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

Key takeaways

Vraylar (cariprazine) and Saphris (asenapine) are both atypical antipsychotics used to treat schizophrenia and bipolar disorder, but they have some key differences. Vraylar is taken once a day by mouth, while Saphris is a dissolvable tablet taken under the tongue twice daily. Vraylar is only available as a brand-name medication, whereas Saphris is available as a lower-cost generic. Vraylar (cariprazine) is used for adults only, but Saphris can be used for bipolar disorder in children aged 10 and older. Weight gain is less common with Vraylar compared to Saphris, which often causes weight gain. Additionally, Vraylar has a higher risk of causing uncontrolled muscle movements, while Saphris can cause mouth numbness and requires you to avoid eating or drinking for 10 minutes after taking it.

Vraylar

(cariprazine)

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Asenapine

(Saphris)

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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 Saphris

Prescription only

Asenapine (Saphris) is an atypical antipsychotic. It's used to treat schizophrenia in adults and bipolar I disorder in people ages 10 years and older. It comes as sublingual (under the tongue) tablets in both a brand-name and generic versions. The usual dosage is to dissolve a tablet under the tongue twice a day. Some potential side effects of this medication include sleepiness, trouble sleeping, and movement problems.

Indications for Saphris

Schizophrenia in adults
Bipolar I disorder in adults and children ages 10 years and older

Pros and Cons for Saphris

Pros

Dissolved under the tongue; good option for people who have a hard time swallowing tablets
Possible option for children who have bipolar I disorder
Less likely to cause weight gain than some other antipsychotic medications, like olanzapine (Zyprexa)

Cons

Can cause drowsiness or trouble sleeping
Taken twice a day
Can't be taken by people who have severe liver problems

Common Side Effects for Saphris

Trouble sleeping (up to 16%)
Sleepiness (up to 15%)
Movement problems (up to 12%)
Restlessness (not being able to sit still, up to 11%)
Dizziness (up to 7%)
Constipation (up to 7%)
Vomiting (up to 7%)
Mouth numbness (up to 7%)

*Note: Side effects listed above were reported by adults with schizophrenia. Similar side effects are seen in adults and children with bipolar disorder.