Vraylar vs. Rexulti: Differences, similarities & side effects

In this article:

• Vraylar vs. Rexulti: Key differences
• Vraylar vs. Rexulti: Conditions treated
• Rexulti vs. Vraylar: Which is better?
• Can you take Vraylar and Rexulti together?
• Vraylar vs. Rexulti: Insurance coverage and cost comparison
• Vraylar vs. Rexulti side effects
• Vraylar and Rexulti drug interactions
• Vraylar and Rexulti drug warnings

In this article

• Vraylar vs. Rexulti: Key differences
• Vraylar vs. Rexulti: Conditions treated
• Rexulti vs. Vraylar: Which is better?
• Can you take Vraylar and Rexulti together?
• Vraylar vs. Rexulti: Insurance coverage and cost comparison
• Vraylar vs. Rexulti side effects
• Vraylar and Rexulti drug interactions
• Vraylar and Rexulti drug warnings

Antipsychotic medications are used to treat conditions related to psychosis, which is a group of symptoms that involve a disconnection from reality. They’re used to treat bipolar disorder, schizophrenia, delirium, and other mental health conditions. There are two main types of antipsychotics: first-generation antipsychotics and second-generation antipsychotics: 

• First-generation antipsychotics are also referred to as typical antipsychotics. These were the first antipsychotic medicines developed. First-generation antipsychotics, which include Haldol (haloperidol), fluphenazine, and others, are not commonly used because of their side effects. 
• Second-generation antipsychotics, or atypical antipsychotics, include drugs such as Abilify (aripiprazole), Geodon (ziprasidone), Latuda (lurasidone), Risperdal (risperidone), Seroquel (quetiapine), and Zyprexa (olanzapine). Because they have less severe side effects, second-generation antipsychotics are preferred over first-generation antipsychotics. 

Vraylar (cariprazine) and Rexulti (brexpiprazole) are brand-name second-generation antipsychotics that treat schizophrenia and other conditions. 

Vraylar and Rexulti are members of the same drug class, so they work the same way—by blocking certain serotonin and dopamine receptors and activating other receptors. Although Vraylar and Rexulti are both second-generation antipsychotics, they are not exactly the same. These two medications have some similarities and some differences as well. Continue reading to learn more about Vraylar and Rexulti.

Vraylar vs. Rexulti: Key differences

Vraylar and Rexulti are both classified as second-generation antipsychotics. Both are currently available as brand-name drugs and do not have generic versions available at this time. (Some generic versions of Rexulti have received tentative approval from the Food and Drug Administration (FDA) but are not yet available in pharmacies.)

While Vraylar is FDA approved for use in adults only, Rexulti can be used in adults and adolescents 13 years and older for schizophrenia. For other indications, it’s only approved for adults. Both drugs can be taken with or without food.

Vraylar vs. Rexulti: Comparing key differences
	Vraylar	Rexulti
Drug class	Second-generation antipsychotic; atypical antipsychotic	Second-generation antipsychotic; atypical antipsychotic
Brand/generic status	Brand	Brand
What is the generic name?	The active ingredient is cariprazine, but there is no generic available	The active ingredient is brexpiprazole, but there is no generic available
What form(s) does the drug come in?	Oral capsules: 1.5 mg, 3 mg, 4.5 mg, and 6 mg	Oral tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, and 4 mg
What is the standard dosage?	Varies by indication; generally, the dose ranges from 1.5 to 3 mg or 6 mg by mouth once daily, with or without food	Varies by indication; generally, the dose ranges from 0.5 to 4 mg by mouth once daily, with or without food
How long is the typical treatment?	Long-term	Long-term
Who typically uses the medication?	Adults	Adults and pediatric patients 13 years and older for schizophrenia Adults for other approved uses

Vraylar vs. Rexulti: Conditions treated

Vraylar and Rexulti are both used for the treatment of schizophrenia, but Vraylar is used in adults only for this indication, while Rexulti can be used in adults and adolescents 13 years and older. Both drugs are FDA approved for use in adults as an add-on medication to antidepressants for the treatment of major depressive disorder—this is called adjunctive treatment. 

Vraylar is also approved to treat bipolar depression as well as manic or mixed episodes associated with bipolar I disorder. Rexulti is FDA approved to treat agitation associated with dementia due to Alzheimer’s disease.

