Does Vraylar (cariprazine) cause weight gain?

Vraylar (Cariprazine) and Weight Gain

Vraylar (cariprazine) is associated with minimal to moderate weight gain, with clinical trials showing weight increases of 0.4-1.0 kg in most patients over 6-8 weeks of treatment, making it one of the more weight-neutral atypical antipsychotics. 1

Weight Gain Profile of Vraylar

Clinical Trial Data

• According to FDA labeling, in 6-week schizophrenia trials, patients on Vraylar experienced mean weight changes of +0.8 kg (1.5-3 mg/day) to +1.0 kg (4.5-6 mg/day) compared to +0.3 kg with placebo 1
• In 3-week bipolar mania trials, mean weight changes were +0.5 kg (3-6 mg/day) to +0.6 kg (9-12 mg/day) compared to +0.2 kg with placebo 1
• In bipolar depression trials, mean weight changes were +0.7 kg (1.5 mg/day) and +0.4 kg (3 mg/day) compared to -0.1 kg with placebo 1
• In major depressive disorder trials, mean weight changes were +0.7 kg (both 1.5 mg/day and 3 mg/day) compared to +0.2 kg with placebo in 6-week trials 1

Long-Term Effects

• In long-term uncontrolled trials for schizophrenia, mean weight changes with Vraylar were 1.2 kg, 1.7 kg, and 2.5 kg at 12,24, and 48 weeks, respectively 1
• The proportion of patients experiencing clinically significant weight gain (≥7% increase from baseline) ranged from 1-3% in short-term bipolar trials and 2-3% in MDD trials, compared to 8-17% in schizophrenia trials 1

Comparison to Other Antipsychotics

• Weight gain is a common side effect of many antipsychotic medications, with clozapine and olanzapine known to cause substantial weight gain 2, 3
• Atypical antipsychotics as a class are associated with weight gain, but the risk varies significantly between agents 4
• Among antipsychotics, olanzapine, clozapine, quetiapine, and risperidone are consistently associated with more significant weight gain 4
• Vraylar appears to have a more favorable weight gain profile compared to many other atypical antipsychotics 1

Monitoring and Management

• The FDA recommends monitoring weight at baseline and frequently thereafter for patients taking Vraylar 1
• Weight gain typically occurs in the initial period after starting antipsychotics, with patients continuing to gain weight in the long term 2
• For patients experiencing significant weight gain on antipsychotics, lifestyle modifications including diet and exercise should be emphasized 2
• Tailoring antipsychotic choice according to individual needs and close monitoring of weight and metabolic parameters are the best preventive strategies 2

Clinical Implications

• Weight gain with antipsychotics can lead to reduced quality of life, poor medication compliance, and increased cardiovascular and metabolic risks 2
• Weight gain is often cited as a reason for medication discontinuation, potentially leading to relapse of psychiatric symptoms 5
• Patients often prefer medications with lower propensity for weight gain, even if they have other side effects 5
• For patients with pre-existing metabolic concerns, Vraylar may be a more appropriate choice compared to antipsychotics with higher weight gain liability 1, 2

While Vraylar does cause some weight gain, it appears to be relatively modest compared to many other antipsychotics, particularly clozapine and olanzapine. Regular weight monitoring remains essential, as individual responses to medications can vary significantly.