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Vraylar (Cariprazine) & Weight Gain vs. Loss: What You Should Know

Vraylar (Cariprazine), also sold under the name Reagila [in European countries], is an atypical antipsychotic developed by the pharmaceutical company Allergan.  In 2015, Vraylar received FDA approval for the treatment of schizophrenia and mania associated with bipolar disorder.  From a pharmacodynamic perspective, Vraylar functions predominantly as a partial agonist at D3 and D2 dopamine receptors, with notable selectivity for the former.

In addition to its dopaminergic action, Vraylar acts as a partial agonist at 5-HT1A receptors; antagonist at 5-HT2A and 5-HT2B receptors; and a weak antagonist at 5-HT2C, 5-HT7, and H1 receptors.  As a result of its pharmacological action, many Vraylar users find that the medication effectively manages severe neuropsychiatric symptoms.  Nevertheless, some users wonder whether Vraylar causes weight gain, weight loss, or has no effect on body weight (i.e. is weight neutral).

Vraylar & Weight Gain (Possible Causes)

If you end up gaining weight while using Vraylar, included below is a list of potential causes.  Realize that the exact causes of weight gain among the subset of Vraylar users who gain weight – might be subject to individual variation.  In other words, certain Vraylar users might gain weight primarily because Vraylar increases their appetite, whereas others might gain weight due to sedation and corresponding lower physical activity.  Others may gain weight while using Vraylar for multiple reasons (e.g. appetite increase, sedation, hormone change) – with varying degrees of impact.

