Cariprazine

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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

  1. behavioral or psychological symptoms of dementia
  2. bipolar depression
  3. bipolar disorder
  4. mania
  5. schizophrenia

Side Effects

  1. abdominal pain
  2. agitation
  3. agranulocytosis
  4. akathisia
  5. anemia
  6. angioedema
  7. anxiety
  8. appetite stimulation
  9. arthralgia
  10. back pain
  11. blurred vision
  12. cataracts
  13. constipation
  14. dental pain
  15. diabetes mellitus
  16. diabetic ketoacidosis
  17. diarrhea
  18. dizziness
  19. drowsiness
  20. dyspepsia
  21. dysphagia
  22. dystonic reaction
  23. elevated hepatic enzymes
  24. fatigue
  25. gastritis
  26. gastroesophageal reflux
  27. headache
  28. hepatitis
  29. hypercholesterolemia
  30. hyperglycemia
  31. hyperhidrosis
  32. hyperlipidemia
  33. hyperprolactinemia
  34. hypertension
  35. hyperthermia
  36. hypertriglyceridemia
  37. hyponatremia
  38. hypotension
  39. hypothermia
  40. increased urinary frequency
  41. insomnia
  42. leukopenia
  43. musculoskeletal pain
  44. nausea
  45. neuroleptic malignant syndrome
  46. neutropenia
  47. orthostatic hypotension
  48. polydipsia
  49. pruritus
  50. pseudoparkinsonism
  51. rash
  52. restlessness
  53. rhabdomyolysis
  54. seizures
  55. SIADH
  56. sinus tachycardia
  57. Stevens-Johnson syndrome
  58. stroke
  59. suicidal ideation
  60. syncope
  61. tardive dyskinesia
  62. torticollis
  63. trismus
  64. urticaria
  65. vomiting
  66. water intoxication
  67. weight gain
  68. 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
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  • Buprenorphine; Naloxone
  • Bupropion
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  • Buspirone
  • Butorphanol
  • Cabergoline
  • Canagliflozin
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  • Cannabidiol
  • Carbamazepine
  • Carbetapentane; Chlorpheniramine
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  • Carbetapentane; Guaifenesin
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  • Carbidopa; Levodopa
  • Carbidopa; Levodopa; Entacapone
  • Carteolol
  • Carvedilol
  • Cenobamate
  • Central-acting adrenergic agents
  • Ceritinib
  • Cetirizine
  • Cetirizine; Pseudoephedrine
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  • Chlordiazepoxide; Clidinium
  • Chlorpromazine
  • Chlorthalidone; Clonidine
  • Ciprofloxacin
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  • Clevidipine
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  • Codeine; Phenylephrine; Promethazine
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  • Diazepam
  • Diazoxide
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  • Diphenhydramine; Hydrocodone; Phenylephrine
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  • Dorzolamide; Timolol
  • Doxylamine
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  • Dronabinol
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  • Elbasvir; Grazoprevir
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  • Empagliflozin
  • Empagliflozin; Linagliptin
  • Empagliflozin; Linagliptin; Metformin
  • Empagliflozin; Metformin
  • Enalapril; Felodipine
  • Entacapone
  • Enzalutamide
  • Eplerenone
  • Epoprostenol
  • Ertugliflozin
  • Ertugliflozin; Metformin
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  • Erythromycin
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  • Esmolol
  • Estazolam
  • Eszopiclone
  • Ethanol
  • Ethotoin
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  • Fenoldopam
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  • Flurazepam
  • food
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  • Levodopa
  • Linagliptin
  • Linagliptin; Metformin
  • Liraglutide
  • Lixisenatide
  • Lofexidine
  • Loop diuretics
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  • Lorazepam
  • Lorlatinib
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  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
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  • Metformin; Sitagliptin
  • Methyldopa
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  • Omeprazole; Amoxicillin; Rifabutin
  • Opiate Agonists
  • Oxazepam
  • Oxcarbazepine
  • Paliperidone
  • Penbutolol
  • Pentazocine
  • Pentazocine; Naloxone
  • Pergolide
  • Perphenazine
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  • Phenylephrine; Promethazine
  • Phenytoin
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