Drug interactions
Brexpiprazole + Nelfinavir
Severity: Major
Brexpiprazole and Nelfinavir: 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
Nelfinavir is a CYP3A4 inhibitor and can raise brexpiprazole exposure, increasing adverse effects such as sedation, akathisia and hypotension. The effect is larger in patients also taking CYP2D6 inhibitors or who are poor CYP2D6 metabolizers.
What this interaction means in plain words
Brexpiprazole and Nelfinavir 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; Nelfinavir belongs to Anti Virals.
Why it happens
Inhibition of CYP3A4-mediated brexpiprazole metabolism by nelfinavir.
What to do
Give half the usual brexpiprazole dose with nelfinavir, and a quarter of the usual dose if a CYP2D6 inhibitor is also given; monitor tolerability.
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 Nelfinavir
- Alfuzosin + Nelfinavir Contraindicated
- Avanafil + Nelfinavir Contraindicated
- Dronedarone + Nelfinavir Contraindicated
- Eletriptan + Nelfinavir Contraindicated
- Ergotamine + Nelfinavir Contraindicated
- Flibanserin + Nelfinavir Contraindicated
Frequently asked questions
Can I take Brexpiprazole with Nelfinavir?
MediHelp rates the interaction as major. Brexpiprazole and Nelfinavir 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. Nelfinavir is a CYP3A4 inhibitor and can raise brexpiprazole exposure, increasing adverse effects such as sedation, akathisia and hypotension. The effect is larger in patients also taking CYP2D6 inhibitors or who are poor CYP2D6 metabolizers.
How serious is the interaction between Brexpiprazole and Nelfinavir?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Give half the usual brexpiprazole dose with nelfinavir, and a quarter of the usual dose if a CYP2D6 inhibitor is also given; monitor tolerability.
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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