Cariprazine Brand Name– VRAYLAR
What is Cariprazine
Cariprazine is an oral phenylpiperazine atypical antipsychotic. Atypical antipsychotics are a first-line treatment option for schizophrenia and related disorders. In addition, some atypical antipsychotics, including cariprazine, are effective in treating manic episodes and depression associated with bipolar disorder.
Adverse events may first appear several weeks after initiating treatment or increasing the dose of cariprazine, due to a prolonged time to reach steady-state resulting from the long half-lives of cariprazine (2 to 4 days) and its major active metabolite (1 to 3 weeks).
Therefore, patients should be monitored for response and tolerability for several weeks after initiating treatment or adjusting the dose.
Because cariprazine is a primary substrate of CYP3A4, drug interactions may occur with potent inhibitors and inducers of CYP3A4. As with all atypical antipsychotics, the label includes a boxed warning regarding an increased mortality risk in elderly patients with dementia-related psychosis.
Indications
- behavioral or psychological symptoms of dementia
- bipolar depression
- bipolar disorder
- mania
- schizophrenia
Side Effects
- abdominal pain
- agitation
- agranulocytosis
- akathisia
- anemia
- angioedema
- anxiety
- appetite stimulation
- arthralgia
- back pain
- blurred vision
- cataracts
- constipation
- dental pain
- diabetes mellitus
- diabetic ketoacidosis
- diarrhea
- dizziness
- drowsiness
- dyspepsia
- dysphagia
- dystonic reaction
- elevated hepatic enzymes
- fatigue
- gastritis
- gastroesophageal reflux
- headache
- hepatitis
- hypercholesterolemia
- hyperglycemia
- hyperhidrosis
- hyperlipidemia
- hyperprolactinemia
- hypertension
- hyperthermia
- hypertriglyceridemia
- hyponatremia
- hypotension
- hypothermia
- increased urinary frequency
- insomnia
- leukopenia
- musculoskeletal pain
- nausea
- neuroleptic malignant syndrome
- neutropenia
- orthostatic hypotension
- polydipsia
- pruritus
- pseudoparkinsonism
- rash
- restlessness
- rhabdomyolysis
- seizures
- SIADH
- sinus tachycardia
- Stevens-Johnson syndrome
- stroke
- suicidal ideation
- syncope
- tardive dyskinesia
- torticollis
- trismus
- urticaria
- vomiting
- water intoxication
- weight gain
- xerostomia
Monitoring Parameters
- AIMS assessment
- blood glucose
- CBC
- glycosylated hemoglobin A1c (HbA1c)
- LFTs
- neurologic function
- pregnancy testing
- serum creatinine
- serum electrolytes
- serum lipid profile
- serum prolactin
- thyroid function tests (TFTs)
- weight
Contraindications
- abrupt discontinuation
- acute myocardial infarction
- agranulocytosis
- ambient temperature increase
- breast cancer
- breast-feeding
- cardiac disease
- cataracts
- cerebrovascular disease
- children
- dehydration
- dementia
- diabetes mellitus
- diabetic ketoacidosis
- driving or operating machinery
- dysphagia
- ethanol ingestion
- geriatric
- heart failure
- hematological disease
- hepatic disease
- history of angioedema
- hyperglycemia
- hyperlipidemia
- hyperprolactinemia
- hyperthermia
- hypotension
- hypothermia
- hypovolemia
- infants
- infertility
- leukopenia
- neonates
- neurological disease
- neutropenia
- obesity
- orthostatic hypotension
- Parkinson’s disease
- pregnancy
- pregnancy testing
- renal failure
- renal impairment
- seizure disorder
- seizures
- strenuous exercise
- stroke
- suicidal ideation
- syncope
- tardive dyskinesia
Interactions
- Acarbose
- Acebutolol
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Diphenhydramine
- Acetaminophen; Pentazocine
- Acetaminophen; Tramadol
- Albiglutide
- Aliskiren
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Aliskiren; Valsartan
- Alogliptin
- Alogliptin; Metformin
- Alogliptin; Pioglitazone
- Alpha-blockers
- Alpha-glucosidase Inhibitors
- Alprazolam
- Ambrisentan
- Amifampridine
- Amiodarone
- Amitriptyline; Chlordiazepoxide
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amprenavir
- Angiotensin II receptor antagonists
- Angiotensin-converting enzyme inhibitors
- Apalutamide
- Aprepitant, Fosaprepitant
- Aripiprazole
- Armodafinil
- Asenapine
- Atazanavir
- Atazanavir; Cobicistat
- Atenolol
- Atenolol; Chlorthalidone
- Barbiturates
- Bendroflumethiazide; Nadolol
- Benzhydrocodone; Acetaminophen
- Benzodiazepines
- Beta-blockers
- Betaxolol
- Bexarotene
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Boceprevir
- Bosentan
- Brexpiprazole
- Brimonidine; Timolol
- Bromocriptine
- Brompheniramine; Carbetapentane; Phenylephrine
- Buprenorphine
- Buprenorphine; Naloxone
- Bupropion
- Bupropion; Naltrexone
- Buspirone
- Butorphanol
- Cabergoline
- Canagliflozin
- Canagliflozin; Metformin
- Cannabidiol
- Carbamazepine
- Carbetapentane; Chlorpheniramine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbetapentane; Pyrilamine
