Ingrezza interactions: Alcohol, medications, and other factors

Ingrezza interactions with other medications  

Before you start treatment with Ingrezza, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Ingrezza interacts with supplements, herbs, or vitamins, see the “Ingrezza and other interactions” section.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Ingrezza. Keep in mind that this table doesn’t include all drugs that may interact with Ingrezza. Some of these interactions are described in detail in “Drug interactions in depth.”

When to avoid Ingrezza

In some cases, factors or conditions could prevent your doctor from prescribing Ingrezza due to the risk of harm. These are known as contraindications. The contraindications of Ingrezza include:

Having had an allergic reaction to Ingrezza or any of its ingredients

If you have had an allergic reaction to Ingrezza or any of its ingredients, your doctor will likely not prescribe Ingrezza. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Ingrezza, it’s important to tell your doctor if this contraindication applies to you. They can determine whether to prescribe Ingrezza.

Ingrezza interaction with alcohol

There aren’t any known interactions between Ingrezza and alcohol. However, your doctor may advise you to avoid or limit alcohol consumption during Ingrezza treatment.

This is because drinking alcohol while taking the drug may worsen some of Ingrezza’s side effects. For example, you may experience:

• nausea
• vomiting
• sleepiness

In addition, consuming alcohol and Ingrezza may slow down your breathing.

If you consume alcohol during Ingrezza treatment, these side effects may be more likely to occur. If you have questions about drinking alcohol while taking Ingrezza, talk with your doctor.

Drug interactions in depth

Here’s a closer look at certain drug interactions of Ingrezza.

Certain antiepileptics

Antiepileptics are drugs used to treat seizures.

Interaction result: Taking Ingrezza with certain antiepileptic drugs can make Ingrezza less effective than usual.

Interaction explained: Certain antiepileptic drugs can speed up the activity of an enzyme in your body that helps break down Ingrezza. (An enzyme is a type of protein.)

If you take these drugs with Ingrezza, your body will break down and clear Ingrezza more quickly than usual. This will lower the levels of Ingrezza in your body, which can make the drug less effective for treating your condition. (Ingrezza is prescribed to treat tardive dyskinesia or chorea related to Huntington’s disease.)

Examples of antiepileptic drugs: Here are some antiepileptics that may interact with Ingrezza:

• phenytoin (Dilantin)
• carbamazepine (Tegretol, others)

Steps you or your doctor may take: Tell your doctor if you take any antiepileptic drugs. They can help determine whether those drugs interact with Ingrezza. If they do, your doctor may suggest alternatives to Ingrezza that don’t interact with your antiepileptic medication.

MAOIs

MAOIs are a class of drugs prescribed to treat depression.

Interaction result: Taking Ingrezza with an MAOI can increase the risk of serious side effects of the MAOI, such as serotonin syndrome. It may also make Ingrezza less effective than usual.

Interaction explained: Both Ingrezza and MAOIs affect the levels of certain neurotransmitters (chemical messengers) in your brain, including dopamine and serotonin.

Ingrezza works by blocking a protein called vesicular monoamine transporter 2 (VMAT2). Blocking this protein leads to lower levels of dopamine.

MAOIs work by blocking a protein called monoamine oxidase. Blocking this protein leads to higher levels of certain chemical messengers.

Higher levels of certain chemical messengers can raise the risk of serotonin syndrome. With this syndrome, your body has a high level of serotonin. This can cause symptoms such as:

• blood pressure changes
• excessive sweating
• diarrhea
• nausea and vomiting

Serotonin syndrome can be life threatening for some people.

Additionally, because MAOIs increase chemical messenger levels, the MAOIs counteract how Ingrezza works. This can make Ingrezza less effective.

Examples of MAOI drugs: Here are some MAOIs that may interact with Ingrezza:

• selegiline (Emsam)
• isocarboxazid (Marplan)
• tranylcypromine (Parnate)
• phenelzine (Nardil)

Steps you or your doctor may take: Before you start treatment with Ingrezza, it’s important to tell your doctor if you take an MAOI. They’ll likely have you stop taking the MAOI and wait at least 2 weeks before starting treatment with Ingrezza.

Certain antidepressants

Antidepressants are prescribed to treat mental health conditions such as depression and anxiety.

Interaction result: Taking Ingrezza with certain antidepressants can increase the risk of side effects of Ingrezza, including QT prolongation. With QT prolongation, your heart takes longer than usual to recharge between beats.

Interaction explained: Certain antidepressants can slow the activity of an enzyme in your body that helps break down Ingrezza. With reduced enzyme activity, it may take longer than usual for your body to break down and clear Ingrezza. This can cause Ingrezza to build up in your body, increasing your risk of side effects.

