Vraylar vs Abilify - How do they compare?

Is Vraylar similar to Abilify?

Abilify (aripiprazole) and Vraylar (cariprazine) are both classified as atypical antipsychotic medications. They help treat mental health conditions such as schizophrenia, bipolar disorder and as additive treatment for depression. Abilify comes as a long-acting injection and oral tablet, while Vraylar comes as an oral capsule. Their side effects are similar.

These medicines both work by changing the actions of chemicals in the brain to help stabilize your thoughts, actions and moods.

Abilify is approved to treat:

• schizophrenia
• bipolar I disorder (with manic or mixed episodes)
• adjunctive treatment of major depressive disorder in adults already using an antidepressant
• Tourette's disorder
• irritability associated with autistic disorder
• the injectable form only: agitation associated with schizophrenia or bipolar mania in adults.

Vraylar is approved to treat:

• schizophrenia
• bipolar I disorder (with manic or mixed episodes)
• adjunctive treatment of major depressive disorder in adults already using an antidepressant
• depressive episodes associated with bipolar I disorder (bipolar depression)

How different are schizophrenia and bipolar disorder?

Schizophrenia is a severe, long-term and disabling disorder of the brain. Symptoms are usually first seen in adults under the age of 30 years and include hearing voices, seeing things that are not there, believing other people are reading their minds or controlling their thoughts, and being suspicious or withdrawn.

Bipolar disorder, also known as manic-depressive illness, is another brain disorder that leads to shifts in mood, energy, activity level and the ability to carry function in day-to-day tasks, such as work or school. Symptoms can include fluctuating periods of depression and high, irritable mood (mania), restlessness, inability to control thoughts, fast talking, impulsive or risky behavior, and changes in sleep patterns.

How do Abilify and Vraylar come at the pharmacy?

Abilify

• Abilify (or its generic options) comes in several different dosage forms, including an oral tablet, an orally disintegrating tablet (which dissolves on your tongue without water), and as an oral liquid solution. It's also available as a long-acting, extended-release injection.
• Abilify MyCite is a unique tablet formulation of aripiprazole. It is embedded with the ingestible Proteus sensor that allows patients, and, if given access, doctors and caregivers, to track ingestion of the medication on a smartphone or web-based portal. The system sends a message from the pill’s sensor to a wearable patch on the patient, which then transmits to the device. Abilify MyCite is approved to treat schizophrenia, bipolar I disorder, and as an adjunctive treatment for major depressive disorder in adults.
• Abilify Maintena is an extended-release, intramuscular injection used to treat schizophrenia and bipolar I disorder in adults. Abilify Maintena is given as a once-a-month injection to help prevent relapse. You would receive this injection at your doctor’s office.
• A long-acting, intramuscular injectable form of aripiprazole is also available as the brand name Aristada or Aristada Initio (aripiprazole lauroxil). These agents are used for the treatment of schizophrenia in adult patients. Aristada Initio is used to initiate treatment. Aristada and Aristada Initio are not interchangeable. You would typically receive this injection at your doctor’s office.

Vraylar

Vraylar comes as a capsule that you take by mouth.

• Vraylar comes in a 1.5 mg, 3 mg, 4.5 mg and 6 mg capsule strength. It is given once a day, and your doctor can determine the best dose for your treatment plan.
• Vraylar does not yet have a generic option and may be more expensive than some of the Abilify options.

Learn More: Dosing (in more detail): Abilify Dosing and Vraylar Dosing

Which has more side effects, Vraylar or Abilify?

The most common side effects (≥ 5%) across various studies with Abilify tablets include:

• Akathisia, restlessness, tremor, extrapyramidal disorder and other movement disorders
• Agitation, anxiety, insomnia (trouble sleeping)
• Blurred vision
• Constipation
• Nausea, vomiting
• Dyspepsia (heartburn)
• Dry mouth
• Drowsiness, fatigue, lethargy, somnolence, dizziness
• Fever
• Headache
• Salivary hypersecretion (in pediatric patients treated for autistic disorder)
• Nasopharyngitis (common cold, in pediatric patients)
• Appetite changes (in pediatric patients)

In clinical trials with Vraylar capsules, the most common side effects (≥ 5%) across various studies included:

• Akathisia, restlessness, tremor, extrapyramidal disorder and other movement disorders
• Dyspepsia (heartburn)
• Nausea, vomiting
• Somnolence (drowsiness), fatigue
• Constipation
• Insomnia (trouble sleeping)
• Dizziness
• Increased appetite

Some side effects may not appear until several weeks after you have started taking Vraylar. The levels of medicine slowly increase in your body over time. Your doctor will monitor you for several weeks after starting Vraylar and any time your dose is increased.

All atypical antipsychotics can have similar side effects, but some agents have an advantage over another. For example,

• If weight gain is a concern for you, you might discuss with your doctor which medicines have a low chance of causing this side effect.
• If you are being treated for type 2 diabetes, it might be important for your doctor to select an antipsychotic that has a lesser effect on increasing your blood sugar.
• If you have concerns about your medicine making you sleepy, you may want to use an antipsychotic that is not associated with this side effect.

Akathisia: Both Abilify and Vraylar appear to have a similar, medium risk for side effects known as akathisia. This is a movement disorder that causes a feeling of inner restlessness and the inability to stay still, especially of the legs. However, other atypical antipsychotics, such as quetiapine (Seroquel) or pimavanserin (Nuplazid) may be associated with an even lower incidence of this side effect.

