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A capusule and a round tablet with "vs." between them: Vraylar vs. Seroquel: Differences, similarities & side effects
Drug vs. Drug

Vraylar vs. Seroquel: Differences, similarities & side effects

We cover the similarities and differences between these two atypical antipsychotics
Karen Berger medical writer and reviewer headshot
By | Sep. 5, 2024

Key takeaways

  • Vraylar and Seroquel are both second-generation antipsychotics.

  • Vraylar is available as a brand-name capsule, while Seroquel comes in brand-name and generic immediate-release and extended-release tablets.

  • Vraylar is FDA approved for adults only, whereas Seroquel can also be used in adolescent populations for certain conditions.

  • Both medications have potential side effects, drug interactions, and serious warnings to consider. Consulting a healthcare provider is crucial for personalized guidance on treatment options.

In this article:

Vraylar (cariprazine) and Seroquel (quetiapine) are brand-name antipsychotics used in the treatment of schizophrenia and bipolar depression. Antipsychotic medicines treat psychosis-related conditions, which involve a disconnection from reality and can occur with mental health conditions such as schizophrenia and bipolar disorder. There are two main types of antipsychotics, first-generation antipsychotics and second-generation antipsychotics. 

  • First-generation antipsychotics, or typical antipsychotics, were the first types of antipsychotics developed. These drugs, such as Haldol (haloperidol), are no longer commonly used to treat psychosis because of their side effects. 
  • Second-generation antipsychotics, also referred to as atypical antipsychotics, are now the preferred drugs to treat psychosis because they have fewer side effects than first-generation antipsychotics. 

Because they are both second-generation antipsychotics, Vraylar and Seroquel work in a similar way—by regulating levels of neurotransmitters (chemical messengers), called dopamine and serotonin, in the brain. Vraylar and Seroquel have some similarities but some differences as well. Read on to learn more about Vraylar and Seroquel.

Vraylar vs. Seroquel: Key differences

Vraylar and Seroquel are both second-generation antipsychotics, or atypical antipsychotics. Vraylar is available as a brand-name drug only. Seroquel is available in both brand name and generic form. Seroquel is also available as an extended-release formulation as brand-name Seroquel XR and generic quetiapine fumarate Er. Vraylar is approved by the Food and Drug Administration (FDA) for use in adults only. Seroquel can be used in adults as well as adolescents, depending on the use. 

Compare Vraylar vs. Seroquel key differences
Vraylar Seroquel
Drug class Second-generation antipsychotic; atypical antipsychotic Second-generation antipsychotic; atypical antipsychotic
Brand/generic status Brand Brand and generic
What is the generic name? The active ingredient is cariprazine, but there is no generic available Quetiapine 
What form(s) does the drug come in? Oral capsules: 1.5 mg, 3 mg, 4.5 mg, and 6 mg Seroquel (oral tablets): 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, and 400 mg

Seroquel XR (oral extended-release tablets): 50 mg, 150 mg, 200 mg, 300 mg, and 400 mg (the XR tablets should be swallowed whole and should not be split, chewed, or crushed)
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 Varies by indication and formulation
How long is the typical treatment? Long-term Long-term
Who typically uses the medication? Adults  Adults 

Adolescents (for certain uses)

 

Vraylar vs. Seroquel: Conditions treated

Vraylar and Seroquel can be used to treat schizophrenia as well as bipolar disorder. Refer to the following chart for detailed information on each medication. 

Compare Vraylar vs. Seroquel conditions treated
Condition Vraylar Seroquel
Schizophrenia Yes (adults) Yes (adults and adolescents 13 years and older); both Seroquel and Seroquel XR
Acute treatment of manic episodes or mixed episodes associated with bipolar I disorder Yes (adults) Seroquel: Yes (manic episodes), when used either alone or in combination with a mood stabilizer such as lithium or divalproex (adults and adolescents 10 years and older)

Seroquel XR: Yes (manic or mixed), when used either alone or in combination with a mood stabilizer such as lithium or divalproex (adults and adolescents 10 years and older)
Bipolar depression Yes, for depressive episodes associated with bipolar I disorder (adults) Yes, (both Seroquel and Seroquel XR) for depressive episodes associated with bipolar I or II disorder (adults)
Add-on medication to antidepressants such as fluoxetine to treat depression Yes (adults) No 
Maintenance treatment of bipolar I disorder, in combination with lithium or divalproex No  Yes (adults); both Seroquel and Seroquel XR

 

Is Seroquel better than Vraylar?

