Vraylar vs. Risperidone for Bipolar Disorder and Schizophrenia: Important Differences and Potential Risks.

Key takeaways

Cariprazine (Vraylar) and risperidone (Risperdal) are both atypical antipsychotic medications used to treat mental health conditions like schizophrenia and bipolar disorder. However, they have some differences. Cariprazine is also used as an add-on treatment for major depressive disorder (MDD), while risperidone can also be used for irritability associated with autism in children. Cariprazine is taken once daily as an oral capsule, whereas risperidone can be taken as a tablet, dissolvable tablet, or oral solution, typically once or twice daily. Cariprazine is only available as a brand-name medication, while risperidone is available in generic form, making it more affordable. Common side effects of both medications include uncontrolled muscle movements and restlessness. Risperidone can also cause extreme sleepiness and dizziness. Both can interact with other medications, so it's important to be sure your pharmacist and prescriber have a complete list of your medications.

Vraylar

(cariprazine)

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Risperidone

(Risperdal)

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Summary for Vraylar

Prescription only

Vraylar (cariprazine) is an atypical antipsychotic used to treat schizophrenia and bipolar I disorder in teens and adults. It can also be added to other medications to help treat depression in adults. You take a dose by mouth once a day. Common side effects include uncontrolled body movements and restlessness. Compared to some other antipsychotic medications, Vraylar (cariprazine) usually causes little to no weight gain.

Indications for Vraylar

Schizophrenia - age 13 years and older
Manic or mixed episodes of bipolar I disorder - age 10 years and older
Bipolar depression of bipolar I disorder - adults
Major depressive disorder (MDD), as an add-on treatment - adults

Pros and Cons for Vraylar

Pros

Taken once a day
Can be taken with or without food
Longer lasting compared to other similar medications
Lower risk of weight gain compared to some antipsychotics

Cons

Might take several weeks to fully work
Risk of uncontrolled body movements
Can cause restlessness or feeling like you can't sit still
Not safe during pregnancy

Common Side Effects for Vraylar

Uncontrolled muscle movements (up to 19%)
Trouble sleeping (up to 13%)
Headache (up to 11%)
Drowsiness (up to 8%)
Constipation (up to 7%)
Nausea (up to 7%)
Restlessness (up to 6%)

*Note: Side effects listed were reported by people in studies who took Vraylar (cariprazine) for schizophrenia.

Warnings for Vraylar

Higher risk of death in older adults with dementia-related psychosis
Suicidal thoughts and behavior
Neuroleptic malignant syndrome
Difficulty controlling movements (tardive dyskinesia)
High blood sugar, high cholesterol, and weight gain
Low white blood cell count
Higher risk of falls and fainting
Seizures
Trouble controlling body temperature
Difficulty swallowing

Summary for Risperidone

Prescription only

Risperidone (Risperdal) is an atypical antipsychotic that's used to improve mood, thoughts, and behaviors in people with schizophrenia, bipolar disorder, and autism. It's taken by mouth, typically once or twice daily. Common side effects of risperidone (Risperdal) include sleepiness, movement problems, and weight gain. Risperidone (Risperdal) can interact with some medications, such as certain antidepressants or blood pressure medications. Taking these medications together can make certain side effects worse.

Indications for Risperidone

Schizophrenia - people ages 13 years and older
Manic or mixed episodes associated with bipolar I disorder - people ages 10 years and older
Irritability associated with autism - children ages 5 to 17 years old

Pros and Cons for Risperidone

Pros

Taken by mouth
Available as a pill, dissolving tablet, and liquid
Can be used in both adults and children
Available as a lower-cost generic

Cons

Higher risk of sexual problems, compared to other atypical antipsychotics
Can cause weight gain
Can cause changes to sleep or movement problems
Shouldn't be mixed with alcohol

Common Side Effects for Risperidone

Adults:

Muscle stiffness, muscle tightening, difficulty with movement (25%)
Extreme sleepiness (11%)
Restlessness, trouble remaining still (9%)
Tremor (6%)
Dizziness (6%)
Nausea (5%)
Repetitive movements, abnormal postures (5%)

Children:

Extreme sleepiness (up to 56%)
Dizziness (up to 16%)
Nausea or vomiting (up to 16%)
Stomach pain (up to 16%)
Muscle stiffness, muscle tightening, difficulty with movement (up to 12%)
Heartburn (up to 10%)
Sore throat (up to 10%)

Warnings for Risperidone

Higher risk of death in older adults with dementia-related psychosis
Neuroleptic malignant syndrome
Difficulty controlling muscle movements (tardive dyskinesia)
Weight gain, higher blood sugar, and higher cholesterol levels
High prolactin levels
Changes in blood pressure and higher risk of falls
Risk of infection (from low white blood cell count)
Difficulty concentrating and extreme sleepiness
Seizures
Prolonged and painful erection
Caution use in people with phenylketonuria (PKU) - orally disintegrating tablets only