Can you take an antidepressant and Vraylar (cariprazine) together?

Taking Antidepressants and Vraylar (Cariprazine) Together

Yes, antidepressants and Vraylar (cariprazine) can be safely taken together, and this combination is actually approved for the treatment of major depressive disorder when used as adjunctive therapy. 1

Approved Combination Use

Vraylar (cariprazine) is FDA-approved as an adjunctive therapy to antidepressants for the treatment of major depressive disorder at doses of 1.5-3 mg once daily 1. This means the FDA has specifically evaluated and approved this combination for clinical use.

Dosing Considerations

When using Vraylar as an adjunctive treatment with antidepressants:

• Starting dose: 1.5 mg once daily
• Can be increased to 3 mg once daily after 14 days based on clinical response and tolerability
• Maximum recommended dosage is 3 mg once daily
• Dosage titration at intervals less than 14 days results in higher incidence of adverse reactions 1

Safety Profile

The combination of antidepressants and Vraylar is generally well-tolerated, but there are some important considerations:

1. No contraindications: The FDA label for Vraylar does not list any contraindications for using it with antidepressants 1

2. No significant drug interactions: Unlike some other antipsychotics, Vraylar does not have clinically significant interactions with antidepressants listed in its FDA label 1

3. Metabolic pathway: Vraylar is primarily metabolized through CYP3A4, not through pathways that would typically interact with most modern antidepressants 1

Clinical Evidence

The effectiveness of this combination is supported by clinical evidence:

• A 2023 case series demonstrated that cariprazine augmentation was effective in patients with treatment-resistant depression who had failed previous antipsychotic augmentation strategies 2
• Seven out of ten patients in this study responded to cariprazine augmentation with antidepressants after failing other antipsychotic augmentation trials 2

Important Monitoring Considerations

When taking this combination, monitoring should include:

• Mental status changes: Watch for any worsening of depression, emergence of suicidal thoughts, or unusual changes in behavior 1
• Metabolic parameters: Monitor weight, blood glucose, and lipid profiles periodically
• Movement disorders: Watch for emergence of extrapyramidal symptoms
• Blood pressure and heart rate: Particularly if combining with SNRIs which can affect blood pressure 3

Potential Side Effects

Common side effects when using this combination may include:

• Akathisia (restlessness)
• Insomnia or somnolence
• Nausea
• Weight changes
• Dizziness

Special Considerations

1. Dose adjustments: If using Vraylar with strong or moderate CYP3A4 inhibitors (which some antidepressants can be), dose adjustments may be necessary 1

2. Elderly patients: Lower starting doses may be appropriate in elderly patients

3. Bipolar disorder: This combination is particularly useful in bipolar depression, where Vraylar is also approved at doses of 1.5-3 mg daily 1

The evidence supports that antidepressants and Vraylar can be safely and effectively used together, with the combination being specifically approved for treatment-resistant depression as an adjunctive therapy.