There are no clinical trials directly comparing Vraylar and Seroquel. A meta-analysis (review of many studies) published in The Lancet, reviewed 32 antipsychotic medications for treating schizophrenia, although not all medications studied are available in the United States. Key findings related to quetiapine included its significant efficacy in improving social functioning. However, quetiapine was also noted for causing QT prolongation (a heart rhythm condition) and anticholinergic side effects such as constipation, dry mouth, and cognitive impairment. The study did not specifically compare Vraylar with other antipsychotics.

Consult your healthcare provider for medical advice on the best treatment for your medical condition. Only your healthcare provider can determine the best treatment based on multiple factors that include your medical condition(s), medical and family history, and other unique considerations.

Vraylar vs. Seroquel: Insurance coverage and cost comparison

Most commercial insurance plans and Medicare prescription plans cover Vraylar and generic Seroquel. Out-of-pocket costs vary by plan design. Since Seroquel is available as generic quetiapine, insurance plans generally charge less for quetiapine. The brand-name drug may cost more—or may not be covered at all. Contact your insurance plan for the most recent pricing estimates on Vraylar or Seroquel.

For those paying without insurance, out of pocket, a one-month supply of Vraylar costs approximately $1,996. You can use a free SingleCare coupon to pay $1,298, saving about $700 per month. 

The out-of-pocket cost of a one-month supply of brand-name Seroquel is about $253. However, using a free SingleCare coupon and choosing generic quetiapine can decrease the price to as low as $9 per month.

 

Compare Vraylar vs. Seroquel cost & coverage
Vraylar Seroquel
Typically covered by insurance? Yes  Yes (generic)
Typically covered by Medicare Part D? Yes  Yes (generic)
Quantity 30, 1.5 mg capsules 30, 100 mg tablets
SingleCare cost $1,298 $9

 

Vraylar vs. Seroquel side effects

Some of the most common side effects of Vraylar include headache, insomnia, and movement problems called extrapyramidal symptoms (EPS).

Common side effects of Seroquel in adults include sleepiness, dizziness, dry mouth, constipation, weakness, stomach pain, and indigestion. Adolescents tend to experience sleepiness, dizziness, dry mouth, increased appetite, nausea, vomiting, fast heartbeat, and weight gain.

In rare cases, allergic reactions to any drug may occur. Patients with symptoms of hives, difficulty breathing, or swelling of the face, lips, tongue, or throat should get emergency medical help right away. 

Antipsychotic drugs have many potential side effects and can vary in severity. The table below provides some general information about the side effects of Vraylar and Seroquel. Where the frequency is a range, side effects vary by factors such as age, dose, indication for use, and whether the drug is used alone or in combination with other medication. This is not a full list of adverse effects, and others may occur. Consult your healthcare provider or pharmacist for more information and a full list of side effects of Vraylar and Seroquel.

Compare Vraylar vs. Seroquel side effects
Vraylar Seroquel
Side effect Applicable? Frequency Applicable? Frequency
Headache  Yes  9%–18% Yes  17%–21%
Insomnia Yes  11%–13% Yes  % not reported
EPS Yes  15%–20% Yes  Varies; up to about 13%
Dry mouth  Yes  1%–3% Yes  Varies; up to about 44%
Increased appetite  Yes  3%–5% Yes  5%
Nausea  Yes  5%–8% Yes  5%–10%
Vomiting  Yes  4%–5% Yes  5%–8%
Drowsiness  Yes  5%–10% Yes  Varies; up to about 57%
Dizziness  Yes  3%–5% Yes  9%–18%
Constipation  Yes  6%–10% Yes  4%–10%
Source: Vraylar (DailyMed), Seroquel (DailyMed)

Vraylar and Seroquel drug interactions

Before taking Vraylar or Seroquel, tell your healthcare provider about all the medications you take, including prescription drugs, over-the-counter medications, vitamins, and dietary supplements. Some combinations of medicines should be avoided, while others may require close monitoring or a dosage change. Avoid alcohol while taking Vraylar or Seroquel. Consult your healthcare provider about drug interactions and how they affect you. 

