Vraylar
Vraylar (cariprazine) is an atypical antipsychotic used to treat schizophrenia and bipolar I disorder in adults. It can also be used as an add-on medication to help with major depressive disorder (MDD). Vraylar (cariprazine) is taken by mouth once a day. Some common side effects of this medication include uncontrolled muscle movements, headache, and restlessness. Unlike some other antipsychotic medications, Vraylar (cariprazine) causes minimal weight gain. Vraylar (cariprazine) is brand name only and not available as a generic medication.
What is Vraylar (cariprazine)?
What is Vraylar (cariprazine) used for?
- Schizophrenia
- Manic or mixed episodes of bipolar I disorder
- Bipolar depression of bipolar I disorder
- Major depressive disorder (MDD), as an add-on medication
How Vraylar (cariprazine) works
Vraylar (cariprazine) is an atypical antipsychotic. The exact way it works isn't well-understood. But it's thought to make dopamine and serotonin levels more stable in your brain to help control your thoughts, mood, and behaviors.
Drug facts
Side effects of Vraylar (cariprazine)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Uncontrolled muscle movements (up to 20%)
- Headache (up to 18%)
- Restlessness (up to 14%)
- Trouble sleeping (up to 13%)
- Constipation (up to 10%)
- Nausea (up to 8%)
- Stomach pain (up to 7%)
- Toothache (up to 6%)
Less Common Side Effects
- Diarrhea
- Agitation
- Anxiety
- Indigestion
- Vomiting
- Dizziness
Please note: Side effects listed were reported by people who took Vraylar (cariprazine) in clinical trials for schizophrenia.
Vraylar (cariprazine) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Stroke: numbness or weakness typically on one side of the body, loss of balance, headache, blurred vision, difficulty speaking
- Neuroleptic malignant syndrome (NMS): high fever, sweating, confusion, stiffness, blood pressure changes
- Extremely high blood sugar levels: feeling very hungry or thirsty, urinating more often, stomach pain, weakness, fruity-smelling breath
- Uncontrolled muscle movements (tardive dyskinesia): involuntarily sticking out your tongue, puffing out your cheeks, puckering your mouth, lip smacking, chewing, and foot tapping
- Suicidal thoughts or behavior
- Seizures
- Dizzy or fainting spells that cause falls
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The following Vraylar (cariprazine) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- High blood sugar (hyperglycemia)—increased thirst or amount of urine, unusual weakness or fatigue, blurry vision
- High fever, stiff muscles, increased sweating, fast or irregular heartbeat, and confusion, which may be signs of neuroleptic malignant syndrome
- Infection—fever, chills, cough, or sore throat
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
- Pain or trouble swallowing
- Seizures
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
- Uncontrolled and repetitive body movements, muscle stiffness or spasms, tremors or shaking, loss of balance or coordination, restlessness, shuffling walk, which may be signs of extrapyramidal symptoms (EPS)
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Constipation
- Dizziness
- Drowsiness
- Nausea
- Trouble sleeping
- Upset stomach
- Vomiting
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Pros and cons of Vraylar (cariprazine)
Pros
- Taken once a day
- Can be taken with or without food
- Works in your body for a longer period of time than other similar medications
Cons
- You might have to see your healthcare provider several times until you find a dose that works best for you.
- Higher risk for uncontrolled muscle movements than some similar medications
- Might take several weeks before you experience the full effects of this medication
Pharmacist tips for Vraylar (cariprazine)
- Continue to take Vraylar (cariprazine) as directed by your psychiatrist even if you don't feel a difference in your mood right away. It might take several weeks before you can feel noticeable improvements to your symptoms. Depending on how your body responds, your psychiatrist might make adjustments to your dose during this time.
- If you're starting Vraylar (cariprazine) for the first time or if your psychiatrist just raised your dose, you might feel dizzy or have a hard time keeping your balance. Make sure to sit up or stand up slowly. This side effect will likely lessen after your body gets used to the medication or the new dose. Talk with your psychiatrist if this continues to bother you.
- You might notice changes to your blood sugar levels or cholesterol levels after you start Vraylar (cariprazine). If you already have certain health conditions, such as diabetes or high cholesterol, your care team might order labs to check your blood sugar or cholesterol levels more often during treatment.
- Vraylar (cariprazine) might make you feel sleepy and drowsy, especially when you first start this medication. Don't drive or do any activities that need a lot of your attention until you know how the medication affects you.
- Vraylar (cariprazine) can cause unusual, uncontrolled, or repetitive movements of your eyes, tongue, face, arm, or legs. If you experience these symptoms, contact your psychiatrist right away because they might ask you to stop taking Vraylar (cariprazine). These might be signs of tardive dyskinesia, a side effect that might become permanent.
- Vraylar (cariprazine) might make it hard for your body to maintain a normal body temperature. Drink water to stay hydrated, especially if you're out in the sun or exercising. Be careful if you're traveling to a place that is very hot.
- Make sure to chew your food completely and swallow carefully while taking Vraylar (cariprazine). Rarely, this medication can cause the muscles in your throat to not work well and make it hard for you to swallow food.
- Let your obstetrician gynecologist (OB-GYN) know if you become pregnant or plan on becoming pregnant while taking this medication. Taking Vraylar (cariprazine) during pregnancy can be harmful to your unborn baby.
