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09/17/2024 | Press release | Distributed by Public on 09/17/2024 15:27

From St. John’s Wort to Seizure Medications: 9 Vraylar Interactions to Be Aware Of

Key takeaways:

  • Vraylar (cariprazine) is an atypical antipsychotic that treats mental health conditions such as bipolar depression and schizophrenia. It interacts with a number of medications.

  • Carbamazepine (Tegretol), phenytoin (Dilantin), and rifampin (Rifadin) interact with Vraylar by lowering its levels in your body. This can make Vraylar less effective. The herbal supplement St. John's wort may also have this effect.

  • Clarithromycin, fluconazole (Diflucan), and some calcium channel blockers can raise Vraylar levels in the body. This increases the risk of Vraylar side effects. Grapefruit juice may also cause this interaction.

GoodRx Health

Vraylar (cariprazine) is an atypical antipsychotic. It's FDA approved to treat mental health conditions, such as schizophrenia and bipolar 1 disorder.

When taking Vraylar, knowing about possible drug interactions is one precaution that can help keep you safe. It's helpful to be aware of food and supplement interactions as well. Some interactions raise the risk of Vraylar side effects. Others could make Vraylar less effective.

Here, we'll review nine key interactions that are discussed in the manufacturer's label for Vraylar. Keep in mind that this isn't a complete list of every possible Vraylar interaction. Sharing your current medication list with your healthcare team can help them check for interactions before you start taking Vraylar.

EXPERT PICKS: WHAT TO READ NEXT

  • Vraylar versus Abilify: Here's how these two medications compare when it comes to treating bipolar disorder.

  • What is it like to live with bipolar disorder? Read these first-hand accounts of how people manage their condition and work to remove the stigma surrounding it.

  • Vraylar side effects: Learn what side effects are possible while taking Vraylar and steps you can take to manage them.

1. Carbamazepine

Carbamazepine (Tegretol) is an antiepileptic medication that helps treat seizures. Carbamazepine may lower Vraylar levels in the body if they're taken together. This can make Vraylar less effective.

Taking both Vraylar and carbamazepine isn't recommended. Your prescriber will likely adjust your medication regimen to avoid combining these medications.

2. Phenytoin

Phenytoin (Dilantin) is another medication that treats seizures. Phenytoin can also lower Vraylar levels in your body and make it less effective if they're taken together.

Similar to carbamazepine, it's best to avoid this combination. If you take phenytoin, your prescriber will likely suggest an alternative to Vraylar.

3. St. John's wort

St. John's wort is a popular dietary supplement. It's marketed for symptoms of depression, but it's also known to interact with a lot of medications, including Vraylar. St. John's wort can make Vraylar less effective if they're taken together.

You should avoid combining St. John's wort with Vraylar. Since you can get St. John's wort over the counter (OTC), make sure to let your healthcare team know if you're taking it before starting Vraylar. If you feel like your mental health symptoms aren't being helped by your current treatment, make sure to share that with them, too.

4. Rifampin

Rifampin (Rifadin) is an antibiotic that treats tuberculosis and other infections. It's also known for interacting with many medications. Rifampin causes your liver to process and clear Vraylar faster from your body. This can lower Vraylar levels, making it less effective.

Unlike most other antibiotics, treatment with rifampin can last for several months. If you need to take rifampin, your prescriber may have you stop taking Vraylar or change you to a different medication until your treatment is finished.

5. Macrolide antibiotics like clarithromycin

Some macrolide antibiotics can also interact with Vraylar. Common examples include clarithromycin and erythromycin (Ery-Tab). These medications can increase Vraylar levels in the body. This raises your risk of Vraylar side effects, such as headaches and sleeping problems.

The manufacturer suggests lowering your Vraylar dosage by half if you're taking it with these antibiotics. So be sure to let your prescriber know you're taking Vraylar if you need antibiotic treatment. They may choose a different antibiotic that doesn't interact with Vraylar. Or they may temporarily lower your Vraylar dosage during your antibiotic treatment.

6. Oral azole antifungals like fluconazole

Oral azole antifungals treat conditions such as yeast infections and oral thrush. Examples include fluconazole (Diflucan) and ketoconazole. Like macrolide antibiotics, these antifungals can increase Vraylar levels in the body. This can make Vraylar side effects worse or more likely to happen.

Your prescriber may lower your Vraylar dosage if you need to take these two medications together. Or they may just have you keep a closer eye out for side effects.