  • Appetite increase: It is understood that many individuals using antipsychotics experience increased appetite as a side effect. Research suggests that increased appetite attributable to atypical antipsychotic medications likely stems from interactions with histamine receptors.  Antipsychotic interactions with histamine receptors can yield downstream upregulation of an enzyme known as “AMPK” in the hypothalamus.  Upregulation of AMPK in the hypothalamus causes increased hunger – and lack of satiety even after eating.  Because Vraylar exhibits minimal action as an H1 receptor antagonist, it’s possible that this could cause appetite increase.  Anyone with increased appetite while using Vraylar may consume more calories than usual, ultimately explaining weight gain.  (Appetite increases might also be due to remission of negative symptoms e.g. anhedonia or depressive symptoms associated with schizophrenia).
  • Bloating: Vraylar may cause some individuals to experience gastrointestinal distress that leads to bloating throughout treatment. Increased water retention associated with bloating may account for a modest amount of weight gain that you observe while using Vraylar.  Excessive intake of dietary sodium may increase likelihood of bloating during treatment (due to the fact that sodium increases water retention).  Furthermore, changes in concentrations of gut bacteria throughout treatment might also contribute to bloating and bloating-related weight gain.  That said, weight gained through bloating is not “fat” gain – it’s merely just a bit of extra water weight.
  • Blood sugar increase: It is known that atypical antipsychotic medications may cause hyperglycemia (high blood sugar) and insulin resistance. Though there’s not significant evidence to suggest that blood sugar fluctuations are common among Vraylar users, it’s possible that blood sugar changes might occur in a subset of individuals throughout treatment.  Substantial and/or detrimental changes to insulin sensitivity and/or blood glucose concentrations might cause you to feel hungrier than usual while using Vraylar, possibly playing a role in weight gain.
  • Constipation: Research suggests that constipation is a relatively common Vraylar side effect, occurring in approximately 8% of all users. In the event that Vraylar is causing constipation, it’s possible that constipation is culpable for some of the weight gain that you experience.  While constipated, most individuals will be heavier than usual due to ongoing or excessive retention of digested food and/or fluids.  Realize that while weight gain from constipation may be unwanted, it’s usually reversible with proper treatment of the constipation.
  • Fat storage increase: It’s possible that Vraylar might interact with hormones, gut bacteria, metabolism, peripheral neurotransmitters, and genes – in ways that increase body fat storage throughout treatment for a subset of users. If you seem to be gaining excessive body fat and losing muscle, this could be a sign that Vraylar is directly altering homeostatic body composition.  Assuming Vraylar is causing increased fat storage, this would explain some degree of weight gain throughout treatment – and changes in body composition.
  • Food cravings: In addition to increased appetite while using Vraylar, you may find yourself craving hyperpalatable, non-nutritious, calorically-dense foods. Some individuals might find that they experience cravings for specific types of foods such as: carbohydrates, sugary foods, or fatty foods – during treatment.  Although self-discipline may help prevent you from acting upon these food cravings (e.g. eating calorically-dense “junk” foods), self-discipline may not be enough to resist the cravings.  If you’re unable to resist the food cravings that you experience on Vraylar, this could result in extra weight gain via increased caloric intake.
  • Gut bacteria: Antipsychotic medications like Vraylar may modulate concentrations of gut bacteria. Modulation of gut bacteria may directly or indirectly affect one’s appetite, metabolism, hormone levels, and gastrointestinal function.  Assuming Vraylar-mediated gut bacteria changes cause increased appetite, reduced satiety, and constipation – this may account for some degree of weight gain among users.  That said, it’s currently unclear as to whether Vraylar (cariprazine) substantially affects the gut.
  • Hormone changes: Production of various hormones throughout the body might become altered as a result of treatment with an atypical antipsychotic like Vraylar. Other atypical antipsychotics are thought to substantially increase levels of the hormone prolactin via dopamine modulation.  If Vraylar increased prolactin secretion in a subset of users via its dopaminergic effects, this prolactin increase could account for weight gain.  Moreover, it’s possible that Vraylar could affect production of various sex hormones such as testosterone and estrogen whereby metabolism is slowed and weight is gained.
  • Lethargy: Research suggests that around 8% of individuals using Vraylar will experience somnolence (i.e. sleepiness) as a side effect. Those who experience somnolence as a side effect may become increasingly sedentary due to constantly feeling drowsy, lethargic, or fatigued while using Vraylar.  A sedentary lifestyle and/or decreased physical activity stemming from Vraylar-induced lethargy might account for some degree of weight gain during treatment.  Less activity means fewer calories burned and a slower metabolism.
  • Social eating: Untreated neuropsychiatric symptoms associated with schizophrenia, bipolar disorder, or major depressive disorder – can often lead to social isolation. If Vraylar is effective in managing neuropsychiatric symptoms, it may lead or enable the individual being treated to become more social.  Because “going out to eat” is a popular social activity, it’s possible that a person who responds well to Vraylar may end up dining out more than usual.  Dining out frequently with friends and/or family after getting symptoms under control may account for some weight gain during treatment – as portion sizes and caloric loads tend to be more substantial at restaurants.
  • Slower metabolism: It’s possible that Vraylar may decrease resting metabolic rate (RMR) in numerous ways. Vraylar-mediated changes in gut bacteria, hormones, body composition, and activity level (due to sedation) could yield a slower metabolism – compared to pre-treatment.  Decreased resting metabolic rate means that the body burns fewer calories at rest than it normally does.  Burning fewer calories at rest makes it much easier to gain weight.
  • Taste improvement: Individuals with severe negative symptoms [of schizophrenia] or depression prior to using Vraylar might exhibit blunted taste as a result of the untreated neuropsychiatric condition. In other words, certain neurochemical imbalances implicated in anhedonia and/or depression might cause foods to be perceived as having limited or no pleasurable taste.  Because Vraylar may reverse neurochemical imbalances and AMPK signaling in the hypothalamus, foods may taste better than usual in treatment.  If taste improves throughout treatment, this could lead some individuals to consume more calories than usual, leading to weight gain.

Note: There may be other ways and/or mechanisms by which Vraylar could cause weight gain.  If you know of additional explanations for Vraylar-mediated weight gain, mention them in the comments.

Vraylar (Cariprazine) & Weight Loss (Possible Causes)

While most individuals won’t end up losing weight while using Vraylar, one study documented that ~11% of Vraylar users lost a clinically significant amount of weight (i.e. body weight decreased by at least 7% from baseline).  This suggests that some individuals may end up losing weight on Vraylar.

