Interactions between Aripiprazole and Galantamine
1 drug interaction and 43 additional warnings found for the following 2 drugs:
- aripiprazole
- galantamine
Drug interactions
Moderate drug interactions
Moderate:
galantamine ARIPiprazole
Applies to: galantamine and aripiprazole
Generally avoid
Due to opposing effects, agents that possess anticholinergic activity (e.g., sedating antihistamines; antispasmodics; neuroleptics; phenothiazines; skeletal muscle relaxants; tricyclic antidepressants; class IA antiarrhythmics especially disopyramide; carbamazepine; cimetidine; ranitidine) may negate the already small pharmacologic benefits of acetylcholinesterase inhibitors in the treatment of dementia. These agents may also adversely affect elderly patients in general. Clinically significant mental status changes associated with anticholinergic agents can range from mild cognitive impairment to delirium, and patients with Alzheimer's disease and other dementia are especially sensitive.
Management
Drugs that possess anticholinergic activity should generally be avoided in patients with Alzheimer's disease or other cognitive impairment, regardless of whether they are receiving an acetylcholinesterase inhibitor. For patients requiring treatment to counteract adverse effects of acetylcholinesterase inhibitor therapy (e.g., gastrointestinal intolerance, urinary problems), an agent without anticholinergic properties should be used whenever possible. Otherwise, a dosage reduction, slower titration, or even discontinuation of the acetylcholinesterase inhibitor should be considered. For patients who are already receiving an acetylcholinesterase inhibitor with anticholinergic agents, every attempt should be made to discontinue the latter or substitute them with less anticholinergic alternatives. Caution is required, however, since anticholinergic withdrawal may occur. Seizures have been reported following abrupt discontinuation of anticholinergics during acetylcholinesterase inhibitor therapy.
References (6)
- Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC (1991) "Explicit criteria for determining inappropriate medication use in nursing home residents." Arch Intern Med, 151, p. 1825-32
- Katz IR, Sands LP, Bilker W, DiFilippo S, Boyce A, D'Angelo K (1998) "Identification of medications that cause cognitive impairment in older people: the case of oxybutynin chloride." J Am Geriatr Soc, 46, p. 8-13
- Roe CM, Anderson MJ, Spivack B (2002) "Use of anticholinergic medications by older adults with dementia." J Am Geriatr Soc, 50, p. 836-42
- Edwards KR, O'Connor JT (2002) "Risk of delirium with concomitant use of tolterodine and acetylcholinesterase inhibitors." J Am Geriatr Soc, 50, p. 1165-6
- Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH (2003) "Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts." Arch Intern Med, 163, p. 2716-2724
- Carnahan RM, Lund BC, Perry PJ, Chrischilles EA (2004) "The concurrent use of anticholinergics and cholinesterase inhibitors: rare event or common practice?" J Am Geriatr Soc, 52, p. 2082-7
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
galantamine Food/Lifestyle
Applies to: galantamine
Adjust dosing interval
The administration of galantamine with food and adequate fluid intake may reduce the impact of nausea, vomiting, diarrhea, anorexia, and weight loss that are commonly associated with acetylcholinesterase inhibitors (AChEIs). According to product labeling, the administration of food with various galantamine formulations (e.g., liquid, immediate-release tablets, modified/extended-release capsules) has no significant effect on the systemic absorption (AUC) of galantamine. While the presence of food has been shown to delay the rate of absorption (Tmax) and reduce peak concentration (Cmax), these changes are unlikely to be clinically significant. For example, when galantamine modified release was given after food, Tmax increased by approximately 30 minutes. Similarly, in 24 healthy elderly subjects, the presence of food with galantamine immediate release tablets (12 mg twice a day) delayed the Tmax by 1.5 hours and decreased the Cmax by about 25% without affecting the AUC.
Monitor
Grapefruit and grapefruit juice may increase the plasma concentrations of galantamine, which is partially metabolized by the CYP450 3A4 isoenzyme. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. Inhibition of hepatic CYP450 3A4 may also contribute. The interaction has not been studied with grapefruit juice, but has been reported with both moderate and potent CYP450 3A4 inhibitors. When study subjects (n=16) received the potent CYP450 3A4 inhibitor ketoconazole (200 mg twice daily for 4 days) with galantamine (4 mg twice daily for 8 days), the systemic exposure (AUC) of galantamine increased by 30%. However, when study subjects (n=16) received the moderate CYP450 3A4 inhibitor erythromycin (500 mg 4 times daily for 4 days) with galantamine (4 mg twice daily for 6 days), the AUC of galantamine only increased by 10%. In general, the effects of grapefruit products are concentration-, dose-, and preparation-dependent, and can vary widely among brands. Certain preparations of grapefruit (e.g., high dose, double strength) have sometimes demonstrated potent inhibition of CYP450 3A4, while other preparations (e.g., low dose, single strength) have typically demonstrated moderate inhibition. While the clinical significance of this interaction is unknown, increased exposure to galantamine may lead to AChEI related adverse effects such as vagotonic effects on the heart rate (e.g., bradycardia and heart block), neurologic side effects (e.g., seizure activity), respiratory distress, bladder outflow obstruction, dizziness or syncope, nausea, vomiting and/or diarrhea.
