Home Drug Guide Cariprazine Hydrochloride

Drug Guide

Generic Name

Cariprazine Hydrochloride

Brand Names Vraylar

Classification

Therapeutic: Antipsychotic, mood stabilizer

Pharmacological: Second-generation (atypical) antipsychotic

FDA Approved Indications

  • Schizophrenia in adults
  • Bipolar disorder (manic/mixed episodes and maintenance treatment)

Mechanism of Action

Cariprazine acts mainly as a partial agonist at dopamine D2 and D3 receptors, with a higher affinity for D3 receptors, and serotonin 5-HT1A receptors, and as an antagonist at 5-HT2A receptors. This modulation helps balance dopamine and serotonin neurotransmission, alleviating psychotic and mood symptoms.

Dosage and Administration

Adult: Start at 1.5 mg once daily, can be increased to a target dose of 3 mg/day, titrated based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; start at lower doses due to increased sensitivity in older adults.

Renal Impairment: Adjust dose based on severity; consult prescribing information.

Hepatic Impairment: Use caution; consider starting at lower doses due to altered metabolism.

Pharmacokinetics

Absorption: Well absorbed orally, with peak plasma concentrations in about 3-4 hours.

Distribution: High protein binding (~71-77%).

Metabolism: Metabolized primarily by CYP3A4 and to a lesser extent by CYP2D6; active metabolites include DCAR and DDCAR.

Excretion: Excreted mainly in feces (~76%) and urine (~13%).

Half Life: Approximately 2-4 days, which supports once-daily dosing.

Contraindications

  • Hypersensitivity to cariprazine or any component of the formulation.

Precautions

  • Use with caution in patients with cardiovascular disease, history of orthostatic hypotension, seizure disorders, or risk of suicide.
  • Monitor for signs of worsening depression or suicidal thoughts, especially during initial therapy.

Adverse Reactions - Common

  • Akathisia (Common)
  • Dizziness (Common)
  • Extrapyramidal symptoms (Common)
  • Somnolence (Common)
  • Nausea (Common)

Adverse Reactions - Serious

  • Neuroleptic malignant syndrome (Rare)
  • Tardive dyskinesia (Rare)
  • Orthostatic hypotension (Uncommon)
  • Changes in blood glucose or lipid levels (Uncommon)

Drug-Drug Interactions

  • CYP3A4 inducers (e.g., carbamazepine, rifampin) may decrease effectiveness.
  • CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) may increase plasma levels.

Drug-Food Interactions

  • Grapefruit juice may increase levels of cariprazine.

Drug-Herb Interactions

  • St. John's Wort may reduce effectiveness.

Nursing Implications

Assessment: Monitor for signs of efficacy (reduction in psychotic or mood symptoms) and adverse effects (EPS, metabolic changes).

Diagnoses:

  • Risk for falls, related to dizziness or hypotension.
  • Ineffective coping, related to psychotic symptoms.

Implementation: Administer once daily, with or without food. Educate patients about potential side effects.

Evaluation: Assess symptom improvement and monitor for adverse reactions regularly.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any worsening symptoms or side effects.
  • Avoid alcohol, CNS depressants, and hazardous activities until stabilized.
  • Sun sensitivity: use sun protection.
  • Inform about potential for drowsiness or dizziness.

Special Considerations

Black Box Warnings:

  • Elderly patients with dementia-related psychosis treated with antipsychotics are at increased risk of death.
  • Suicidal thoughts and behaviors: May increase risk in some patients.

Genetic Factors: Metabolism varies with CYP3A4/CYP2D6 polymorphisms affecting drug levels.

Lab Test Interference: No significant interference reported.

Overdose Management

Signs/Symptoms: Drowsiness, tachycardia, agitation, extrapyramidal symptoms.

Treatment: Supportive care; monitor vital signs; consider gastric lavage or activated charcoal if ingestion is recent; no specific antidote.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable for at least 24 months when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.