Vraylar alternatives: What can I take instead of Vraylar?

Compare Vraylar alternatives | Abilify | Latuda | Risperdal | Seroquel | Zyprexa | Natural alternatives | How to switch meds

Vraylar is a prescription drug used for the following conditions in adults:

• Treatment of schizophrenia
• Acute treatment of manic or mixed episodes associated with bipolar I disorder (bipolar mania)
• Treatment of depressive episodes associated with bipolar I disorder (bipolar depression)

Vraylar is available as an oral capsule that is taken once daily with or without food. Vraylar is a brand-name medication made by Allergan, Inc. There is no generic available for Vraylar at this time. 

Vraylar contains the ingredient cariprazine. Cariprazine is part of a drug class called atypical antipsychotics, or second-generation antipsychotics. The way Vraylar works is not completely understood, but it is thought to work by acting on dopamine and serotonin receptors in the brain. 

In some cases, patients may be looking for an alternative treatment to Vraylar. Some people may not have the desired effect and want to try a different medication to see if it works better. Others may have side effects that persist or are bothersome. Common side effects of Vraylar include:

• Extrapyramidal symptoms (EPS; involuntary body movements; a common side effect of antipsychotic medications)
• Akathisia (restlessness)
• Trouble sleeping
• Excess sleepiness
• Stomach problems such as nausea, constipation, vomiting, indigestion
• Dizziness
• Blurred vision
• Increased blood pressure
• Fatigue 
• Dry mouth 
• Back pain 
• Weight gain 
• Fast heart rate

Or, a serious side effect could occur, such as seizures, high blood sugar, suicidal thoughts, severe extrapyramidal symptoms, tardive dyskinesia (repetitive muscle movements in the face, neck, arms, and legs), neuroleptic malignant syndrome, or a severe or life-threatening allergic or skin reaction. 

Some people cannot take Vraylar at all. Vraylar has a boxed warning, which is the strongest warning required by the U.S. Food and Drug Administration (FDA). According to the prescribing information, Vraylar is not approved for use in older adults with dementia-related psychosis. This is because older adults with dementia-related psychosis who take antipsychotic medication are at an increased risk of death.

Another part of the boxed warning states that antidepressant medications can increase the risk of suicidal thoughts and behaviors, particularly in children, adolescents, and young adults. Although classified as an antipsychotic, Vraylar has antidepressant effects and thus carries this disclaimer. Patients of any age who take Vraylar should be monitored by their families, caregivers, and healthcare providers for changes in mood or behavior.  

In some cases, the price of Vraylar may be too high due to insurance copays. Whatever the reason, there are alternatives to Vraylar that you can discuss with your healthcare provider. 

What can I take in place of Vraylar?

There are other options available to treat schizophrenia or bipolar I disorder symptoms that do not improve with Vraylar, or when Vraylar cannot be tolerated. The table below compares Vraylar (in bold), with common alternatives. All of the drugs listed are prescription medications that are approved by the FDA.

*Dosages provided are examples; dosage can vary based on indication, side effects, and response to treatment. Other dosage forms, such as injections, are available for some drugs. This article focuses on oral medications. Consult your healthcare provider for more information. 

Other alternatives to Vraylar

• Clozaril (clozapine) is used to treat schizophrenia that is resistant to other medicines. Because of the risk of severe neutropenia, Clozaril is only available through a special program called the Clozapine Risk Evaluation Mitigation Strategy (REMS) Program. Severe neutropenia is when there is a very low number of neutrophils, a type of white blood cell that fights infections. Having a low number of neutrophils puts the patient at risk for serious infections that can be life-threatening and cause death.
• Depakote (divalproex sodium) can be used to treat manic episodes associated with bipolar disorder. 
• Lithium can be used to treat bipolar I disorder (acute manic or mixed episodes or maintenance).
• Tegretol (carbamazepine) is sometimes used off-label for bipolar disorder.

Note that Vraylar is a second-generation antipsychotic, or atypical antipsychotic. This group of antipsychotics is newer and causes less movement-related side effects than the first-generation, or typical antipsychotics. First-generation antipsychotics are prescribed less often. Examples of typical antipsychotics include:

• Haldol (haloperidol)
• Loxitane (loxapine)
• Mellaril (thioridazine)
• Moban (molindone)
• Navane (thiothixene)
• Prolixin (fluphenazine)
• Stelazine (trifluoperazine)
• Trilafon (perphenazine)
• Thorazine (chlorpromazine)

Top 5 Vraylar alternatives

The following are some of the most common alternatives to Vraylar.

