Cariprazine Side Effects

Medically reviewed by Philip Thornton, DipPharm. Last updated on Oct 8, 2024.

Applies to cariprazine: oral capsule.

Important warnings This medicine can cause some serious health issues

Oral route (capsule)

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.

Cariprazine is not approved for the treatment of patients with dementia-related psychosis. Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies.

Closely monitor all antidepressant-treated patients for clinical worsening, and for the emergence of suicidal thoughts and behaviors.

The safety and effectiveness of cariprazine have not been established in pediatric patients.

Serious side effects of cariprazine

Along with its needed effects, cariprazine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking cariprazine:

More common side effects

• blurred vision
• chills
• dizziness
• drooling
• fever
• headache
• inability to move the eyes
• inability to sit still
• increased blinking or spasms of the eyelid
• loss of balance control
• muscle trembling, jerking, or stiffness
• need to keep moving
• nervousness
• pounding in the ears
• restlessness
• shuffling walk
• slow or fast heartbeat
• sticking out of the tongue
• stiffness of the limbs
• trouble with breathing, speaking, or swallowing
• twisting movements of the body
• uncontrolled movements, especially of the face, neck, arms, or legs
• unusual facial expressions

Less common side effects

• bladder pain
• bloody or cloudy urine
• confusion
• decreased urine output
• difficult, burning, or painful urination
• dizziness
• fast, pounding, or irregular heartbeat or pulse
• frequent urge to urinate
• increased thirst
• loss of consciousness
• lower back or side pain
• muscle aches, pain, or cramps
• nausea
• seizures
• sore throat
• stuffy or runny nose
• swelling of the face, ankles, or hands
• thoughts or attempts at killing oneself
• unusual tiredness or weakness
• vomiting

Rare side effects

• burning feeling in the chest or stomach
• dark urine
• difficulty in speaking
• double vision
• general tiredness and weakness
• inability to move the arms, legs, or facial muscles
• inability to speak
• indigestion
• light-colored stools
• muscle spasms or stiffness
• slow speech
• stomach upset
• tenderness in the stomach area
• upper right abdominal or stomach pain
• yellow eyes and skin

Incidence not known

• blistering, peeling, or loosening of the skin
• confusion
• cough
• diarrhea
• drooling
• high fever
• increased sweating
• itching
• joint pain
• lip smacking or puckering
• muscle trembling, jerking, or stiffness
• puffing of the cheeks
• rapid or worm-like movements of the tongue
• red skin lesions, often with a purple center
• red, irritated eyes
• severe muscle stiffness
• sores, ulcers, or white spots in the mouth or on the lips
• uncontrolled chewing movements
• unusually pale skin

Other side effects of cariprazine

Some side effects of cariprazine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common side effects

• decreased appetite
• difficulty having a bowel movement
• sleepiness or unusual drowsiness
• stomach pain
• trouble sleeping

Less common side effects

• anxiety
• back pain
• belching
• difficulty with moving
• dry mouth
• heartburn
• indigestion
• irritability
• pain in the arms or legs
• rash
• shaking
• weight gain

For healthcare professionals

Applies to cariprazine: oral capsule.

General adverse events

The most frequently reported adverse effects were extrapyramidal symptoms, akathisia, nausea, vomiting, somnolence, and restlessness.^[Ref]

Nervous system

• Very common (10% or more): Extrapyramidal symptoms (up to 45%), parkinsonism (up to 26%), akathisia (up to 21%), headache (up to 18%), somnolence (up to 10%)
• Common (1% to 10%): Dizziness, dystonia, other abnormal movement disorders, other extrapyramidal diseases, sedation
• Uncommon (0.1% to 1%): Dysesthesia, dyskinesia, lethargy, tardive dyskinesia, vertigo
• Rare (less than 0.1%): Amnesia, aphasia, convulsion, ischemic stroke, seizures
• Frequency not reported: Akinesia, balance disorder, bradykinesia, cerebrovascular adverse reactions, choreoathetosis, circadian rhythm sleep disorder, cognitive impairment, cogwheel rigidity, drooling, dysarthria, extrapyramidal disorder, gait deviation, gait disturbance, glabellar reflex abnormal, grimacing, hypersomnia, hypokinesia, hyporeflexia, masked facies, motor impairment, movement disorder, neuroleptic malignant syndrome, oromandibular dystonia, psychomotor hyperactivity, restless legs syndrome, stroke, syncope, tension headache, tremor^[Ref]

