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Two medicine capsules with "vs." between them: Vraylar vs. lithium
Drug vs. Drug

Vraylar vs. lithium: Differences, similarities & side effects

Both drugs treat some of the same symptoms but are very different
Karen Berger medical writer and reviewer headshot
By | Oct. 8, 2024

Key takeaways

  • Vraylar is an atypical antipsychotic used for conditions like bipolar disorder and schizophrenia, while lithium is an antimanic agent used primarily for bipolar disorder.

  • Vraylar can cause side effects such as movement issues, sleep disturbances, and weight gain. Lithium may cause restlessness, weight changes, and potential toxicity.

  • Both medications are generally covered by insurance, but out-of-pocket costs for lithium are typically lower than for Vraylar.

  • Discuss potential drug interactions with your healthcare provider to ensure safe use of these medications.

In this article:

Vraylar and lithium are prescription medications used to treat acute manic or mixed episodes associated with bipolar I disorder. Vraylar is classified in a group of medicines called atypical antipsychotics, while lithium is classified as an antimanic agent. Although these medications are used to bipolar 1 symptoms, they have other uses as well and have many differences, which we will explain below. 

Vraylar vs. lithium: Key differences

Vraylar is a brand-name second-generation antipsychotic with the active ingredient cariprazine. It is available in oral capsule form and is FDA approved for use in adults only. It works by regulating levels of dopamine and serotonin, which are neurotransmitters (chemical messengers) in the brain.

Lithium, a mood stabilizer, comes in both brand-name (Lithobid) and generic forms. It is available as oral tablets (including extended-release), capsules, and a liquid solution. Lithium can be used in adults and pediatric patients. It works in the brain by affecting how sodium moves in and out of nerve and muscle cells. This helps to balance the chemicals in the brain that control mood.

Compare Vraylar vs. lithium key differences
Vraylar Lithium
Drug class Second-generation antipsychotic; atypical antipsychotic Antimanic agent (mood stabilizer)
Brand/generic status Brand Brand and generic
What is the generic or brand name? The active ingredient is cariprazine, but there is no generic available. Lithium is a generic drug and is most commonly dispensed in pharmacies as generic. However, Lithobid is a brand-name formulation. 
What form(s) does the drug come in? Oral capsules Oral tablets 

Oral extended-release tablets

Oral capsules

Oral solution (liquid)
What is the standard dosage? Varies by indication; generally, the dose ranges from 1.5 to 6 mg by mouth once daily Varies by indication and formulation
How long is the typical treatment? Varies by indication; short-term or long-term Long-term
Who typically uses the medication? Adults  Adults and pediatric patients 7 years and older

 

Vraylar vs. lithium: Conditions treated

Vraylar and lithium both treat acute manic or mixed episodes associated with bipolar I disorder. 

Additional FDA-approved uses for Vraylar are schizophrenia and bipolar depression. It can also be combined with antidepressants for treating depression. 

Lithium is used for the maintenance treatment of bipolar I disorder and is sometimes prescribed off-label (for a non-FDA-approved use) for bipolar depression and as an add-on to antidepressants to treat depression. 

Compare Vraylar vs. lithium conditions treated
Condition Vraylar Lithium
Schizophrenia Yes  No 
Bipolar mania / acute treatment of manic episodes or mixed episodes associated with bipolar I disorder Yes  Yes 
Maintenance treatment of bipolar I disorder No  Yes 
Depressive episodes / depressive symptoms associated with bipolar I disorder (bipolar depression) Yes  Off-label 
Add-on (adjunctive) medication to antidepressants to treat depression (major depressive disorder) Yes  Off-label 

 

Vraylar vs. lithium: Insurance coverage and cost comparison

Most commercial health insurance plans and Medicare prescription plans cover Vraylar and lithium. Out-of-pocket costs vary depending on your insurance plan. Generic lithium is considerably less expensive than brand-name Lithobid, which may not be covered at all. For the most recent information on pricing estimates, contact your health insurance provider.

