Vraylar (cariprazine) is an atypical antipsychotic medication used to treat several mental health conditions. It is approved for use in adults to treat:
- Major depressive disorder, when taken along with antidepressant medications
- Short-term treatment of manic or mixed episodes that occur with bipolar I disorder
- Depressive episodes that occur with bipolar I disorder (bipolar depression)
- Schizophrenia
Like many medications, Vraylar carries the potential for side effects, and one of the most commonly discussed is weight gain. This article provides a comprehensive overview of the relationship between Vraylar and weight changes, including the factors that influence weight gain or loss, strategies for managing weight, and other important considerations.
How Vraylar Works
Vraylar works by affecting the levels of certain chemicals in the brain, specifically dopamine and serotonin. It's a dopamine D2 and D3 partial agonist, meaning it can help balance dopamine levels uniquely, instead of completely blocking them. Dopamine and serotonin are neurotransmitters that play a key role in regulating mood, appetite, and metabolism. By influencing these neurotransmitters, Vraylar helps stabilize thoughts, actions, and moods.
Understanding Atypical Antipsychotics
Vraylar is classified as an "atypical antipsychotic," a term that distinguishes it from older, typical antipsychotics. Atypical antipsychotics are often preferred because they generally have a lower risk of extrapyramidal side effects. However, they can still cause metabolic changes that may result in weight gain.
Vraylar and Weight Gain: What the Studies Say
Weight gain has been reported as a side effect of Vraylar in clinical studies. However, it's important to note that not everyone taking Vraylar will experience weight gain. The extent of weight gain can vary depending on the individual, the condition being treated, and other factors.
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An analysis of electronic medical records from patients prescribed cariprazine for bipolar I disorder (BP-I) depression, BP-I mania/mixed, schizophrenia, or as an adjunctive treatment for major depressive disorder (MDD) showed that patients gained an estimated + 3.55 kg/year during the baseline period, which was reduced to an estimated + 0.91 kg/year after cariprazine initiation. The CI of the weight change trajectory during cariprazine treatment crossed zero, indicating the weight change was not significantly different from zero.
Factors Influencing Weight Gain
Several factors can influence whether a person gains weight while taking Vraylar:
- Individual Biochemistry: Each person's body reacts differently to medications. Your unique biochemistry plays a significant role in how Vraylar affects your appetite and metabolism.
- Lifestyle: Your daily habits, including diet and exercise, can significantly impact your weight while taking Vraylar.
- Diet: A diet high in carbohydrates and processed sugars can contribute to weight gain.
- Genetics: A personal or family history of weight gain, diabetes, or obesity may increase your risk of weight gain while on Vraylar.
- Dosage: While the different dosages of Vraylar aren’t known to cause different side effects, the rates of side effects may be slightly different, depending on your Vraylar dose
Impact on Metabolism
Vraylar's effect on dopamine and serotonin can influence appetite and metabolism. Some people may experience increased hunger, while others may find that their body uses fuel from food differently.
- Dopamine Regulation: Vraylar doesn't fully block dopamine production like older medications; it just downregulates it a little. This should mean that you won’t have intense, extreme cravings; instead, you might notice that you’re slightly more hungry than usual.
- Serotonin Management: Vraylar also affects your brain’s use and management of serotonin. For some people, this may result in increased cravings specifically for sweets or carbs, which tend to have a marked effect on blood sugar levels (and subsequent diabetes or obesity risk).
Some studies suggest Vraylar could have a lower risk of raising a patient’s blood sugar when compared to other atypical antipsychotics. If you have prediabetes or know that you have insulin resistance, it’s a good idea to monitor your blood sugar levels very closely. Since Vraylar may result in changed blood sugar levels, patients may rightly wonder if taking Vraylar or another antipsychotic could result in diabetes. Vraylar is considered a lower-risk antipsychotic in this way. But your risk will vary, and your specific risk will depend on your lifestyle, your genetic risk, and several other factors.
Managing Weight Gain While Taking Vraylar
While weight gain is a potential side effect of Vraylar, there are steps you can take to manage your weight and minimize the risk:
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- Monitor Your Diet: Avoid high-carb snacks and processed sugar whenever possible. Instead, opt for fibrous veggies, whole grains, and proteins to keep you full and satisfied. Cook your food and aim to make half your plate vegetables or fruit and a quarter protein and the rest whole grains.
- Stay Active: Regular physical activity can help you burn calories and maintain a healthy weight. Schedule one 30-minute walk daily or split it into two or three shorter 15-minute walks.
- Stay Hydrated: Drinking lots of water can help you determine when you’re actually hungry and when you’re actually just dehydrated.
- Monitor Your Weight: Your doctor should record your weight at the beginning of treatment and check it often throughout treatment. Weigh yourself daily or at least every second day in the morning before breakfast.
- Get Enough Sleep: Aim for 7 to 8 hours sleep per night. Increased stress and inadequate sleep can elevate cortisol levels and disrupt hunger hormones, potentially leading to weight gain.
