How long does Vraylar take to kick in?

In this article:

• What to expect when taking Vraylar
• What to avoid while taking Vraylar
• When to see a doctor when taking Vraylar
• Vraylar vs. alternatives

In this article

• What to expect when taking Vraylar
• What to avoid while taking Vraylar
• When to see a doctor when taking Vraylar
• Vraylar vs. alternatives

Vraylar (cariprazine) is a brand-name prescription drug that is approved by the Food and Drug Administration (FDA) to treat schizophrenia and bipolar disorder (characterized by manic and depressive episodes). It is also sometimes prescribed along with antidepressants to treat major depressive disorder (MDD). Vraylar helps improve symptoms of mental health conditions by balancing levels of serotonin and dopamine, two neurotransmitters (chemical messengers) that significantly impact mood.

Anyone taking this atypical antipsychotic for the first time might wonder: How long does Vraylar take to kick in? Experts say it can take four to six weeks to experience the full benefits of Vraylar. However, clinical trial participants experienced symptom improvement in as little as one week.

What to expect when taking Vraylar

Antipsychotic drugs do not provide immediate relief like over-the-counter painkillers. It takes time for antipsychotic medication to impact neurotransmitter activity. Similar to other antipsychotics, Vraylar’s positive effects (as well as side effects) develop over the course of a few weeks.

It’s very important to stay in touch with a healthcare professional during the first few weeks of taking Vraylar. A healthcare provider can adjust dosage as needed, although it will take several weeks to determine if this is the best medication for a patient.

First day

Because Vraylar is not a fast-acting medication, people are highly unlikely to experience symptom improvement within the first 24 hours. 

Taking Vraylar may cause drowsiness, so anyone starting this drug for the first time should avoid driving or operating heavy machinery until they know how their body responds.

“They should notice [sleepiness] within the first few doses,” says Blair Gingerich, Pharm.D., a clinical care and retail pharmacist in northern Indiana. “People should avoid driving until the medication no longer makes them tired.”

Any severe side effects that develop within hours of dosing may indicate an allergic reaction to Vraylar. Drug-induced allergic reactions can quickly turn into a medical emergency. 

Seek emergency medical attention if a person develops anaphylaxis symptoms such as:

• Facial or throat swelling
• Wheezing or trouble breathing
• Hives
• Feeling lightheaded
• Vomiting
• Shock or loss of consciousness

First week

Although Vraylar won’t reach its full effectiveness for a few weeks, patients may notice improvement in symptoms of mania, psychosis, and depression within the first week of treatment, says Sid Khurana, MD, a board-certified psychiatrist and medical director of outpatient services at Nevada Mental Health in Las Vegas. 

Side effects may also begin to develop within the first week or two of taking Vraylar. Dr. Khurana says initial side effects may include:

• Restlessness
• Stiffness
• Tremors
• Nausea
• Tiredness
• Occasional vomiting 

First month

Symptoms of schizophrenia, bipolar disorder, or depression should gradually improve over the first month on Vraylar. “Some of the side effects that appear in the first week might get better by now, or some of them might get worse as the levels of the medicine in the body increase over time,” Dr. Khurana explains.

The most common side effects of Vraylar are:

• Trouble sleeping
• Extrapyramidal symptoms (e.g., tremors, shaking, involuntary movements, drooling)
• An uncontrollable urge to move (akathisia)
• Nausea and vomiting
• Constipation
• Fatigue
• Muscle stiffness
• Restlessness
• Dizziness
• Indigestion
• Blurred vision
• Increased blood pressure
• Back pain
• Weight gain
• Increased heart rate 
• Dry mouth

Even common side effects can be very unpleasant. Discuss severe or worsening side effects with your healthcare provider. They may be able to adjust the dose of Vraylar or suggest supplementary medications to help manage side effects.

After the first month

It can take up to six weeks to experience the full benefits of Vraylar—or even up to three months. If symptoms of schizophrenia, bipolar disorder, or depression have not improved after six weeks on Vraylar, a dose adjustment may be necessary. 

