Cariprazine: Drug information

For additional information see "Cariprazine: Patient drug information"

For abbreviations, symbols, and age group definitions show table

ALERT: US Boxed Warning

Increased mortality in elderly patients with dementia-related psychosis:

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Cariprazine is not approved for the treatment of patients with dementia-related psychosis.

Suicidal thoughts and behaviors:

Antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening and for the emergence of suicidal thoughts and behaviors. The safety and efficacy of cariprazine have not been established in pediatric patients.

Brand Names: US

Vraylar

Brand Names: Canada

Vraylar

Pharmacologic Category

Antimanic Agent;
Second Generation (Atypical) Antipsychotic

Dosing: Adult

Dosage guidance:

Safety: Antipsychotics are not indicated for use in catatonia and may worsen psychosis and increase risk for neuroleptic malignant syndrome in patients with catatonia (Ref).

Clinical considerations: Consult a psychiatry specialist for all management decisions; select antipsychotic carefully based on patient preference, clinical characteristics, history, comorbidities, and adverse effect profile (Ref).

Bipolar disorder

Bipolar disorder:

Acute mania and acute episodes with mixed features (monotherapy): Oral: Initial: 1.5 mg once daily; adjust dose based on response and tolerability to 3 mg on day 2 and make further adjustments in increments of 1.5 or 3 mg. Recommended dosing range: 3 mg to 6 mg once daily. Maximum dose: 6 mg/day (product labeling); doses up to 12 mg/day have been evaluated in clinical trials, however, greater efficacy has not been demonstrated (Ref).

Bipolar major depression (monotherapy): Oral: Initial: 1.5 mg once daily; increase based on response and tolerability to 3 mg on day 15. Maximum dose: 3 mg/day (Ref).

Major depressive disorder

Major depressive disorder (unipolar) (adjunctive therapy with antidepressant): Oral: Initial: 1.5 mg once daily, may increase based on response and tolerability to 3 mg once daily on day 15. Maximum dose: 3 mg/day, however, some experts recommend increasing to 4.5 mg/day based on response and tolerability (Ref).

Schizophrenia

Schizophrenia:

Oral: Initial: 1.5 mg once daily; may adjust dose based on response and tolerability to 3 mg once daily on days 2 or 3. Starting as early as day 4, may further increase to 4.5 or 6 mg once daily based on response and tolerability. Monitor for akathisia, anticholinergic effects, and sedation during titration. Maximum dose: 6 mg/day (Ref).

Discontinuation of therapy: In the treatment of chronic psychiatric disease, switching therapy rather than discontinuation is generally advised if side effects are intolerable or treatment is not effective. If patient insists on stopping treatment, gradual dose reduction (ie, over several weeks to months) is advised to detect a re-emergence of symptoms and to avoid withdrawal reactions (eg, agitation, alternating feelings of warmth and chill, anxiety, diaphoresis, dyskinesias, GI symptoms, insomnia, irritability, myalgia, paresthesia, psychosis, restlessness, rhinorrhea, tremor, vertigo) unless discontinuation is due to significant adverse effects. Monitor closely to allow for detection of prodromal symptoms of disease recurrence (Ref).

Switching antipsychotics: An optimal universal strategy for switching antipsychotic drugs has not been established. Strategies include: cross-titration (gradually discontinuing the first antipsychotic while gradually increasing the new antipsychotic) and abrupt change (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose). In patients with schizophrenia at high risk of relapse, the current medication may be maintained at full dose as the new medication is increased (ie, overlap); once the new medication is at therapeutic dose, the first medication is gradually decreased and discontinued over 1 to 2 weeks (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

CrCl ≥30 mL/minute: No dosage adjustment necessary.

CrCl <30 mL/minute: Use not recommended (has not been studied).

Dosing: Liver Impairment: Adult

Mild to moderate impairment (Child-Pugh class A or B): No dosage adjustment necessary.

Severe impairment (Child-Pugh class C): Use not recommended (has not been studied).

Dosing: Older Adult

Note: Avoid for behavioral problems associated with dementia or delirium unless alternative nonpharmacologic therapies have failed and patient may harm self or others. If used, consider deprescribing attempts to assess continued need and/or lowest effective dose. Of note, use in certain indications (eg, adjunctive treatment of unipolar major depressive disorder, schizophrenia, bipolar disorder) may be appropriate (Ref). Consult a psychiatry specialist for all management decisions (Ref).

All indications: Refer to adult dosing; dosages in the lower range of recommended adult dosing are generally sufficient. Titrate dosage slowly and monitor carefully.

Adverse Reactions (Significant): Considerations

Activating/Sedating effects

Both activating effects (eg, akathisia, restlessness) and sedating effects (eg, drowsiness, somnolence) may occur with cariprazine. In clinical studies, most instances of akathisia were considered mild or moderate, though events leading to treatment discontinuation were rarely reported (Ref). The mean duration of akathisia/restlessness in clinical studies was reported between 15 and 24 days (Ref).

Mechanism: Dose-related; sedation from antipsychotics is believed to be due to H₁ receptor antagonism; mechanism of activating effects is not clear but is thought to involve GABA and serotonin effects on dopamine signaling (Ref)

Onset: Varied; in clinical studies, akathisia/restlessness most commonly occurred within the first 2 to 6 weeks of therapy (Ref)

Risk factors:

• Akathisia, restlessness: High doses, rapid up-titration (Ref)

• Somnolence: Doses ≥4.5 mg/day (Ref)

• Specific antipsychotic (cariprazine is generally considered to be minimally sedating at usual therapeutic doses in comparison with other antipsychotics) (Ref)

Extrapyramidal symptoms

Cariprazine may cause an extrapyramidal reaction, also known as drug-induced movement disorders. Antipsychotics can cause four main extrapyramidal symptoms (EPS): drug-induced parkinsonism, akathisia, acute dystonia, and tardive dyskinesia. EPS presenting as dysphagia, esophageal dysmotility, or aspiration have also been reported with antipsychotics, which may not be recognized as EPS (Ref). In clinical studies, the mean duration of EPS for cases that resolved during study period was ~10 days (Ref).

