From the Research
Aripiprazole (Abilify) typically causes more drowsiness than cariprazine (Vraylar). Both medications are atypical antipsychotics, but they differ in their side effect profiles. Aripiprazole is more likely to cause sedation and drowsiness, particularly when starting treatment or after dose increases. This drowsiness often occurs because aripiprazole has a higher binding affinity for histamine H1 receptors, which are associated with sedative effects. Cariprazine generally has a lower incidence of sedation and somnolence in clinical studies, as seen in a phase 3 study where cariprazine at 1.5 mg/day demonstrated efficacy in reducing depressive symptoms with a safety profile that included common treatment-emergent adverse events such as akathisia and nausea, but not significant sedation 1. However, individual responses to these medications can vary significantly. Some patients may experience minimal drowsiness with aripiprazole, while others might feel unexpectedly sedated with cariprazine. If drowsiness is a concern, taking the medication at bedtime rather than in the morning may help manage this side effect. It's also important to avoid alcohol and other CNS depressants while taking either medication, as these can intensify drowsiness. Always discuss any troublesome side effects with your healthcare provider, as dosage adjustments or medication changes may be necessary.
Some key points to consider when comparing the drowsiness effects of aripiprazole and cariprazine include:
- The mechanism of action: Aripiprazole's higher affinity for histamine H1 receptors may contribute to its sedative effects.
- Clinical study findings: Cariprazine has shown a lower incidence of sedation and somnolence in clinical studies, such as the phase 3 study mentioned earlier 1.
- Individual patient responses: Patients may react differently to these medications, and what works for one person may not work for another.
- Management of side effects: Taking the medication at bedtime, avoiding alcohol and CNS depressants, and discussing concerns with a healthcare provider can help manage drowsiness.
In terms of the most recent and highest quality evidence, a 2023 study on adjunctive cariprazine for the treatment of patients with major depressive disorder found that cariprazine at 1.5 mg/day was effective in reducing depressive symptoms with a safety profile that was consistent with previous findings 1. This study provides strong evidence for the efficacy and safety of cariprazine, and its findings can inform clinical decision-making when considering the use of cariprazine versus aripiprazole.