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Drug Interactions between haloperidol and st. john's wort

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

haloperidol St. John's wort

Applies to: haloperidol and st. john's wort

MONITOR CLOSELY: Rifampin and other strong CYP450 3A4 inducers may significantly decrease serum concentrations of haloperidol. The mechanism may be related to induction of the CYP450 3A4 metabolism of haloperidol. In an observational study of 12 schizophrenic patients taking oral haloperidol, the administration of rifampin for 28 days reduced haloperidol plasma levels by a mean of 70%, and scores in the Brief Psychiatric Rating Scale (BPRS) were increased. In the same study, another 5 schizophrenic patients receiving haloperidol and rifampin had rifampin discontinued, which led to a mean 3.3-fold increase in haloperidol blood levels. Another observational study involving schizophrenic patients (n=7) also reported significant reduction of serum haloperidol concentration and reduction in haloperidol half-life from 9.4 hours in the control group to 4.9 hours in the rifampin and haloperidol group.

MANAGEMENT: Close observation for reduced clinical effects is recommended if these drugs must be used together. It may be necessary to adjust haloperidol dosage and/or dosage interval whenever a strong CYP450 3A4 inducer is added to or discontinued from therapy.

References

  1. Takeda M, Nishinuma K, Yamashita S, et al. (1986) "Serum haloperidol levels of schizophrenics receiving treatment for tuberculosis." Clin Neuropharmacol, 9, p. 386-97
  2. Borcherding SM, Baciewicz AM, Self TH (1992) "Update on rifampin drug interactions." Arch Intern Med, 152, p. 711-6
  3. (2002) "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical
  4. (2001) "Product Information. Rifadin (rifampin)." Hoechst Marion Roussel
  5. (2001) "Product Information. Lysodren (mitotane)." Bristol-Myers Squibb
  6. Kim YH, Cha IJ, Shim JC, Shin JG, Yoon YR, Kim YK, Kim JI, Park GH, Jang IJ, Woo JI, Shin SG (1996) "Effect of rifampin on the plasma concentration and the clinical effect of haloperidol concomitantly administered to schizophrenic patients." J Clin Psychopharmacol, 16, p. 247-52
  7. Strayhorn VA, Baciewicz AM, Self TH (1997) "Update on rifampin drug interactions, III." Arch Intern Med, 157, p. 2453-8
  8. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  9. Cerner Multum, Inc. "Australian Product Information."
  10. Agencia Española de Medicamentos y Productos Sanitarios Healthcare (2008) Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html
  11. (2015) "Product Information. Orkambi (ivacaftor-lumacaftor)." Vertex Pharmaceuticals
  12. Cerner Multum, Inc (2015) "ANVISA Bulário Eletrônico."
  13. Hesslinger B, Normann C, Langosch J, Klose P, Berger M, Walden J (1999) "Effects of carbamazepine and valproate on haloperidol plasma levels and on psychopathologic outcome in schizophrenic patients." J Clin Psychopharmacol, 19, p. 310-5
View all 13 references

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Drug and food interactions

Moderate

haloperidol food

Applies to: haloperidol

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

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. 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.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Moderate

St. John's wort food

Applies to: st. john's wort

GENERALLY AVOID: An isolated case report suggests that foods containing large amounts of tyramine may precipitate a hypertensive crisis in patients treated with St. John's wort. The mechanism of interaction is unknown, as St. John's wort is not thought to possess monoamine oxidase (MAO) inhibiting activity at concentrations achieved in vivo. The case patient was a 41-year-old man who had been taking St. John's wort for seven days prior to presentation at the emergency room with confusion and disorientation. The patient recalled last eating aged cheese and having a glass of red wine approximately 10 hours prior to admission. No other cause of delirium or hypertension could be identified. In addition, alcohol may potentiate some of the pharmacologic effects of St. John's wort. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Until further information is available, patients treated with St. John's wort should consider avoiding consumption of protein foods in which aging or breakdown of protein is used to increase flavor. These foods include cheese (particularly strong, aged or processed cheeses), sour cream, wine (particularly red wine), champagne, beer, pickled herring, anchovies, caviar, shrimp paste, liver (particularly chicken liver), dry sausage, figs, raisins, bananas, avocados, chocolate, soy sauce, bean curd, yogurt, papaya products, meat tenderizers, fava beans, protein extracts, and dietary supplements. Caffeine may also precipitate hypertensive crisis so its intake should be minimized as well. Patients should also be advised to avoid or limit consumption of alcohol.

References

  1. Patel S, Robinson R, Burk M (2002) "Hypertensive crisis associated with St. John's Wort." Am J Med, 112, p. 507-8

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor 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.
Unknown No interaction information available.

Further information

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