Mechanism: Dose-related; due to antagonism of dopaminergic D₂ receptors in nigrostriatal pathways (cariprazine is a partial agonist) (Ref)

Onset: Intermediate; in clinical studies, acute EPS occurred within the first 3 weeks of therapy (Ref).

Risk factors:

EPS (in general):

• Higher doses (Ref)

• Prior history of EPS (Ref)

Acute dystonia:

• Males (Ref)

• Young age (Ref)

Akathisia:

• Rapid up-titration (Ref)

• Mood disorders (Ref)

• Females (Ref)

• Older patients (Ref)

Drug-induced parkinsonism:

• Higher doses (Ref)

• Older patients (Ref)

• Females (Ref)

• Dementia (Ref)

Tardive dyskinesia:

• Greater total antipsychotic exposure (especially first-generation antipsychotics) (Ref)

• Concomitant treatment with anticholinergic medications (Ref)

• Substance misuse or dependence (Ref)

• Age >55 years (Ref)

• Cognitive impairment (Ref)

• Diabetes (Ref)

• Diagnosis of schizophrenia or affective disorders (Ref)

• Females (Ref)

• History of extrapyramidal symptoms (Ref)

Esophageal dysfunction (associated with EPS):

• Certain comorbidities such as neurologic degenerative disease, dementia, stroke, Parkinson disease, or myasthenia gravis (Ref)

• Older adults >75 years of age (may be risk factor due to age-related muscle atrophy, cognitive impairment, reduced esophageal peristalsis) (Ref)

Hematologic abnormalities

Leukopenia and neutropenia have been reported with cariprazine. Agranulocytosis has been reported with other second-generation antipsychotics.

Onset: Varied; in general, drug-induced neutropenia usually manifests after 1 or 2 weeks of exposure; however, the onset may be insidious (Ref)

Risk factors:

• Preexisting low white blood cell count or absolute neutrophil count

• History of drug-induced leukopenia or neutropenia

Hyperglycemia

Antipsychotics are associated with hyperglycemia to varying degrees, which is a component of the metabolic syndrome, observed with this pharmacologic class. Cariprazine is associated with a low risk of metabolic alterations; however, increased A_1c and blood glucose have been reported with long-term use (Ref).

Mechanism: Mechanism is not entirely understood (Ref)

Risk factors:

Antipsychotics in general:

• African American race (Ref)

• Males (Ref)

• Age <35 years (Ref)

• Preexisting obesity, poor exercise habits, or other risk factors for diabetes, including family history of diabetes (Ref)

• Exposure to other agents that also increase the risk of hyperglycemia (Ref)

• Specific antipsychotic: Metabolic disturbances appear to be the greatest with clozapine and olanzapine and lower with cariprazine (Ref)

Neuroleptic malignant syndrome

Antipsychotics are associated with neuroleptic malignant syndrome (NMS), although the incidence is lower with second-generation (atypical) antipsychotics compared to first-generation (typical) antipsychotics. There is one published case report of NMS with cariprazine (in combination with other psychiatric medications) (Ref).

Mechanism: Non–dose-related; idiosyncratic. Believed to be due to a reduction in CNS dopaminergic tone, along with the dysregulation of autonomic nervous system activity (Ref)

Onset: Varied; in general, most patients develop NMS within 2 weeks of initiating an antipsychotic, and in some patients, prodromal symptoms emerge within hours of initiation; once the syndrome starts, the full syndrome usually develops in 3 to 5 days (Ref). However, there are many cases of NMS occurring months after stable antipsychotic therapy (Ref)

Risk factors:

Antipsychotics in general:

• Males (twice as likely to develop NMS compared to females) (Ref)

• Dehydration (Ref)

• High-dose antipsychotic treatment (Ref)

• Concomitant lithium or benzodiazepine (potential risk factors) (Ref)

• Catatonia (Ref)

• Polypharmacy (Ref)

• Pharmacokinetic interactions (Ref)

• Intramuscular administration (Ref)

• Rapid dosage escalation (Ref)

• Psychomotor agitation (Ref)

Temperature dysregulation

Antipsychotics may impair the body's ability to regulate core body temperature, which may cause a potentially life-threatening heat stroke during predisposing conditions, such as heat wave or strenuous exercise.

Risk factors:

Heat stroke (antipsychotics in general):

• Psychiatric illness (regardless of medication use) (Ref)

• Dehydration (Ref)

• Strenuous exercise (Ref)

• Heat exposure (Ref)

• Concomitant medications possessing anticholinergic effects (Ref)

Weight gain

Cariprazine may cause significant weight gain (increase of ≥7% from baseline), which is a component of the metabolic syndrome observed with this pharmacologic class.

Mechanism: Multiple proposed mechanisms, including actions at serotonin, dopamine, histamine, and muscarinic receptors, with differing effects explained by differing affinity of antipsychotics at these receptors (Ref). A low affinity for serotonin and histamine receptors may account for the relatively low risk of weight gain associated with cariprazine (Ref).

Onset: Varied; antipsychotic-induced weight gain usually occurs rapidly in the initial period following initiation, then gradually plateaus over several months with patients continuing to gain weight in the long term (Ref).