Though weight loss may be more likely among persons who transition to Vraylar from an antipsychotic associated with significant weight gain (e.g. Zyprexa), there are other reasons as to why someone might lose weight from Vraylar treatment.  Below is a list of potential reasons as to why weight loss might occur among a subset of Vraylar users.  Keep in mind that the particular reasons one Vraylar user loses weight may differ from those of another.

  • Appetite reduction: It’s possible that you might experience appetite reduction or a lower appetite than usual while using Vraylar. If you transition to Vraylar from another antipsychotic associated with appetite increase, you may find that your appetite is much lower on Vraylar by comparison – ultimately leading to lower caloric intake and weight loss.  Furthermore, some individuals experience increased appetite as a result of untreated neuropsychiatric conditions (e.g. depression).  Assuming Vraylar is effective in treating neuropsychiatric conditions, appetite could end up decreasing – which may lead to weight loss.  Moreover, appetite reduction might occur due to relatively common Vraylar side effects including: constipation, indigestion, nausea, and/or vomiting.
  • Dehydration: Some weight loss that’s observed while using Vraylar could be attributable to dehydration or lower water retention throughout treatment. Dehydration and diminished water retention throughout the body might occur in a subset of Vraylar users due to treatment-related side effects such as diarrhea and/or vomiting.  If you’re one of the 5-6% of users who experiences diarrhea or vomiting throughout treatment, and you aren’t replenishing lost water stores (i.e. re-hydrating), this could explain some of your weight loss.
  • Diarrhea: Diarrhea, or the rapid progression of bowels through the digestive tract, can sometimes occur while using Vraylar. Data indicate that approximately 5-6% of Vraylar users experience diarrhea as a side effect.  In the event that you experience diarrhea, your body may have a difficult time absorbing calories from food and storing them as fat.  Moreover, as was mentioned, diarrhea can dehydrate the body, causing loss of water weight.  If you fail to get the side effect of diarrhea under control, this could certainly explain some weight loss.
  • Healthy food choices: It is understood that many individuals with untreated neuropsychiatric conditions like schizophrenia, bipolar disorder, and major depressive disorder consume high calorie diets devoid of adequate nutritional value. Individuals with untreated neuropsychiatric conditions may lack motivation and/or self-esteem to take good care of themselves by adhering to a nutrient-dense diet without excessive calories.  If Vraylar proves efficacious in managing symptoms, this could increase motivation and/or self-esteem such that an individual might focus on making healthier food choices and limiting excessive calories – possibly resulting in weight loss.
  • Increased metabolism: There are a host of ways in which someone’s metabolism might increase while using Vraylar. Anyone who was using an atypical antipsychotic associated with significant slowing of metabolism might transition to Vraylar and experience a faster metabolism – making weight loss relatively effortless.  Metabolism might also increase while using Vraylar due to increased physical activity via exercise and/or non-exercise activity related thermogenesis.  In the event that your metabolism increases from Vraylar, you’ll be burning more calories at rest which could yield weight loss.
  • Increased motivation: Many individuals with schizophrenia experience debilitating negative symptoms such as anhedonia, avolition, and apathy. If Vraylar effectively manages these negative symptoms, it could increase motivation and energy levels in the person undergoing treatment.  Increased motivation or energy might lead the individual to exercise more frequently or engage in more physical activity than pre-treatment.  Increased physical activity will result in greater energy expenditure and a faster metabolism – possibly contributing to weight loss.
  • Nausea: An estimated 8% of individuals using Vraylar will experience nausea as a side effect. If you constantly feel nauseous or on the verge of vomiting, you may have a difficult time maintaining an appetite or eating as many calories as you did prior to treatment.  Assuming the nausea is severe enough to decrease your daily caloric intake, you’ll end up losing some weight.
  • Restlessness: One of the most common side effects of Vraylar is akathisia or inner restlessness characterized by the inability to remain still. Assuming a person becomes extremely restless while using Vraylar from the side effect of akathisia, this might cause significant increases in energy expenditure via non-exercise activity thermogenesis (NEAT).  In other words, because Vraylar is causing restlessness, the extra calories burned as a result of ongoing restlessness yields weight loss.
  • Self-regulation: Many individuals with untreated neuropsychiatric conditions like schizophrenia experience debilitating cognitive symptoms (i.e. cognitive dysfunction). Cognitive dysfunction as a result of an untreated neuropsychiatric condition might make it difficult to employ self-discipline (i.e. self-regulation) around unhealthy foods.  As a result, cognitive dysfunction could lead to overeating and weight gain.  In the event that Vraylar attenuates cognitive deficits or improves cognitive abilities, it may become easier to remain disciplined around unhealthy foods whereby they are consumed less frequently, ultimately leading to weight loss.
  • Taste impairment: It is understood that antipsychotics may alter taste perception or cause taste disturbances in a subset of individuals. Though there’s no substantial evidence to suggest that Vraylar causes taste disturbances, it’s possible that taste abnormalities might occur as an adverse reaction in a subset of users.  If your taste perception is blunted while using Vraylar such that food tastes bland or less flavorful, there’s a chance that this could cause you to eat fewer calories and ultimately lose a bit of weight.
  • Vomiting: Data indicate that approximately 6% of Vraylar users experience vomiting as an adverse reaction. If you end up vomiting, there’s a chance that the vomiting might cause some weight loss.  Vomiting not only dehydrates the body (such that water weight is lost), but it also interferes with the absorption and storage of calories and can suppress appetite.  If you vomit frequently throughout treatment, you may lose weight until it is properly managed.

