Cariprazine: Drug information

(For additional information see "Cariprazine: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (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

Note: Due to the long half-life of cariprazine and its active metabolites, changes in dose will not be fully reflected in plasma for several weeks.

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; 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: 1.5 mg to 6 mg once daily. Maximum dose: 6 mg/day (product labeling); doses up to 9 mg/day have been evaluated in clinical trials, however, greater efficacy has not been demonstrated (Ref).

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

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). Based upon clinical experience, some experts generally prefer cross-titration and overlap approaches rather than abrupt change (Ref).

Dosing: Kidney Impairment: Adult

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

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

Dosing: Hepatic 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. May be appropriate for labeled indications, including schizophrenia or bipolar disorder (Ref).

Refer to adult dosing. Dosages in the lower range of recommended adult dosing are generally sufficient with late-onset schizophrenia or psychosis. Titrate dosage slowly and monitor carefully (Ref).

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 (Heck 2021)

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.

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) [contains fd&c blue #1 (brilliant blue), fd&c red #40 (allura red ac dye)]

Generic Equivalent Available: US

Pricing: US

Capsule Therapy Pack (Vraylar Oral)

1.5 & 3 mg (per each): $57.86

Capsules (Vraylar Oral)

1.5 mg (per each): $57.86

3 mg (per each): $57.86

4.5 mg (per each): $57.86

6 mg (per each): $57.86

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/2019/204370s006lbl.pdf#page=39

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); 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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

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

Alcohol (Ethyl): CNS Depressants may enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy

Alizapride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Amifampridine: Agents With Seizure Threshold Lowering Potential may enhance the neuroexcitatory and/or seizure-potentiating effect of Amifampridine. Risk C: Monitor therapy

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

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

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Anti-Parkinson Agents (Dopamine Agonist): Antipsychotic Agents (Second Generation [Atypical]) may diminish the therapeutic effect 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

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

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

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

Azelastine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

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

Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider therapy modification

Blood Pressure Lowering Agents: May enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Risk C: Monitor therapy

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

Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Bromopride: May enhance the adverse/toxic effect of Antipsychotic Agents. Risk X: Avoid combination

Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider therapy modification

BuPROPion: May enhance the neuroexcitatory and/or seizure-potentiating effect of Agents With Seizure Threshold Lowering Potential. Risk C: Monitor therapy

Cabergoline: May diminish the therapeutic effect of Antipsychotic Agents. Risk X: Avoid combination

Cannabinoid-Containing Products: CNS Depressants may enhance the CNS depressant effect of Cannabinoid-Containing Products. Risk C: Monitor therapy

Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider therapy modification

Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Risk C: Monitor therapy

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

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

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

CloZAPine: Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk of seizures may be increased. Risk C: Monitor therapy

CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapy

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

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

CYP3A4 Inhibitors (Moderate): May increase serum concentrations of the active metabolite(s) of Cariprazine. Specifically, concentrations of didesmethylcariprazine (DDCAR), the primary active metabolite of cariprazine, may increase. CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Cariprazine. Risk C: Monitor therapy

CYP3A4 Inhibitors (Strong): May increase serum concentrations of the active metabolite(s) of Cariprazine. Specifically, concentrations of didesmethylcariprazine (DDCAR), the primary active metabolite of cariprazine, may increase. CYP3A4 Inhibitors (Strong) may increase the serum concentration of Cariprazine. Management: Decrease cariprazine dose 50% (4.5 mg to 1.5 mg or 3 mg; 1.5 mg to 1.5 mg every other day) if starting a strong CYP3A4 inhibitor. If on a strong CYP3A4 inhibitor, start cariprazine at 1.5 mg day 1, 0 mg day 2, then 1.5 mg daily. May increase to 3 mg daily Risk D: Consider therapy modification

Daridorexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification

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

DexmedeTOMIDine: CNS Depressants may enhance the CNS depressant effect of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider therapy modification

Difelikefalin: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Donepezil: May enhance the neurotoxic (central) effect of Antipsychotic Agents. Risk C: Monitor therapy

Doxylamine: CNS Depressants may enhance the CNS depressant effect of Doxylamine. Risk C: Monitor therapy

DroPERidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider therapy modification

Esketamine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Fexinidazole: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination

Flunarizine: CNS Depressants may enhance the CNS depressant effect of Flunarizine. Risk X: Avoid combination

Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider therapy modification

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

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

Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination

Galantamine: May enhance the neurotoxic (central) effect of Antipsychotic Agents. Risk C: Monitor therapy

Guanethidine: Antipsychotic Agents may diminish the therapeutic effect of Guanethidine. Risk C: Monitor therapy

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

Huperzine A: May enhance the neurotoxic (central) effect of Antipsychotic Agents. Risk C: Monitor therapy

HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider therapy modification

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

Iohexol: Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect 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 enhance the adverse/toxic effect 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 enhance the adverse/toxic effect 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

Ixabepilone: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Kava Kava: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Kratom: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Lemborexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider therapy modification

Lithium: May enhance the neurotoxic effect of Antipsychotic Agents. Lithium may decrease the serum concentration of Antipsychotic Agents. Specifically noted with chlorpromazine. Risk C: Monitor therapy

Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

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

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

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

Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Mequitazine: Antipsychotic Agents may enhance the arrhythmogenic effect of Mequitazine. Management: Consider alternatives to one of these agents when possible. While this combination is not specifically contraindicated, mequitazine labeling describes this combination as discouraged. Risk D: Consider therapy modification

Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider therapy modification

Metoclopramide: May enhance the adverse/toxic effect of Antipsychotic Agents. Risk X: Avoid combination

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

Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

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

Nabilone: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

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

Olopatadine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification

Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Risk X: Avoid combination

Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Oxybate Salt Products: CNS Depressants may enhance the CNS depressant effect of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider therapy modification

OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification

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

Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Risk X: Avoid combination

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

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

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

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

Pipamperone [INT]: Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Pipamperone [INT]. Specifically, the risk of seizures may be increased. Risk C: Monitor therapy

Piribedil: Antipsychotic Agents may diminish the therapeutic effect of Piribedil. Piribedil may diminish the therapeutic effect 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 combination

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

Procarbazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

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

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

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

Quinagolide: Antipsychotic Agents may diminish the therapeutic effect of Quinagolide. Risk C: Monitor therapy

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

Rivastigmine: May enhance the neurotoxic (central) effect of Antipsychotic Agents. Risk C: Monitor therapy

Ropeginterferon Alfa-2b: CNS Depressants may enhance the adverse/toxic effect of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider therapy modification

Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Risk C: Monitor therapy

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

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

Sodium Phosphates: Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect 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 therapy

Sulpiride: Antipsychotic Agents may enhance the adverse/toxic effect of Sulpiride. Risk X: Avoid combination

Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification

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

Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Risk X: Avoid combination

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

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

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

Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Valerian: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

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

Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider therapy modification

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

Zuranolone: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider therapy modification

Pregnancy Considerations

Antipsychotic use during the third trimester of pregnancy has a risk for abnormal muscle movements (extrapyramidal symptoms [EPS]) and/or withdrawal symptoms in newborns following delivery. Symptoms in the newborn may include agitation, feeding disorder, hypertonia, hypotonia, respiratory distress, somnolence, and tremor; these effects may be self-limiting or require hospitalization.

The ACOG recommends that therapy during pregnancy be individualized; treatment with psychiatric medications during pregnancy should incorporate the clinical expertise of the mental health clinician, obstetrician, primary health care provider, and pediatrician. Safety data related to atypical antipsychotics during pregnancy are limited and routine use is not recommended. However, if a woman is inadvertently exposed to an atypical antipsychotic while pregnant, continuing therapy may be preferable to switching to a typical antipsychotic that the fetus has not yet been exposed to; consider risk:benefit (ACOG 2008).

Health care providers are encouraged to enroll women exposed to cariprazine during pregnancy in the National Pregnancy Registry for Atypical Antipsychotics (866-961-2388 or http://www.womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/).

Breastfeeding Considerations

It is not known if cariprazine is excreted in breast milk. The manufacturer recommends the development and health benefits of breast-feeding be considered along with the mother’s clinical need for therapy and any potential adverse effects on the breast-fed infant.

Monitoring Parameters

Frequency of Antipsychotic Monitoring^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	12 weeks after initiation and dose change; annually	Check more frequently than annually if abnormal. Follow diabetes guidelines.
Lipid panel	12 weeks after initiation and dose change; 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).

