From the Guidelines
Yes, Seroquel (quetiapine) generally causes more weight gain than Vraylar (cariprazine).
Comparison of Weight Gain Effects
The difference in weight gain potential between these two medications can be attributed to their distinct pharmacological profiles. Seroquel has a stronger affinity for histamine H1 and serotonin 5-HT2C receptors, which are known to contribute to increased appetite and metabolic changes, leading to weight gain 1. On the other hand, Vraylar has a more favorable metabolic profile due to its partial agonist activity at dopamine receptors without significant histamine blockade.
Clinical Implications
Patients concerned about weight gain should discuss this with their healthcare provider, as medication choice should balance efficacy for the condition being treated against potential side effects. Regular monitoring of weight, blood glucose, and lipids is recommended with either medication, but particularly with Seroquel. According to a recent review in JAMA, medications like Seroquel that promote weight gain increase the risk of weight-related complications, including cardiovascular disease, diabetes, and hepatic steatosis 1.
Management Strategies
When prescribing medications that promote weight gain, clinicians should counsel patients on the risk of weight gain, discuss lifestyle modifications, and monitor weight trajectory. Additionally, medications like metformin and topiramate can be considered as adjunctive therapy to counteract the weight gain effects of antipsychotics like Seroquel 1.
Key Points
- Seroquel is associated with significant weight gain potential.
- Vraylar is considered weight-neutral or has minimal weight gain effects.
- Medication choice should balance efficacy against potential side effects.
- Regular monitoring of weight, blood glucose, and lipids is recommended.
- Lifestyle modifications and adjunctive therapies can help mitigate weight gain.
From the Research
Weight Gain Comparison
- Quetiapine (Seroquel) and Cariprazine (Vraylar) are both atypical antipsychotics, but there is limited direct comparison between the two in terms of weight gain.
- According to 2, Cariprazine is one of the new second-generation antipsychotics that is advisable for its lower propensity to cause weight gain and metabolic abnormalities, similar to Ziprasidone and Aripiprazole.
- In contrast, Quetiapine has been shown to produce less weight gain than Olanzapine 3, 4, but more weight gain than Ziprasidone 3, 4.
- There is no direct comparison between Quetiapine and Cariprazine in the provided studies, but based on the available data, it can be inferred that Cariprazine may have a lower risk of weight gain compared to Quetiapine.
Weight Gain Profile of Quetiapine
- Quetiapine has been shown to have a similar weight gain profile to Risperidone, as well as Clozapine and Aripiprazole, although data are very limited for the latter two comparators 3.
- Quetiapine may produce greater weight gain than Ziprasidone 3, 4 and less weight gain than Olanzapine and Paliperidone 3.
- A study on the long-term effect of Quetiapine monotherapy on weight in patients with schizophrenia found that Quetiapine had a weight-neutral or 'normalizing' effect, with a tendency towards favourable shifts in body weight in underweight patients and severely obese patients 5.
Limitations of Available Data
- Most data that have been reported within existing comparisons are of very limited value because of assumptions and biases within them 3, 4.
- There is much scope for further research into the effects of Quetiapine and other atypical antipsychotics, including Cariprazine, on weight gain and metabolic variables.