Risk factors:

Antipsychotics in general:

• Family history of obesity (Ref)

• Parental BMI (Ref)

• Rapid weight gain in the initial period: Younger age, lower baseline BMI, more robust response to antipsychotic, and increase in appetite; rapid weight gain of >5% in the first month has been observed as the best predictor for significant long-term weight gain (Ref)

• Duration of therapy (although weight gain plateaus, patients continue to gain weight over time) (Ref)

• Schizophrenia (regardless of medication) is associated with a higher prevalence of obesity compared to the general population due to components of the illness, such as negative symptoms, sedentary lifestyles, and unhealthy diets (Ref)

• Specific antipsychotic: Cariprazine is considered to have a minimal or low risk for weight gain; clozapine and olanzapine are considered to have high propensity (Ref)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions reported for monotherapy in adults.

>10%:

Gastrointestinal: Nausea (7% to 13%)

Nervous system: Akathisia (6% to 20%) (table 1)Akathisia, extrapyramidal reaction (4% to 26%; including dyskinesia, dystonia, muscle rigidity, Parkinsonism, tardive dyskinesia) (table 2)Extrapyramidal Reaction, headache (14%), insomnia (9% to 13%)

**Cariprazine: Adverse Reaction: Akathisia**
Drug (Cariprazine)	Placebo	Dose	Indication	Number of Patients (Cariprazine)	Number of Patients (Placebo)
10%	2%	3 mg/day	Bipolar disorder, depressive episode	469	468
6%	2%	1.5 mg/day	Bipolar disorder, depressive episode	470	468
20%	5%	3 to 6 mg/day	Bipolar mania	263	442
13%	4%	4.5 to 6 mg/day	Schizophrenia	575	584
9%	4%	1.5 to 3 mg/day	Schizophrenia	539	584

**Cariprazine: Adverse Reaction: Extrapyramidal Reaction**
Drug (Cariprazine)	Placebo	Dose	Indication	Number of Patients (Cariprazine)	Number of Patients (Placebo)
6%	2%	3 mg/day	Bipolar disorder, depressive episode	469	468
4%	2%	1.5 mg/day	Bipolar disorder, depressive episode	470	468
26%	12%	3 to 6 mg/day	Bipolar mania	263	442
19%	8%	4.5 to 6 mg/day	Schizophrenia	575	584
15%	8%	1.5 to 3 mg/day	Schizophrenia	539	584

1% to 10%:

Cardiovascular: Hypertension (2% to 5%), tachycardia (2%)

Endocrine & metabolic: Weight gain (1% to 8%) (table 3)Weight Gain

**Cariprazine: Adverse Reaction: Weight Gain**
Drug (Cariprazine)	Placebo	Dose	Indication	Number of Patients (Cariprazine)	Number of Patients (Placebo)	Comments
3%	1%	1.5 mg/day	Bipolar disorder, depressive episode	467	463	Patients with weight increase ≥7%
3%	1%	3 mg/day	Bipolar disorder, depressive episode	465	463	Patients with weight increase ≥7%
2%	<1%	1.5 mg/day	Bipolar disorder, depressive episode	470	468	N/A
2%	<1%	3 mg/day	Bipolar disorder, depressive episode	469	468	N/A
2%	2%	3 to 6 mg/day	Bipolar mania	263	442	N/A
1%	2%	3 to 6 mg/day	Bipolar mania	259	439	Patients with weight increase ≥7%
8%	5%	1.5 to 3 mg/day	Schizophrenia	512	573	Patients with weight increase ≥7%
8%	5%	4.5 to 6 mg/day	Schizophrenia	570	573	Patients with weight increase ≥7%
3%	1%	1.5 to 3 mg/day	Schizophrenia	539	584	N/A
2%	1%	4.5 to 6 mg/day	Schizophrenia	575	584	N/A

Gastrointestinal: Abdominal pain (6%), constipation (6% to 7%), decreased appetite (3%), diarrhea (4%), dyspepsia (5% to 7%), increased appetite (3%), toothache (4%), vomiting (4% to 10%), xerostomia (3%)

Hepatic: Increased serum transaminases (≥3 x ULN; 2% to 4%)

Nervous system: Agitation (5%), anxiety (5% to 6%), dizziness (3% to 7%), drowsiness (5% to 8%) (table 4)Drowsiness, fatigue (3% to 4%), restlessness (2% to 7%) (table 5)Restlessness

**Cariprazine: Adverse Reaction: Drowsiness**
Drug (Cariprazine)	Placebo	Dose	Indication	Number of Patients (Cariprazine)	Number of Patients (Placebo)
7%	4%	1.5 mg/day	Bipolar disorder, depressive episode	470	468
6%	4%	3 mg/day	Bipolar disorder, depressive episode	469	468
7%	4%	3 to 6 mg/day	Bipolar mania	263	442
8%	5%	4.5 to 6 mg/day	Schizophrenia	575	584
5%	5%	1.5 to 3 mg/day	Schizophrenia	539	584

**Cariprazine: Adverse Reaction: Restlessness**
Drug (Cariprazine)	Placebo	Dose	Indication	Number of Patients (Cariprazine)	Number of Patients (Placebo)
7%	3%	3 mg/day	Bipolar disorder, depressive episode	469	468
2%	3%	1.5 mg/day	Bipolar disorder, depressive episode	470	468
7%	2%	3 to 6 mg/day	Bipolar mania	263	442
6%	3%	4.5 to 6 mg/day	Schizophrenia	575	584
4%	3%	1.5 to 3 mg/day	Schizophrenia	539	584

Neuromuscular & skeletal: Arthralgia (2%), back pain (3%), increased creatine phosphokinase in blood specimen (2% to 6%), limb pain (4%)

Ophthalmic: Blurred vision (4%)

<1%:

Dermatologic: Hyperhidrosis

Endocrine & metabolic: Hyponatremia

Gastrointestinal: Gastritis, gastroesophageal reflux disease

Genitourinary: Pollakiuria

Hepatic: Hepatitis

Nervous system: Cerebrovascular accident, suicidal ideation, suicidal tendencies

Neuromuscular & skeletal: Rhabdomyolysis

Frequency not defined:

Endocrine & metabolic: Diabetes mellitus, dyslipidemia, hyperglycemia

Ophthalmic: Cataract

Postmarketing:

Dermatologic: Stevens-Johnson syndrome

Endocrine & metabolic: Hyperprolactinemia (Ref)

Gastrointestinal: Dysphagia

Hematologic & oncologic: Leukopenia, neutropenia

Contraindications

Hypersensitivity (rash, pruritus, urticaria, angioedema) to cariprazine or any component of the formulation.