Good to know: If you're using a topical antifungal product, such as a cream or shampoo, less medication gets absorbed into your body. So a topical antifungal probably won't interact with Vraylar the way oral antifungals do. Still, it's best to let your prescriber know about any topical or OTC products you're using.

7. Some calcium channel blockers

Calcium channel blockers (CCBs) are a group of medications used for heart-related conditions. A few of them - diltiazem (Cardizem), nifedipine (Procardia), and verapamil (Verelan) - can raise Vraylar levels and increase your risk of side effects.

Your prescriber may suggest a lower Vraylar dosage if you take it with a CCB. Or they may keep an eye out for side effects and only adjust your dosage if they occur. Be sure to let your prescriber know if any symptoms change or appear while you're taking both medications.

8. Ritonavir

Ritonavir (Norvir) is an antiviral medication that's known to interact with many medications, including Vraylar. It's frequently added to other antivirals to boost their effectiveness. Paxlovid (nirmatrelvir / ritonavir), a COVID-19 treatment, is one example. Kaletra (lopinavir / ritonavir), an HIV medication, is another.

Ritonavir can increase Vraylar levels. Your prescriber may lower your Vraylar dosage if you're taking it with ritonavir. But for a short course of treatment, such as with Paxlovid, you may not need a dosage change. Follow your prescriber's instructions and ask questions if something seems unclear.

9. Grapefruit juice

Grapefruit juice is well-known for interacting with medications. The most common reason is that grapefruit blocks an enzyme (protein) that breaks down many medications, including Vraylar. Consuming grapefruit (both the juice and the fruit itself) could lead to higher levels of Vraylar in your body, raising the risk of side effects.

It's best to avoid grapefruit while you're taking Vraylar. But if you're really craving some, talk to your healthcare team. They can let you know if there's a safe amount of grapefruit you can have without causing an issue.

10. Alcohol

You shouldn't drink alcohol if you're taking Vraylar or any other atypical antipsychotics. Alcohol can contribute to side effects such as dizziness, vomiting, and erectile dysfunction. It can also increase the risk of more serious side effects, such as Type 2 diabetes and seizures. What's more, alcohol may worsen the symptoms of the mental health condition you're taking Vraylar to treat.

These issues mainly apply to drinking large amounts of alcohol or frequent drinking. But you should still check with your prescriber about whether 1 or 2 drinks on occasion is OK. Everyone responds to alcohol differently, and your prescriber can look at your medical history to help determine what's safe for you.

Frequently asked questions

Does Vraylar interact with caffeine?
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Caffeine can interact with some antipsychotic medications, but Vraylar doesn't seem to be one of them. Caffeine can increase the levels of olanzapine (Zyprexa) and clozapine (Clozaril) because it blocks an enzyme that breaks them down in the body. But Vraylar isn't broken down by this enzyme, so caffeine isn't likely to cause a problem if you're taking it.

Can you take Vraylar with antidepressants like Wellbutrin and Prozac?
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Yes, Vraylar is approved to treat depression if it's taken along with another antidepressant medication. Clinical studies showed that combining Vraylar with medications such as bupropion (Wellbutrin), fluoxetine (Prozac), and escitalopram (Lexapro) was safe and effective. But you should only combine Vraylar with other medications if your prescriber OKs it. They can make sure you're on a dose and combination that's safe for you.

The bottom line

Vraylar (cariprazine) is an atypical antipsychotic medication that's approved to treat certain mental health conditions. Carbamazepine (Tegretol, Equetro), phenytoin (Dilantin), and St. John's wort can make Vraylar less effective. It's best to avoid taking Vraylar with these medications.

Clarithromycin, fluconazole (Dilfucan), and calcium channel blockers can raise the risk of Vraylar side effects. Ritonavir, an antiviral that's an ingredient in Paxlovid, can also have this effect. You may need a lower Vraylar dosage if you're taking it with these medications.

It's best to avoid grapefruit and alcohol if you're taking Vraylar. They can increase your risk of side effects. Talk to your prescriber about whether a small amount of either is safe for you on occasion.

Why trust our experts?

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.
Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.
Reviewed by:
Daphne Berryhill, RPh
Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

References

Broderick, P. J., et al. (2005). Caffeine and psychiatric medication interactions: A review. The Journal of the Oklahoma State Medical Association.

Remedy Repack Inc. (2024). Vraylar-cariprazine capsule, gelatin coated [package insert].

View All References (3)
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GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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