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How does Vraylar compare with Seroquel?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Dec 22, 2022.

Official answer

by Drugs.com

Vraylar and Seroquel are both oral prescription medicines in a drug class called atypical antipsychotics. They are used to treat the mental health conditions schizophrenia and bipolar disorder. Vraylar is also approved to treat Major depressive disorder in adults. They work by changing the actions of chemicals in your brain to help stabilize thoughts, actions and moods.

Vraylar is more expensive than generic Seroquel. A generic option for Vraylar has not yet been marketed in the U.S.

Vraylar is only approved by the FDA to be used in adults, while Seroquel can also be used for children and adolescents for certain conditions.

Vraylar (cariprazine) is approved for the treatment of:

  • Schizophrenia in adults
  • Bipolar I disorder in adults (manic or mixed episodes
  • Bipolar depression in adults
  • Major depressive disorder (MDD) in adults (as adjunctive therapy to antidepressants)

Seroquel (quetiapine) is approved for the treatment of:

  • Schizophrenia in people 13 years of age or older
  • Bipolar disorder in adults, including: depressive episodes associated with bipolar disorder; manic episodes associated with bipolar I disorder, given alone or with lithium or divalproex; long-term treatment of bipolar I disorder with lithium or divalproex
  • Manic episodes associated with bipolar I disorder in children ages 10-17 years old

Schizophrenia is a severe and long-term mental health disorder of the brain. Symptoms often start in adults under 30 years of age. Patients may report hearing voices, seeing things that are not there, believing other people are reading their minds or controlling their thoughts, and being suspicious or withdrawn of others.

Bipolar disorder, also known as manic-depressive illness, is also a brain disorder that leads to shifts in mood, energy, activity level and the ability to carry on day-to-day tasks, such as work or school. Symptoms include periods of deep depression with a high, irritable mood (mania), restlessness, inability to control one's thoughts, talking rapidly, carrying out impulsive or risky behavior, and changes in sleep patterns.

Major depressive disorder (MDD) is a common mood condition marked by persistent and overwhelming feelings of sadness. These mood changes can affect your daily activities and how you think, feel, and behave. Sometimes it can affect your outlook on life and make you feel that life isn’t worth living. Major depressive disorder is usually just called "depression" or clinical depression.

How does Vraylar or Seroquel come at the pharmacy?

Vraylar comes as an oral capsule that you take by mouth.

  • It comes in 1.5 mg, 3 mg, 4.5 mg and 6 mg strengths. It is given once a day and can be taken with or without food. Your doctor will determine the best dose for you.
  • Vraylar, known by the generic name cariprazine, does not yet come as a generic medicine.

Seroquel comes as an oral tablet that you take by mouth.

  • It comes in 25 mg, 50 mg, 100 mg, 200 mg, 300 mg and 400 mg strengths. It is given once or twice a day and can be given with or without food. Your doctor can determine the best dose for you.
  • Seroquel, known by the generic name quetiapine, comes as a generic option at the pharmacy and may help to save you money. Ask your pharmacist about the generic.

Do not change your dose or stop taking Vraylar or Seroquel without first talking to your healthcare provider.

How do side effects compare between Vraylar and Seroquel?

Vraylar and Seroquel have some common side effects that include:

  • Nausea
  • Vomiting
  • Sleepiness (somnolence or sedation)
  • Heartburn, indigestion, upset stomach

Compared to Vraylar, Seroquel may lead to more high cholesterol (lipid) levels, sleepiness, orthostatic hypotension and abnormal heart rhythms.

Vraylar

The most common side effects (≥ 5%) in adults across studies with Vraylar include:

  • Akathisia, restlessness (feeling like you need to move around)
  • Tremors, and other uncontrolled movement disorders
  • Dyspepsia (heartburn, indigestion)
  • Nausea
  • Vomiting
  • Somnolence (sleepiness)

Seroquel

In both adults and children, Seroquel common side effects (≥ 5%) include:

  • Somnolence (sleepiness)
  • Dry mouth
  • Dizziness
  • Weight gained or increased

In adults, other common Seroquel side effects include:

  • Constipation
  • Weakness
  • Abdominal (stomach) pain
  • Orthostatic hypotension (sudden drop in blood pressure when standing; may lead to dizziness or falls)
  • Sore throat
  • Lethargy or sluggishness
  • Increased liver enzymes (which may signal the potential for liver toxicity)
  • heartburn, indigestion

In children and adolescents, other common Seroquel side effects include:

  • Fatigue (tiredness)
  • Increased appetite
  • Nausea
  • Vomiting
  • Fast heart rate

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

  • If you are concerned about weight gain, discuss with your doctor which medicines have a lower chance of causing this side effect.
  • If you have type 2 diabetes, talk to your doctor about which antipsychotic drugs have a lower effect on increasing your blood sugar.
  • If you have concerned about sedation with your medicine, ask your doctor about an atypical antipsychotic that is not associated with this side effect.

Sedation (somnolence): Seroquel usually causes more sedation than Vraylar, but this can vary among patients.

