Names and pronunciation
(kar-ip′ra-zeen) Vraylar
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Drug reference
(kar-ip′ra-zeen) Vraylar
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Func. class.: Antipsychotic, atypical
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Do not confuse: Vraylar/Valchlor
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ACTION: May act on central dopa- mine and serotonin receptors
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USES: Schizophrenia, manic or mixed episodes with bipolar I, unipolar depres- sive disorder, depressive episodes in bipolar I disorder
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CONTRAINDICATIONS: Hyper- sensitivity, pregnancy Precautions: Breastfeeding, orthostatic hypotension, opioids, tardive dyskinesia, seizures, CV disease, leukopenia, neutrope- nia, children, severe hepatic/renal disease
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Black Box Warning: Children, dementia- related psychosis, suicidal ideation Black Box Warning: Suicidal ideation: monitor for thoughts, behaviors in young adults, adolescents, and children Black Box Warning: Dementia-related psychosis: do not use in these patients Black Box Warning: Discuss the risks of taking opioids with benzodiazepines, to seek emergency services for severe sleepi- ness, stupor, slow breathing, or coma
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SIDE EFFECTS CNS: EPS, headache, fatigue, fever, dizzi- ness, agitation, insomnia, restlessness CV: Hypertension, tachycardia GI: Nausea, vomiting, constipation, diar- rhea, dry mouth, abdominal pain, weight gain, anorexia GU: UTI EENT: Blurred vision, dental pain, nasopharyngitis MS: Back pain, arthralgia INTEG: Rash, pruritus, urticaria, SJS, NMS RESP: Cough
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INTERACTIONS Increase: CNS depression: CNS depres- sants, opioids Increase: cariprazine effect: CYP3A4 inhibitors Decrease: effect of cariprazine: dopa- mine agonists Increase or decrease: cariprazine effect: CYP3A4 inducers Drug/Herb Increase: cariprazine side effects: kava kava Decrease: cariprazine effect: St. John’s wort Drug/Food Increase: cariprazine effect: grapefruit juice, avoid using together Drug/Lab Increase: LFTs, CK Decrease: WBC NURSING CONSIDERATIONS
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DOSAGE AND ROUTES Schizophrenia • Adult: PO 1.5 mg on day 1, then may increase to 3 mg daily on day 2, may in- crease by either 1.5 mg or 3 mg to a max 6 mg daily Unipolar, augmentation of antidepres- sant (unlabeled) • Adult: PO 1.5 mg once daily, initially. May increase to 3 mg PO once daily on day 15 based on response/tolerability. Max: 3 mg/day Depressive episodes in bipolar I disorder • Adult: 1.5 mg daily, then may in- crease to 3 mg daily on day 15, max 3 mg/day Adult: PO starting a strong CYP3A4 inhibitor while on a stable dose of this drug: Reduce the current dose of this drug by 50%; initiating this drug while receiving a strong CYP3A4 inhibitor: 1.5 mg daily on days 1 and 3, with no dose given on day 2; starting on day 4, 1.5 mg daily, max 3 mg/day; withdrawing a strong CYP3A4 inhibitor while on this drug: May need dose increase
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Available forms: Capsules 1.5 mg, 3 mg, 4.5 mg, 6 mg Administer • Protect from light (3 mg and 4.5 mg) • May give without regard to meals
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Assess: • Hypersensitivity: monitor for rash, pruritis, urticaria, edema of face, tongue, lips, throat • NMS: elevated CK, hyperpyrexia, rigid- ity, delirium, renal failure, rhabdomyolysis, provide immediate medical intervention • Seizures: monitor for seizures in those with underlying seizure disorders • EPS: monitor for tardive dystonia (males), tardive dyskinesia (elderly fe- males), may need to be discontinued, assess for involuntary movements • Blood studies: monitor lipids, triglyc- erides, blood glucose, A1c, CBC, serum creatinine, pregnancy test, serum electro- lytes, serum prolactin, thyroid function tests baseline and periodically C • Hyperpyrexia: monitor for overheat- ing, dehydration, strenuous exercise • Pregnancy/breastfeeding: Do not use in pregnancy, if pregnant, enroll in the National Registry for Atypical Antipsy- chotics (866-961-2388), effects in breast- feeding are unknown
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Evaluate: • Therapeutic response: decrease in symptoms of schizophrenia, depression, bipolar disorder
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Patient and caregiver information: • The need for continued follow-up • To report hypersensitivity including rash, itching • To avoid overheating, dehydration, strenuous exercise, make sure enough fluid is taken • The signs of EPS and when to notify the provider • To notify the provider of the signs of NMS, if seizures occur • To rise slowly from lying or sitting to minimize orthostatic hypotension • To notify provider if pregnancy is planned or suspected or if breastfeed- ing • To avoid using with grapefruit juice • To avoid driving or other hazardous tasks until results are known • To discuss all OTC/Rx/herbs/supple- ments used with prescriber
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PHARMACOKINETICS Onset unknown, peak 3-6 hr, duration unknown, half-life 48-96 hr, 1 day to 21 days metabolite
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• Adult: PO 1.5 mg on day 1, then may increase to 3 mg daily on day 2, may in- crease by either 1.5 mg or 3 mg to a max 6 mg daily Unipolar, augmentation of antidepres- sant (unlabeled)
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• Adult: PO 1.5 mg once daily, initially. May increase to 3 mg PO once daily on day 15 based on response/tolerability. Max: 3 mg/day Depressive episodes in bipolar I disorder
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• Adult: 1.5 mg daily, then may in- crease to 3 mg daily on day 15, max 3 mg/day Adult: PO starting a strong CYP3A4 inhibitor while on a stable dose of this drug: Reduce the current dose of this drug by 50%; initiating this drug while receiving a strong CYP3A4 inhibitor: 1.5 mg daily on days 1 and 3, with no dose given on day 2; starting on day 4, 1.5 mg daily, max 3 mg/day; withdrawing a strong CYP3A4 inhibitor while on this drug: May need dose increase
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