From the Guidelines
Switching from Vraylar (cariprazine) to Caplyta (lumateperone) should be considered under medical supervision, prioritizing antipsychotic monotherapy to minimize health service costs and reduce the overall risk of adverse effects. When considering this switch, it's essential to note that antipsychotic polypharmacy may be appropriate for patients who still have symptoms despite treatment attempts with an adequate dose, an adequate choice of therapeutic, and confirmed adherence 1.
Key Considerations
- Antipsychotic monotherapy, either with clozapine or non-clozapine antipsychotics, should be strived for with most patients, as it generally incurs less health service costs to society and gives a lower overall risk for adverse effects 1.
- Medication adherence may also be better with monotherapies, as the patient needs to remember to take only one antipsychotic 1.
- The effect of other pharmaceuticals or over-the-counter products on the speed of metabolism and blood drug concentrations should be contemplated when switching medications 1.
Switching Approach
A cross-titration approach is recommended when switching from Vraylar to Caplyta. This involves:
- Continuing the current Vraylar dose while starting Caplyta at a recommended dose.
- Gradually reducing the Vraylar dose over a period of weeks while maintaining the Caplyta dose.
- Discontinuing Vraylar completely after the transition period, while continuing Caplyta.
Mechanism and Side Effects
- Vraylar affects multiple neurotransmitter systems as a partial agonist at dopamine D2/D3 receptors.
- Caplyta has a unique mechanism with preferential action at serotonin 5-HT2A receptors and lower dopamine D2 receptor occupancy, which may result in fewer movement-related side effects.
- Common side effects of Caplyta include sleepiness, dry mouth, and dizziness, and any concerning symptoms should be reported to the doctor immediately 1.
Monitoring and Follow-up
- The full therapeutic effect of Caplyta may take several weeks to develop, so it's crucial to maintain consistent dosing and follow-up appointments during the transition.
- Regular monitoring of symptoms, side effects, and medication adherence is necessary to ensure a successful transition from Vraylar to Caplyta.
From the Research
Considerations for Switching from Vraylar (cariprazine) to Caplyta (lumateperone)
- The decision to switch from Vraylar (cariprazine) to Caplyta (lumateperone) should be based on individual patient needs and response to treatment, as there is limited information available on direct comparisons between the two medications 2, 3.
- Cariprazine (Vraylar) is a dopamine D3 and D2 receptor partial agonist, which preferentially binds to the D3 receptor, and also has partial agonist activity at serotonin 5-HT1A receptors 2, 4.
- There is no specific guidance on switching from Vraylar (cariprazine) to Caplyta (lumateperone), but a study on switching between β-blockers may provide some general insights on the importance of considering drug interchangeability, rationale for switching, and necessary initial adjustments to dose/frequency 5.
- A survey of psychiatrists found that Vraylar (cariprazine) and Caplyta (lumateperone) are among the medications most frequently requested by patients, highlighting the need for clinicians to be aware of the potential benefits and limitations of these medications 6.
- Cariprazine (Vraylar) has been shown to be efficacious in improving schizophrenia symptoms, including improvements in Positive and Negative Syndrome Scale (PANSS) total scores, and is generally well tolerated in clinical trials 3.
- The pharmacological profile of cariprazine, including its affinity for dopamine D3 receptors and modest affinity for 5-HT1A, 5-HT2A, and histamine H1 receptors, may be an important consideration when switching to Caplyta (lumateperone) 4.