From the FDA Drug Label
2.7 Treatment Discontinuation Following discontinuation of VRAYLAR, the decline in plasma concentrations of active drug and metabolites may not be immediately reflected in patients’ clinical symptoms; the plasma concentration of cariprazine and its active metabolites will decline by 50% in ~1 week [see Clinical Pharmacology (12.3)].
- The FDA drug label does not provide explicit instructions for tapering Vraylar (cariprazine) when discontinuing.
- However, it mentions that plasma concentrations of the active drug and metabolites will decline by 50% in approximately 1 week after discontinuation.
- No specific guidance on tapering is provided in the label, but it does discuss the decline in plasma concentrations after discontinuation 1.
From the Research
Tapering is recommended when discontinuing Vraylar (cariprazine) to minimize the risk of relapse and discontinuation symptoms, as suggested by the most recent and highest quality study 2. When considering discontinuation of Vraylar, it's essential to consult with a healthcare provider to determine the best approach based on individual circumstances, including the duration of treatment, dose, and overall health status. Some key points to consider when tapering Vraylar include:
- Gradual tapering over months or years to minimize the risk of relapse and discontinuation symptoms 2
- Reducing the dose by one quarter or one half of the most recent dose, equivalent to a reduction of 5 or 10 percentage points of D2 blockade, sequentially, at intervals of 3-6 months, titrated to individual tolerance 2
- Final doses before complete cessation may need to be as small as 1/40th of a therapeutic dose to prevent a large decrease in D2 blockade when stopped 2 It's crucial to prioritize individual tolerance and monitor for any return of symptoms that might require alternative treatment. While some studies suggest that Vraylar's long half-life may minimize discontinuation symptoms, the most recent and highest quality study 2 recommends a gradual tapering approach to ensure the best possible outcome. Therefore, a gradual tapering approach is recommended when discontinuing Vraylar to minimize the risk of relapse and discontinuation symptoms.