Updated: January 13, 2026

Ingrezza Drug Interactions: What to Avoid and What to Tell Your Doctor

Author

Peter Daggett

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Contraindicated Combinations: Do Not Use Together
CYP3A4 Inhibitors: Can Increase Ingrezza Levels
CYP3A4 Inducers: Can Decrease Ingrezza Effectiveness
CYP2D6 Inhibitors: Can Increase Active Metabolite Levels
Digoxin: Important Cardiac Interaction
Alcohol and CNS Depressants
QT-Prolonging Drugs

Ingrezza (valbenazine) has important drug interactions with MAOIs, CYP3A4 drugs, and others. Learn what to avoid and what to tell your doctor in 2026.

Ingrezza (valbenazine) is metabolized by enzymes in the liver, particularly CYP3A4 and CYP2D6. This means many common medications can interact with Ingrezza — some by increasing its levels (raising the risk of side effects), others by decreasing its levels (reducing its effectiveness). This guide covers the most important Ingrezza drug interactions you and your doctor need to know about.

Important: Always tell your doctor and pharmacist about every medication, supplement, and herbal product you take. Do not start or stop any medication without consulting your healthcare provider.

Contraindicated Combinations: Do Not Use Together

MAOIs (Monoamine Oxidase Inhibitors): Combining Ingrezza with MAOIs (such as phenelzine, tranylcypromine, selegiline, rasagiline, isocarboxazid, or linezolid) can cause a dangerous buildup of monoamine neurotransmitters in synapses, potentially leading to serotonin syndrome or other serious reactions. Do not take Ingrezza if you are using an MAOI or have used one within the past 14 days.

Other VMAT2 inhibitors (tetrabenazine, deutetrabenazine): Taking Ingrezza at the same time as tetrabenazine (Xenazine) or deutetrabenazine (Austedo) is contraindicated due to pharmacodynamic synergism — the combined dopamine-depleting effect can cause severe parkinsonism and other serious adverse effects.

Mavorixafor: A strong CYP2D6 inhibitor that is contraindicated with drugs highly dependent on CYP2D6 for clearance, including valbenazine.

CYP3A4 Inhibitors: Can Increase Ingrezza Levels

Strong CYP3A4 inhibitors block the enzyme that breaks down valbenazine, causing it to accumulate in the blood. This increases the risk of side effects, particularly QT prolongation and sedation. If you must take a strong CYP3A4 inhibitor, your doctor may need to reduce your Ingrezza dose to 40 mg/day. Examples include:

Ketoconazole (antifungal)

Itraconazole (antifungal)

Clarithromycin (antibiotic)

Cobicistat (HIV treatment)

Ceritinib (cancer treatment)

CYP3A4 Inducers: Can Decrease Ingrezza Effectiveness

Strong CYP3A4 inducers speed up the breakdown of valbenazine, reducing its blood levels and potentially making it less effective at controlling your movements. Concomitant use is generally not recommended. Examples include:

Carbamazepine (Tegretol) — seizure/mood disorder treatment

Rifampin (antibiotic)

Phenytoin (seizure treatment)

Apalutamide (prostate cancer treatment)

Enzalutamide (prostate cancer treatment)

St. John's Wort (herbal supplement — a CYP3A4 inducer)

CYP2D6 Inhibitors: Can Increase Active Metabolite Levels

Valbenazine is converted in the liver to its active metabolite ([+]-alpha-HTBZ) via the CYP2D6 enzyme. Strong CYP2D6 inhibitors increase levels of this active metabolite, raising the risk of side effects. Your doctor should consider reducing Ingrezza to 40 mg/day if you take a strong CYP2D6 inhibitor. Examples include:

Paroxetine (Paxil) — antidepressant

Fluoxetine (Prozac) — antidepressant

Bupropion (Wellbutrin) — antidepressant/smoking cessation aid

Quinidine — antiarrhythmic

Dacomitinib — cancer treatment

Digoxin: Important Cardiac Interaction

Ingrezza (specifically Ingrezza Sprinkle) increases digoxin exposure. If you take digoxin (Lanoxin) for heart conditions, your doctor may need to adjust your digoxin dose and monitor digoxin blood levels more closely.

Alcohol and CNS Depressants

Ingrezza causes sedation. Taking it with alcohol, benzodiazepines, sleep aids, opioids, or other central nervous system (CNS) depressants can significantly increase drowsiness and impair your ability to function safely. Avoid alcohol while taking Ingrezza, and inform your doctor of any other sedating medications.

QT-Prolonging Drugs

Ingrezza can mildly prolong the QT interval (a heart rhythm measurement). The risk is not clinically significant at recommended doses under normal circumstances. However, combining Ingrezza with other QT-prolonging drugs or with strong CYP2D6/3A4 inhibitors (which raise Ingrezza levels) can increase the risk. Tell your doctor if you take any antiarrhythmic drugs, certain antibiotics, or antipsychotics known to prolong QT.

For more on Ingrezza's side effect profile, see: Ingrezza Side Effects: What to Expect.

Once you're set up with your therapy, use medfinder to locate a pharmacy that can fill your Ingrezza prescription quickly.

Frequently Asked Questions

It depends on the antidepressant. Some antidepressants like paroxetine (Paxil), fluoxetine (Prozac), and bupropion (Wellbutrin) are strong CYP2D6 inhibitors that increase levels of Ingrezza's active metabolite — your doctor may reduce your Ingrezza dose to 40 mg/day. MAOIs (like phenelzine or tranylcypromine) are contraindicated with Ingrezza and must not be taken together. Tell your doctor about all antidepressants you take.

Carbamazepine is a strong CYP3A4 inducer that significantly decreases valbenazine blood levels, potentially reducing Ingrezza's effectiveness. Concomitant use is generally not recommended. If you need carbamazepine for seizures or bipolar disorder, discuss with your doctor whether an alternative seizure medication would be more compatible with your Ingrezza therapy.

No. St. John's Wort is a strong CYP3A4 inducer — it increases the breakdown of valbenazine and can reduce Ingrezza blood levels, potentially making it less effective. Avoid St. John's Wort while taking Ingrezza. This is an important example of why you should always tell your doctor and pharmacist about herbal supplements.

Yes — since Ingrezza is primarily used in patients who take antipsychotics (because TD is caused by antipsychotic use), these combinations are common. However, tell your doctor about any antipsychotics that prolong the QT interval, and those that are CYP2D6 or CYP3A4 inhibitors, as dose adjustments may be needed. Never stop your antipsychotic medication without consulting your psychiatrist.

Always inform your doctor or pharmacist when starting any new medication while on Ingrezza. Ask specifically: 'Does this new drug interact with valbenazine or affect CYP2D6 or CYP3A4?' Your specialty pharmacy can also run a drug interaction check. If a new interaction is identified, do not adjust your Ingrezza dose on your own — wait for your doctor's guidance.

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