  • In studies, somnolence was reported in 7% of patients treated with Vraylar compared to 6% of placebo-treated patients.
  • In Seroquel studies somnolence ranged from 18% to 57%. In addition, sedation was a common reason patients stopped Seroquel treatment.
  • Overall, clozapine (Clozaril), olanzapine (Zyprexa), and quetiapine (Seroquel) are the most sedating atypical antipsychotics.

You should avoid or limit alcohol use or taking other sedating drugs while taking either Vraylar or Seroquel. Do not drive, operate hazardous machinery or perform other dangerous activities if you are drowsy or until you know how you will respond to this medicine.

Akathisia: Both Vraylar and Seroquel appear to have a similar, medium to low risk for a side effect 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. Seroquel may be less likely than Vraylar to cause this side effect in some patients.

Postural hypotension: A sudden drop in blood pressure when standing, which may lead to dizziness or falls in some patients. Seroquel has a greater risk for this side effect than Vraylar. The FDA issued a warning in 2017 about the risk of falls and fractures with all antipsychotics due to sedation, postural hypotension, and dizziness of instability.

Weight gain: Vraylar may have a slight advantage over Seroquel when it comes to weight gain, but your results can vary. Also, compared to some other antipsychotics, such as olanzapine (Zyprexa) and clozapine (Clozaril), Seroquel may cause less weight gain. Aripiprazole (Abilify), lurasidone (Latuda), and ziprasidone (Geodon) are the preferred agents to minimize weight gain.

Blood sugar levels: Vraylar may have a slight advantage over Seroquel 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 lipids: Seroquel can have a greater effect on elevating blood lipids like cholesterol or LDL than Vraylar. Olanzapine (Zyprexa) can also worsen blood lipid levels.

Anticholinergic effects: Seroquel and Vraylar may both cause intermediate anticholinergic effects, leading to dry mouth, constipation, blurred vision or urinary retention. Some experts state anticholinergic effects may be greater with Seroquel.

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

  • There is a higher chance of death in older adults who take antipsychotics for mental problems caused by dementia. Most of the deaths were linked to heart disease or infection.
  • These medicines are not approved to treat mental health problems caused by dementia.
  • A Boxed Warning is the most stringent prescription safety warning from the FDA.

This is not a complete list of side effects and warnings associated with Vraylar or Seroquel. The incidence of side effects may be different for you. Discuss side effects with your doctor.

Which is more effective, Vraylar or Seroquel?

Both Vraylar and Seroquel have been shown in clinical trials to be effective for their uses. The decision of which drug to use may depend upon your medical condition, previous treatments, preferred formulation, side effects and cost. For most, but not all patients, these drugs are well-tolerated and effective.

Advantages with Vraylar

Vraylar has a much longer half-life (up to 504 hours) and stays in your body longer compared to Seroquel’s half-life (6-12 hours). Therefore, missing a Vraylar dose or taking your dose late may not be as much of a problem as with Seroquel.

  • A half-life is the time it takes a dose of the drug to be reduced by one-half. It takes on average 4 to 5 half-lives for a drug to be fully eliminated.
  • This can vary based on your age, weight, genetics, kidney or liver function, drug interactions, and even medical conditions.

Vraylar is dosed once per day while Seroquel is often given twice a day. However, there is an extended release form of Seroquel that is dosed once per day that your doctor may be able to prescribe.

Vraylar has not been associated with as much weight gain or heart rhythm problems as some other antipsychotics. Seroquel has been associated with QT prolongation and carries a warning in patients with heart risks. QT prolongation can cause irregular heartbeats (known as arrhythmia), which may lead to a sudden cardiac death.

Advantages with Seroquel

Seroquel is approved by the FDA to treat bipolar disorder and schizophrenia in both children and adults, while Vraylar is only approved in adults.

The long half-life of Vraylar can be a disadvantage if you are experiencing side effects. It may take longer for your side effects to decrease if you must stop taking Vraylar. Only stop treatment if directed by your doctor.

Also, it may take several weeks before your symptoms improve due to the long half-life of Vraylar. Keep using this medicine as directed. Tell your doctor if your symptoms do not improve.

Seroquel is available in a cost-saving generic known as quetiapine or the extended-release quetiapine ER (Seroquel XR).

Seroquel has been approved since 1997, which may be an advantage. Your doctor may be more familiar with its uses, dosing and side effects. Vraylar was first approved in 2015.

Which is more expensive - Vraylar or Seroquel?

Vraylar and Seroquel differ in price. Seroquel is available as a generic and may help to save you money. Vraylar is only available as the brand name drug and can be very expensive.

  • In general, the price for 60 tablets (usually a 30-day supply) of generic Seroquel (known as quetiapine) 50 mg tablets will cost you about $60 using an online coupon. The same amount of brand name Seroquel costs about $400.
  • Vraylar is not yet available in a generic and cost about $1,350 for a 30-day supply of the 3 mg oral capsule.
  • These prices can vary based on your location, pharmacy, insurance or discount coupons.

If you prefer generics, be sure to tell your doctor or pharmacist before you receive your prescription.

Your insurance may help you pay for these medications, or may have a preferred atypical antipsychotic medicine that might also save you money. If needed, you can call your insurance to discuss which antipsychotic medications are covered under your plan.

This is not all the information you need to know about Vraylar (cariprazine) or Seroquel (quetiapine) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.

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