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Fosphenytoin: (Reasonable) Use ciprofloxacin and fosphenytoin along with caution as ciprofloxacin has been reported to both enhance and decrease phenytoin concentrations. Monitor phenytoin serum concentrations and response to therapy throughout and shorty after coadministration to keep away from the loss of seizure control associated with decreased phenytoin ranges and to stop overdose-associated opposed occasions upon the discontinuation of ciprofloxacin.
Cariprazine: (Main) The dose of cariprazine must be reduced in patients additionally receiving ketoconazole. When ketoconazole is initiated in a affected person who is on a stable dose of cariprazine, cut back the cariprazine dosage by half. For grownup patients taking cariprazine 4.5 mg every day, the dosage must be diminished to 1.5 mg or 3 mg each day. For patients taking cariprazine 1.5 mg every day, the dosing frequency should be adjusted to each other day. When initiating cariprazine in a affected person who's stable on ketoconazole, the patient needs to be administered 1.5 mg of cariprazine on Day 1 and on Day three with no dose administered on Day 2. From Day four onward, the dose must be administered at 1.5 mg every day, and then elevated to a most dose of three mg every day. When ketoconazole is withdrawn, the cariprazine dosage may should be elevated. Cariprazine is metabolized by CYP3A4 to its major active metabolite. ketoconazole is a strong CYP3A4 inhibitor. Concurrent use with ketoconazole increased the exposure of cariprazine by about 4-fold; elevated the AUC of DDCAR metabolite by about 1.5-fold; and decreased DCAR metabolite AUC by about one-third.