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: 1 to 2 days; DDCAR: 1 to 3 weeks

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

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

Note: After multiple dose administration of cariprazine, mean cariprazine and desmethyl cariprazine (DCAR) reached steady state at around week 1 to week 2 and mean didesmethyl cariprazine (DDCAR) appeared to be approaching steady state around week 4 to week 8. After discontinuation, mean cariprazine and DCAR concentration decreased by about 50% in a day and mean DDCAR concentrations decreased by ~50% in 1 week after the last dose. There was an approximately 90% decline in plasma exposure within 1 week for cariprazine and DCAR and at about 4 weeks for DDCAR. Following a single dose of 1 mg of cariprazine, DDCAR remained detectable 8 weeks post-dose.

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;
(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;
(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

2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372 [PubMed 37139824]
ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 92, April 2008 (Replaces Practice Bulletin Number 87, November 2007). Use of Psychiatric Medications During Pregnancy and Lactation. Obstet Gynecol. 2008;111(4):1001-1020. [PubMed 18378767]
Agid O, Kapur S, Arenovich T, Zipursky RB. Delayed-onset hypothesis of antipsychotic action: a hypothesis tested and rejected. Arch Gen Psychiatry. 2003;60(12):1228-1235. doi:10.1001/archpsyc.60.12.1228 [PubMed 14662555]
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. J Clin Psychiatry. 2004;65(2):267-272. [PubMed 15003083]
Annamalai A, Kosir U, Tek C. Prevalence of obesity and diabetes in patients with schizophrenia. World J Diabetes. 2017;8(8):390-396. doi:10.4239/wjd.v8.i8.390 [PubMed 28861176]
Bark N. Deaths of psychiatric patients during heat waves. Psychiatr Serv. 1998;49(8):1088-90. doi:10.1176/ps.49.8.1088. [PubMed 9712220]
Belvederi Murri M, Guaglianone A, Bugliani M, et al. Second-generation antipsychotics and neuroleptic malignant syndrome: Systematic review and case report analysis. Drugs R D. 2015;15(1):45-62. doi:10.1007/s40268-014-0078-0 [PubMed 25578944]
Bouchama A, Dehbi M, Mohamed G, Matthies F, Shoukri M, Menne B. Prognostic factors in heat wave related deaths: a meta-analysis. Arch Intern Med. 2007;167(20):2170-6. doi:10.1001/archinte.167.20.ira70009 [PubMed 17698676]
Calabrese JR, Keck PE Jr, Starace A, et al. Efficacy and safety of low- and high-dose cariprazine in acute and mixed mania associated with bipolar I disorder: a double-blind, placebo-controlled study. J Clin Psychiatry. 2015;76(3):284-292. doi:10.4088/JCP.14m09081 [PubMed 25562205]
Caroff SN, Hurford I, Lybrand J, Campbell EC. Movement disorders induced by antipsychotic drugs: implications of the CATIE schizophrenia trial. Neurol Clin. 2011;29(1):127-48, viii. doi:10.1016/j.ncl.2010.10.002 [PubMed 21172575]
Cerovecki A, Musil R, Klimke A, et al. Withdrawal symptoms and rebound syndromes associated with switching and discontinuing atypical antipsychotics: theoretical background and practical recommendations. CNS Drugs. 2013;27(7):545-572. doi:10.1007/s40263-013-0079-5 [PubMed 23821039]
Citrome L, Yatham LN, Patel MD, Barabássy Á, Hankinson A, Earley WR. Cariprazine and akathisia, restlessness, and extrapyramidal symptoms in patients with bipolar depression. J Affect Disord. 2021;288:191-198. doi:10.1016/j.jad.2021.03.076 [PubMed 33915374]
Crouse EL, Alastanos JN, Bozymski KM, Toscano RA. Dysphagia with second-generation antipsychotics: a case report and review of the literature. Ment Health Clin. 2018;7(2):56-64. doi:10.9740/mhc.2017.03.056 [PubMed 29955499]
Cruz N, Sanchez-Moreno J, Torres F, Goikolea JM, Valentí M, Vieta E. Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: a meta-analysis. Int J Neuropsychopharmacol. 2010;13(1):5-14. doi:10.1017/S1461145709990344 [PubMed 19638254]
Dayabandara M, Hanwella R, Ratnatunga S, Seneviratne S, Suraweera C, de Silva VA. Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatr Dis Treat. 2017;13:2231-2241. doi:10.2147/NDT.S113099 [PubMed 28883731]
De Hert M, Detraux J, van Winkel R, Yu W, Correll CU. Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nat Rev Endocrinol. 2011;8(2):114-126. doi:10.1038/nrendo.2011.156 [PubMed 22009159]
Desai S, Hirachan T, Toma A, Gerolemou A. Malignant catatonia versus neuroleptic malignant syndrome. Cureus. 2021;13(6):e15818. doi:10.7759/cureus.15818 [PubMed 34306883]
Do A, Keramatian K, Schaffer A, Yatham L. Cariprazine in the treatment of bipolar disorder: Within and beyond clinical trials. Front Psychiatry. 2021;12:769897. doi:10.3389/fpsyt.2021.769897 [PubMed 34970166]
Durgam S, Earley W, Li R, Li D, et al. Long-term cariprazine treatment for the prevention of relapse in patients with schizophrenia: a randomized, double-blind, placebo-controlled trial. Schizophr Res. 2016;176(2-3):264-271. doi:10.1016/j.schres.2016.06.030 [PubMed 27427558]
Earley W, Burgess MV, Rekeda L, et al. Cariprazine treatment of bipolar depression: a randomized double-blind placebo-controlled phase 3 study. Am J Psychiatry. 2019;176(6):439-448. doi:10.1176/appi.ajp.2018.18070824 [PubMed 30845817]
Earley WR, Burgess MV, Khan B, et al. Efficacy and safety of cariprazine in bipolar I depression: a double-blind, placebo-controlled phase 3 study. Bipolar Disord. 2020;22(4):372-384. doi:10.1111/bdi.12852 [PubMed 31628698]
Earley W, Durgam S, Lu K, Laszlovszky I, Debelle M, Kane JM. Safety and tolerability of cariprazine in patients with acute exacerbation of schizophrenia: a pooled analysis of four phase II/III randomized, double-blind, placebo-controlled studies. Int Clin Psychopharmacol. 2017;32(6):319-328. doi:10.1097/YIC.0000000000000187 [PubMed 28692485]
Evcimen H, Alici-Evcimen Y, Basil B, Mania I, Mathews M, Gorman JM. Neuroleptic malignant syndrome induced by low dose aripiprazole in first episode psychosis. J Psychiatr Pract. 2007;13(2):117-119. doi:10.1097/01.pra.0000265770.17871.01 [PubMed 17414689]
Fang F, Sun H, Wang Z, Ren M, Calabrese JR, Gao K. Antipsychotic drug-induced somnolence: Incidence, mechanisms, and management. CNS Drugs. 2016;30(9):845-867. doi:10.1007/s40263-016-0352-5 [PubMed 27372312]
Flanagan RJ, Dunk L. Haematological toxicity of drugs used in psychiatry. Hum Psychopharmacol. 2008;23(suppl 1):27-41. doi:10.1002/hup.917 [PubMed 18098216]
Goikolea JM, Colom F, Capapey J, et al. Faster onset of antimanic action with haloperidol compared to second-generation antipsychotics. A meta-analysis of randomized clinical trials in acute mania. Eur Neuropsychopharmacol. 2013;23(4):305-316. doi:10.1016/j.euroneuro.2012.05.017 [PubMed 22841129]
Greger J, Aladeen T, Lewandowski E, et al. Comparison of the metabolic characteristics of newer second generation antipsychotics: Brexpiprazole, lurasidone, asenapine, cariprazine, and iloperidone with olanzapine as a comparator. J Clin Psychopharmacol. 2021;41(1):5-12. doi:10.1097/JCP.0000000000001318 [PubMed 33177350]
Gugger JJ. Antipsychotic pharmacotherapy and orthostatic hypotension: identification and management. CNS Drugs. 2011;25(8):659-671. doi:10.2165/11591710-000000000-00000 [PubMed 21790209]
Hansen A, Bi P, Nitschke M, Ryan P, Pisaniello D, Tucker G. The effect of heat waves on mental health in a temperate Australian city. Environ Health Perspect. 2008;116(10):1369-1375. doi:10.1289/ehp.11339 [PubMed 18941580]
Hasan A, Falkai P, Wobrock T, et al; World Federation of Societies of Biological Psychiatry (WFSBP) Task Force on Treatment Guidelines for Schizophrenia. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, part 1: update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World J Biol Psychiatry. 2012;13(5):318-378. doi:10.3109/15622975.2012.696143 [PubMed 22834451]
