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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by MuseMemento on October 24, 2015, at 14:49:42
I'm currently taking 300 mg fluvoxamine and 10 mg abilify. Prior to taking the fluvoxamine, I was on clomipramine at a high dose along with 20 mg of abilify. I lowered the abilify specifically because of the inhibition of cyp3a4 by fluvoxamine but I've noticed decreased efficacy. Is fluvoxamine a strong inhibitor of cyp3a4 or is it rather mild? Could I try raising the abilify up to 15 mg and see the response?
Posted by SLS on October 24, 2015, at 16:25:36
In reply to Fluvoxamine Abilify interaction, posted by MuseMemento on October 24, 2015, at 14:49:42
> I'm currently taking 300 mg fluvoxamine and 10 mg abilify. Prior to taking the fluvoxamine, I was on clomipramine at a high dose along with 20 mg of abilify. I lowered the abilify specifically because of the inhibition of cyp3a4 by fluvoxamine but I've noticed decreased efficacy. Is fluvoxamine a strong inhibitor of cyp3a4 or is it rather mild? Could I try raising the abilify up to 15 mg and see the response?
I think fluvoxamine is a rather strong inhibitor of CYP3A4.
People sometimes go up to 30 mg/day of Abilify. So, even if fluvoxamine were to cause the level of Abilify to double, you would still be safe at 15 mg/day. If you were to go too high with the dosage of Abilify, you would feel somewhat less motivated and numb cognitively. I think it is hard to become toxic on Abilify. The ideal dosage of Abilify for me is 10 mg/day. If I double the dosage, I experience the side effects I described, but they are rather mild.
- Scott
Posted by Christ_empowered on October 25, 2015, at 7:19:21
In reply to Fluvoxamine Abilify interaction, posted by MuseMemento on October 24, 2015, at 14:49:42
I think there was a similar issue when I was Rx'd Prozac w/ my ongoing Abilify. I was told to cut the dose in 1/2--from 30 to 15.
Hope this helps.
Posted by SLS on October 25, 2015, at 8:00:29
In reply to Re: Fluvoxamine Abilify interaction, posted by Christ_empowered on October 25, 2015, at 7:19:21
The following reference should be accurate. However, the one scenario not addressed is that of a rapid metabolizer (rather than a poor metabolizer) subject to a CYP 2D6 enzyme inhibiting comedication. Here, the dosage adjustment of Abilify may require a smaller reduction. The best approach might be to begin with a 50% reduction in Abilify and titrate clinically by 5 mg/day every week until you attain an optimal response. Since you have already begun your titration at 10 mg/day (50% of your original 20 mg/day dose), your next move is to go to 15 mg/day. If you are a 2D6 rapid metabolizer, you may end up at 20 mg/day again.
Caucasians tend to be rapid metabolizers of CYP 2D6.
I find it interesting that the recommendation of not adjusting the dosage of Abilify when it is used to treat depression probably assumes a dosage of 2 - 5 mg/day.
- Scott------------------------------------------
http://www.drugs.com/dosage/aripiprazole.html
"Dose Adjustments...
CYP450 Dose Adjustments: Oral Formulations:
-Known CYP450 2D6 poor metabolizers (PM): Administer one-half usual dose
-Known CYP450 2D6 PM receiving concomitant strong CYP450 3A4 inhibitors: Administer one-quarter usual dose
-Concomitantly receiving strong CYP450 2D6 or 3A4 inhibitors: Administer one-half usual dose
-Concomitantly receiving strong CYP450 2D6 and 3A4 inhibitors: Administer one-quarter usual dose
-Concomitantly receiving CYP450 3A4 inducer: Double the usual dose over 1 to 2 weeks
IMPORTANT NOTES:-When coadministered drug is withdrawn, aripiprazole dose should be adjusted to the original level over 1 to 2 weeks.
-Patients receiving a combination of strong, moderate, and weak inhibitors of CYP450 3A4 and CYP450 2D6 may need an initial dose reduction to one-quarter of the usual dose with adjustments to achieve a clinical response.
-When aripiprazole is administered to patients with major depressive disorder, dose adjustments are not recommended."
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Posted by MuseMemento on October 26, 2015, at 11:13:58
In reply to Re: Fluvoxamine Abilify interaction, posted by SLS on October 25, 2015, at 8:00:29
Thanks, Scott.
This is the end of the thread.
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