Cariprazine

Cariprazine is an atypical antipsychotic medication approved for the treatment of schizophrenia and bipolar I disorder in adults. It acts as a partial agonist at dopamine D2 and D3 receptors, with a relative preference for D3, and as a partial agonist at 5-HT1A receptors and an antagonist at 5-HT2A receptors. This pharmacology is thought to provide efficacy on positive symptoms and may offer benefits on negative symptoms and functioning.

Cariprazine is taken orally once daily. It has a long elimination half-life due to active metabolites, notably didesmethyl-cariprazine, which contributes to a slow onset of full effect and gradual washout. It is primarily metabolized by CYP3A4 and, to a lesser extent, by CYP2D6; strong CYP3A4 inhibitors or inducers can markedly affect drug exposure. Dosing typically begins at 1.5 mg daily and may be titrated up to 3–4.5 mg; some indications permit up to 6 mg daily, depending on response and tolerability.

Common adverse events include akathisia, insomnia, and headache; extrapyramidal symptoms and weight gain may occur. Clinicians monitor for metabolic changes and mood activation in bipolar patients. Contraindications are limited to hypersensitivity; caution is advised in elderly patients and those with a history of movement disorders.

Cariprazine is marketed under the brand name Vraylar in many markets. It is approved for schizophrenia and for bipolar I disorder, including manic or mixed episodes; in some jurisdictions it is approved for bipolar I depression. As with other antipsychotics, its use should be individualized, balancing benefits and risks.