Heck J, Seifert J, Stichtenoth DO, et al. A case series of serious and unexpected adverse drug reactions under treatment with cariprazine. Clin Case Rep. 2021;9(5):e04084. doi:10.1002/ccr3.4084 [PubMed 34084502]
Hiemke C, Bergemann N, Clement HW,et al. Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: update 2017. Pharmacopsychiatry. 2018;51(1-02):9-62. doi:10.1055/s-0043-116492 [PubMed 28910830]
Howard R, Rabins PV, Seeman MV, Jeste DV. Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. The International Late-Onset Schizophrenia Group. Am J Psychiatry. 2000;157(2):172-178. doi:10.1176/appi.ajp.157.2.172 [PubMed 10671383]
Kane JM, Zukin S, Wang Y, et al. Efficacy and safety of cariprazine in acute exacerbation of schizophrenia: results from an international, phase III clinical trial. J Clin Psychopharmacol. 2015;35(4):367-373. doi:10.1097/JCP.0000000000000346 [PubMed 26075487]
Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. 2020;177(9):868-872. doi:10.1176/appi.ajp.2020.177901 [PubMed 32867516]
Keks N, Hope J, Schwartz D, McLennan H, Copolov D, Meadows G. Comparative tolerability of dopamine D2/3 receptor partial agonists for schizophrenia. CNS Drugs. 2020;34(5):473-507. doi:10.1007/s40263-020-00718-4 [PubMed 32246399]
Kogoj A, Velikonja I. Olanzapine induced neuroleptic malignant syndrome--a case review. Hum Psychopharmacol. 2003;18(4):301-309. doi:10.1002/hup.483 [PubMed 12766935]
Kwok JS, Chan TY. Recurrent heat-related illnesses during antipsychotic treatment. Ann Pharmacother. 2005;39(11):1940-1942. doi:10.1345/aph.1G130 [PubMed 16174785]
Lambert TJ. Switching antipsychotic therapy: what to expect and clinical strategies for improving therapeutic outcomes. J Clin Psychiatry. 2007;68(suppl 6):10-13. [PubMed 17650054]
Lehman AF, Lieberman JA, Dixon LB, et al; American Psychiatric Association; Steering Committee on Practice Guidelines. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry. 2004;161(2 Suppl):1-56. [PubMed 15000267]
Levine SZ, Rabinowitz J. Trajectories and antecedents of treatment response over time in early-episode psychosis. Schizophr Bull. 2010;36(3):624-632. doi:10.1093/schbul/sbn120 [PubMed 18849294]
Martinez M, Devenport L, Saussy J, Martinez J. Drug-associated heat stroke. South Med J. 2002;95(8):799-802. [PubMed 12190212]
Moncrieff J, Gupta S, Horowitz MA. Barriers to stopping neuroleptic (antipsychotic) treatment in people with schizophrenia, psychosis or bipolar disorder. Ther Adv Psychopharmacol. Published online July 6, 2020. doi:10.1177/2045125320937910 [PubMed 32670542]
Mustafa S, Joober R, Iyer S, Shah J, Lepage M, Malla A. Early stabilization of weight changes following treatment with olanzapine, risperidone, and aripiprazole: A 12-month naturalistic study of first episode psychosis. J Clin Psychiatry. 2019;80(5):18m12717. doi:10.4088/JCP.18m12717 [PubMed 31509359]
Nasrallah HA, Earley W, Cutler AJ, et al. The safety and tolerability of cariprazine in long-term treatment of schizophrenia: a post hoc pooled analysis. BMC Psychiatry. 2017;17(1):305. doi:10.1186/s12888-017-1459-z [PubMed 28836957]
Nelson C. Unipolar depression in adults: treatment with second-generation antipsychotics. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed February 7, 2023.
Nielsen RE, Wallenstein Jensen SO, Nielsen J. Neuroleptic malignant syndrome-an 11-year longitudinal case-control study. Can J Psychiatry. 2012;57(8):512-518. doi:10.1177/070674371205700810 [PubMed 22854034]
Patterson-Lomba O, Ayyagari R, Carroll B. Risk assessment and prediction of TD incidence in psychiatric patients taking concomitant antipsychotics: a retrospective data analysis. BMC Neurol. 2019;19(1):174. doi:10.1186/s12883-019-1385-4 [PubMed 31325958]
Pelonero AL, Levenson JL, Pandurangi AK. Neuroleptic malignant syndrome: a review. Psychiatr Serv. 1998;49(9):1163-1172. doi:10.1176/ps.49.9.1163 [PubMed 9735957]