Note: There may be other ways and/or mechanisms by which Vraylar might induce weight loss.  If you can think of additional explanations for Vraylar-mediated weight loss, mention them in the comments.

Vraylar & Body Weight Change (Research)

Included below are scientific reports in which the effect of Vraylar (Cariprazine) on body weight was discussed.  A majority of available evidence indicates that Vraylar is unlikely to cause significant weight gain or weight loss for most users.  While some individuals may gain a small (i.e. modest) amount of weight during treatment, odds of gaining a substantial amount of weight as a result of using Vraylar are considered minimal.

2017: Safety and tolerability of cariprazine in patients with acute exacerbation of schizophrenia: a pooled analysis of four phase II/III randomized, double-blind, placebo-controlled studies.

Earley, Durgam, Lu, et al. analyzed 4 double-blinded, placebo-controlled trials in which the efficacy of cariprazine was investigated for the treatment of schizophrenia.  Researchers reflected upon the pharmacodynamic profile of cariprazine (as a D3 and D2 partial agonist) and conducted a post-hoc safety/tolerability analysis to determine whether it caused weight gain among recipients.

In the trials assessed by researchers, all recipients had received more than 1 dose of cariprazine and daily dosages falling within one of several ranges: 1.5-3 mg; 4.5-6 mg; and 9-12 mg.  It was concluded that cariprazine was well-tolerated among recipients.  Common side effects of cariprazine based on the 4 trials included: akathisia, extrapyramidal symptoms, and diastolic blood pressure change.

There were no apparent differences in metabolic measures between the cariprazine recipients and placebo recipients.  It was reported that cariprazine caused small increases in average body weight by approximately 1 to 2 kg – compared to the placebo.  This suggests that Vraylar could cause weight gain between 2.2 lbs. and 4.4 lbs. – not an amount most would consider to be significant, but weight gain nonetheless.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/28692485

2017: The safety and tolerability of cariprazine in long-term treatment of schizophrenia: a post hoc pooled analysis.

Nasrallah, Earley, Cutler, et al. evaluated the long-term safety and tolerability of cariprazine in the treatment of schizophrenia.  To determine the long-term effects of cariprazine, researchers compiled data from two open-label, flexible-dose extension studies in which cariprazine was administered for 48 weeks within one of the following daily dosage ranges: 1.5-3 mg; 4.5-6 mg; and 9 mg.

Thereafter, researchers conducted a post-hoc safety analysis with data from patients that had received at least 1 dose of cariprazine during the open-label phase.  Data revealed that 679 patients participated in these trials and 40.1% completely finished the trials.  Adverse effects that caused cariprazine discontinuation included: akathisia, exacerbation of schizophrenia, and/or psychosis.

