Hyperthermia While Taking Vraylar (Cariprazine)
If you experience significant hyperthermia (feeling excessively hot or elevated body temperature) while taking Vraylar, you should immediately contact your healthcare provider or go to the emergency room, as this could represent neuroleptic malignant syndrome (NMS)—a potentially fatal condition that requires urgent medical attention and discontinuation of the medication. 1
Understanding the Risk
Vraylar (cariprazine) is an atypical antipsychotic that can cause serious temperature regulation problems, including:
- Neuroleptic malignant syndrome (NMS): A life-threatening condition characterized by high fever, muscle rigidity, confusion, increased sweating, and changes in breathing, heart rate, and blood pressure 1
- Impaired body temperature control: The FDA label specifically warns that Vraylar can cause "problems controlling your body temperature so that you feel too warm" 1
Immediate Actions to Take
If You Have Severe Symptoms (High Fever, Muscle Stiffness, Confusion):
Call 911 or go to the nearest emergency room immediately if you experience:
- High fever (temperature ≥40°C/104°F) 2
- Stiff or rigid muscles 1
- Confusion or altered mental status 1
- Profuse sweating 1
- Rapid or irregular heartbeat 1
- Difficulty breathing 1
If You Have Mild Symptoms (Just Feeling Hot):
Contact your healthcare provider the same day to discuss whether to continue the medication. In the meantime 1:
- Avoid excessive exercise
- Stay in cool, air-conditioned environments
- Avoid direct sun exposure
- Wear light, breathable clothing
- Drink plenty of water to stay hydrated
- Do not wear heavy or excessive clothing
What Your Healthcare Provider Will Do
If NMS is suspected, treatment requires 3, 4:
Immediate medication discontinuation: Vraylar must be stopped immediately 1
Emergency cooling measures 3:
- Administration of 2000-3000 mL of chilled (4°C) intravenous saline
- Surface cooling with wet sheets, fans, and ice packs in the armpits and groin
- Cooling until temperature drops below 38.5°C
Intensive monitoring 3:
- Continuous temperature monitoring
- Blood tests for potassium, creatine kinase, kidney function, and myoglobin
- Cardiac monitoring
- At least 24 hours of intensive care observation
Potential pharmacologic treatment: In severe cases, medications like dantrolene or bromocriptine may be considered 5
Critical Considerations
Important Warning About Delayed Effects:
Vraylar stays in your body for a long time—side effects may not appear immediately and can start weeks after beginning treatment or after a dose increase. 1 This means hyperthermia could develop even after you've been taking the medication without problems.
Risk Factors That Increase Danger:
Drug-induced hyperthermia is more likely to be severe if you have 6, 7:
- Increased muscle activity or agitation
- Absence of sweating despite high temperature
- Seizures (which may not respond to anticonvulsants until temperature is lowered)
Poor Outcomes Without Prompt Treatment:
Research shows that once body temperature remains above 40.5°C for a prolonged period, cooling may not prevent death or permanent neurologic damage 6. Early recognition and immediate action are essential.
Prevention Strategy
To minimize risk while taking Vraylar 1:
- Avoid situations that increase body temperature (hot weather, strenuous exercise, saunas)
- Stay well-hydrated at all times
- Be aware of early warning signs (feeling unusually hot, muscle stiffness, confusion)
- Inform all healthcare providers that you take Vraylar, especially before any surgical procedures
- Never abruptly stop or change your dose without medical supervision
Common Pitfall to Avoid
Do not dismiss feeling excessively hot as a minor side effect or attribute it solely to environmental factors. 1 While mild temperature regulation issues can occur, the development of true hyperthermia with Vraylar requires immediate medical evaluation to rule out NMS, which has a mortality risk if untreated. 5, 7