- Consult Your Doctor: Talk with your doctor to understand how you can best incorporate exercise during Vraylar treatment. They also may have recommendations on nutrition that can help you manage your weight.
Exercise and Vraylar: Precautions
Exercise is generally beneficial for maintaining weight, but there are some precautions to be aware of while taking Vraylar. Strenuous exercise contributes to an increase in core body temperature, which can rise as high as 104°F. Vraylar can disrupt the body’s ability to reduce its core body temperature. So it’s important not to overheat the body.
Follow these guidelines for exercising during Vraylar treatment:
- Do not exercise too much
- Do not become too hot
- Do not become dehydrated
- Drink plenty of water
Also, tell them all prescription and OTC medications you take so they’re aware if you’re taking an anticholinergic drug. Taking an anticholinergic medication with Vraylar also could contribute to an increase in core body temperature.
Other Important Considerations
Besides weight gain, Vraylar can cause other side effects that you should be aware of:
- Increased Risk of Death in Older Adults with Dementia-Related Psychosis: Elderly people with dementia-related psychosis taking medicines like VRAYLAR are at an increased risk of death. Vraylar is not FDA approved for treating psychosis caused by dementia in older adults.
- Suicidal Thoughts and Behaviors: VRAYLAR and antidepressants may increase suicidal thoughts or actions in some children and young adults especially within the first few months of treatment or when the dose is changed. Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, especially sudden changes in mood, behaviors, thoughts, or feelings.
- Neuroleptic Malignant Syndrome (NMS): Call your healthcare provider or go to the nearest hospital emergency room right away if you have high fever, stiff muscles, confusion, increased sweating, or changes in breathing, heart rate, and blood pressure. These can be symptoms of a rare but potentially fatal side effect called NMS.
- Uncontrolled Body Movements (Tardive Dyskinesia or TD): VRAYLAR may cause movements that you cannot control in your face, tongue, or other body parts. Tardive dyskinesia may not go away, even if you stop taking VRAYLAR.
- Late-Occurring Side Effects: VRAYLAR stays in your body for a long time. Some side effects may not happen right away and can start a few weeks after starting VRAYLAR, or if your dose increases.
- High Blood Sugar and Diabetes: Increases in blood sugar can happen in some people who take VRAYLAR. Extremely high blood sugar can lead to coma or death. Your healthcare provider should check your blood sugar before or soon after starting VRAYLAR and regularly during treatment.
- Low White Blood Cell Count: Low white blood cell counts have been reported with antipsychotic drugs, including VRAYLAR. This may increase your risk of infection.
- Sleepiness, Drowsiness, Feeling Tired, Difficulty Thinking and Doing Normal Activities: Do NOT drive, operate machinery, or do other dangerous activities until you know how VRAYLAR affects you.
Common Side Effects
Common side effects of Vraylar include:
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- Movement problems (extrapyramidal symptoms)
- Stomach problems (such as indigestion, nausea, vomiting, or constipation)
- Sleep problems such as drowsiness, dizziness, feeling sleepy all the time, fatigue, or trouble sleeping
- Increased appetite and weight gain
Managing Side Effects
If you experience side effects from Vraylar, talk with your doctor or pharmacist. They can discuss ways to manage side effects or other available treatment options. Do not stop taking Vraylar without consulting your doctor first.
Questions and Answers about Vraylar
1. Does Vraylar cause weight gain?
For most patients, Vraylar doesn’t cause significant weight gain. Some, however, do experience mild-to-moderate weight increases.
2. Does Vraylar increase hunger?
Yes, for some people, taking Vraylar does tend to correlate to an increase in hunger levels. Vraylar’s effect on serotonin and dopamine likely has something to do with this. If you’re experiencing increased hunger, you don’t have to fight it. However, if you’re hoping to avoid unnecessary weight gain, when you feel hungry, eat protein-rich, fiber-rich foods to keep blood sugar low and keep you satiated as long as possible.
3. Is Vraylar likely to lead to serious weight gain?
Vraylar can cause mild weight gain, but, overall, it’s less likely to lead to the serious weight gain often associated with other atypical antipsychotics. It’s worth remembering, though, that this is not the only way to assess a medication. Just because a medication like Zyprexa may be associated with a high risk of weight gain doesn’t necessarily mean it’s a bad fit for you-just that if you’re already at risk for weight gain, you may need to be particularly careful about lifestyle changes. Talk to your doctor to determine your next best steps.
4. Can you lose weight while taking Vraylar?
For the most part, this happens when a person is predisposed to weight loss genetically or is extremely conscious about the lifestyle choices they make after starting their medication.
5. How long can you stay on Vraylar?
You can stay on Vraylar for quite a long time. It’s designed for long-term use, which is fitting, as its primary indications are long-term conditions that require ongoing management. If you are planning on taking Vraylar for a while, it may be worth investing in regular health monitoring and bloodwork, dosing adjustments in collaboration with your licensed healthcare provider, and a tapering-off plan if you find that one is necessary.