Management
According to product labeling, galantamine should be administered with food and adequate fluid intake to reduce the impact of cholinergic-related gastrointestinal adverse effects (e.g., nausea, vomiting, diarrhea, anorexia, and weight loss). Caution and closer monitoring for AChEI related adverse effects may advisable if galantamine is used in combination with grapefruit and/or grapefruit juice. Modified and/or extended-release formulations must also be swallowed whole and not crushed, chewed, or divided.
References (6)
- (2024) "Product Information. Galantamine Hydrobromide ER (galantamine)." Aurobindo Pharma USA Inc
- (2024) "Product Information. Galantamine Hydrobromide (galantamine)." Aurobindo Pharma USA Inc
- (2022) "Product Information. Gaalin (galantamine)." Auro Pharma Inc
- (2023) "Product Information. Galzemic (galantamine)." Zentiva Pharma UK Ltd
- (2023) "Product Information. Galantyl (galantamine)." Viatris UK Healthcare Ltd
- (2020) "Product Information. Auro-Galantamine ER (galantamine)." Auro Pharma Inc
Moderate:
ARIPiprazole Food/Lifestyle
Applies to: aripiprazole
Generally avoid
Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.
Management
Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.
References (4)
- Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
- Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
- (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
- (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka America Pharmaceutical, Inc.
Disease interactions
41 potential interactions Applies to: 36 conditions, including High Cholesterol, Depression, Bipolar Disorder, Weight Loss, and Heart Failure.
Alcoholism
Major:
aripiprazole
ARIPiprazole has a major potential interaction with Alcoholism.
The use of neuroleptic agents is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of neuroleptic agents may be additive with those of alcohol. Severe respiratory depression and respiratory arrest may occur. Therapy with neuroleptic agents should be administered cautiously in patients who might be prone to acute alcohol intake.
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Alcoholism.
Antipsychotic and neuroleptic drugs can lower the seizure threshold and trigger seizures in a dose-dependent manner. This risk is greatest in patients with a history of seizures or with conditions that lower the seizure threshold. Therapy with these drugs should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism.
Altered Consciousness
Major:
aripiprazole
ARIPiprazole has a major potential interaction with Altered Consciousness.
The use of neuroleptic agents is contraindicated in comatose patients and patients with severe central nervous system depression. Neuroleptic agents may potentiate the CNS and respiratory depression in these patients.
Arrhythmia
Major:
galantamine
Galantamine has a major potential interaction with Arrhythmia.
Due to their pharmacological action, cholinesterase inhibitors can have a vagotonic effect on the sinoatrial and atrioventricular nodes producing bradycardia or heart block. Therapy with cholinesterase inhibitors should be administered cautiously in patients with preexisting bradycardia or underlying cardiac conduction abnormalities. Syncopal episodes have been reported. Atropine may be used to reverse bradycardia produced by cholinesterase inhibitors.
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Arrhythmia.
The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.
Asthma
Major:
galantamine
Galantamine has a major potential interaction with Asthma.
Cholinesterase inhibitors inhibit the hydrolysis of acetylcholine. The enhanced effect of acetylcholine produces constriction of the bronchi, increased bronchial secretions, and bronchospasm. Therapy with cholinesterase inhibitors should be administered cautiously in patients with respiratory dysfunction, history of asthma, or obstructive pulmonary disease. Respiratory function should be closely monitored for the occurrence of respiratory adverse reactions. Use of atropine along with discontinuation of the cholinesterase inhibitor may be required for serious respiratory distress.
Bipolar Disorder
Major:
aripiprazole
ARIPiprazole has a major potential interaction with Bipolar Disorder.
Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials; these trials did not show increased risk in patients older than 24 years and risk was reduced in patients 65 years and older. Adult and pediatric patients with major depressive disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressants; this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders; such disorders are the strongest predictors of suicide. Patients of all ages treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of drug therapy, and at times of dose changes. Family members/caregivers should be advised to monitor for changes in behavior and to notify the health care provider. Changing the therapeutic regimen (including discontinuing the medication) should be considered in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors.
