Can an adult patient with a psychiatric condition, such as schizophrenia or bipolar disorder, stop taking Vraylar (cariprazine) after only two weeks of treatment?

Can You Stop Taking Vraylar After Two Weeks?

No, you should not abruptly stop Vraylar (cariprazine) after only two weeks of treatment—gradual withdrawal over a period greater than one month is recommended to minimize potential discontinuation effects, and importantly, two weeks is insufficient to assess therapeutic efficacy. 1

Critical Timing Considerations

Why Two Weeks Is Too Early to Stop

• Cariprazine requires 4-6 weeks at therapeutic doses to properly assess efficacy, as its principal active metabolite (didesmethyl-cariprazine) has a half-life of 1-3 weeks and becomes the predominant circulating moiety only at steady state 2
• Premature discontinuation before completing an adequate trial (4-6 weeks) prevents proper assessment of whether the medication is effective 1
• Approximately 65% of patients receiving placebo will relapse within 1 year of their acute psychotic phase, compared with only 30% receiving antipsychotics, highlighting the importance of continuing treatment 3

Risks of Abrupt Discontinuation

Abrupt discontinuation of antipsychotics has associated difficulties including dyskinesias, parkinsonian symptoms, dystonias, and neuroleptic malignant syndrome. 1

• Withdrawal should be gradual, in most cases extending over a period of greater than one month 1
• You may need to re-escalate dosing if persisting withdrawal symptoms result in distress 1

Proper Discontinuation Protocol (If Medically Indicated)

When Discontinuation Might Be Considered

• A medication-free trial may only be considered in newly diagnosed patients who have been completely symptom-free for at least 6 to 12 months 3
• Any evidence of disorder recurrence warrants immediate resumption of treatment 3

Tapering Schedule

• Taper gradually over 2-4 weeks minimum, reducing by 25% of the daily dose every 1-2 weeks 1
• Monitor closely during the taper for mood destabilization, increased depression, or emerging manic symptoms 1
• The greatest risk of relapse occurs in the first 8-12 weeks after discontinuing medication 4

What to Do Instead After Two Weeks

Continue Treatment for Adequate Trial

• Maintenance treatment should continue for at least 12 months after beginning of remission 3
• For patients stable for several years, any future discontinuation attempts should only be considered in consultation with mental health professionals 3
• Close monitoring is essential during the first 4 weeks after any medication changes 3

Expected Timeline for Response

• Effects of cariprazine become apparent after 1-2 weeks, but an adequate trial requires 4-6 weeks at therapeutic doses before concluding ineffectiveness 4
• Cariprazine demonstrated significant efficacy in preventing relapse, with 60.5% of patients treated with cariprazine sustaining remission through the final visit compared to 34.9% with placebo 5

Common Pitfalls to Avoid

• Never discontinue abruptly—this dramatically increases risk of rebound symptoms and acute destabilization 1
• Underdosing or premature discontinuation can delay therapeutic response and lead to inadequate trial 4
• Stopping before 4-6 weeks prevents proper assessment of whether the medication would have been effective 1

Critical Safety Consideration

If you are experiencing intolerable side effects after two weeks (such as severe akathisia, extrapyramidal symptoms, nausea, or constipation—the most common adverse effects of cariprazine), contact your prescribing physician immediately rather than stopping on your own. 6 Your physician can adjust the dose, add medications to manage side effects, or implement a proper taper if discontinuation is truly necessary. 1