Post RM. Bipolar disorder in adults: Choosing maintenance treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. Accessed October 29, 2020. http://www.uptodate.com.
Refer to manufacturer's labeling.
Remington G, Chue P, Stip E, Kopala L, Girard T, Christensen B. The crossover approach to switching antipsychotics: what is the evidence? Schizophr Res. 2005;76(2-3):267-272. doi:10.1016/j.schres.2005.01.009 [PubMed 15949658]
Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016;173(5):543-546. Accessed May 26, 2016. doi:10.1176/appi.ajp.2015.173501. http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2015.173501. [PubMed 27133416]
Salem H, Nagpal C, Pigott T, Teixeira AL. Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges. Curr Neuropharmacol. 2017;15(5):789-798. doi:10.2174/1570159X14666161208153644 [PubMed 27928948]
Seitz DP, Gill SS. Neuroleptic malignant syndrome complicating antipsychotic treatment of delirium or agitation in medical and surgical patients: Case reports and a review of the literature. Psychosomatics. 2009;50(1):8-15. doi:10.1176/appi.psy.50.1.8 [PubMed 19213967]
Soares-Weiser K, Fernandez HH. Tardive dyskinesia. Semin Neurol. 2007;27(2):159-169. [PubMed 17390261]
Solmi M, Murru A, Pacchiarotti I, et al. Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review. Ther Clin Risk Manag. 2017;13:757-777. doi:10.2147/TCRM.S117321 [PubMed 28721057]
Solmi M, Pigato G, Kane JM, Correll CU. Clinical risk factors for the development of tardive dyskinesia. J Neurol Sci. 2018;389:21-27. doi:10.1016/j.jns.2018.02.012 [PubMed 29439776]
Stroup TS, Marder S. Schizophrenia in adults: maintenance therapy and side effect management. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. Accessed January 28, 2022. http://www.uptodate.com.
Takeuchi H, Kantor N, Uchida H, Suzuki T, Remington G. Immediate vs gradual discontinuation in antipsychotic switching: a systematic review and meta-analysis. Schizophr Bull. 2017;43(4):862-871. doi:10.1093/schbul/sbw171 [PubMed 28044008]
Tohen M, Jacobs TG, Feldman PD. Onset of action of antipsychotics in the treatment of mania. Bipolar Disord. 2000;2(3, pt 2):261-268. doi:10.1034/j.1399-5618.2000.20307.x [PubMed 11249804]
van Harten PN, Hoek HW, Kahn RS. Acute dystonia induced by drug treatment. BMJ. 1999;319(7210):623-626. doi:10.1136/bmj.319.7210.623 [PubMed 10473482]
Vieta E, Durgam S, Lu K, Ruth A, Debelle M, Zukin S. Effect of cariprazine across the symptoms of mania in bipolar I disorder: Analyses of pooled data from phase II/III trials. Eur Neuropsychopharmacol. 2015;25(11):1882-1891. doi:10.1016/j.euroneuro.2015.08.020 [PubMed 26419293]
Vraylar (cariprazine) [prescribing information]. Madison, NJ: Allergan USA Inc; December 2022.
Vraylar (cariprazine) [product monograph]. St-Laurent, Quebec, Canada: AbbVie Corporation; September 2022.
Welten CC, Koeter MW, Wohlfarth TD, et al. Early nonresponse in the antipsychotic treatment of acute mania: a criterion for reconsidering treatment? Results from an individual patient data meta-analysis. J Clin Psychiatry. 2016;77(9):e1117-e1123. doi:10.4088/JCP.15r10051 [PubMed 27780320]
Wen XJ, Wang LM, Liu ZL, Huang A, Liu YY, Hu JY. Meta-analysis on the efficacy and tolerability of the augmentation of antidepressants with atypical antipsychotics in patients with major depressive disorder. Braz J Med Biol Res. 2014;47(7):605-616. doi:10.1590/1414-431x20143672 [PubMed 24919175]
Wu CY, Mitchell SR, Seyfried LS. Quetiapine-induced hyperglycemic crisis and severe hyperlipidemia: a case report and review of the literature. Psychosomatics. 2014;55(6):686-691. doi:10.1016/j.psym.2014.07.002 [PubMed 25497507]
Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97-170. doi:10.1111/bdi.12609 [PubMed 29536616]

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Cariprazine: Drug information