Breast Cancer
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Breast Cancer.
The chronic use of neuroleptic agents can cause persistent elevations in prolactin levels due to antagonism of dopamine D2 receptors. Based on in vitro data, approximately one-third of human breast cancers are thought to be prolactin-dependent. The clinical significance of this observation with respect to long-term neuroleptic therapy is unknown. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in rodent studies but not in human clinical or epidemiologic studies. Until further data are available, therapy with neuroleptic agents should be administered cautiously in patients with a previously detected breast cancer. Caution is also advised in patients with preexisting hyperprolactinemia. Hyperprolactinemia may suppress hypothalamic gonadotrophin releasing hormone (GnRH), resulting in reduced pituitary gonadotropin secretion. This, in turn, may inhibit reproductive function by impairing gonadal steroidogenesis in both female and male patients. Galactorrhea, amenorrhea, gynecomastia, and impotence have been reported in patients receiving prolactin-elevating compounds; however, the clinical significance of elevated serum prolactin levels is unknown for most patients. Long-standing hyperprolactinemia when associated with hypogonadism may lead to decreased bone density in both female and male patients.
Cerebrovascular Insufficiency
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Cerebrovascular Insufficiency.
The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.
COPD
Major:
galantamine
Galantamine has a major potential interaction with COPD.
Cholinesterase inhibitors inhibit the hydrolysis of acetylcholine. The enhanced effect of acetylcholine produces constriction of the bronchi, increased bronchial secretions, and bronchospasm. Therapy with cholinesterase inhibitors should be administered cautiously in patients with respiratory dysfunction, history of asthma, or obstructive pulmonary disease. Respiratory function should be closely monitored for the occurrence of respiratory adverse reactions. Use of atropine along with discontinuation of the cholinesterase inhibitor may be required for serious respiratory distress.
Dehydration
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Dehydration.
The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.
Dementia
Major:
aripiprazole
ARIPiprazole has a major potential interaction with Dementia.
Antipsychotic drugs are not approved for the treatment of patients with dementia-related psychosis. Older patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; although the causes were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. A causal relationship with antipsychotic use has not been established. In controlled trials in older patients with dementia-related psychosis, patients randomized to risperidone, aripiprazole, and olanzapine had higher incidence of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, compared to patients treated with placebo.
Depression
Major:
aripiprazole
ARIPiprazole has a major potential interaction with Depression.
Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials; these trials did not show increased risk in patients older than 24 years and risk was reduced in patients 65 years and older. Adult and pediatric patients with major depressive disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressants; this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders; such disorders are the strongest predictors of suicide. Patients of all ages treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of drug therapy, and at times of dose changes. Family members/caregivers should be advised to monitor for changes in behavior and to notify the health care provider. Changing the therapeutic regimen (including discontinuing the medication) should be considered in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors.
Diabetes Mellitus
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Diabetes Mellitus.
Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported with the use of atypical antipsychotic agents. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents. It is recommended that patients with risk factors for diabetes mellitus starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment, and periodically thereafter. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when treatment with these agents was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the atypical antipsychotic drug.
Diarrhea
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Diarrhea.
The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.
Dysphagia
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Dysphagia.
Esophageal dysmotility and aspiration have been associated with the use of antipsychotic drugs. These drugs should be administered cautiously in patients at risk for aspiration pneumonia.
Gastrointestinal Obstruction
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Gastrointestinal Obstruction.
Most neuroleptic agents have anticholinergic activity, to which elderly patients are particularly sensitive. Clozapine and low- potency agents such as chlorpromazine and thioridazine tend to exhibit the greatest degree of anticholinergic effects in the class, while haloperidol as well as the newer, atypical agents like quetiapine, risperidone and ziprasidone have generally been associated with very low frequencies of anticholinergic adverse effects. Therapy with neuroleptic agents should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders.
Glaucoma/Intraocular Hypertension
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Glaucoma/Intraocular Hypertension.
Most neuroleptic agents have anticholinergic activity, to which elderly patients are particularly sensitive. Clozapine and low- potency agents such as chlorpromazine and thioridazine tend to exhibit the greatest degree of anticholinergic effects in the class, while haloperidol as well as the newer, atypical agents like quetiapine, risperidone and ziprasidone have generally been associated with very low frequencies of anticholinergic adverse effects. Therapy with neuroleptic agents should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders.
Head Injury
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Head Injury.
Antipsychotic and neuroleptic drugs can lower the seizure threshold and trigger seizures in a dose-dependent manner. This risk is greatest in patients with a history of seizures or with conditions that lower the seizure threshold. Therapy with these drugs should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism.