Compare Vraylar vs. Seroquel drug interactions
Drug Drug class Interacts with Vraylar? Interacts with Seroquel?
Clarithromycin 

Ketoconazole

Ritonavir

Voriconazole 

 Strong CYP3A4 inhibitors Yes  Yes 
Diltiazem 

Erythromycin 

Verapamil 

 Moderate CYP3A4 inhibitors  Yes  Yes 
Carbamazepine

Phenytoin 

Rifampin 

St. John’s wort

 Strong CYP3A4 inducers  Yes  Yes 
Bosentan 

Modafinil 

Nafcillin 

 Moderate CYP3A4 inducers Yes  Yes 
Fluvoxamine SSRI antidepressant Yes  Yes 
Benztropine

Diphenhydramine

 Anticholinergic drugs  Yes  Yes 
Atenolol 

Lisinopril 

Valsartan 

 Medications that lower blood pressure  Yes  Yes 
Alcohol

Anxiety medicines

Muscle relaxants

Opioid pain medicines 

Seizure medicines

Sleeping medicines

 Drugs that cause central nervous system (CNS) depression Yes  Yes 
Amiodarone

Procainamide 

Quinidine 

 Drugs that prolong the QT interval  No  Yes 

RELATED: How long does Vraylar stay in your system?

Vraylar and Seroquel drug warnings

Before taking Vraylar or Seroquel, tell your healthcare provider about any medical conditions you have, including if you are pregnant, planning to become pregnant, or breastfeeding.

Both Vraylar and Seroquel have a black box warning, or boxed warning, listed in the prescribing information. A black box warning is the most serious warning required by the FDA. This warning states that older adults with dementia-related psychosis who are taking antipsychotic medicine have a higher risk of death and should not take Vraylar or Seroquel.

Individuals of any age who take Vraylar or Seroquel should be closely monitored for changes in mood and behavior or suicidal thoughts and behaviors since antidepressants can increase the risk of suicidal thoughts and behaviors—especially in children, adolescents, and young adults.

Other warnings for both drugs include:

  • Neuroleptic malignant syndrome (NMS) is a rare, serious condition associated with antipsychotic medications that can cause death and must be treated right away in a hospital. Symptoms of NMS include muscle stiffness, very high fever, delirium, and kidney failure. 
  • People who take Vraylar or Seroquel should be monitored for the development of movement disorders like tardive dyskinesia, which is a type of EPS that causes involuntary and repetitive movements such as grimacing, lip-smacking, and blinking.
  • Metabolic changes, including weight gain, high blood sugar or diabetes, and high cholesterol, can occur among individuals who take Vraylar, requiring monitoring by a healthcare provider. 
  • Vraylar and Seroquel can cause orthostatic hypotension (a drop in blood pressure when standing up from a sitting or lying down position) and fainting. Because Vraylar or Seroquel can cause these effects, as well as significant drowsiness, sedation, and incoordination, people who take these medicines may be at higher risk for falls and fractures. People who take Vraylar or Seroquel should avoid drinking alcohol and should not drive or operate machinery until they know how the medication affects them, as these drugs can cause cognitive and motor impairment.  
  • Vraylar or Seroquel may make you more sensitive to very hot temperatures. Drink plenty of fluids to avoid becoming too hot or dehydrated, especially when exercising and in the heat.

Can you take Vraylar and Seroquel together?

In most cases, Vraylar and Seroquel are not taken together due to the way they work and the potential for increased side effects, such as movement disorders, low blood pressure, fainting, and impairment. Consult your healthcare provider for more information or if you have any questions about your treatment plan.