The most common side effects of cariprazine in these trials (occurring in over 10% of users) included: akathisia, insomnia, headache and weight gain.  Clinically significant weight gain (defined as at least 7% body weight increase from baseline), occurred in 27% of cariprazine recipients, whereas clinically significant weigh loss (defined as at least 7% body weight decrease from baseline) occurred in 11% of cariprazine recipients.

Average weight change was 1.58 kg – or ~3.48 lbs.  This research suggests that long-term cariprazine treatment (at dosages between 1.5 and 6 mg per day) can cause body weight change in a subset of recipients.  Nevertheless, the significance of body weight change that’s attributable to long-term cariprazine use appears minimal.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/28836957

2017: Brexpiprazole and cariprazine: distinguishing two new atypical antipsychotics from the original dopamine stabilizer aripiprazole.

Frankel and Schwartz published a paper in which cariprazine (i.e. Vraylar), brexpiprazole (i.e. Rexulti), and aripiprazole (i.e. Abilify) were compared.  Authors noted that cariprazine and brexpiprazole function as partial agonists of D2 dopamine receptors – analogous to aripiprazole.  Nevertheless, authors also stated that the three medications differ in specific affinities for D2 receptors and serotonin receptors.

While reflecting upon cariprazine, authors noted that most common side effects include: extrapyramidal symptoms (~21%); Parkinsonism (~18%); and akathisia (~14%).  Other common side effects of cariprazine were: insomnia (~8%), constipation (~8%), sleepiness (~7%), indigestion (~6%); and vomiting (~6%).  When compared to brexpiprazole and aripiprazole, cariprazine appears most likely to cause extrapyramidal symptoms.

That said, cariprazine appeared least likely to cause weight gain; tachycardia; dry mouth; and vomiting – when compared with brexpiprazole and aripiprazole.  Although cariprazine may cause weight change, the likelihood of significant weight gain among cariprazine users appears lower than other popular atypical antipsychotics.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/28101322

2016: Cariprazine for the Treatment of Schizophrenia: A Review of this Dopamine D3-Preferring D3/D2 Receptor Partial Agonist.

Citrome reported upon the use of cariprazine as a treatment for schizophrenia.  In this report, Citrome discussed: the mechanism of action associated with cariprazine; the therapeutic dosage range; cariprazine pharmacokinetics; efficacy of the medication in clinical trials; and the most common side effects associated with cariprazine use.

Most common side effects associated with cariprazine use were determined based upon data from three 6-week randomized controlled trials in which cariprazine was compared to a placebo for the treatment of schizophrenia, as well as one 26-72 week randomized withdrawal study.  Data indicated that the most common side effects of cariprazine (occurring in at least 5% of users and at twice the rate of placebo recipients) included: extrapyramidal symptoms and akathisia.

Short-term clinically relevant weight gain (defined as at least 7% body weight increase from baseline) was observed in ~8% of cariprazine recipients at dosages between 1.5 mg and 6 mg per day.  This research suggests that significant weight gain can occur in a small percentage of cariprazine users over the short-term.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/27440212

2013: A new generation of antipsychotics: pharmacology and clinical utility of cariprazine in schizophrenia.

Caccia, Invernizzi, Nobili, and Pasina reported upon the pharmacodynamics, pharmacokinetics, therapeutic potential, and side effects of cariprazine.  Researchers noted that cariprazine appears effective when administered at dosages of 1.5 mg to 12 mg per day with its most common side effects being: akathisia and extrapyramidal symptoms.  That said, at the time of this report, short-term controlled trial data indicated that cariprazine did not cause weight gain, metabolic changes, prolactin level fluctuations, or QT prolongation.

  • Source: https://www.ncbi.nlm.nih.gov/pubmed/23966785

Based on the research, how much weight change will most Vraylar users likely experience?

A modest or negligible amount.  Available data from short-term and long-term trials in which Vraylar was evaluated for the treatment of schizophrenia suggest that weight change is unlikely to occur in most Vraylar users (~62% to ~92%).  Nevertheless, data indicate that up to ~27% of Vraylar users might experience clinically significant weight gain and up to ~11% of Vraylar users might experience clinically significant weight loss.

  • Weight gain: Research by Citrome (2016) reported that ~8% of Vraylar users experience clinically significant weight gain in short-term (6-week) trials when administered at dosages of 1.5 mg to 6 mg per day. Earley, Durgam, Lu, et al. (2017) reported that Vraylar causes weight gain between 2.2 lbs. to 4.4 lbs. when administered at dosages of 1.5 mg to 12 mg per day. Nasrallah, Earley, Cutler, et al. (2017) reported that Vraylar can cause clinically significant weight gain of ~3.48 lbs. (1.58 kg) in up to ~27% of recipients when administered at dosages of 1.5 mg to 9 mg per day.
  • Weight neutral: Early research by Caccia, Invernizzi, Nobili, and Pasina (2013) reported zero significant weight change among recipients of Vraylar at dosages between 1.5 mg and 12 mg per day. Subsequent research by Frankel and Schwartz (2017) suggested that Vraylar is less likely to cause significant weight gain when compared to Rexulti and Abilify.
  • Weight loss: Nasrallah, Earley, Cutler, et al. (2017) documented that up to ~11% of Vraylar recipients can experience weight loss – when administered at dosages of 1.5 mg to 9 mg per day. The average amount of weight loss occurring as a result of Vraylar was ~3.48 lbs. (1.58 kg).

In summary, Vraylar can cause clinically relevant weight gain in 8% to 27% of users over the short-term and long-term.  Weight gain tends to be modest, ranging from ~2.2 lbs. to ~4.4 lbs. (1 kg to 2 kg), and occurs within the dosage ranges of 1.5 mg/day to 12 mg/day.  That said, Vraylar can cause clinically relevant weight loss in 11% of users over the short-term and long-term.

Reflecting upon the data, it seems as though less than 38% of all Vraylar users are likely to experience significant body weight change throughout treatment.  Or, from another perspective, Vraylar is weight neutral in 62% of users such that body weight doesn’t significantly change throughout treatment (by at least 7% from baseline).  Overall, compared to most antipsychotic medications, Vraylar is relatively “weight neutral.”

Why doesn’t Vraylar cause as much weight gain as other antipsychotics?

Some speculate that Vraylar is less likely to cause weight gain due to its limited action at histamine receptors and its effectiveness in attenuating negative symptoms of schizophrenia.  Less prominent action at histamine receptors (as an antagonist) minimizes sedation and lethargy and attenuation of negative symptoms may increase motivation.  The combination of lower sedation and increased motivation might lead Vraylar users to engage in more physical activity and maintain higher resting metabolic rates (RMRs) – compared to other antipsychotics, possibly accounting for less weight gain.

Why weight gain may be more common with Vraylar than the data suggest…

Nonetheless, an argument could be made that side effect data from trials of Vraylar are somewhat misleading in regards to Vraylar’s effect on body weight.  Why? Because many individuals participating in randomized controlled trials of Vraylar for the treatment of schizophrenia and/or bipolar disorder likely have a history of antipsychotic use.

A history of antipsychotic use likely caused prior weight gain (most antipsychotics cause weight gain) such that, when switching or transitioning to Vraylar – body weight probably won’t change much (due to similar pharmacodynamics among atypical antipsychotics).  Even if there were a reasonable time gap between using another antipsychotic and initiating treatment with Vraylar, it’s possible that delay wouldn’t be long enough for weight to return to homeostatic baseline prior to Vraylar initiation.

If participants aren’t at homeostatic or baseline body weights prior to Vraylar initiation, we wouldn’t be getting an accurate representation of the drug’s effect on body weight.  In other words, there’s a chance that the lack of weight gain observed among Vraylar recipients is due to the fact that recipients weren’t antipsychotic-naïve.  Prior antipsychotic use causes physiologic adaptations associated with weight gain, however, it would be unlikely for significant additional weight gain to occur while switching to another antipsychotic of similar action with minimal layover between treatments.

Variables that influence Vraylar (Cariprazine) weight change

There are multiple variables that could influence the significance of weight change (gain or loss) – or lack thereof – that you experience while using Vraylar.  These influential variables could include: prior substance use (e.g. medications); genetics and epigenetics; your lifestyle; concurrent substance use; duration of Vraylar use; and Vraylar dosage.  It is the combination of these variables that likely determines who will gain weight, lose weight, or experience no weight change – while using Vraylar.

  1. Previous medication use: If you were using medications or supplements prior to Vraylar, there’s a chance that those substances may have caused weight change. Assuming you used a medication that made you gain weight (e.g. an antipsychotic) prior to using Vraylar, you may experience no weight change – or even weight loss on Vraylar.  On the other hand, if you were using a medication that made you lose weight prior to using Vraylar, you may be at increased risk of gaining weight during treatment.  A combination of reversion to homeostatic physiology (and body weight) after discontinuation of a previous medication that caused weight change – might explain some of the weight gain or loss that you observe in Vraylar treatment (even if it’s more attributable to homeostatic reversion than Vraylar).
  2. Genetics & epigenetics: Individuals who gain or lose a substantial amount of weight while using Vraylar might have certain genetic or epigenetic expressions that differ from a majority of users – making their physiology more susceptible to Vraylar-induced body weight gains or losses. For example, certain individuals may exhibit genetics that interact with Vraylar in a way that modulates appetite, fat storage, metabolism, and/or concentrations of sex hormones within the body.  Although specific gene and epigenetic interactions with Vraylar remain unelucidated, Vraylar-gene interactions might be culpable for some degree of weight change.
  3. Lifestyle choices: A Vraylar user’s lifestyle choices may influence likelihood of weight change during treatment. Someone who: isn’t getting adequate sleep, fails to properly manage stress, makes no effort to engage in exercise, and consistently eats non-nutritious “junk” food – may be at increased risk of ongoing weight gain – regardless of the medication.  Moreover, unhealthy lifestyle choices may alter physiology in ways that are synergistic with the antipsychotic to promote weight gain.  Oppositely, someone who: adheres to a sleep regimen, maintains low stress, exercises on a daily basis, and eats low-calorie foods – may be at lower risk of weight gain throughout treatment.
  4. Concurrent substance use: Using other substances such as medications and/or supplements along with Vraylar could influence the amount of weight change that you experience during treatment. It’s possible that any substances you regularly administer in addition to Vraylar could be causing more significant weight change than Vraylar.  It’s also possible that the weight change you experience while using Vraylar is fully caused by other substances you’re using – rather than the Vraylar.  Furthermore, there could be pharmacokinetically-mediated and/or pharmacodynamically-mediated interactions between Vraylar and other substances you’re using that could account for the weight change.
  5. Duration of Vraylar use: The duration or total length of time over which you’ve used Vraylar could also influence weight change. Some individuals might end up gaining or losing weight with short-term treatment (e.g. 6 weeks), yet when treated for a longer-term (e.g. 1 year), weight ends up normalizing.  Oppositely, certain people might experience negligible weight change over a short-term, yet when treated for a longer-term, weight gain occurs.  In short, the duration of your Vraylar treatment might dictate the amount of weight you gain or lose.
  6. Vraylar dosage: Evidence suggests that there aren’t dose-dependent effects of Vraylar on body weight. Still, the evidence does not account for individual variation in body weight change relative to Vraylar dose.  It’s possible that certain individuals may experience more significant weight gain (or loss) at higher doses compared to lower doses; or vice-versa.  It may help to track your body weight throughout treatment to determine whether dosing changes have any significant effect on your weight.

Possible ways to minimize weight change on Vraylar (Cariprazine)

A majority of individuals who use Vraylar (~62%) will experience no clinically relevant changes in body weight throughout treatment.  However, some data suggest that up to ~38% of Vraylar users could experience some weight change.  Specifically, up to ~27% of Vraylar users might gain weight, whereas up to ~11% of Vraylar users might lose weight.

If your aim is to minimize weight change throughout treatment, below are some potentially-useful weight management strategies to consider.  That said, you should only implement these weight management strategies after confirming safety and hypothetical utility with a medical doctor.