Examples of antidepressant drugs: Here are some antidepressants that may interact with Ingrezza:

• fluoxetine (Prozac)
• paroxetine (Paxil, Brisdelle)

Steps you or your doctor may take: Before you start taking Ingrezza, tell your doctor if you take antidepressants. They can tell you whether any of the ones you take interact with Ingrezza. If you’re taking one of these antidepressants, they may prescribe a lower dosage of Ingrezza. They’ll likely monitor you closely for side effects of Ingrezza as well.

Note: Ingrezza has boxed warnings about the risks of depression and suicidal thoughts and behavior. These are serious warnings from the FDA. For details, see “Boxed warnings” at the top of this article.

Ingrezza and other interactions

Ingrezza may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Ingrezza.

Ingrezza interactions with supplements

Before you start treatment with Ingrezza, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Ingrezza interactions with herbs

Doctors will typically recommend that you avoid taking St. John’s wort with Ingrezza. St. John’s wort is an herbal supplement that may be used to treat depression and other conditions.

St. John’s wort may speed up the activity of an enzyme in your body called cytochrome P450 3A4 (CYP3A4). This enzyme helps break down Ingrezza.

By speeding up this enzyme, St. John’s wort can cause Ingrezza to break down more quickly. And this may lead to a low level of Ingrezza in your system. If the level of Ingrezza in your system is too low, the drug may not work to treat your condition.

Your doctor may be able to suggest a treatment option other than St. John’s wort.

Ingrezza and vitamins

There are no specific reports of vitamins interacting with Ingrezza. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Ingrezza.

Ingrezza interactions with food

Grapefruit and grapefruit juice can interact with Ingrezza. Specifically, grapefruit products can stop your body from breaking down Ingrezza. This raises the level of Ingrezza in your body, which increases your risk of side effects from Ingrezza. Due to this risk, your doctor may recommend not consuming grapefruit and grapefruit juice while taking the drug.

Ingrezza and vaccines

There aren’t any known interactions between Ingrezza and vaccines. Talk with your doctor or pharmacist to see whether you’re due for any vaccines.

Ingrezza and lab tests

Ingrezza isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

INGREZZA INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Ingrezza. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Ingrezza. The impact of cannabis may affect how well you stick to your Ingrezza treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Ingrezza and health-related interactions

Certain medical conditions and other factors may increase the risk of interactions with Ingrezza. Before you take this drug, be sure to talk with your doctor about your health history. Ingrezza may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Ingrezza include:

• Irregular heart rhythm: Ingrezza can cause long QT syndrome (a problem with your heart’s electrical rhythm). If you have an irregular heart rhythm and take Ingrezza, your risk of long QT syndrome may be higher. If you have an irregular heart rhythm that increases your risk of long QT syndrome, your doctor will likely not prescribe Ingrezza.
• Liver problems: If you have certain liver problems, such as liver failure, your doctor may prescribe a lower dose of Ingrezza. Before you start Ingrezza, tell your doctor if you have any liver conditions. They’ll determine the dosage that’s safe for you.
• Heart problems: Ingrezza can cause long QT syndrome as a side effect. Certain heart problems, such as heart disease, heart failure, or a recent heart attack, may increase your risk of long QT syndrome. Tell your doctor if you have any heart problems. They will determine whether Ingrezza is safe for you.
• Allergic reaction: If you’ve had an allergic reaction to Ingrezza or any of its ingredients, your doctor will likely not prescribe Ingrezza. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
• Breastfeeding: It’s not known whether Ingrezza passes into breast milk or how it can affect a child who is breastfed. Due to this risk, you should not breastfeed during Ingrezza treatment or for 5 days after your last dose. If you’re breastfeeding or planning to, talk with your doctor before taking Ingrezza. They can talk with you about treatment options and ways to feed your child.
• Pregnancy: Ingrezza can harm a developing fetus. If you’re pregnant or planning to become pregnant, tell your doctor before starting Ingrezza. They can discuss alternative medications for you.
• Risk of depression and suicidal thoughts and behavior: Ingrezza has boxed warnings about the risks of depression and suicidal thoughts and behavior. These are serious warnings from the FDA. A boxed warning alerts doctors and patients about drug effects that may be dangerous. For details, see “Boxed warnings” at the top of this article.

Preventing interactions

You can take certain steps to help prevent interactions with Ingrezza. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Ingrezza label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Ingrezza doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Ingrezza by taking it exactly as your doctor prescribes.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.