Drug interactions
Brexpiprazole + Mitotane
Severity: Major
Brexpiprazole and Mitotane: 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
Mitotane is a potent CYP3A4 inducer, and its effect persists for weeks after discontinuation. It can markedly lower brexpiprazole concentrations and cause loss of efficacy.
What this interaction means in plain words
Brexpiprazole and Mitotane 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; Mitotane belongs to Oncology.
Why it happens
Strong induction of CYP3A4 by mitotane accelerates brexpiprazole metabolism.
What to do
Monitor response and increase brexpiprazole dose gradually over 1 to 2 weeks as needed. Because induction persists after mitotane is stopped, reassess dose slowly.
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 Mitotane
- Doravirine + Mitotane Contraindicated
- Fostemsavir + Mitotane Contraindicated
- Lorlatinib + Mitotane Contraindicated
- Abiraterone + Mitotane Major
- Apixaban + Mitotane Major
- Aprepitant + Mitotane Major
Frequently asked questions
Can I take Brexpiprazole with Mitotane?
MediHelp rates the interaction as major. Brexpiprazole and Mitotane 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. Mitotane is a potent CYP3A4 inducer, and its effect persists for weeks after discontinuation. It can markedly lower brexpiprazole concentrations and cause loss of efficacy.
How serious is the interaction between Brexpiprazole and Mitotane?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor response and increase brexpiprazole dose gradually over 1 to 2 weeks as needed. Because induction persists after mitotane is stopped, reassess dose slowly.
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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