- Carbidopa; Levodopa
- Carbidopa; Levodopa; Entacapone
- Carteolol
- Carvedilol
- Cenobamate
- Central-acting adrenergic agents
- Ceritinib
- Cetirizine
- Cetirizine; Pseudoephedrine
- Cetrorelix
- Chloramphenicol
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chlorpromazine
- Chlorthalidone; Clonidine
- Ciprofloxacin
- Clarithromycin
- Clevidipine
- Clobazam
- Clonazepam
- Clonidine
- Clorazepate
- Clozapine
- Cobicistat
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- COMT inhibitors
- Conivaptan
- Danazol
- Dapagliflozin
- Dapagliflozin; Metformin
- Dapagliflozin; Saxagliptin
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Degarelix
- Delavirdine
- Deutetrabenazine
- Dexamethasone
- Dexmethylphenidate
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Promethazine
- Diazepam
- Diazoxide
- Diltiazem
- Dipeptidyl Peptidase-4 Inhibitors
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Dorzolamide; Timolol
- Doxylamine
- Doxylamine; Pyridoxine
- Dronabinol
- Dronedarone
- Dulaglutide
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elagolix
- Elagolix; Estradiol; Norethindrone acetate
- Elbasvir; Grazoprevir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Empagliflozin
- Empagliflozin; Linagliptin
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Enalapril; Felodipine
- Entacapone
- Enzalutamide
- Eplerenone
- Epoprostenol
- Ertugliflozin
- Ertugliflozin; Metformin
- Ertugliflozin; Sitagliptin
- Erythromycin
- Erythromycin; Sulfisoxazole
- Esketamine
- Eslicarbazepine
- Esmolol
- Estazolam
- Eszopiclone
- Ethanol
- Ethotoin
- Etravirine
- Exenatide
- Felodipine
- Fenoldopam
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurazepam
- food
- Fosamprenavir
- Fosphenytoin
- Gabapentin
- Ganirelix
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide; Metformin
- Glyburide; Metformin
- Goserelin
- Guanabenz
- Guanfacine
- Haloperidol
- Heterocyclic antidepressants
- Histrelin
- Hydralazine
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydralazine; Isosorbide Dinitrate, ISDN
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydroxyzine
- Idelalisib
- Iloperidone
- Imatinib
- Incretin Mimetics
- Indinavir
- Insulin Degludec; Liraglutide
- Insulin Glargine; Lixisenatide
- Insulins
- Isavuconazonium
- Isocarboxazid
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Isradipine
- Itraconazole
- Ketoconazole
- Labetalol
- Lasmiditan
- Lemborexant
- Letermovir
- Leuprolide
- Leuprolide; Norethindrone
- Levobetaxolol
- Levobunolol
- Levocetirizine
- Levodopa
- Linagliptin
- Linagliptin; Metformin
- Liraglutide
- Lixisenatide
- Lofexidine
- Loop diuretics
- Lopinavir; Ritonavir
- Lorazepam
- Lorlatinib
- Loxapine
- Lumateperone
- Lurasidone
- Macitentan
- Meglitinides
- Meperidine; Promethazine
- Meprobamate
- Mesoridazine
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methyldopa
- Methylphenidate
- Metoclopramide
- Metoprolol
- Midazolam
- Mifepristone
- Miglitol
- Minoxidil
- Mirtazapine
- Mitotane
- Modafinil
- Molindone
- Monoamine oxidase inhibitors
- Nabilone
- Nadolol
- Nafarelin
- Nalbuphine
- Nateglinide
- Nebivolol
- Nebivolol; Valsartan
- Nefazodone
- Nelfinavir
- Nevirapine
- Nicardipine
- Nifedipine
- Nilotinib
- Nisoldipine
- Nitroprusside
- Olanzapine
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole; Amoxicillin; Rifabutin
- Opiate Agonists
- Oxazepam
- Oxcarbazepine
- Paliperidone
- Penbutolol
- Pentazocine
- Pentazocine; Naloxone
- Pergolide
- Perphenazine
- Perphenazine; Amitriptyline
- Phenelzine
- Phentermine; Topiramate
- Phenylephrine; Promethazine
- Phenytoin
- Pindolol
- Pioglitazone
- Posaconazole
- Potassium-sparing diuretics
- Pramipexole
- Pramlintide
- Pregabalin
- Prochlorperazine
- Promethazine
- Propranolol
- Quazepam
- Quetiapine
- Quinine
- Ramelteon
- Rasagiline
- Repaglinide
- Reserpine
- Ribociclib
- Ribociclib; Letrozole
- Rifabutin
- Rifampin
- Riociguat
- Risperidone
- Ritonavir
- Ropinirole
- Rosiglitazone
- Rotigotine
- Safinamide
- Saxagliptin
- Selegiline
- Semaglutide
- SGLT2 Inhibitors
- Sibutramine
- Sildenafil
- Simvastatin; Sitagliptin
- Sitagliptin
- Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
- Sotalol
- St. John’s Wort, Hypericum perforatum
- Sulfonylureas
- Suvorexant
- Tadalafil
- Tasimelteon
- Tazemetostat
- Telaprevir
- Telithromycin
- Telotristat Ethyl
- Temazepam
- Thiazide diuretics
- Thiethylperazine
- Thioridazine
- Thiothixene
- Timolol
- Tipranavir
- Tolcapone
- Topiramate
- Tramadol
- Trandolapril; Verapamil
- Tranylcypromine
- Trazodone
- Treprostinil
- Triazolam
- Tricyclic antidepressants
- Trifluoperazine
- Triptorelin
- Tucatinib
- Verapamil
- Voriconazole
- Zaleplon
- Ziprasidone
- Zolpidem
- Zonisamide