Vraylar vs. Seroquel: Differences, similarities & side effects

In this article:

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

In this article

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

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.