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.
Manic or mixed episodes of bipolar I disorder
Bipolar depression of bipolar I disorder
Major depressive disorder (MDD), as an add-on medication
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.
Source: DailyMed
Side effects that you should report to your care team as soon as possible:
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
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
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
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.
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.
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).
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.
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.
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.
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.
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).
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).
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.
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.
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.
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.
Manic or mixed episodes of bipolar I disorder
Bipolar depression of bipolar I disorder
Major depressive disorder (MDD), as an add-on medication
Tourette syndrome in children
Depression (add-on treatment)
Irritability associated with autistic disorder in children
Schizophrenia in people age 13 years and older
Depression from bipolar disorder in people age 10 years and older
Add-on therapy to lithium (Lithobid) or divalproex (Depakote) for depression from bipolar disorder in adults
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Allergan, Inc. (2024). Vraylar- cariprazine capsule, gelatin coated; cariprazine kit [package insert]. DailyMed.
Frankel, J. S., et al. (2017). Brexpiprazole and cariprazine: Distinguishing two new atypical antipsychotics from the original dopamine stabilizer aripiprazole. Therapeutic Advances in Psychopharmacology.
MGH Center for Women’s Mental Health. (n.d.). National Pregnancy Registry for Psychiatric Medications©.
Nasrallah, H. A., et al. (2017). The safety and tolerability of cariprazine in long-term treatment of schizophrenia: A post hoc pooled analysis. BioMed Central Psychiatry.
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