Canadian labeling: Additional contraindications (not in US labeling): Coadministration with or within 2 weeks of moderate and strong CYP3A4 inhibitors; coadministration with moderate and strong CYP3A4 inducers.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Warnings/Precautions

Concerns related to adverse effects:

• Falls: May increase the risk for falls due to somnolence, orthostatic hypotension, and motor or sensory instability.

• Orthostatic hypotension: May cause orthostatic hypotension; risk is increased at initial dose titration and when increasing the dose. Use with caution in patients at risk of this effect or in those who would not tolerate transient hypotensive episodes (patients who are antipsychotic-naive or have cerebrovascular disease, cardiovascular disease, hypovolemia, dehydration, or are taking concurrent medication use which may predispose to hypotension/bradycardia).

Disease-related concerns:

• Dementia: [US Boxed Warning]: Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death compared to placebo. Most deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature. Use with caution in patients with Lewy body dementia or Parkinson disease dementia due to greater risk of adverse effects, increased sensitivity to extrapyramidal effects, and association with irreversible cognitive decompensation or death (APA [Reus 2016]). Cariprazine is not approved for the treatment of dementia-related psychosis.

• Hepatic impairment: Use with caution in patients with hepatic impairment; use is not recommended in severe impairment.

• Renal impairment: Use with caution in patients with renal impairment; use is not recommended if CrCl <30 mL/minute.

• Seizures: Use with caution in patients at risk of seizures or with conditions that potentially lower the seizure threshold. Elderly patients may be at increased risk of seizures due to an increased prevalence of predisposing factors.

Other warnings/precautions:

• Discontinuation of therapy: When discontinuing antipsychotic therapy, gradually taper antipsychotics to avoid physical withdrawal symptoms and rebound symptoms (APA [Keepers 2020]; WFSBP [Hasan 2012]). Withdrawal symptoms may include agitation, alternating feelings of warmth and cold, anxiety, diaphoresis, dyskinesia, GI symptoms, insomnia, irritability, myalgia, paresthesia, psychosis, restlessness, rhinorrhea, tremor, and vertigo (Lambert 2007; Moncrieff 2020). The risk of withdrawal symptoms is highest following abrupt discontinuation of highly anticholinergic or dopaminergic antipsychotics (Cerovecki 2013). Patients with chronic symptoms, repeated relapses, and clear diagnostic features of schizophrenia are at risk for poor outcomes if medications are discontinued (APA [Keepers 2020]).

• Pharmacokinetics: Plasma levels of cariprazine and its major metabolites accumulate over time. Adverse reactions may not appear until several weeks after initiation of treatment. Monitor response and for adverse reactions several weeks after the patient has begun treatment and after each dose increase. With treatment discontinuation the plasma concentration of cariprazine and active metabolites declines by 50% in ~1 week; therefore, the decline of plasma concentrations of active drug and metabolite may not be immediately reflected in the patient's clinical symptoms.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Vraylar: 1.5 mg

Vraylar: 3 mg, 4.5 mg [contains fd&c blue #1 (brilliant blue), fd&c red #40 (allura red ac dye)]

Vraylar: 6 mg [contains fd&c blue #1 (brilliant blue)]

Capsule Therapy Pack, Oral:

Vraylar: 1.5 mg (1) and 3 mg (6s) (7 ea [DSC]) [contains fd&c blue #1 (brilliant blue), fd&c red #40 (allura red ac dye)]

Generic Equivalent Available: US

Pricing: US

Capsules (Vraylar Oral)

1.5 mg (per each): $60.76

3 mg (per each): $60.76

4.5 mg (per each): $60.76

6 mg (per each): $60.76

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Vraylar: 1.5 mg

Vraylar: 3 mg, 4.5 mg [contains fd&c blue #1 (brilliant blue), fd&c red #40 (allura red ac dye)]

Vraylar: 6 mg [contains fd&c blue #1 (brilliant blue), fd&c red #3 (erythrosine sodium)]

Administration: Adult

Oral: Administer with or without food.

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:

Vraylar: https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/204370s012lbl.pdf#page=46

Use: Labeled Indications

Bipolar disorder: Acute treatment of mania or episodes with mixed features and major depression associated with bipolar I disorder.

Major depressive disorder (unipolar): Adjunctive therapy in adults with an inadequate response to antidepressants for the treatment of unipolar major depressive disorder.

Schizophrenia: Treatment of schizophrenia.

Medication Safety Issues

Older Adult: High-Risk Medication:

Beers Criteria: Antipsychotics are identified in the Beers Criteria as potentially inappropriate medications to be avoided in patients 65 years and older due to an increased risk of stroke and a greater rate of cognitive decline and mortality in patients with dementia. Evidence also suggests there may be an increased risk of mortality with use independent of dementia. Avoid antipsychotics for behavioral problems associated with dementia or delirium unless alternative nonpharmacologic therapies have failed and patient may harm self or others. In addition, antipsychotics should be used with caution in older adults due to their potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium closely with initiation or dosage adjustments in older adults. Use of antipsychotics may be appropriate for labeled indications including schizophrenia, bipolar disorder, Parkinson disease psychosis, adjunctive therapy in major depressive disorder, or for short-term use as an antiemetic (Beers Criteria [AGS 2023]).