During 6-week schizophrenia placebo-controlled trials, 17% of patients reported extrapyramidal symptoms, excluding akathisia and restlessness in the treatment group. This led to study discontinuation in 0.3% of patients. Akathisia occurred in 11% of patients, leading to study discontinuation of 0.5%.

In 3-week bipolar mania placebo-controlled trials, 28% of patients given this drug experienced extrapyramidal symptoms, excluding akathisia and restlessness. This led to study discontinuation in 1% of patients. Akathisia occurred in 20% of patients, leading to study discontinuation of 2%.^[Ref]

Gastrointestinal

• Very common (10% or more): Nausea (up to 13%), constipation (up to 11%), vomiting (up to 10%)
• Common (1% to 10%): Abdominal pain, diarrhea, dry mouth, dyspepsia, toothache
• Uncommon (0.1% to 1%): Gastritis, gastroesophageal reflux disease
• Rare (0.01% to 0.1%): Dysphagia
• Frequency not reported: Abdominal discomfort, abdominal pain lower, abdominal pain upper, abdominal tenderness, frequent bowel movements, gastrointestinal pain, lip swelling, salivary hypersecretion, swallowing difficulty, tongue movement disturbance, tongue protrusion, tongue swelling^[Ref]

Metabolic

• Very common (10% or more): Weight gain (up to 17%)
• Common (1% to 10%): Decreased appetite, dyslipidemia, hyperglycemia, increased appetite
• Uncommon (0.1% to 1%): Blood glucose abnormal, blood sodium abnormal, diabetes mellitus, hyponatremia, thirst
• Frequency not reported: Metabolic changes^[Ref]

Hyperglycemia/Diabetes Mellitus: In long-term, open label studies in patients with schizophrenia or bipolar disorder, 4% of patients with normal baseline hemoglobin A1c developed elevated levels (HbA1c 6.5% or higher). In short-term trials, the number of patients with shifts from normal fasting glucose (less than 100 mg/dL) to high (greater than 126 mg/dL) and borderline (100 to less than 126 mg/dL) levels were similar to placebo-treated patients.

Dyslipidemia: In the 3-week placebo controlled bipolar mania and 6-week placebo controlled schizophrenia trials, the shifts in fasting total cholesterol, LDL, HDL, and triglycerides were similar in treatment and placebo groups.

Weight gain: In the 6-week placebo controlled trial of patients with schizophrenia, a 7% weight increase or greater was observed in 8% of the patients receiving 1.5 mg to 3 mg of drug daily (n=512), 8% of patients receiving 4.5 mg to 6 mg daily (n=570), and 17% in the 9 mg to 12 mg once daily group (n=203). During a long term, uncontrolled trial in patients with schizophrenia, the mean change from baseline weight at 48 weeks was 2.5 kg.^[Ref]

Psychiatric

• Very common (10% or more): Insomnia (up to 13%)
• Common (1% to 10%): Agitation, anxiety, restlessness, sleep disorders
• Uncommon (0.1% to 1%): Delirium, depression, libido decreased/increased, suicidal behavior, suicidal ideation, suicide attempts
• Rare (less than 0.1%): Completed suicide
• Frequency not reported: Abnormal dreams, bradyphrenia, bruxism, dyssomnia, increased mortality in elderly patients with dementia-related psychosis, initial insomnia, middle insomnia, neonatal drug withdrawal syndrome, nightmare, somnambulism, terminal insomnia^[Ref]

