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Vraylar vs Lithium
Introduction
For patients dealing with bipolar disorder, schizophrenia or other types of mood disorders, certain medicines that modify the balance of chemicals in the brain, known as neurotransmitters, can help stabilize their mood swings and manage symptoms. Vraylar and Lithium are two such drugs typically prescribed for these conditions. They each influence different neurotransmitters in the brain but have a common goal - stabilizing the patient's moods.
Vraylar is an atypical antipsychotic that works by changing the activity of certain natural substances in your brain. It’s classified as a dopamine D2 receptor partial agonist and serotonin 5HT1A receptor partial agonist which means it primarily affects levels of dopamine and serotonin.
On the other hand, Lithium is classified as a mood stabilizer. While its exact mechanism isn't entirely understood, it's believed to work by affecting sodium transport in nerve and muscle cells; adjusting glutamate uptake and release; inhibiting glycogen synthase kinase-3 beta; aiding reuptake of norepinephrine; increasing production of white matter in gray areas thus improving connectivity between neurons.
What is Vraylar?
Cariprazine (the generic name for Vraylar) is a relatively new addition to the class of atypical antipsychotics, which marked a significant development from the older class of mood stabilizers like lithium. Cariprazine was first approved by the FDA in 2015 and acts as an antagonist at dopamine D2 and serotonin 5-HT2A receptors, while also acting as a partial agonist at dopamine D3 receptors. It is prescribed for the treatment of schizophrenia and bipolar disorder. Meanwhile, lithium has been used as a mood stabilizer since its approval in 1970. Lithium works by affecting sodium transport in nerve cells and muscle cells and influences several neurotransmitters that control our moods such as norepinephrine, serotonin, GABA (gamma-aminobutyric acid), glutamate etc., thereby effectively reducing extreme mood swings experienced during episodes of manic depression or bipolar disorder. The side-effect profile between these two drugs differs significantly due to their different mechanisms of action with Vraylar having fewer typical antipsychotic side effects than lithium.
What conditions is Vraylar approved to treat?
Vraylar is approved for the treatment of various manifestations of mental disorders:
- Schizophrenia in adults
- Bipolar I disorder, specifically manic or mixed episodes in adults
- Depressive episodes associated with bipolar I disorder as a monotherapy and an adjunct to lithium or valproate.
How does Vraylar help with these illnesses?
Vraylar aids in managing symptoms of bipolar disorder and schizophrenia by balancing dopamine and serotonin levels in the brain. It functions as a partial agonist at dopamine D2 receptors and serotonin 5-HT1A receptors, meaning it can both stimulate these receptors to increase neurotransmitter levels when they are too low, or block them when their activity is too high. Dopamine plays a crucial role in our ability to feel pleasure, stay motivated, maintain focus, and regulate mood. Serotonin similarly influences mood, but also has considerable impact on appetite, sleep cycles, memory function among other things. Patients with bipolar disorder or schizophrenia often have imbalances of these neurotransmitters which contribute to their symptoms. Therefore Vraylar's unique mechanism allows it not only to alleviate these symptoms but also helps stabilize patient’s mood over time.
What is Lithium?
Lithium, often sold under brand names such as Lithobid or Eskalith, is an element used in the treatment of bipolar disorder to help control symptoms of mania. This includes reducing episodes of exaggerated euphoria or feelings of agitation and restlessness. It accomplishes this by altering sodium transport in nerve and muscle cells and enhancing the reuptake of norepinephrine and serotonin while also inhibiting the release of both neurotransmitters. Lithium has been recognized for its medicinal properties since the mid-20th century, being approved by FDA in 1970.
As lithium does not inhibit dopamine reuptake nor act on serotonergic systems like SSRI antidepressants do, it has a unique side-effect profile. While weight gain can occur with long-term use, many other common side effects associated with SSRIs—like sedation or sexual dysfunction—are less likely with lithium therapy. Its effect on modulating norepinephrine and serotonin can be particularly beneficial for managing bipolar disorder—a condition requiring different medication strategies compared to typical depression treated primarily through SSRIs such as Prozac.
What conditions is Lithium approved to treat?
Lithium is a well-established drug that has been approved for the treatment of:
- Bipolar disorder, both acute manic episodes and maintenance therapy
- Major depressive disorder (MDD), when used in conjunction with other antidepressants
How does Lithium help with these illnesses?
Lithium is a mood stabilizer that has been used for decades in the treatment of bipolar disorder. It works by altering the balance of certain neurotransmitters and ions within nerve cells, which helps to stabilize mood fluctuations and reduce the intensity of manic episodes. In comparison to Vraylar, which also acts on dopamine receptors but additionally antagonizes serotonin receptors, lithium's mechanism of action primarily involves modulation of intracellular signaling pathways and synaptic plasticity rather than direct receptor antagonism or stimulation. As such, Lithium may be prescribed when a patient does not respond well to atypical antipsychotics like Vraylar or it may be combined with them in order to potentiate their effects.
How effective are both Vraylar and Lithium?