If you are paying out of pocket, a one-month supply of Vraylar costs approximately $2,000 for 30, 1.5 mg capsules, which is a one-month supply. However, you can use a free coupon from SingleCare to reduce the monthly cost to $1,298.

The out-of-pocket price for a one-month supply of lithium is about $28 for 90, 300 mg capsules, but using a free SingleCare coupon can lower the price to around $3.

Compare Vraylar vs. lithium cost & coverage
Vraylar Lithium
Typically covered by insurance? Yes  Yes 
Typically covered by Medicare Part D? Yes  Yes 
Quantity 30, 1.5 mg capsules 90, 300 mg capsules
SingleCare cost* $1,298 $3
*Drug prices fluctuate and vary by pharmacy. This is the cost as of the time of publication.

Vraylar vs. lithium side effects

Common Vraylar side effects include:

  • Movement issues known as extrapyramidal symptoms (EPS)
  • Feeling tired or sleepy
  • Trouble sleeping
  • Increased appetite 
  • Nausea and vomiting
  • Indigestion 
  • Constipation 
  • Dizziness 

Common side effects of lithium include:

  • Restlessness 
  • Unsteady hand movements
  • Thirst
  • Feeling less hungry
  • Stomach problems, including stomach pain, gas, indigestion, constipation
  • Depression 
  • Weight changes (weight gain or weight loss)
  • Dry mouth; or excess saliva in the mouth
  • Taste changes
  • Swollen lips
  • Acne 
  • Hair loss
  • Sensitivity to cold
  • Joint or muscle pain
  • Pale skin
  • Rash, itching
  • Weak and brittle nails or hair

Additionally, lithium toxicity can occur if the medicine is taken in excessive amounts or if serum levels become too high. Early signs of toxicity include diarrhea, vomiting, drowsiness, and muscle weakness. More severe symptoms, such as giddiness, coordination issues, blurred vision, and tinnitus (ringing in the ears), may develop as lithium levels rise. Extremely high levels can affect multiple organs and systems. Regular monitoring is important to manage and reduce these risks. Persistent or severe symptoms may require discontinuation of the medication. 

In rare instances, an allergic reaction could occur. If you experience symptoms such as hives, difficulty breathing, or swelling of the face, lips, tongue, or throat, seek emergency medical attention right away.

The above lists do not include all possible adverse effects. For more information and a full list of side effects, consult your pharmacist or prescribing healthcare provider.

Vraylar and lithium drug interactions

Before taking Vraylar or lithium, tell your healthcare provider about all the medications you are taking, including prescription drugs, over-the-counter medications, vitamins, and supplements. The table below provides a general overview of some interactions with each drug, but it is not a complete list. Consult your healthcare provider for more information and medical advice on drug interactions and how they may affect you.

Drugs that interact with Vraylar Drugs that interact with lithium

Vraylar and lithium drug warnings

Before taking Vraylar or lithium, tell your healthcare provider about any medical conditions you have, including if you are pregnant, planning to become pregnant, or breastfeeding. More important information about both drugs follows below.

Vraylar warnings

Vraylar has a black box warning, also called a boxed warning, stating that:

  • Older adults with dementia-related psychosis who take Vraylar or similar antipsychotic medications have a higher risk of death and should not use these drugs.
  • Antidepressants, including those taken with Vraylar, can increase the risk of suicidal thoughts and behaviors, especially in children and young adults. Patients of any age taking Vraylar should be closely monitored for changes in mood, behavior, or suicidal thoughts.