Vraylar vs. Rexulti: Comparing conditions treated
Condition	Vraylar	Rexulti
Schizophrenia	Yes (adults)	Yes (adults and pediatric patients 13 years and older)
Add-on medication to antidepressants to treat major depressive disorder (MDD or depression)	Yes (adults)	Yes (adults)
Acute treatment of manic or mixed episodes associated with bipolar I disorder (bipolar mania)	Yes (adults)	No
Depressive episodes associated with bipolar I disorder (bipolar depression)	Yes (adults)	No
Treatment of agitation associated with dementia due to Alzheimer’s disease	No	Yes

Rexulti vs. Vraylar: Which is better?

A meta-analysis (review of many clinical trials) compared Vraylar, Rexulti, and another atypical antipsychotic, lurasidone, for the treatment of schizophrenia. The researchers concluded that all three medications were similar in both safety and efficacy (although Latuda was more effective when taken at the maximum dose).

Another study compared Vraylar, Rexulti, and Abilify (aripiprazole). The researchers found that all three drugs were similar in effectiveness but that the way they worked varied slightly, which could play a role in the side effect profile for each drug. The researchers also noted that despite differences in FDA-approved uses, all of these medications could help symptoms of agitation, anxiety, aggression, insomnia, fatigue, and attention—regardless of the medical condition being treated. The study authors recommend any of these medications as a first-choice drug when used for an FDA-approved indication. However, they also noted that if side effects persist, one of the other three can be prescribed, as rates of side effects differ slightly among the three medications.

Only a healthcare provider can determine the best treatment option for your condition, considering individual factors such as symptoms, medical conditions, medical and family history, potential side effects, and drug interactions. 

Can you take Vraylar and Rexulti together?

Some healthcare professionals may prescribe more than one antipsychotic medication to be used at the same time. However, there is limited evidence that this is safe and effective. Also, prescribing two or more antipsychotic medicines can increase the risk of certain complications, like medication errors or drug interactions. Prescribing two or more antipsychotic medications is generally avoided, except in certain instances. 

Vraylar vs. Rexulti: Insurance coverage and cost comparison

The majority of health insurance plans and Medicare prescription plans offer some type of coverage for Vraylar and Rexulti. However, copays will vary based on individual plans. You can reach out to your insurance plan provider to ask about coverage for these medications.

For those who do not have insurance, the out-of-pocket cost for a one-month supply of Vraylar is approximately $1,916. However, using a free SingleCare card can lower the price to about $1,328 per month. 

For uninsured patients, the out-of-pocket cost for a one-month supply of Rexulti is about $1,939. You can use a free SingleCare card to pay as low as $1,371 per month.

Vraylar vs. Rexulti: Comparing insurance & cost
	Vraylar	Rexulti
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	Yes	Yes
Quantity	30, 1.5 mg capsules	30, 1 mg tablets
SingleCare cost*	$1,328	$1,371

*Cost at the time of publication. Drug prices vary by pharmacy.

Vraylar vs. Rexulti side effects

Extrapyramidal symptoms (EPS) are a group of movement disorders often caused by antipsychotic medications. There are various types of movement problems along the spectrum of EPS, including:

• Dystonia: Involuntary muscle contractions that result in abnormal posture and repetitive movements. It can affect the back, stomach, pelvis, neck, jaw, eyes, face, and tongue.
• Akathisia: Feeling restless and having an urge to move. People with akathisia may cross their legs repetitively or shift back and forth from one foot to the other.
• Parkinsonism: Symptoms may include tremors, rigidity, a slow and shuffling gait, stooped posture, imbalance, and difficulty standing up. 
• Tardive dyskinesia: Involuntary movements affecting the face and tongue, such as grimacing, lip smacking, and blinking.

Common side effects of Vraylar are headache, insomnia (trouble sleeping), and EPS. Because Vraylar has a long half-life (the amount of time it takes for half of a dose of medication to leave the body), some adverse effects may take longer to appear.

Common Rexulti side effects include fatigue, weight gain, headache, and movement disorders.

Serious side effects may also occur with either drug. Individuals who have symptoms of an allergic reaction, such as hives, trouble breathing, or swelling, should get emergency medical help. 

The table below displays information about the common side effects of Vraylar and Rexulti. The frequency is a range, which can vary by dose. This is not a full list of side effects, and others may occur. You can ask your pharmacist or healthcare provider for more information about the side effects of Vraylar and Rexulti.

