Should Vraylar (cariprazine) be taken in the morning (am) or evening (pm)?

Vraylar (Cariprazine) Administration Time: Morning or Evening

Vraylar (cariprazine) can be taken either in the morning or evening, but taking it in the evening may be preferable if sedation occurs as a side effect.

Factors Influencing Administration Time

• Cariprazine is an atypical antipsychotic approved for schizophrenia and bipolar I disorder that acts as a dopamine D3-preferring D2/D3 receptor partial agonist 1
• Unlike many first-generation antipsychotics, cariprazine does not have strong sedative properties that would necessitate evening-only dosing 2
• Common side effects include akathisia, insomnia, and extrapyramidal symptoms, which may influence optimal timing of administration 3

Morning Administration Benefits

• If cariprazine causes insomnia in a particular patient, morning administration would be preferable to minimize sleep disruption 3
• Morning dosing may be beneficial for patients who experience activation effects from the medication 2

Evening Administration Benefits

• If a patient experiences sedation as a side effect, evening administration would be more appropriate 4
• Taking medications with potential CNS effects in the evening can minimize daytime impairment if sedation occurs 4

Pharmacokinetic Considerations

• Cariprazine has a long half-life, with its active metabolite didesmethyl-cariprazine (DDCAR) having a half-life of 1-3 weeks 5
• Due to this extended half-life, the timing of daily administration is less critical for maintaining therapeutic blood levels compared to medications with shorter half-lives 5

Clinical Recommendations

• For new patients starting cariprazine, consider initiating in the evening to monitor for potential sedation effects 4
• After assessing individual response, administration time can be adjusted based on side effect profile 3
• If akathisia or activation occurs, morning dosing may be preferred 2
• If mild sedation is experienced, evening dosing would be more appropriate 4

Special Considerations

• Monitor for insomnia as this is one of the more common side effects reported in clinical trials 3
• Unlike some psychotropic medications that have strong recommendations for morning or evening dosing, cariprazine's timing is more flexible and can be individualized based on patient response 5
• Consistent daily administration timing is more important than whether it's taken in the morning or evening 5