“Long-term side effects include weight gain, and also an increase in lipids and blood glucose,” Dr. Khurana says. Late-onset side effects are also possible, especially if the dosing of Vraylar is increased. If side effects worsen or serious side effects occur, it’s important to contact a healthcare provider about adjusting dosing or discontinuing the use of Vraylar.

What to avoid while taking Vraylar

There are several restrictions associated with Vraylar. This drug has a boxed warning, also called a black-box warning (the most serious warning required by the FDA), due to the increased risk of suicidal thoughts, especially in young adults. People of any age who take Vraylar should be closely monitored for changes in mood or behavior, or suicidal thoughts. 

There are also restrictions certain people should be aware of, including the following: 

• Vraylar is not appropriate for older adults with dementia-related psychosis because of an increased risk of death. 
• Vraylar is not approved for use in people younger than 18 years old. Further testing is necessary to determine whether Vraylar is safe for children. 
• There is not enough research to know whether Vraylar is safe to take while pregnant. Taking Vraylar in the third trimester of pregnancy may cause a baby to experience abnormal muscle movements and drug withdrawal after birth.
• There is also a lack of research indicating whether Vraylar is safe for a breastfeeding mother. However, there is a risk of cariprazine (the active ingredient in Vraylar) affecting milk supply. 

Anyone taking Vraylar for the first time should also be aware of potential drug and supplement interactions. CYP3A4 inhibitors and inducers can change how the body processes cariprazine, the active ingredient in Vraylor. 

When a person is taking a CYP3A4 inhibitor, a healthcare provider must prescribe a reduced dose of Vraylar. Some CYP3A4 inhibitors include:

• Certain antibiotics, such as clarithromycin and erythromycin
• Certain antifungals such as itraconazole and ketoconazole
• Antivirals, such as ritonavir
• Certain calcium channel blockers such as verapamil and diltiazem 
• Goldenseal (a medicinal herb)
• Grapefruit and grapefruit juice

People taking a CYP3A4 inducer should not take Vraylar at all. CYP3A4 inducers include:

• Certain anticonvulsants such as carbamazepine, phenobarbital, and phenytoin
• The antibiotic rifampin
• The supplement St. John’s wort

When to see a doctor when taking Vraylar

Some examples of serious Vraylar side effects that warrant immediate medical attention include, but are not limited to:

• Sudden numbness or weakness
• Slurred speech
• Blurry vision
• Seizures
• Feeling lightheaded
• Agitation 
• Uncontrollable movements like lip-smacking or blinking
• Trouble swallowing
• Signs of infection like fever and chills
• Severe stiffness 

High blood sugar (hyperglycemia) is a rare but possible serious side effect of Vraylar, according to Dr. Khurana. Serious symptoms of high blood sugar such as vomiting, confusion, or loss of consciousness require emergency medical care. Another serious reason to seek emergency medical care is symptoms of neuroleptic malignant syndrome (NMS), such as high fever, muscle rigidity, and unstable vitals, according to Dr. Khurana.

Vraylar vs. alternatives

Most antipsychotics reach full effectiveness in about the same amount of time—four to six weeks, according to Dr. Gingerich. She says dose adjustments or changes in medications are usually reserved for after that time period.

Although it takes Vraylar the same amount of time to kick in as similar drugs, this drug stands out from its alternatives in a few ways, according to Dr. Khurana. He says that, as a second-generation (atypical) antipsychotic, Vraylar is less likely to cause drug-induced movement disorders than first-generation antipsychotics (such as haloperidol). Vraylar is also more likely to help with schizophrenia-related flat affect (a lack of emotional expression) and decreased motivation than typical first-generation (typical) antipsychotics. 

Ultimately, a healthcare provider who is familiar with your health history and symptoms will be able to determine whether Vraylar or a Vraylar alternative is best for you.

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