Metabolism/Transport Effects

Substrate of CYP2D6 (Minor), CYP3A4 (Major with inhibitors), CYP3A4 (Minor with inducers); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Agents With Seizure Threshold Lowering Potential: May increase adverse/toxic effects of Cariprazine. Specifically, the risk of seizures may be increased. Risk C: Monitor

Amifampridine: Agents With Seizure Threshold Lowering Potential may increase neuroexcitatory and/or seizure-potentiating effects of Amifampridine. Risk C: Monitor

Amisulpride (Oral): Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Amisulpride (Oral). Specifically, the risk of seizures may be increased. Risk C: Monitor

Amisulpride (Oral): May increase adverse/toxic effects of Antipsychotic Agents. Specifically, the risk of neuroleptic malignant syndrome or increased QTc interval may be increased. Risk C: Monitor

Anti-Parkinson Agents (Dopamine Agonist): Antipsychotic Agents (Second Generation [Atypical]) may decrease therapeutic effects of Anti-Parkinson Agents (Dopamine Agonist). Management: Consider avoiding atypical antipsychotic use in patients with Parkinson disease. If an atypical antipsychotic is necessary, consider using clozapine, quetiapine, or ziprasidone at lower initial doses, or a non-dopamine antagonist (eg, pimavanserin). Risk D: Consider Therapy Modification

Antidiabetic Agents: Hyperglycemia-Associated Agents may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

ARIPiprazole Lauroxil: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of ARIPiprazole Lauroxil. Specifically, the risk of seizures may be increased. Risk C: Monitor

ARIPiprazole: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of ARIPiprazole. Specifically, the risk of seizures may be increased. Risk C: Monitor

Asenapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Asenapine. Specifically, the risk of seizures may be increased. Risk C: Monitor

Benperidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Benperidol. Specifically, the risk of seizures may be increased. Risk C: Monitor

Benzgalantamine-Galantamine: May increase neurotoxic (central) effects of Antipsychotic Agents. Risk C: Monitor

Blonanserin: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Blonanserin. Specifically, the risk of seizures may be increased. Risk C: Monitor

Blood Pressure Lowering Agents: May increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor

Bornaprine: May increase adverse/toxic effects of Antipsychotic Agents. Specifically, tardive dyskinesia symptoms may be potentiated. Risk C: Monitor

Brexpiprazole: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Brexpiprazole. Specifically, the risk of seizures may be increased. Risk C: Monitor

Bromopride: May increase adverse/toxic effects of Antipsychotic Agents. Risk X: Avoid

Bromperidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Bromperidol. Specifically, the risk of seizures may be increased. Risk C: Monitor

BuPROPion: May increase neuroexcitatory and/or seizure-potentiating effects of Agents With Seizure Threshold Lowering Potential. Risk C: Monitor

Cabergoline: May decrease therapeutic effects of Antipsychotic Agents. Risk X: Avoid

ChlorproMAZINE: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of ChlorproMAZINE. Specifically, the risk of seizures may be increased. Risk C: Monitor

Clofazimine: May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor

Clothiapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Clothiapine. Specifically, the risk of seizures may be increased. Risk C: Monitor

CloZAPine: Cariprazine may increase adverse/toxic effects of CloZAPine. Specifically, the risk of seizures may be increased. Cariprazine may decrease serum concentration of CloZAPine. Cariprazine may decrease active metabolite exposure of CloZAPine. Risk C: Monitor

CYP3A4 Inducers (Moderate): May decrease serum concentration of Cariprazine. Risk X: Avoid

CYP3A4 Inducers (Strong): May decrease serum concentration of Cariprazine. Risk X: Avoid

CYP3A4 Inhibitors (Moderate): May increase serum concentration of Cariprazine. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Cariprazine. Management: Cariprazine dose adjustments are recommended and depend upon whether a patient is initiating a moderate CYP3A4 inhibitor or cariprazine, as well as cariprazine indication. See full mono for details. Some non-US labels contraindicate this combination. Risk D: Consider Therapy Modification

CYP3A4 Inhibitors (Strong): May increase serum concentration of Cariprazine. CYP3A4 Inhibitors (Strong) may increase active metabolite exposure of Cariprazine. Specifically, concentrations of didesmethylcariprazine (DDCAR), the primary active metabolite of cariprazine, may increase. Management: Cariprazine dose adjustments are recommended and depend upon whether a patient is initiating a strong CYP3A4 inhibitor or cariprazine, as well as cariprazine indication. See full mono for details. Some non-US labels contraindicate this combination. Risk D: Consider Therapy Modification

Deutetrabenazine: May increase adverse/toxic effects of Antipsychotic Agents. Specifically, the risk for akathisia, parkinsonism, or neuroleptic malignant syndrome may be increased. Risk C: Monitor

Dexmethylphenidate-Methylphenidate: Antipsychotic Agents may increase adverse/toxic effects of Dexmethylphenidate-Methylphenidate. Dexmethylphenidate-Methylphenidate may increase adverse/toxic effects of Antipsychotic Agents. Specifically, the risk of extrapyramidal symptoms may be increased when these agents are combined. Risk C: Monitor

Donepezil: May increase neurotoxic (central) effects of Antipsychotic Agents. Risk C: Monitor

DroPERidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of DroPERidol. Specifically, the risk of seizures may be increased. Risk C: Monitor

Flupentixol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Flupentixol. Specifically, the risk of seizures may be increased. Risk C: Monitor

FluPHENAZine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of FluPHENAZine. Specifically, the risk of seizures may be increased. Risk C: Monitor

Fusidic Acid (Systemic): May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider Therapy Modification

Grapefruit Juice: May increase serum concentration of Cariprazine. Management: Advise patients taking cariprazine to avoid consumption of grapefruit juice. Because grapefruit juice consumption is highly variable, typical dose adjustments associated with moderate CYP3A4 inhibitors are not likely feasible. Risk D: Consider Therapy Modification

