What to do if a young adult on Vraylar (cariprazine) 1.5mg experiences suicidal thoughts?

Management of Suicidal Thoughts in Young Adults on Vraylar (Cariprazine)

When a young adult on Vraylar 1.5 mg develops suicidal thoughts, immediately discontinue Vraylar and implement close monitoring with a safety plan while considering alternative treatment options. 1

Immediate Assessment and Intervention

• Discontinue Vraylar: The emergence of suicidal thoughts in a young adult taking Vraylar requires immediate action, as young adults under 24 years are at higher risk for medication-induced suicidality 1, 2

• Safety Assessment: Determine if hospitalization is needed based on:

  • Severity of suicidal ideation
  • Presence of a plan or intent
  • Access to means
  • History of previous attempts
  • Support system availability 1

• Develop a Safety Plan: Create a detailed safety plan that includes:

  • Emergency contacts (mental health providers, crisis hotlines)
  • Removal of lethal means
  • Identification of warning signs and coping strategies
  • Clear steps for the patient and caregivers to follow if thoughts worsen 1

Monitoring and Follow-up

• Increased Visit Frequency: Schedule follow-up within 24-48 hours, then at least weekly for the first month 1

• Daily Check-ins: Establish daily check-ins (in person, telehealth, or phone) during the first week after discontinuation 1

• Involve Support System: Educate family members/caregivers about warning signs and the importance of supervision 1

Alternative Treatment Considerations

• For Schizophrenia: Consider aripiprazole starting at 5-10 mg daily, which has a similar partial agonist mechanism but longer established safety profile 3

• For Bipolar Disorder: Consider lurasidone 20-40 mg daily with food, which has demonstrated efficacy for bipolar depression with lower risk of suicidality 1

• For Adjunctive MDD Treatment: Consider alternative adjunctive therapies such as aripiprazole 2-5 mg daily or cognitive behavioral therapy 1

Pharmacological Management of Acute Suicidality

• Short-term Anxiolytic Support: If needed for severe anxiety or agitation, consider lorazepam 0.5-1 mg as needed (maximum 2 mg/day) for short-term use only while transitioning to a new treatment regimen 1

• Avoid Benzodiazepines in patients with:

  • History of substance abuse
  • Respiratory conditions
  • Elderly patients (increased fall risk)
  • Concurrent CNS depressant use 1

Special Considerations

• Monitoring During Medication Transition: During any medication switch, monitor closely for:

  • Worsening of suicidal thoughts
  • Emergence of withdrawal symptoms
  • Changes in mood or behavior
  • Sleep disturbances 1

• Documentation: Thoroughly document the rationale for discontinuing Vraylar, the safety assessment, and the treatment plan 1

Common Pitfalls to Avoid

• Continuing the medication at the same dose despite emergence of suicidal thoughts in a young adult 1, 2

• Failing to implement a comprehensive safety plan with clear action steps for the patient and caregivers 1

• Inadequate follow-up frequency during the critical period after medication changes 1

• Not educating patients and caregivers about warning signs that require immediate attention 1

• Overlooking the FDA black box warning regarding increased risk of suicidality in young adults taking antipsychotics and antidepressants 2

The emergence of suicidal thoughts in young adults taking psychiatric medications requires immediate and decisive action. While Vraylar is an effective medication for several psychiatric conditions, the risk of suicidality in young adults outweighs the benefits when such symptoms emerge during treatment 1, 2.