Drug interactions
Brexpiprazole + Lopinavir
Severity: Major
Brexpiprazole and Lopinavir: 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
Lopinavir is co-formulated with ritonavir, which strongly inhibits CYP3A4 and also inhibits CYP2D6, so brexpiprazole exposure can rise substantially. This increases the risk of akathisia, sedation and orthostatic hypotension.
What this interaction means in plain words
Brexpiprazole and Lopinavir 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.
Brexpiprazole belongs to Central Nervous System; Lopinavir belongs to Anti Virals.
Why it happens
Ritonavir-boosted lopinavir inhibits CYP3A4 and CYP2D6, reducing brexpiprazole clearance.
What to do
Reduce brexpiprazole to a quarter of the usual dose when both pathways are inhibited, and monitor for adverse effects. Restore the usual dose after the protease inhibitor 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 Brexpiprazole
Other interactions of Lopinavir
- Alfuzosin + Lopinavir Contraindicated
- Avanafil + Lopinavir Contraindicated
- Cisapride + Lopinavir Contraindicated
- Dronedarone + Lopinavir Contraindicated
- Eletriptan + Lopinavir Contraindicated
- Eplerenone + Lopinavir Contraindicated
Frequently asked questions
Can I take Brexpiprazole with Lopinavir?
MediHelp rates the interaction as major. Brexpiprazole and Lopinavir 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. Lopinavir is co-formulated with ritonavir, which strongly inhibits CYP3A4 and also inhibits CYP2D6, so brexpiprazole exposure can rise substantially. This increases the risk of akathisia, sedation and orthostatic hypotension.
How serious is the interaction between Brexpiprazole and Lopinavir?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reduce brexpiprazole to a quarter of the usual dose when both pathways are inhibited, and monitor for adverse effects. Restore the usual dose after the protease inhibitor is stopped.
What other medicines interact with Brexpiprazole?
MediHelp also lists interactions of Brexpiprazole with, for example, Alfentanil, Amisulpride, Apalutamide. The full list is on the Brexpiprazole page.
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