Cariprazine
VRAYLAR
Pronunciation: kar-IP-ra-zeen (VRAY-lar)
“Car ripper seen (going) Vroom!”
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
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.
Cariprazine prescription history
Animated chart of estimated U.S. prescriptions per year, Bipolar disorder meds (1954–2026). Cariprazine enters in 2016.
FDA-approved for
- schizophrenia (2015)
- bipolar mania (2015)
- bipolar depression (2019)
- adjunct for depression (2022)
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.
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
Available strengths
- cap 0.5, 0.75, 1.5, 3, 4.5, 6 mg
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
Cost
| Strength | #/mo | generic $/mo | brand $/mo | CostPlus | |
|---|---|---|---|---|---|
| 0.5 mg | cap | 30 qd | — | $1,523.36 | not offered |
| 0.75 mg | cap | 30 qd | — | $1,525.16 | not offered |
| 1.5 mg | cap | 30 qd | — | $1,525.27 | not offered |
| 3 mg | cap | 30 qd | — | $1,526.52 | not offered |
| 4.5 mg | cap | 30 qd | — | $1,523.58 | not offered |
| 6 mg | cap | 30 qd | — | $1,523.28 | not offered |
Generic entry2029 est.
Active metabolites
Open Cariprazine in the interactive console ↗
Memory aids: interaction avatars
Open Cariprazine in the interactive console ↗
Self-check
- Why can cariprazine adverse effects linger after stopping?
Long-lived active metabolites. - What is cariprazine’s dose-limiting adverse effect?
Akathisia.