Is Vraylar an Antipsychotic?
Yes, Vraylar (cariprazine) is definitively an atypical antipsychotic medication. 1
Classification and Mechanism
Vraylar is classified as an atypical antipsychotic in its FDA-approved drug labeling. 1 The medication works as a dopamine D2 and D3 receptor partial agonist, with preferential binding to D3 receptors, and also demonstrates partial agonist activity at serotonin 5-HT1A receptors and antagonist activity at 5-HT2A receptors. 1, 2
FDA-Approved Indications
Vraylar has received FDA approval for three specific psychiatric conditions:
- Schizophrenia (acute and maintenance treatment) 1, 2, 3
- Manic or mixed episodes associated with bipolar I disorder 1, 2
- Depressive episodes in adults with bipolar I disorder (bipolar depression) 1, 3
- Adjunctive therapy to antidepressants for major depressive disorder 1
Clinical Context
As an atypical antipsychotic, cariprazine belongs to the same medication class as other agents like risperidone, olanzapine, and aripiprazole. 4 The "atypical" designation reflects its receptor binding profile and generally more favorable side effect profile compared to traditional (first-generation) antipsychotics, particularly regarding extrapyramidal symptoms. 4
The medication demonstrates efficacy in treating both positive symptoms (hallucinations, delusions) and negative symptoms (apathy, avolition) of schizophrenia. 3, 5 Its unique pharmacological profile with D3 receptor preferential binding distinguishes it from other atypical antipsychotics. 2, 6
Important Clinical Considerations
Cariprazine carries the same black box warnings as other antipsychotic medications, including increased mortality risk in elderly patients with dementia-related psychosis and increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults when used as adjunctive therapy for depression. 1
The medication requires careful dosing adjustments when used with CYP3A4 inhibitors or inducers, as it is primarily metabolized through this pathway. 1, 7