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Table 6: Select LAI Atypical Antipsychotic Drug-Drug Interactions

Target Drug Interacting Drug Interaction Recommendation Clinical Significance Level
Aripiprazole Citalopram Increased risk of QT prolongation and serotonin syndrome because aripiprazole is a partial agonist of 5-HT1A and citalopram is a selective serotonin reuptake inhibitor Avoid use Major (DrugReax) 2-major(CP)
Aripiprazole Strong CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole) Increased risk of aripiprazole overexposure because aripiprazole is metabolized by CYP3A4 Monitor patient closely and adjust aripiprazole dosages as needed Major (DrugReax) 3-moderate (CP)
Long-acting injectable atypical antipsychotics (LAI AAs) CNS depressants Increased risk of respiratory and central nervous system depression due to additive pharmacologic effects Use cautiously together; observe patients for enhanced CNS adverse effects Major (DrugReax) 3-moderate (CP)
LAI AAs Metoclopramide Increased risk of extrapyramidal reactions or neuroleptic malignant syndrome Avoid use Contraindicated (DrugReax) 1-severe,2-major (CP)
LAI AAs QT interval- prolonging medications (e.g. posaconazole) Increased risk of QT interval prolongation Avoid use; if combined use necessary, administer cautiously together and monitor closely     Contraindicated (DrugReax) 1-severe,2-major,3-moderate (CP)
Olanzapine Agents that lower seizure threshold (e.g. clomipramine) Increased seizure risk because psychotropic drugs may reduce the seizure threshold Use caution when administered concomitantly Major (DrugReax) 3-moderate (CP)
Atypical antipsychotics CYP3A4 and CYP1A2 inducers (e.g. carbamazepine) Concomitant use can lead to decreased serum concentrations of atypical antipsychotics Monitor treat efficacy and adjust atypical antipsychotic dosages as needed Major (DrugReax) 2-major (CP)
Olanzapine (CYP1A2 substrate) CYP1A2 inhibitor (e.g. fluvoxamine) Increased olanzapine serum concentrations Monitor patient closely and adjust olanzapine dosages as needed Major (DrugReax) 2-major (CP)
Risperidone Serotonergic agents (e.g. linezolid) Increased risk of serotonin syndrome Monitor patients for serotonin syndrome Major (DrugReax) 2-major (CP)
Risperidone, Olanzapine Lithium Increased extrapyramidal symptoms; encephalopathy and brain damage have occurred in case reports due to unknown mechanism Monitor patients closely for symptoms and monitor lithium levels Major (DrugReax) 3-moderate (CP)