Guanethidine: Antipsychotic Agents may decrease therapeutic effects of Guanethidine. Risk C: Monitor

Haloperidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Haloperidol. Specifically, the risk of seizures may be increased. Risk C: Monitor

Huperzine A: May increase neurotoxic (central) effects of Antipsychotic Agents. Risk C: Monitor

Iloperidone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Iloperidone. Specifically, the risk of seizures may be increased. Risk C: Monitor

Iohexol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic antiseizure drugs. Risk D: Consider Therapy Modification

Iomeprol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic antiseizure drugs. Risk D: Consider Therapy Modification

Iopamidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic antiseizure drugs. Risk D: Consider Therapy Modification

Lithium: May increase neurotoxic effects of Antipsychotic Agents. Lithium may decrease serum concentration of Antipsychotic Agents. Specifically noted with chlorpromazine. Risk C: Monitor

Loxapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Loxapine. Specifically, the risk of seizures may be increased. Risk C: Monitor

Lumateperone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Lumateperone. Specifically, the risk of seizures may be increased. Risk C: Monitor

Lurasidone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Lurasidone. Specifically, the risk of seizures may be increased. Risk C: Monitor

Metergoline: Antipsychotic Agents may decrease therapeutic effects of Metergoline. Metergoline may decrease therapeutic effects of Antipsychotic Agents. Risk C: Monitor

Methotrimeprazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Methotrimeprazine. Specifically, the risk of seizures may be increased. Risk C: Monitor

Metoclopramide: May increase adverse/toxic effects of Antipsychotic Agents. Risk X: Avoid

MetyroSINE: May increase adverse/toxic effects of Antipsychotic Agents. Specifically, the risk for extrapyramidal symptoms and excessive sedation may be increased. Risk C: Monitor

Molindone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Molindone. Specifically, the risk of seizures may be increased. Risk C: Monitor

OLANZapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of OLANZapine. Specifically, the risk of seizures may be increased. Risk C: Monitor

Paliperidone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Paliperidone. Specifically, the risk of seizures may be increased. Risk C: Monitor

Periciazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Periciazine. Specifically, the risk of seizures may be increased. Risk C: Monitor

Perphenazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Perphenazine. Specifically, the risk of seizures may be increased. Risk C: Monitor

Pimozide: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Pimozide. Specifically, the risk of seizures may be increased. Risk C: Monitor

Pipamperone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Pipamperone. Specifically, the risk of seizures may be increased. Risk X: Avoid

Piribedil: Antipsychotic Agents may decrease therapeutic effects of Piribedil. Piribedil may decrease therapeutic effects of Antipsychotic Agents. Management: Use of piribedil with antiemetic neuroleptics is contraindicated, and use with antipsychotic neuroleptics, except for clozapine, is not recommended. Risk X: Avoid

Polyethylene Glycol-Electrolyte Solution: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Polyethylene Glycol-Electrolyte Solution. Specifically, the risk of seizure may be increased. Risk C: Monitor

Prochlorperazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Prochlorperazine. Specifically, the risk of seizures may be increased. Risk C: Monitor

Promazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Promazine. Specifically, the risk of seizures may be increased. Risk C: Monitor

QUEtiapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of QUEtiapine. Specifically, the risk of seizures may be increased. Risk C: Monitor

Quinagolide: Antipsychotic Agents may decrease therapeutic effects of Quinagolide. Risk C: Monitor

RisperiDONE: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of RisperiDONE. Specifically, the risk of seizures may be increased. Risk C: Monitor

Rivastigmine: May increase neurotoxic (central) effects of Antipsychotic Agents. Risk C: Monitor

Serotonergic Agents (High Risk): May increase adverse/toxic effects of Antipsychotic Agents. Specifically, serotonergic agents may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotic Agents may increase serotonergic effects of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Risk C: Monitor

Sertindole: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Sertindole. Specifically, the risk of seizures may be increased. Risk C: Monitor

Sodium Phosphates: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Sodium Phosphates. Specifically, the risk of seizure or loss of consciousness may be increased in patients with significant sodium phosphate-induced fluid or electrolyte abnormalities. Risk C: Monitor

Sulpiride: Antipsychotic Agents may increase adverse/toxic effects of Sulpiride. Risk X: Avoid

Tetrabenazine: May increase adverse/toxic effects of Antipsychotic Agents. Specifically, the risk for NMS and extrapyramidal symptoms may be increased. Risk C: Monitor

Thioridazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Thioridazine. Specifically, the risk of seizures may be increased. Risk C: Monitor

Thiothixene: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Thiothixene. Specifically, the risk of seizures may be increased. Risk C: Monitor

Trifluoperazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Trifluoperazine. Specifically, the risk of seizures may be increased. Risk C: Monitor

Ziprasidone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Ziprasidone. Specifically, the risk of seizures may be increased. Risk C: Monitor

Zuclopenthixol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Zuclopenthixol. Specifically, the risk of seizures may be increased. Risk C: Monitor

Reproductive Considerations

Evaluate pregnancy status and provide preconception counseling prior to initiating treatment in patients who could become pregnant (APA [Keepers 2020]; BAP [McAllister-Williams 2017]; CANMAT [Yatham 2018]). Patients effectively treated may continue their current antipsychotic medication when planning a pregnancy unless contraindications exist (ACOG 2023; BAP [McAllister-Williams 2017]); the lowest effective dose and avoidance of polytherapy is recommended (BAP [Barnes 2020]; BAP [McAllister-Williams 2017]; CANMAT [Yatham 2018]). Management of mental health conditions in patients who could become pregnant should be based on a shared decision-making process that considers the possibility of pregnancy during treatment and the risks of discontinuing antipsychotic therapy (ACOG 2023; BAP [McAllister-Williams 2017]; CANMAT [Yatham 2018]).

