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Vraylar withdrawal: What to expect when stopping the drug

Learn what to expect when you stop taking Vraylar and how to reduce your risk of withdrawal side effects
Leandra Beabout
By | May 10, 2024 Medically reviewed by Anne Jacobson, MD, MPH
A prescription bottle with an exclamation mark on the label: Vraylar withdrawal: What to expect when stopping the drug

Key takeaways

  • Vraylar is an antipsychotic medication used to treat major depressive disorder (along with an antidepressant), schizophrenia, and bipolar disorder in adults.

  • Withdrawal is not a known issue with Vraylar, but it’s still important to seek medical advice before quitting this medication.

  • Quitting antipsychotics can cause a chemical imbalance in the brain, which can trigger withdrawal-like symptoms such as upset stomach, headache, heart palpitations, and more.

  • The most significant risk associated with quitting Vraylar is a relapse of the condition it’s being used to treat.

In this article:

Vraylar (cariprazine) is a brand-name prescription drug used to treat schizophrenia and bipolar disorder. It is also sometimes used with antidepressants for major depressive disorder. Vraylar is not intended to treat dementia-related psychosis in older adult patients as it may cause an increased risk of death. 

This drug is part of a class of medications called second-generation, or atypical, antipsychotics. Vraylar reduces symptoms of mental health conditions by balancing levels of serotonin and dopamine—the brain chemicals responsible for mood. Although actual drug withdrawal is not a known issue with this medication, abruptly stopping Vraylar may still cause issues, namely a relapse.

“The issue I worry about with my patients the most is that the underlying psychiatric disorder that we were using [antipsychotics] to treat may re-emerge as the medications are tapered or discontinued,” said Howard Weeks, MD, chief medical officer at Pathlight Mood & Anxiety Center in Denver, Colorado.

Causes of Vraylar withdrawal

There are no studies or clinical trials on Vraylar withdrawal. Withdrawal is not known to be an issue with this medication, according to psychiatrist Sid Khurana, MD, the medical director for Nevada Mental Health in Las Vegas, Nevada. However, stopping antipsychotic drugs such as Vraylar may cause a return of symptoms of the treated mental illness. That’s why it’s essential to consult your healthcare provider before stopping antipsychotic drugs.

Although Vraylar withdrawal is not a documented issue, there are reports of withdrawal-like symptoms from quitting other antipsychotics. Research published in 2021 found that while antipsychotic withdrawal is not widely recognized, some patients do experience symptoms after quitting second-generation antipsychotics. However, none of the clinical trials in the report included Vraylar or other brands of cariprazine.

Quitting Vraylar changes brain chemical activity, and despite the fact that withdrawal symptoms haven’t been documented, such chemical changes can trigger unpleasant symptoms or even mental health condition relapse. Dr. Khurana says withdrawal-like symptoms are most likely when:

  • Stopping Vraylar suddenly
  • Stopping Vraylar after being on a high dose for a long time
  • Stopping Vraylar and experiencing a relapse of schizophrenia or bipolar disorder (in this case, rebound symptoms are mistaken for withdrawal symptoms)

It’s important to remember that Vraylar is not known for causing withdrawal. That’s because it remains in the body long after the last dose. 

The half-life of cariprazine, Vraylar’s active ingredient, is one week, which means the drug takes weeks to leave the body entirely. 

Vraylar withdrawal symptoms

“While discontinuation of Vraylar is not associated with withdrawal, it can be associated with relapse of the condition it was being used to treat,” Dr. Khurana emphasized, whether that’s schizophrenia, bipolar disorder, or depression.

Though Vraylar should not cause withdrawal, withdrawal symptoms from quitting other antipsychotics include:

  • Gastrointestinal issues (stomach pain, nausea, vomiting, or diarrhea)
  • Headache 
  • Fast heart rate
  • Dizziness or lightheadedness (orthostatic hypotension)
  • Heavy sweating
  • Dry mouth 
  • Muscle restlessness, aches, and pains
  • Anxiety
  • Difficulty sleeping

People who stop taking Vraylar should watch for a relapse of symptoms and report them to their healthcare provider. 

Individuals with schizophrenia or bipolar disorder should watch for a relapse of psychosis symptoms that include:

  • Hearing voices
  • Seeing objects or people that are not there
  • Believing that something or someone else is controlling your thoughts, feelings, or behaviors
  • Attaching deep significance to passing remarks or trivial objects
  • Believing you have special powers or are on a special mission

Individuals with schizophrenia should also watch for a relapse of schizophrenia symptoms that include:

  • Sudden changes in sleeping habits
  • Sudden changes in appetite
  • Missing therapy or doctor’s appointments
  • Increased agitation, irritability, restlessness, or anxiety
  • Trouble concentrating
  • Apathy, sadness, or hopelessness
  • Social withdrawal 
  • Lapsed hygiene (forgetting to shower, brush teeth, or wear clean clothes)

Individuals with bipolar disorder should watch for a relapse of bipolar disorder symptoms that include:

  • Signs of a bipolar manic episode: Racing thoughts, impulsivity, fast speech, inflated sense of self, and making grandiose plans. 
  • Bipolar depression symptoms: Feeling sad, empty, or worthless; loss of interest in normal daily activities; low energy; restlessness or slowness; trouble focusing and making decisions; and thoughts of suicide.

Sometimes, long-term use of antipsychotic medications can also cause a condition called dopamine supersensitivity psychosis (DSP). A patient may develop DSP even while discontinuing Vraylar since this drug stays in the body for so long. DSP is characterized by psychosis symptoms accompanied by tardive dyskinesia—jerky, uncontrolled body movements, including facial tics.

Finally, serious side effects of Vraylar include suicidal thoughts. There is an even higher risk of this side effect in children and young adults taking Vraylar. This side effect can still occur while the body is clearing the medication. It’s very important to seek medical help if you experience suicidal thoughts after taking Vraylar, even if your last dose was weeks ago.

Vraylar withdrawal timeline

There is no Vraylar withdrawal timeline because Vraylar is not associated with withdrawal, per Dr. Khurana. 

Vraylar’s long half-life means it is slowly eliminated from the body. It takes about eight weeks for the body to clear its last dose of Vraylar. As the weeks progress, the concentration of Vraylar in the bloodstream slowly diminishes. If a patient experiences symptoms from stopping Vraylar, the symptoms should resolve after eight weeks.

Risks and complications of Vraylar withdrawal

The most significant risk of quitting Vraylar is a relapse of the condition(s) it is being used to treat. Discontinuing an antipsychotic like Vraylar can have a substantial impact on daily functioning if it results in a relapse of schizophrenia or bipolar disorder.

“Stay in close contact with your prescriber because after you taper and discontinue these medications, there is the chance that the underlying psychiatric symptoms that the medication was helping to treat may return,” Dr. Weeks emphasized. “This could be within days to months, depending on the severity of the underlying disorder.”

Ultimately, Vraylar should never be discontinued without the guidance of a healthcare professional. Because this antipsychotic drug was prescribed to treat a severe mental health condition, people and their healthcare providers need to be alert to signs of relapse.

How to manage Vraylar withdrawal symptoms

Remember, Vraylar is not usually associated with withdrawal. It may be possible to avoid withdrawal-like symptoms and reduce the risk of rebound psychosis by tapering off this medication gradually. It is crucial to follow the dosage schedule provided by your healthcare provider, even if that means taking weeks or months to discontinue this medication fully.

While there are no natural remedies that fully take the place of antipsychotic medications, there are a few lifestyle changes that, along with medication, may improve symptoms of schizophrenia and bipolar disorder while withdrawing from Vraylar:

  • Take omega-3 fatty acids. Supplements are not a substitute for medications, but omega-3 fatty acids (found in fish oil) may boost mental and emotional stability. Research has shown that people with bipolar disorder who take omega-3 supplements tend to experience fewer manic episodes.
  • Prioritize sleep. Lack of sleep can cause manic or depressive episodes in people with bipolar disorder. Cultivating healthy bedtime habits can help people feel more grounded and well while quitting Vraylar.
  • Schedule regular movement. Research shows that regular body movement can improve mental processes in people with schizophrenia. Exercise is also recommended while taking Vraylar since weight gain due to increased appetite is one of the most common Vraylar side effects.

Ultimately, the most important advice for managing Vraylar discontinuation is to stay in close contact with your healthcare team. 

Bottom line: The importance of safe Vraylar withdrawal 

While Vraylar is not known for causing drug withdrawal, discontinuing this medication can cause adverse reactions, including mental illness relapse. 

It is essential to seek medical advice from a healthcare professional before stopping Vraylar. This is especially important for people who want to stop taking it right away. Only a healthcare provider who understands a person’s complete medical history and medications can offer guidance on the best drug and dosage for schizophrenia, bipolar disorder, or major depressive disorder. 

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