Heart Failure
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Heart Failure.
The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.
High Cholesterol
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with High Cholesterol.
Atypical antipsychotic drugs have been associated with undesirable alterations in lipid levels. While all agents in the class have been shown to produce some changes, each drug has its own specific risk profile. Before or soon after initiation of antipsychotic medications, a fasting lipid profile should be obtained at baseline and monitored periodically during treatment.
History - Myocardial Infarction
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with History - Myocardial Infarction.
The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.
Hyperprolactinemia
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Hyperprolactinemia.
The chronic use of neuroleptic agents can cause persistent elevations in prolactin levels due to antagonism of dopamine D2 receptors. Based on in vitro data, approximately one-third of human breast cancers are thought to be prolactin-dependent. The clinical significance of this observation with respect to long-term neuroleptic therapy is unknown. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in rodent studies but not in human clinical or epidemiologic studies. Until further data are available, therapy with neuroleptic agents should be administered cautiously in patients with a previously detected breast cancer. Caution is also advised in patients with preexisting hyperprolactinemia. Hyperprolactinemia may suppress hypothalamic gonadotrophin releasing hormone (GnRH), resulting in reduced pituitary gonadotropin secretion. This, in turn, may inhibit reproductive function by impairing gonadal steroidogenesis in both female and male patients. Galactorrhea, amenorrhea, gynecomastia, and impotence have been reported in patients receiving prolactin-elevating compounds; however, the clinical significance of elevated serum prolactin levels is unknown for most patients. Long-standing hyperprolactinemia when associated with hypogonadism may lead to decreased bone density in both female and male patients.
Hypotension
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Hypotension.
The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.
Ischemic Heart Disease
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Ischemic Heart Disease.
The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.
Liver Disease
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Liver Disease.
Most neuroleptic agents are extensively metabolized by the liver. The plasma concentrations of these agents may be increased and the half-lives prolonged in patients with impaired hepatic function. Therapy with neuroleptic agents should be administered cautiously in patients with significant liver disease. Lower initial dosages and slower titration may be appropriate.
Moderate:
galantamine
Galantamine has a moderate potential interaction with Liver Disease.
In patients with moderate hepatic impairment (Child-Pugh score of 7 to 9), the dosage of galantamine or benzgalantamine should generally not exceed 16 mg/day or 20 mg/day, respectively. The use of galantamine or benzgalantamine in patients with severe hepatic impairment (Child-Pugh score of 10 to 15) is not recommended.
Neuroleptic Malignant Syndrome
Major:
aripiprazole
ARIPiprazole has a major potential interaction with Neuroleptic Malignant Syndrome.
The central dopaminergic blocking effects of neuroleptic agents may precipitate or aggravate a potentially fatal symptom complex known as neuroleptic malignant syndrome (NMS). NMS is observed most frequently when high-potency agents like haloperidol are administered intramuscularly, but may occur with any neuroleptic agent given for any length of time. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac arrhythmias). Additional signs may include elevated creatine phosphokinase, myoglobinuria, and acute renal failure. Neuroleptic agents should not be given to patients with active NMS and should be immediately discontinued if currently being administered in such patients. In patients with a history of NMS, introduction or reintroduction of neuroleptic agents should be carefully considered, since NMS may recur.
Neutropenia
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Neutropenia.
Cases of leukopenia, neutropenia, and agranulocytosis have been reported with the use of atypical antipsychotic agents. Patients with preexisting low white blood cell count may be at increased risk. Therapy with these agents should be administered cautiously in patients with a history of, or predisposition to, decreased white blood cell or neutrophil counts. Clinical monitoring of hematopoietic function is recommended. At the first sign of a clinically significant decline in white blood cells, discontinuation of atypical antipsychotic therapy should be considered in the absence of other causative factors, and the patient closely monitored for fever or other signs and symptoms of infection.
Parkinsonism
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Parkinsonism.
The use of neuroleptic agents is associated with pseudo-parkinsonian symptoms such as akinesia, bradykinesia, tremors, pill-rolling motion, cogwheel rigidity, and postural abnormalities including stooped posture and shuffling gait. The onset is usually 1 to 2 weeks following initiation of therapy or an increase in dosage. Older neuroleptic agents such as haloperidol are more likely to induce these effects, and their use may be contraindicated in patients with Parkinson's disease or parkinsonian symptoms.
Peptic Ulcer
Moderate:
galantamine
Galantamine has a moderate potential interaction with Peptic Ulcer.
The use of cholinesterase inhibitors is associated with an increase in gastric acid secretion and gastric contractions. Monitor for symptoms of active or occult gastrointestinal bleeding, especially in patients at increased risk for developing ulcers (e.g., history of ulcer disease or concurrent use of nonsteroidal anti-inflammatory drugs).