Antipsychotic agents may be associated with sexual dysfunction. Some second generation (atypical) antipsychotics may cause hyperprolactinemia, resulting in menstrual disorders or impaired spermatogenesis. Consider changing to a medication that is prolactin-sparing in patients with clinical symptoms. Contraception should be provided if pregnancy is not desired, as unintended pregnancies may occur when changing to a prolactin-sparing medication (APA [Keepers 2020]; BAP [McAllister-Williams 2017]).

Pregnancy Considerations

Outcome data following exposure to second generation (atypical) antipsychotics (SGAs) as a class do not show a significant increased risk of major congenital malformations (BAP [Barnes 2020]); however, specific outcomes vary due to differences in study design and data are not specific for cariprazine (BAP [McAllister-Williams 2017]; Viguera 2021; Wang 2021). Additional studies are needed for individual agents and specific outcomes (BAP [Barnes 2020]). Data related to the long-term effects of in utero antipsychotic exposure on infant neurodevelopment and behavior are limited (BAP [McAllister-Williams 2017]; Straub 2022; Swetlik 2024).

Antipsychotic use during the third trimester of pregnancy increases the risk for extrapyramidal symptoms and/or withdrawal symptoms in newborns following delivery (Viguera 2023). Symptoms in the newborn may include agitation, feeding disorder, hypertonia, hypotonia, respiratory distress, somnolence, and tremor. These effects may require prolonged hospitalization or resolve within hours or days without specific treatment. Tapering the dose late in pregnancy to reduce the risk of symptoms is not recommended (APA [Keepers 2020]).

Atypical antipsychotics are associated with metabolic changes and the risk varies by specific agent. Available studies that evaluated the risk of developing gestational diabetes mellitus (GDM) during antipsychotic therapy have conflicting results, possibly due to differences in study design (ACOG 2023; Uguz 2019). Pregnant patients with diabetes mellitus or GDM may continue antipsychotic treatment (ACOG 2023). Consider the metabolic risks of the specific antipsychotic if treatment is initiated for the first time during pregnancy (Heinonen 2022). Screening for GDM should continue as part of standard prenatal care; early screening is not needed due to psychiatric medication exposure (ACOG 2023; BAP [McAllister-Williams 2017]).

Untreated and undertreated mental health conditions are associated with adverse pregnancy outcomes (ACOG 2023). Adverse obstetric and neonatal outcomes are associated with schizophrenia; however, comparisons between treated and untreated pregnancies are limited (BAP [McAllister-Williams 2017]). Untreated or undertreated depression is associated with preterm birth, low birth weight, preeclampsia, postpartum depression, and impaired infant attachment (associated with long-term developmental effects). Untreated bipolar disorder is associated with fetal growth restriction, preterm birth, adverse neurodevelopment, and may increase the risk of postpartum psychosis, worsening mood, and postpartum hospitalization. Discontinuing effective medications during pregnancy increases the risk of symptom relapse (ACOG 2023).

Patients effectively treated for schizophrenia or bipolar disorder pre-pregnancy may use the same medication during pregnancy unless contraindications exist (ACOG 2023; APA [Keepers 2020]). SGAs are better tolerated and have fewer extrapyramidal adverse effects than first-generation (typical) antipsychotics (ACOG 2023). SGAs are not considered a first-line medication for depression in pregnant patients who are treatment naive or who do not have a history of effective treatment in the past (ACOG 2023; BAP [McAllister-Williams 2017]).

Management of mental health conditions should be made as part of a shared decision-making process (ACOG 2023; BAP [McAllister-Williams 2017]). Treatment should not be withheld or discontinued based only on pregnancy status. When medications are used, the lowest effective dose of a single agent is recommended. Optimize dosing prior to changing a medication or adding additional agents whenever possible. Close monitoring for symptom improvement with a validated screening tool during pregnancy is recommended. Manage side effects as needed (ACOG 2023).

Data collection to monitor pregnancy and infant outcomes following exposure to psychiatric medications is ongoing. Encourage pregnant patients 45 years of age and younger with a history of psychiatric illness to enroll in the National Pregnancy Registry for Psychiatric Mediations (1-866-961-2388 or https://womensmentalhealth.org/research/pregnancyregistry/).

Breastfeeding Considerations

It is not known if cariprazine is present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.

Drowsiness, irritability, motor abnormalities, poor feeding, sedation, and slowed development have been reported in infants exposed to antipsychotics via breast milk. Monitor breastfed infants, especially those who are premature or of low birth weight, or when other sedative drugs are also prescribed (BAP [Barnes]; BAP [McAllister-Williams 2017]).