1. Abilify (aripiprazole)

Abilify is indicated to treat schizophrenia, manic and mixed episodes associated with bipolar I disorder, depression (in combination with other medication), irritability associated with autistic disorder, and Tourette’s disorder. Abilify is an atypical antipsychotic. The most common side effects are stomach problems like nausea, vomiting, and constipation. Other common side effects include headache, dizziness, akathisia, anxiety, trouble sleeping, and restlessness. Abilify has the same boxed warning as Vraylar in regard to avoiding use in older adults with dementia-related psychosis, and monitoring patients for suicidal thoughts and behaviors. 

2. Latuda (lurasidone)

Latuda is also an atypical antipsychotic and can be used to treat bipolar depression (alone or in combination with other medicine) or schizophrenia. The most common side effects of Latuda are nausea, excess sleepiness, EPS, and akathisia. Latuda has the same boxed warning as Abilify and Vraylar. 

3. Risperdal (risperidone)

Risperdal, an atypical antipsychotic, can be used to treat bipolar mania (alone or in combination with other medication), schizophrenia, or irritability associated with autistic disorder. Common side effects include movement disorders, sedation, dizziness, anxiety, vision disturbances, stomach problems (discomfort, nausea, vomiting, indigestion, diarrhea, constipation), dry mouth, and increased appetite and weight. Risperdal has a boxed warning to avoid use in older adults with dementia-related psychosis. 

4. Seroquel (quetiapine)

Seroquel is an atypical antipsychotic that can be used to treat schizophrenia, bipolar I disorder (acute treatment of manic episodes), and bipolar depression. The most common side effects of Seroquel are excess sleepiness, dry mouth, dizziness, constipation, weakness, stomach pain, weight gain, indigestion, and orthostatic hypotension. 

Seroquel has the same boxed warning as Latuda, Abilify, and Vraylar. 

5. Zyprexa (olanzapine)

Zyprexa is an atypical antipsychotic. It can be used to treat schizophrenia or bipolar I disorder (acute manic or mixed episodes or maintenance). The most common side effects of Zyprexa are orthostatic hypotension, constipation, weight gain, restlessness, weakness, dry mouth, increased appetite, excess sleepiness, dizziness, and tremor. Like Risperdal, Zyprexa has a boxed warning to avoid use in older adults with dementia-related psychosis. 

Natural alternatives to Vraylar

Mental health conditions can be treated as a comprehensive approach. In addition to Vraylar or an antipsychotic, many patients require treatment with an antidepressant medication as well, such as Lexapro (escitalopram) or Prozac (fluoxetine). Although medication is an important part of the treatment plan, there are other parts of a treatment plan that help too. For example, cognitive behavioral therapy, or CBT, a type of talk therapy, can be very helpful. Some people find other measures, such as exercise, meditation, yoga, and prayer, to help as well. However, these are not a substitute for medication, rather a complement to the medication. Talk to your healthcare provider about various natural methods you can try, in combination with your medications. Always check with your healthcare provider for medical advice before trying an herbal supplement, as some may have drug interactions or dangerous adverse effects. 

How to switch to a Vraylar alternative

If you are interested in switching to a Vraylar alternative, you can:

• Reach out to your insurance provider if price is a concern. Inquire about which Vraylar alternatives are covered on your formulary, and what the copay would be for each medication. Be sure to ask if your deductible has been met, or if you are still paying towards your deductible. 
• Contact your healthcare provider. You may be required to make an appointment before he or she will change your medication regimen. You can review your medical conditions and history, and discuss alternative medications—as well as potential side effects and drug interactions—with your provider. If your provider decides to prescribe a Vraylar alternative, they can send (or call in) the prescription to your preferred pharmacy. Notify the pharmacist that you are switching from Vraylar to the new medication, so your file can be updated.
• Search SingleCare for coupons. SingleCare customers save up to 80% on prescription prices, and the coupons can be applied to refills, too.  

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