Renal Dysfunction
Moderate:
galantamine
Galantamine has a moderate potential interaction with Renal Dysfunction.
In patients with creatinine clearance of 9 to 59 mL/min, the dosage of galantamine or benzgalantamine should generally not exceed 16 mg/day or 20 mg/day, respectively. In patients with creatinine clearance less than 9 mL/min, the use of galantamine or benzgalantamine is not recommended.
Respiratory Arrest
Major:
aripiprazole
ARIPiprazole has a major potential interaction with Respiratory Arrest.
The use of neuroleptic agents is contraindicated in comatose patients and patients with severe central nervous system depression. Neuroleptic agents may potentiate the CNS and respiratory depression in these patients.
Seizures
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Seizures.
Antipsychotic and neuroleptic drugs can lower the seizure threshold and trigger seizures in a dose-dependent manner. This risk is greatest in patients with a history of seizures or with conditions that lower the seizure threshold. Therapy with these drugs should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism.
Moderate:
galantamine
Galantamine has a moderate potential interaction with Seizures.
Cholinesterase inhibitors have been associated with convulsions and tremor. Therapy with cholinesterase inhibitors should be administered cautiously in patients with seizure disorders. Patients with Alzheimer's disease should be closely monitored for seizures.
Syncope
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Syncope.
The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.
Tardive Dyskinesia
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Tardive Dyskinesia.
Tardive dyskinesia (TD) has occurred in patients treated with antipsychotic drugs; the syndrome consists of potentially irreversible, involuntary, dyskinetic movements. The risk appears highest in older patients (particularly older women) but it is not possible to predict which patients are likely to develop TD; whether antipsychotic drugs differ in their potential to cause TD is unknown. The risk of TD and the likelihood that it will become irreversible increase with the duration of therapy and the total cumulative dose. The syndrome can develop after relatively brief treatment periods, even at low dosages; it may also occur after discontinuation of therapy. TD may remit (partially or completely) upon discontinuation of antipsychotic therapy, although antipsychotic therapy itself may suppress (or partially suppress) signs/symptoms of TD, possibly masking the underlying process; the effect of symptomatic suppression on the long-term course of TD is unknown. In patients with preexisting drug-induced TD, initiating or increasing the dosage of antipsychotic therapy may temporarily mask the symptoms of TD but could eventually worsen the condition. In patients requiring chronic therapy, the lowest dose and shortest duration of therapy producing a satisfactory clinical response are recommended; the need for continued therapy should be reassessed periodically. If signs/symptoms of TD occur during antipsychotic therapy, discontinuation of the offending agent should be considered; however, some patients may require treatment despite the presence of TD.
Urinary Retention
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Urinary Retention.
Most neuroleptic agents have anticholinergic activity, to which elderly patients are particularly sensitive. Clozapine and low- potency agents such as chlorpromazine and thioridazine tend to exhibit the greatest degree of anticholinergic effects in the class, while haloperidol as well as the newer, atypical agents like quetiapine, risperidone and ziprasidone have generally been associated with very low frequencies of anticholinergic adverse effects. Therapy with neuroleptic agents should be administered cautiously in patients with preexisting conditions that are likely to be exacerbated by anticholinergic activity, such as urinary retention or obstruction; angle-closure glaucoma, untreated intraocular hypertension, or uncontrolled primary open-angle glaucoma; and gastrointestinal obstructive disorders.
Vomiting
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Vomiting.
The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.
Weight Loss
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Weight Loss.
Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported with the use of atypical antipsychotic agents. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents. It is recommended that patients with risk factors for diabetes mellitus starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment, and periodically thereafter. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when treatment with these agents was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the atypical antipsychotic drug.
Moderate:
aripiprazole
ARIPiprazole has a moderate potential interaction with Weight Loss.
Weight gain has been observed with atypical antipsychotic use. While all agents in the class have been shown to produce some changes, each drug has its own specific risk profile. When treating pediatric patients with atypical antipsychotic agents, weight gain should be monitored and assessed against that expected for normal growth. Monitor weight at baseline and frequently thereafter.
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aripiprazole
A total of 760 drugs are known to interact with aripiprazole.
- Aripiprazole is in the drug class atypical antipsychotics.
- Aripiprazole is used to treat the following conditions:
galantamine
A total of 456 drugs are known to interact with galantamine.
- Galantamine is in the drug class cholinesterase inhibitors.
- Galantamine is used to treat Alzheimer's Disease.
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
| No interaction information available. |
Further information
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