Monitoring Parameters

Frequency of Antipsychotic Monitoring for Cariprazine^a,b
Monitoring parameter	Frequency of monitoring	Comments
Adherence	Every visit
Blood chemistries (electrolytes, renal function, liver function, TSH)	Annually
CBC	As clinically indicated	Check frequently during the first few months of therapy in patients with preexisting low WBC or history of drug-induced leukopenia/neutropenia
Extrapyramidal symptoms	Every visit; 4 weeks after initiation and dose change; annually. Use a formalized rating scale at least annually or every 6 months if high risk^c
Fall risk	Every visit
Fasting plasma glucose/HbA_1c	4 months after initiation; annually	Check more frequently than annually if abnormal. Follow diabetes guidelines.
Lipid panel	4 months after initiation; annually	Check more frequently than annually if abnormal. Follow lipid guidelines.
Mental status and alertness	Every visit
Metabolic syndrome history	Annually	Evaluate for personal and family history of obesity, diabetes, dyslipidemia, hypertension, or cardiovascular disease
Prolactin	Ask about symptoms at every visit until dose is stable. Check prolactin level if symptoms are reported.	Hyperprolactinemia symptoms: Changes in menstruation, libido, gynecomastia, development of galactorrhea, and erectile and ejaculatory function
Tardive dyskinesia	Every visit; annually. Use a formalized rating scale at least annually or every 6 months if high risk^d
Vital signs (BP, orthostatics, temperature, pulse, signs of infection)	Every visit (at least weekly during first 3 to 4 weeks of treatment); 4 weeks after dose change.
Weight/Height/BMI	8 and 12 weeks after initiation and dose change; quarterly	Consider monitoring waist circumference at baseline and annually, especially in patients with or at risk for metabolic syndrome. Consider changing antipsychotic if BMI increases by ≥1 unit. Some experts recommend checking weight and height at every visit.
^aFor all monitoring parameters, it is appropriate for check at baseline and when clinically relevant (based on symptoms or suspected ADRs) in addition to the timeline. ^b ADA 2004; APA [Keepers 2020]; De Hert 2011; Gugger 2011; manufacturer’s labeling. ^c Risk factors for extrapyramidal symptoms (EPS) include prior history of EPS, high doses of antipsychotics, young age (children and adolescents at higher risk than adults), and dopaminergic affinity of individual antipsychotic. ^dRisk factors for tardive dyskinesia include age >55 years; females; White or African ethnicity; presence of a mood disorder, intellectual disability, or central nervous system injury; and past or current EPS.

Reference Range

Timing of serum samples: Draw trough just before next dose (Hiemke 2018).

Therapeutic reference range: 10 to 20 ng/mL (SI: 23.4 to 46.8 nmol/L) (Hiemke 2018). Note: Dosing should be based on therapeutic response as opposed to serum concentrations; however, therapeutic drug monitoring can be used to confirm adherence (APA [Keepers 2020]).

Laboratory alert level: 40 ng/mL (SI: 93.6 nmol/L) (Hiemke 2018).

Mechanism of Action

Cariprazine is a second generation antipsychotic which displays partial agonist activity at dopamine D₂ and serotonin 5-HT_1A receptors and antagonist activity at serotonin 5-HT_2A receptors. It exhibits high affinity for dopamine (D₂ and D₃) and serotonin (5-HT_1A) receptors and has low affinity for serotonin 5-HT_2C and alpha_1A-adrenergic receptors. Cariprazine functions as an antagonist for 5-HT_2B (high affinity) and 5-HT_2A receptors (moderate affinity), binds to histamine H₁ receptors, and has no affinity for muscarinic (cholinergic) receptors.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Oral:

Bipolar disorder, acute mania: Initial effects may be observed within days of treatment with continued improvements over 1 to 2 weeks (Goikolea 2013; Tohen 2000; Welten 2016).

Bipolar disorder, depressive episode: Initial effects may be observed within 1 week of treatment with continued improvements through 6 weeks (Cruz 2010).

Major depressive disorder, unipolar: Initial effects may be observed within 1 week with continued improvements over 6 to 12 weeks (Wen 2014).

Schizophrenia: Initial effects may be observed within 1 to 2 weeks of treatment with continued improvements through 4 to 6 weeks (Agid 2003; Levine 2010). Due to its long half-life and active metabolites, it may take longer for cariprazine to reach steady state at a therapeutic dose, resulting in delayed efficacy and tolerability issues compared to other antipsychotics (APA [Keepers 2020]).

Protein binding: 91% to 97%.

Metabolism: Extensively metabolized by CYP3A4 and, to a lesser extent, by CYP2D6 to active metabolites (desmethyl cariprazine [DCAR] and didesmethyl cariprazine [DDCAR]). DCAR is further metabolized into DDCAR by CYP3A4 and CYP2D6. DDCAR is then metabolized by CYP3A4 to a hydroxylated metabolite.

Half-life elimination: Cariprazine: 2 to 4 days; DCAR (active metabolite): 1 to 2 days; DDCAR (active metabolite): 1 to 3 weeks.

Time to peak, plasma: Cariprazine: 3 to 6 hours.

Excretion: Urine (21%; 1.2% as unchanged drug cariprazine).

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Hepatic function impairment: C_max and AUC for cariprazine was increased in patients with mild to moderate hepatic impairment and exposure was decreased for the active metabolites.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Reagila;
(AR) Argentina: Caripral | Carplex | Vraylar;
(AT) Austria: Reagila;
(AU) Australia: Reagila;
(BE) Belgium: Reagila;
(BG) Bulgaria: Reagila;
(CH) Switzerland: Reagila;
(CZ) Czech Republic: Reagila;
(DE) Germany: Reagila;
(EE) Estonia: Reagila;
(EG) Egypt: Reagila;
(ES) Spain: Reagila;
(FI) Finland: Reagila;
(GB) United Kingdom: Reagila;
(GR) Greece: Reagila;
(HU) Hungary: Reagila;
(ID) Indonesia: Symvenu;
(IE) Ireland: Reagila;
(IN) India: Carilift | Carinia | Cariquel | Carispec;
(IT) Italy: Reagila;
(LB) Lebanon: Reagila;
(LT) Lithuania: Reagila;
(LU) Luxembourg: Reagila;
(LV) Latvia: Reagila;
(MY) Malaysia: Symvenu;
(NL) Netherlands: Reagila;
(NO) Norway: Reagila;
(PL) Poland: Reagila;
(PR) Puerto Rico: Vraylar;
(PT) Portugal: Reagila;
(QA) Qatar: Reagila;
(RO) Romania: Reagila;
(RU) Russian Federation: Reagila;
(SA) Saudi Arabia: Reagila;
(SE) Sweden: Reagila;
(SG) Singapore: Symvenu;
(SI) Slovenia: Reagila;
(SK) Slovakia: Reagila;
(UA) Ukraine: Reagila;
(ZA) South Africa: Reagila

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Cariprazine: Drug information