Drug Interactions between Aristada Initio and voriconazole

ADJUST DOSE: Coadministration with ketoconazole or other potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of aripiprazole, which is partially metabolized by the isoenzyme. According to the product labeling, administration of aripiprazole (15 mg single dose) following pretreatment with ketoconazole (200 mg/day for 14 days) increased the systemic exposure (AUC) to aripiprazole and its active metabolite, dehydro-aripiprazole, by 63% and 77%, respectively, compared to administration of aripiprazole alone. The effect of a higher dosage of ketoconazole has not been studied.

MANAGEMENT: Pharmacologic response to aripiprazole should be monitored more closely whenever ketoconazole or other potent inhibitors of CYP450 3A4 (e.g., itraconazole, ketoconazole, posaconazole, voriconazole, conivaptan, nefazodone, cobicistat, delavirdine, protease inhibitors, ketolide and certain macrolide antibiotics) are added to or withdrawn from therapy. The manufacturer recommends that aripiprazole dosage be reduced to one-half the normal dosage during concomitant administration with ketoconazole, and additional dosage adjustments be made based on clinical evaluation. Although clinical data are lacking, similar dosage adjustments may be appropriate during coadministration with other potent CYP450 3A4 inhibitors. Aripiprazole dosage should be increased accordingly if these agents are discontinued.