alkermes Inc (per FDA), Waltham, MA, 2018.
- Product Information: ARISTADA INITIO (R) intramuscular extended-release injection, aripiprazole lauroxil intramuscular extended-release injection. Alkermes, Inc (per manufacturer), Waltham, MA, 2020.
- 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
Keep reading about St John's Wort
Keep reading about Aripiprazole Injection
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist