Cariprazine
VRAYLAR
What it isD3-preferring D2/D3 partial agonist with serotonergic activity; schizophrenia, bipolar disorder, and adjunctive depression.
Why this oneIts unusually broad mood labeling spans bipolar mania, bipolar depression, and adjunctive unipolar depression.
What limits itAkathisia is dose-limiting; long-lived active metabolites delay steady response and make adverse effects linger after stopping.
FDA-approved for
- schizophrenia (2015)
- bipolar mania (2015)
- bipolar depression (2019)
- adjunct for depression (2022)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Schizophrenia | Adults | 1.5 mg QD | 1.5–6 mg QD | 6 mg/day |
| Schizophrenia | Adolescents 13–17 yr | 0.5 mg QD | 1.5–4.5 mg QD | 4.5 mg/day |
| Bipolar I mania/mixed | Adults | 1.5 mg QD | 3–6 mg QD | 6 mg/day |
| Bipolar I mania/mixed | Children 10–17 yr | 0.5 mg QD | 3 or 4.5 mg QD | 4.5 mg/day |
| Bipolar depression | Adults | 1.5 mg QD | 1.5 or 3 mg QD | 3 mg/day |
| MDD, adjunct to antidepressant | Adults | 1.5 mg QD | 1.5 or 3 mg QD | 3 mg/day |
Titration Bipolar depression & adjunctive MDD: wait ≥14 days before increasing to 3 mg (titration <14 days raises adverse reactions)
Renal CrCl ≥30 mL/min: no adjustment; CrCl <30 mL/min: not evaluated
Hepatic Mild–moderate (Child-Pugh 5–9): no adjustment; severe (10–15): not recommended
Long half-life — dose changes not fully reflected in plasma for several weeks
Instructions
- Take once daily with or without food
- Long half-life — monitor for several weeks after start and after each dose change
- Reduce starting/current dose with strong or moderate CYP3A4 inhibitors; avoid CYP3A4 inducers
Cautions
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- Metabolic changes (hyperglycemia, dyslipidemia, weight gain)
- Leukopenia/neutropenia/agranulocytosis
- Orthostatic hypotension and syncope
- Late-occurring adverse reactions (accumulation)
- Seizures
- Cognitive/motor impairment
- Cerebrovascular reactions in elderly with dementia
Adverse reactions
- Extrapyramidal symptoms
- Akathisia
- Restlessness
- Nausea/vomiting
- Dyspepsia
- Somnolence
- Insomnia
- Constipation
Pregnancy May cause fetal harm (animal data); pregnancy registry available; third-trimester exposure risks EPS/withdrawal in neonate
Lactation No human data; present in rat milk — weigh benefits vs. risk
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Cost, est. cash$200–$1,200/month
Generic entry2029 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.
Active metabolites
Mechanism of action: Cariprazine ballicule
Open Cariprazine in the interactive console ↗
Memory aids: mascots and interaction avatars
Antipsychotics are represented with spooky mascots
Vroom! → potentially activating, not sedating
Engine running → akathisia
Jaw clenched → dystonia
V-forming headlights are “V-Rays”
Bright headlight → possibly sharpened cognition
Long headlights → extremely long half-life
