Adding aripiprazole to topiramate.
- Topiramate induces CYP3A4 and is an inhibitor of CYP2C19.
- Aripiprazole is metabolized by CYP2D6 and CYP3A4 to an active metabolite.
- This combination of drugs may have possible synergistic effects. However, this combination will also have additive side effects.
- Start aripiprazole according general dosing advice.
- Dose adaptation of aripiprazole could be necessary because of the enzym induction by topiramate.
- Caution is advised when topiramate is prescribed with other drugs that predispose patients to heat-related disorders, including carbonic anhydrase inhibitors and drugs with anticholinergic activity. 
- Patients, particularly pediatric patients, should be monitored closely for evidence of decreased sweating and increased body temperature, especially in warm or hot weather.
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