Drug interactions
Aripiprazole + St john's wort
Severity: Major
Aripiprazole and St john's wort: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
St John's wort induces CYP3A4 and can substantially lower aripiprazole concentrations. This may lead to loss of antipsychotic or mood-stabilizing effect and relapse.
What this interaction means in plain words
Aripiprazole and St john's wort can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Induction of CYP3A4 (and possibly P-glycoprotein) increases aripiprazole clearance.
What to do
Avoid the combination. If a strong CYP3A4 inducer is unavoidable, labeling advises roughly doubling the aripiprazole dose, and the dose should be reduced again after the inducer is stopped.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Aripiprazole
- Aripiprazole + Pimozide Contraindicated
- Aripiprazole + Thioridazine Contraindicated
- Amisulpride + Aripiprazole Major
- Aripiprazole + Arsenic trioxide Major
- Aripiprazole + Calcium / magnesium / potassium / sodium oxybates Major
- Aripiprazole + Carbamazepine Major
Frequently asked questions
Can I take Aripiprazole with St john's wort?
MediHelp rates the interaction as major. Aripiprazole and St john's wort can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. St John's wort induces CYP3A4 and can substantially lower aripiprazole concentrations. This may lead to loss of antipsychotic or mood-stabilizing effect and relapse.
How serious is the interaction between Aripiprazole and St john's wort?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination. If a strong CYP3A4 inducer is unavoidable, labeling advises roughly doubling the aripiprazole dose, and the dose should be reduced again after the inducer is stopped.
What other medicines interact with Aripiprazole?
MediHelp also lists interactions of Aripiprazole with, for example, Pimozide, Thioridazine, Amisulpride. The full list is on the Aripiprazole page.
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