Musculoskeletal

• Common (1% to 10%): Arthralgia, back pain, blood creatine phosphokinase increased, musculoskeletal stiffness, pain in extremities
• Rare (less than 0.1%): Rhabdomyolysis
• Frequency not reported: Joint stiffness, muscle rigidity, muscle tightness, neck muscle spasm, nuchal rigidity, torticollis, trismus^[Ref]

Cardiovascular

• Common (1% to 10%): Hypertension, tachyarrhythmia, tachycardia
• Uncommon (0.1% to 1%): Bradyarrhythmia, cardiac conduction disorders, electrocardiogram QT prolonged, electrocardiogram T wave abnormal, hypotension
• Frequency not reported: Blood pressure diastolic increased, blood pressure increased, blood pressure systolic increased, deep vein thrombosis, heart rate increased, orthostatic hypotension, sinus tachycardia, venous thromboembolism^[Ref]

In 3 placebo-controlled trials, during a three-week period of treating bipolar mania (n=1065), there was no clinically significant difference between this drug and placebo-treated patients regarding changes from baseline to endpoint supine blood pressure parameters. There was, however, an increase in supine diastolic blood pressure in patients given 9 to 12 mg orally once a day.^[Ref]

Respiratory

• Common (1% to 10%): Cough, nasopharyngitis, oropharyngeal pain
• Uncommon (0.1% to 1%): Hiccups
• Frequency not reported: Difficulty breathing, pharyngeal edema, pulmonary embolism, throat tightness^[Ref]

Other

• Common (1% to 10%): Fatigue, pyrexia
• Frequency not reported: Asthenia, body temperature dysregulation, body temperature increased, falls, late-occurring adverse reactions^[Ref]

Ocular

• Common (1% to 10%): Blurred vision
• Uncommon (0.1% to 1%): Accommodation disorder, cataracts, eye irritation, intraocular pressure increased, visual acuity reduced
• Rare (0.01% to 0.1%): Photophobia
• Frequency not reported: Blepharospasm, oculogyric crisis^[Ref]

In long term uncontrolled schizophrenia (48-week) and bipolar mania (16-week) trials, cataracts occurred in 0.1% and 0.2% of participants respectively.^[Ref]

Genitourinary

• Common (1% to 10%): Urinary tract infection
• Uncommon (0.1% to 1%): Dysuria, erectile dysfunction, pollakiuria^[Ref]

Dermatologic

• Common (1% to 10%): Rash
• Uncommon (0.1% to 1%): Hyperhidrosis, pruritus
• Frequency not reported: Face edema, face swelling, urticaria
• Postmarketing reports: Stevens-Johnson syndrome^[Ref]

Hepatic

• Common (1% to 10%): Increase in hepatic enzymes
• Uncommon (0.1% to 1%): Blood bilirubin increased
• Rare (less than 0.1%): Hepatitis
• Frequency not reported: ALT increased, AST increased, toxic hepatitis, transaminases increased^[Ref]

Transaminase elevations 3 times the upper limit of normal or greater occurred in 1% to 2% of patients in the group treated with this drug during 6-week schizophrenia trials; the incidence increased with dose. Elevations occurred in 2% to 4% of patients during 3-week bipolar mania trials.^[Ref]

Hematologic

• Uncommon (0.1% to 1%): Anemia, eosinophilia
• Rare (0.01% to 0.1%): Neutropenia
• Frequency not reported: Agranulocytosis, leukopenia^[Ref]

Endocrine

• Uncommon (0.1% to 1%): Blood thyroid stimulating hormone decreased
• Rare (0.01% to 0.1%): Hypothyroidism^[Ref]

Hypersensitivity

• Rare (0.01% to 0.1%): Hypersensitivity
• Frequency not reported: Angioedema, hypersensitivity reaction^[Ref]

Frequently asked questions

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Further information

Cariprazine side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer