Interaction Between Abilify (Aripiprazole) and Lexapro (Escitalopram)
Abilify (aripiprazole) and Lexapro (escitalopram) can be safely used together with minimal risk of clinically significant interactions. According to the FDA drug label for aripiprazole, no dosage adjustment is necessary when co-administered with escitalopram 1.
Pharmacokinetic Interaction Profile
The interaction between these two medications has been specifically studied:
Aripiprazole's FDA label explicitly states that "no dosage adjustment is necessary for substrates of CYP2D6, CYP2C9, CYP2C19, or CYP3A4 when co-administered with aripiprazole," and specifically mentions escitalopram as not requiring dose adjustment 1.
Research confirms that escitalopram has minimal effect on aripiprazole plasma concentrations. A study in Japanese patients showed that while paroxetine (another SSRI) increased aripiprazole plasma concentrations by 1.7-fold, escitalopram did not significantly affect aripiprazole levels 2.
Clinical Applications and Safety
The combination of aripiprazole and escitalopram has been studied in clinical settings:
In patients with psychotic major depressive disorder, the combination demonstrated good efficacy with a 62.5% response rate and 50% remission rate 3.
A recent randomized controlled trial found that escitalopram combined with low-dose aripiprazole (5 mg/day) may improve cognitive function in patients with major depressive disorder, particularly in executive function and continuous attention domains 4.
Potential Side Effects to Monitor
While the combination is generally safe, clinicians should monitor for:
Akathisia: This was the most common side effect in combination therapy studies, with 10 out of 16 subjects developing akathisia in one study, though 9 of those cases resolved with dose adjustment or propranolol 3.
Extrapyramidal symptoms: The combination presents a risk of extrapyramidal side effects with long-term treatment 5.
Serotonin syndrome: Although the risk is low with this specific combination, caution should be exercised when combining serotonergic drugs. Symptoms can arise within 24-48 hours and include mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity 6.
Practical Recommendations
Starting the combination:
- No specific dose adjustments are needed when initiating the combination
- Consider starting aripiprazole at a low dose (e.g., 5 mg/day) when adding to established escitalopram therapy 4
Monitoring:
- Watch for akathisia, especially in the first few weeks
- Monitor for extrapyramidal symptoms during long-term treatment
- Be alert for any signs of serotonin syndrome, though the risk is low
Management of side effects:
- If akathisia develops, consider dose adjustment or adding propranolol
- For extrapyramidal symptoms, dose reduction may be necessary
Conclusion
The combination of aripiprazole and escitalopram is pharmacokinetically safe with no significant drug-drug interactions requiring dose adjustments. This combination may offer therapeutic advantages in certain conditions like major depression with psychotic features or treatment-resistant depression, with manageable side effects primarily related to akathisia and extrapyramidal symptoms.