Weight gain: Abilify may have slight advantage over Vraylar when it comes to weight gain, but your results can vary. Also, compared to some other antipsychotics, such as olanzapine (Zyprexa) and clozapine (Clozaril), Abilify may cause less weight gain.

Blood sugar control: Both Abilify and Vraylar seem to be similar and have a low effect on causing elevations in blood sugar levels. Clozapine (Clozaril) and olanzapine (Zyprexa) may lead to blood sugar elevations more frequently than other atypical antipsychotics.

Elevations in blood cholesterol and lipids: Both Vraylar and Abilify have a low effect on your blood cholesterol or other lipids, and are less likely than other atypical antipsychotics to cause these changes, especially olanzapine (Zyprexa) or quetiapine (Seroquel).

Sedation: Abilify may lead to less sedation than Vraylar, but this can vary among patients. Plus, Vraylar also has a low incidence of drowsiness. In studies, somnolence (hypersomnia, sedation, and somnolence) was reported in 7% of patients treated with Vraylar compared to 6% of placebo-treated patients. Clozapine (Clozaril), olanzapine (Zyprexa), and quetiapine (Seroquel) are the most sedating atypical antipsychotics.

All antipsychotic medications contain a Boxed Warning about use in patients with dementia. Neither Vraylar nor Abilify are approved to treat such patients.

• There is a higher chance of death in older adults who take antipsychotics for mental health problems caused by dementia (dementia-related psychosis). Most of the deaths were linked to heart disease or infection.
• These medicines are not approved to treat mental health problems caused by dementia.
• Antidepressants increased the risk of suicidal thoughts and behaviors in
  pediatric and young adult patients. The safety and effectiveness of Vraylar have
  not been established in children.
• A Boxed Warning is the most stringent prescription safety warning from the FDA.

This is not a complete list of side effects, precautions and warnings associated with Vraylar, Abilify or other atypical antipsychotics. The types or incidence of side effects may be different for you. Discuss these topics with your doctor.

Related Questions

• Should you take Vraylar in the morning or at night?
• What are 6 Vraylar side effects you need to be aware of?
• How does Vraylar compare with Seroquel?

Which is more effective - Vraylar or Abilify?

Both Vraylar and Abilify have been shown in clinical trials to be effective for their approved uses. Ultimately, the decision of which drug to use may depend upon your condition, previous treatments, preferred formulation, side effects, cost and doctor preferences. For most patients, these drugs are well-tolerated and effective.

Advantages with Abilify

• Abilify is approved by the FDA to treat more types of mental health disorders when compared to Vraylar. For example, Abilify may be used in pediatric patients for Autistic disorder, Tourette's syndrome, schizophrenia, or bipolar mania. Vraylar is not approved for any use in children.
• Abilify comes in many different forms, such as oral tablets, orally disintegrating tablets, oral solution, and injections. This may be an advantage when deciding upon which medicine to use and compliance with treatment. Vraylar only comes as an oral capsule.
• Abilify is available in a cost-saving generic for some dosage forms like oral tablets. orally-dissolving tablets and the oral solution. Vraylar is not yet available as a generic.
• Abilify has been approved since 2002, which may be an advantage in some cases. Your doctor may be more familiar with its uses, doses and side effects. Vraylar was first approved in 2015.

Advantages with Vraylar

• Vraylar has a longer half-life and stays in your body longer so missing a dose or taking your dose late may not be as much of a problem as with other antipsychotics. This longer time in your body helps to stabilize blood levels with once-daily dosing.
• Vraylar has not been associated with as much weight gain as some other antipsychotics.

Which is more affordable, Abilify or Vraylar?

Abilify is available as a generic for some dosage forms like tablets and oral solution and this can save you money. Vraylar is not yet available as a generic option, so it will be more expensive in most cases, if you are paying full cash price for the medicine.

• Abilify, known generically as aripiprazole, is available as a generic oral tablet, generic orally disintegrating tablet and generic oral solution. These options can save you money.
• Vraylar capsule is only available as the brand name drug and can be very expensive.
• If you prefer generics, be sure to tell your doctor before you receive your prescription.

Compare the prices, coupons and patient assistance programs for each medication below:

• Abilify Price Guide
• Vraylar Price Guide

Your insurance may pay for these medications, in either the brand name or generic form. Call your prescription benefit company to discuss which atypical antipsychotic medications are covered under your plan and your copay amount.

Bottom Line

• Abilify and Vraylar are both atypical antipsychotic medications. They help to treat mental health conditions such as schizophrenia, bipolar disorder (also known as manic-depression) and as an add-on therapy for depression.
• Most patients tolerate these drugs well and have a good response for their condition. Ultimately, which drug you use may depend upon your treatment needs, previous or current medicines, preferred dosage form, side effects, and cost.
• Abilify is available in a generic form for tablets and oral solution and is more affordable than Vraylar if you are paying cash, but your insurance may cover a portion of the cost of these drugs.

This is not all the information you need to know about Vraylar (cariprazine) and Abilify (aripirazole) for safe and effective use and does not replace your doctor's instructions. Review the full Vraylar and Abilify product information, and discuss this information with your health care provider.