  1. Monitor calories & activity level: One way to determine whether Vraylar is culpable for your weight gain and/or loss is to track calories. If you weren’t tracking your caloric intake and/or activity level prior to initiation of Vraylar treatment – it will remain unknown as to whether Vraylar was the actual cause of your weight change.  In any regard, assuming you know how to calculate your maintenance calories (caloric intake needed to maintain your present weight), then monitoring calories and eating at maintenance calories while using Vraylar may help prevent weight gain or loss throughout treatment.
  2. Manage side effects: Various side effects of Vraylar like sedation could cause weight gain, whereas others like nausea and vomiting could cause weight loss. If you experience significant weight change as a result of Vraylar side effects – report this to your doctor and ask what can be done to get side effects under control.  Managing side effects could prevent weight gain or weight loss – if the side effects are primarily responsible for your weight change.  After you’ve controlled side effects, body weight might revert back to normal.
  3. Dosage adjustment: On occasion, it may be helpful to adjust the dosage of Vraylar that you’re using to prevent weight change. Though there don’t seem to be dose-dependent effects of Vraylar on body weight in the general population, there could be individual-specific dose-dependent effects such that certain people exhibit increased propensity for gaining or losing weight at particular dosage thresholds.  Sometimes, using the “minimal effective dose,” or lowest dose of Vraylar needed to manage neuropsychiatric symptoms, may help decrease weight change due to less significant physiologic influence of the drug.  That said, talk to a medical doctor to determine whether reducing or increasing your dose is likely to be better for your weight.
  4. Concurrent substance use: If you’re experiencing unwanted weight change on Vraylar, it may be helpful to reflect upon concurrent substance use (the medications and/or supplements that you regularly administer in addition to Vraylar). For some individuals, eliminating all medically-unnecessary substances might help improve body weight.  On the other hand, adding certain concurrent substances to your regimen (that are prescribed or recommended by a medical doctor) to address weight change – or side effects that are causing weight change – could help normalize your body weight while using Vraylar.
  5. Use Vraylar for a longer-term: If you experienced significant weight change (gain or loss) after short-term Vraylar treatment, there’s a chance that your weight may stabilize with longer-term use. Body weight might fluctuate unpredictably with short-term Vraylar treatment due to lack of physiologic adaptation.  Once the body full adapts to the effects of Vraylar over a longer duration, body weight may revert back to normal – or stabilize such that no additional weight gain or loss occurs beyond a certain threshold (e.g. 2 lbs.).

Note: If you experience significant unfavorable weight change while using Vraylar and none of the aforementioned strategies help in getting your weight under control – it is recommended to discuss your dissatisfaction with a medical doctor.  A medical doctor may recommend Vraylar withdrawal and/or transitioning to another antipsychotic medication.

Have you experienced weight gain or loss on Vraylar (Cariprazine)?

If you’ve used Vraylar (Cariprazine) for any reasonable duration, leave a comment below mentioning whether you gained weight, lost weight, or experienced zero noticeable weight change throughout treatment.  To help others get a better understanding of your situation, mention: how much weight change you experienced (e.g. 5 lb. gain) and how long it took for you to notice weight change after initiating Vraylar treatment.

Moreover, if you’ve experienced significant weight change on Vraylar, share why you think the weight change occurred (e.g. appetite change; energy level change; slower metabolism; etc.).  Also note things like: your Vraylar dose; how long you’ve used Vraylar (in total); and whether your weight change worsened, subsided, or corrected over a longer-term.

Have you considered that medication use prior to Vraylar – or usage of substances along with Vraylar (e.g. medications supplements, etc.) might have accounted for some of your weight change throughout treatment?  Have you considered that your caloric intake and/or physical activity level might’ve changed throughout treatment to explain your weight change?

In your experience, is the weight change attributable to Vraylar unfavorable enough to warrant treatment discontinuation or switching to another medication?  In summary, according to the research, Vraylar is a relatively weight-neutral antipsychotic medication – and arguably one of the better atypical antipsychotics for weight management.  That said, if Vraylar affects your weight unfavorably, there are alternatives to consider.

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