Vraylar is also associated with:

  • Neuroleptic Malignant Syndrome (NMS): This rare but serious condition can be life-threatening. Symptoms include stiff muscles, high fever, delirium, and kidney failure. Seek emergency medical attention if these symptoms occur.
  • Tardive dyskinesia: This is a type of extrapyramidal symptom (EPS) that causes involuntary movements like grimacing, blinking, and lip-smacking. To reduce the risk, healthcare providers prescribe the lowest effective dose and monitor for movement disorders.
  • Metabolic changes: Vraylar can cause weight gain, high blood sugar or diabetes, and high cholesterol. Regular monitoring is essential.
  • Blood cell counts: People taking Vraylar will have their blood cell counts monitored regularly.
  • Orthostatic hypotension and fainting: Vraylar can cause a drop in blood pressure when standing, leading to dizziness and fainting. People taking Vraylar should be sure to rise from sitting to standing slowly. They should also have their heart rate and blood pressure monitored, especially if they have heart disease or other conditions.
  • Increased risk of falls and fractures: Due to potential drowsiness, sedation, and incoordination, people taking Vraylar are at higher risk for falls and fractures. Avoid alcohol, and do not drive or operate machinery until you know how Vraylar affects you.
  • Heat sensitivity: Vraylar may increase sensitivity to hot temperatures. Stay hydrated and avoid overheating, especially during exercise or in hot weather.

Lithium warnings 

Lithium has a boxed warning due to the risk of lithium toxicity, which is closely related to serum lithium levels and can occur even at doses close to therapeutic levels. Signs of lithium toxicity include diarrhea, vomiting, tremor, lack of coordination, drowsiness, and muscle weakness. If any of these symptoms occur, stop taking lithium right away and call your healthcare provider.

Lithium is also associated with:

  • Brugada Syndrome: Lithium may trigger a heart condition called Brugada Syndrome, which can cause sudden death. People with Brugada Syndrome should not take lithium. If you have a family history of sudden death or fainting, consult a cardiologist before starting lithium.
  • Mental and physical impairment: Lithium can make you feel drowsy or uncoordinated. Do not drive or operate machinery until you know how the medicine affects you.
  • Pregnancy: Lithium can harm an unborn baby, especially in the first trimester. If you are pregnant or planning to become pregnant, consult your healthcare provider.
  • Kidney health: Long-term lithium use can affect the kidneys. Regular monitoring of kidney health is important during treatment. If you experience changes in urination or kidney function, contact your healthcare provider.

What is the difference between first-generation and second-generation antipsychotics?

Antipsychotic medications are commonly prescribed for conditions related to psychosis, such as schizophrenia, bipolar disorder, and delirium. There are two main types of antipsychotic drugs.

First-generation antipsychotics (typical antipsychotics), such as Haldol (haloperidol), were the earliest antipsychotic drugs developed. They are less commonly used today because of their more bothersome side effects compared to newer medications.

Second-generation antipsychotics, or atypical antipsychotics, are newer medications that are now more commonly prescribed for psychosis. They tend to have fewer side effects than first-generation antipsychotics. Besides Vraylar, examples of second-generation antipsychotics include:

What are extrapyramidal side effects?

Some antipsychotic medications are linked to side effects known as extrapyramidal symptoms (EPS). These movement disorders can manifest in various forms:

  • Dystonia: Involuntary muscle contractions causing abnormal postures and repetitive movements, affecting areas like the back, neck, jaw, eyes, and tongue
  • Akathisia: A persistent feeling of restlessness and an uncontrollable urge to move, leading to constant fidgeting or shifting weight
  • Parkinsonism: Symptoms similar to Parkinson’s disease, including tremors, muscle stiffness, a slow, shuffling walk, balance problems, and difficulty standing up
  • Tardive dyskinesia: Involuntary movements primarily affecting the face and tongue, such as grimacing, lip smacking, and excessive blinking

Can you take Vraylar and lithium together?

Vraylar and lithium can be taken together to manage symptoms of bipolar disorder if approved by your healthcare provider. Vraylar can help with mood stabilization and psychosis, while lithium helps with mood stabilization and preventing future episodes. Consult your healthcare provider for more information and medical advice.

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