What is the interaction between Tizanidine and Aripiprazole (Abilify)?

From the Guidelines

Tizanidine and aripiprazole can be used together, but caution is advised due to potential additive central nervous system depression effects. Both medications can be prescribed simultaneously when clinically indicated - tizanidine for muscle spasticity as a muscle relaxant and aripiprazole as an atypical antipsychotic for conditions like schizophrenia, bipolar disorder, or as an adjunct for depression.

Key Considerations

• Patients taking both medications should be monitored for excessive sedation, dizziness, confusion, and impaired coordination, especially when initiating therapy or adjusting doses.
• Starting with lower doses of each medication and gradually titrating upward may help minimize adverse effects, as suggested by the guidelines for managing delirium in adult cancer patients 1.
• Patients should avoid alcohol and other CNS depressants while on this combination and should not drive or operate machinery until they know how these medications affect them.
• The combination may be particularly concerning in elderly patients or those with respiratory conditions, who may be more sensitive to CNS depressant effects, as noted in the discussion of antipsychotic use in delirium management 1.
• Regular follow-up appointments are essential to assess efficacy and monitor for side effects, in line with the practice point that pharmacological interventions should be used in the lowest effective dose and for a short period of time only 1.

Medication Interactions

• Tizanidine's clearance is significantly reduced when given concomitantly with certain medications, such as ciprofloxacin and fluvoxamine, and is contraindicated in these cases 1.
• Aripiprazole, as a third-generation antipsychotic, may have fewer side effects compared to first-generation antipsychotics but still requires careful monitoring, especially in elderly patients or those with hepatic impairment 1.

Clinical Guidelines

• The use of pharmacological interventions in the management of delirium in adults should be limited to patients who have distressing delirium symptoms or if there are safety concerns, as outlined in the clinical practice guidelines for delirium in adult cancer patients 1.
• Medications should be used in the lowest effective dose and for a short period of time only to achieve the appropriate balance between benefit and potential harm 1.

From the Research

Interaction between Tizanidine and Aripiprazole

There are no direct research papers to assist in answering this question about the interaction between Tizanidine and Aripiprazole (Abilify). However, we can look at the properties of each medication:

• Tizanidine is an alpha-2 adrenergic agonist used to treat muscle spasticity, and it can cause hypotension as a side effect 2, 3, 4.
• Aripiprazole is an antipsychotic medication used to treat bipolar disorder and schizophrenia, and it has a unique receptor-binding profile with a low propensity for weight gain and metabolic disturbances 5.

Potential Interactions

While there is no direct evidence of an interaction between Tizanidine and Aripiprazole, consider the following:

• Tizanidine can cause hypotension, and patients taking other medications that affect blood pressure may need to be monitored closely 3, 4.
• Aripiprazole has a relatively favorable tolerability profile, but its interaction with other medications that affect the central nervous system or blood pressure is not well-studied in the context of Tizanidine 5.

Key Points

• Tizanidine is used to treat muscle spasticity and can cause hypotension as a side effect 2, 3, 4.
• Aripiprazole is an antipsychotic medication with a unique receptor-binding profile and a relatively favorable tolerability profile 5.
• There is no direct evidence of an interaction between Tizanidine and Aripiprazole, but patients taking both medications should be monitored closely for potential side effects such as hypotension.