Vraylar vs. Rexulti: Comparing side effects
	Vraylar		Rexulti
Side effect	Applicable?	Frequency	Applicable?	Frequency
Headache	Yes	9%–18%	Yes	4%–9%
Insomnia	Yes	11%–13%	Yes	2%–5%
EPS/all types of movement disorders	Yes	15%–20%	Yes	6% (excluding akathisia); 4%–7% akathisia
Nausea	Yes	5%–8%	Yes	% not reported
Vomiting	Yes	4%–5%	No	n/a
Drowsiness	Yes	5%–10%	Yes	4%–6%
Weight gain	Yes	2–3%	Yes	6%–8%
Fatigue	Yes	1%–3%	Yes	2%–5%
Dizziness	Yes	3%–5%	Yes	1%–5%
Constipation	Yes	6%–10%	Yes	1%–3%
Anxiety	Yes	3%–6%	Yes	2%–4%

Source: Vraylar (DailyMed), Rexulti (DailyMed)

Vraylar and Rexulti drug interactions

Before you take Vraylar or Rexulti, tell your healthcare professional about all the medications you take. This includes prescription and over-the-counter medicines, vitamins, and dietary supplements. Certain medications can affect how Vraylar or Rexulti are processed in the body, and Vraylar or Rexulti can affect other medications. Certain drugs should be avoided, while others may need an adjustment in dosage. Consult your healthcare provider about drug interactions and how they may affect you. 

Vraylar vs. Rexulti: Comparing drug interactions
Drug	Drug Class	Vraylar	Rexulti
Clarithromycin  Ketoconazole Ritonavir Voriconazole	Strong CYP3A4 inhibitors	Yes	Yes
Diltiazem  Erythromycin  Fluconazole  Verapamil	Moderate CYP3A4 inhibitors	Yes	Yes
Carbamazepine Phenytoin  Rifampin  St. John’s wort	Strong CYP3A4 inducers	Yes	Yes
Bosentan  Efavirenz  Modafinil  Nafcillin	Moderate CYP3A4 inducers	Yes	Yes
Bupropion  Fluoxetine Paroxetine	Strong CYP2D6 inhibitors	Yes	Yes

Vraylar and Rexulti drug warnings

Before you start to take Vraylar or Rexulti, let your healthcare provider know about any medical conditions you have, including if you are pregnant, planning to become pregnant, or breastfeeding.

Both Vraylar and Rexulti have a black box warning. Also called a boxed warning, it is the most serious warning required by the FDA. This warning states that:

• Older adult patients who have dementia-related psychosis and take antipsychotic medication are at an increased risk of death. Therefore, they should not take Vraylar or Rexulti.
• Antidepressant medicines may increase the risk of suicidal thoughts and behaviors, generally in children and young adults. Therefore, patients of any age who take Vraylar or Rexulti should be carefully monitored for mood and behavior changes or suicidal thoughts and behaviors.

Other warnings for Vraylar and Rexulti include an increased risk of:

• Neuroleptic malignant syndrome (NMS), which can be fatal – Signs and symptoms may include rigid muscles, high fever, delirium, and kidney failure. If any of these occur, seek emergency medical attention.
• Tardive dyskinesia – Healthcare professionals prescribe the lowest possible effective dose of antipsychotic medication to mitigate risk. People who take Vraylar or Rexulti will be monitored for movement disorders.
• Metabolic changes, such as high blood sugar and diabetes, high cholesterol, or weight gain – Patients will be monitored for these changes.
• Orthostatic hypotension, which is a drop in blood pressure when standing up and can also cause fainting – Heart rate and blood pressure will be monitored.
• Falls and fractures due to side effects such as drowsiness and incoordination – When taking Vraylar or Rexulti, avoid alcohol, and do not drive or operate machinery until you know how the medication affects you.  
• Heat sensitivity – Avoid becoming too hot or dehydrated—drink plenty of fluids, especially when exercising and spending time outside in hot weather.
• Seizures – Especially in patients with a history of seizures or with conditions that lower the seizure threshold. 

Rexulti has an additional warning that is not associated with Vraylar. Some patients who have taken Rexulti have reported experiencing intense urges to gamble. Other urges have been reported but with less frequency, such as urges to have sex, shop, and eat or binge eat. Report any new or intense urges to your healthcare provider, who will give you medical advice on whether you need a lower dose or a different medication.