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Common questions about Vraylar (cariprazine)
Risks and warnings for Vraylar (cariprazine)
Vraylar (cariprazine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Higher risk of death in older adults with dementia-related psychosis
- Risk factors: Older adults with dementia-related psychosis
Older adults who also have dementia sometimes have some of the symptoms of schizophrenia, like hallucinations and delusions. This is called dementia-related psychosis, and it should not be treated with Vraylar (cariprazine). If Vraylar (cariprazine) is used for dementia-related psychosis, it can cause death. The cause of death is typically from heart problems, stroke, or infections. Let your provider know if you or your loved one has dementia before starting Vraylar (cariprazine).
Suicidal thoughts and behavior
- Risk factors: People age 24 or younger | Taking antidepressants
Taking Vraylar (cariprazine) can put you at risk for suicidal thoughts and behavior. Your risk is higher if you're 24 years old or younger, or taking other antidepressants like sertraline (Zoloft) or fluoxetine (Prozac). Look out for worsening depression or any unusual changes in your mood, behavior, thoughts, or feelings, especially during the first few months of treatment or when your dose changes. Talk to your provider if you have any concerns about this side effect.
Neuroleptic malignant syndrome
- Risk factors: Taking antipsychotic medications
Vraylar (cariprazine) can cause neuroleptic malignant syndrome (NMS), which is a rare but serious condition that can lead to death. Be careful using Vraylar (cariprazine) if you're also on other medications that might cause NMS. Stop this medication and get medical attention right away if you notice symptoms of NMS, such as high fever, fast heart rate, full body stiffness, and confusion.
High blood sugar, high cholesterol, and weight gain
- Risk factors: History of diabetes | History of high cholesterol
Vraylar (cariprazine) can raise your blood sugar, sometimes to dangerous levels resulting in coma or death. Let your provider know if you have symptoms of high blood sugar, such as feeling very hungry or thirsty, urinating more often, stomach pain, weakness, or fruity-smelling breath.
Vraylar (cariprazine) can also cause high cholesterol and weight gain. Your provider might check your weight and order blood tests regularly to make sure your blood sugar, cholesterol, and weight are not too high.
Difficulty controlling movements (tardive dyskinesia)
- Risk factors: Older adults | Female and 65 years or older | Higher than recommended doses of Vraylar (cariprazine) | Taking Vraylar (cariprazine) for a long time
Vraylar (cariprazine) can cause uncontrolled and possibly permanent muscle movements in the tongue, face, mouth, lips, neck, hands, arms, legs, and feet (tardive dyskinesia). This side effect can happen weeks after you first start or even after you've stopped this medication. To lower your risk of tardive dyskinesia, use the lowest dose for your symptoms. Get medical help right away if you notice any unusual movements you can't control.
Higher risk of infections
- Risk factors: History of low white blood cell counts | Taking other medications that lower white blood cell counts
Vraylar (cariprazine) can lower the amount of white blood cells in your body and put you at higher risk for serious infection. You might need to get lab work done regularly to make sure your white blood cell count is healthy. If the levels are too low, your provider might stop your medication. Talk to your provider right away if you experience symptoms of an infection, including fever, weakness, or sore throat, while taking Vraylar (cariprazine).
Higher risk of falls
- Risk factors: Starting Vraylar (cariprazine) for the first time | Recent rise in Vraylar (cariprazine) dose | Older adults | Not enough fluids in your body | History of heart problems | History of low blood pressure | Taking medications that lower blood pressure
Vraylar (cariprazine) can cause sleepiness, dizziness, difficulties keeping your balance, and drops in blood pressure when you sit up or stand too quickly. This can result in fainting and falling. Sit up or stand up slowly, especially during the first few days after you start Vraylar (cariprazine) or when your provider raises your dose. Your risk of falls is higher if you have heart problems or if you don't have enough fluids in your body. Talk to your healthcare provider if you continue to experience dizziness while taking Vraylar (cariprazine).
Trouble controlling body temperature
Vraylar (cariprazine) can make it harder for your body to control its own temperature. Your body might have a difficult time cooling down after being in hot weather or extreme exercise. Drink water to stay hydrated, especially if you're out in the sun or exercising. Be careful to find shade or wear clothing to protect yourself if you're traveling to a place that is very hot.
Difficulty swallowing
Rarely, Vraylar (cariprazine) can cause the muscles in your throat to not work well and make it hard for you to swallow food. This can be dangerous because it might cause you to choke. Make sure to chew your food completely and swallow carefully while taking this medication.
Seizures
- Risk factors: History of seizures | Health conditions that raise the risk of seizures | Older adults
Taking Vraylar (cariprazine) puts you at higher risk for seizures. Let your healthcare provider know if you have history of seizures before starting this medication.
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Vraylar (cariprazine) dosage
Typical dosage for Vraylar (cariprazine)
- Schizophrenia and bipolar mania: The typical starting dose is 1.5 mg by mouth once a day. Your psychiatrist might raise your dose after a few days. The usual dosing range is 1.5 mg to 6 mg once a day.
- Bipolar depression and MDD: The typical starting dose is 1.5 mg by mouth once a day. Your psychiatrist might raise your dose after 2 weeks. The usual dosing range is 1.5 mg to 3 mg once a day.
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