Both cariprazine (Vraylar) and lithium have established histories of success in treating patients with bipolar disorder, though they were initially approved by the FDA several decades apart. Since they act on different neurotransmitters and pathways in the brain, they may be prescribed under different circumstances.
The effectiveness of cariprazine and lithium was studied directly in a 2015 double-blind clinical trial; both drugs exhibited similar efficacy in managing symptoms of mania associated with bipolar I disorder as well as similar safety profiles. In this study, none of the different metrics studied to measure efficacy in treating manic episodes differed significantly between patients receiving cariprazine or those receiving lithium.
A review conducted on multiple studies regarding Vraylar showed that it is effective at alleviating symptoms from the first week of treatment for acute manic or mixed episodes associated with bipolar I disorder. It has also shown to be favorable over many other antipsychotics due to its unique mechanism involving dopamine D3 receptors.
On the other hand, Lithium is often considered a first-line treatment option for bipolar disorders because it can effectively treat both depressive and manic episodes. Notably it's one of few treatments proved to reduce suicide risks among people who are diagnosed with mood disorders such as Bipolar Disorder. However, despite its notable benefits, regular monitoring is necessary when using Lithium due to its narrow therapeutic index which means small difference exists between therapeutic level and toxic level.
Major research into Vraylar involves cases where it was co-prescribed alongside an SSRI or SNRI antidepressant medication since these combinations are often used together for their synergistic effects towards managing depression components within Bipolar Disorders. Nonetheless, Vraylar does carry certain side-effects including extrapyramidal symptoms like akathisia (a distressing restlessness), so careful management must be undertaken during treatment plans involving its use.
At what dose is Vraylar typically prescribed?
Oral dosages of Vraylar range from 1.5–6 mg/day, but studies have indicated that a starting dose of 1.5 mg/day is sufficient for treating bipolar disorder and schizophrenia in most people. For the treatment of depressive episodes associated with bipolar I disorder, dosage can start at 1.5 mg/day and gradually increase to a maximum of 3 mg/day depending on the individual’s response and tolerability. On the other hand, Lithium dosages typically range between 900-2400mg per day divided into two or three doses depending on the severity of symptoms and how well they are controlled; blood levels must be monitored regularly due to potential serious side effects at high doses.
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At what dose is Lithium typically prescribed?
Lithium treatment is generally initiated at a dosage of 600-900 mg/day, divided into two or three doses. The dose can then be increased to 1200-2400 mg/day if required, depending on the individual's blood lithium level and clinical response. This daily dose should be divided into two to three doses, spaced evenly throughout the day. It's important that individuals taking lithium maintain a consistent salt intake in their diet and stay hydrated, as changes could impact how well they tolerate this medication or how effective it is. If there is no adequate response to treatment after several weeks at maximum therapeutic doses, further consultation with your healthcare provider may be necessary.
What are the most common side effects for Vraylar?
Common side effects of Vraylar include:
- Restlessness or feeling like you need to move around (akathisia)
- Insomnia
- Nausea and vomiting
- Dyspepsia (burning, discomfort, or pain in the digestive tract)
- Constipation
- Abnormal weight gain
- Dizziness
- Dry mouth -Uncontrolled movements of your face, tongue, or other parts of body.
On the other hand, common side effects of Lithium may consist:
-Frequent urination
-Thirstiness
-Dry mouth
-Nausea,
-Tremors,
-Diarrhea,
-Vomiting.
It's important to note that both drugs should be taken under medical supervision as they can lead to severe adverse effects if not properly managed.
Are there any potential serious side effects for Vraylar?
While Vraylar and Lithium are both used for the treatment of bipolar disorder, they have different side effects. In rare cases, Vraylar may cause:
- Thoughts about suicide or self-harm
- Signs of allergic reaction such as hives, difficulty breathing, swelling in your face or throat
- Neuroleptic malignant syndrome: high fever, sweating, confusion, fast or uneven heartbeats
- Tardive dyskinesia: uncontrollable movements of your lips, tongue or limbs
- Changes in body weight
On the other hand, Lithium could potentially cause:
- Low sodium levels - headache, confusion slurred speech severe weakness vomiting loss coordination feeling unsteady
- Kidney problems - increased thirst and urination
- Thyroid disorders – unexpected weight changes fatigue hair loss feeling cold all the time
- Hand tremors Both medications can also lead to an increased risk of falls due to drowsiness or dizziness. Remember that these risks must be weighed against the potential benefits with your healthcare provider.
What are the most common side effects for Lithium?
Lithium, a long-standing and frequently-prescribed treatment for bipolar disorder, can present a variety of side effects:
- Dry mouth or increased thirst
- Frequent urination
- Hand tremors or shaking hands
- Nausea, vomiting, stomach discomfort after eating
- Changes in heart rate
- General fatigue or lethargy
- Weight gain rather than loss
- Problems with memory recall or concentration
- Hair thinning or skin rash conditions.
Less commonly but more seriously, Lithium may also cause confusion and even delirium. It's crucial to maintain regular check-ups when on this medication due to its potential impact on kidney function. Despite these side effects, many patients find the benefits outweigh the drawbacks when balanced against effective control of manic episodes.
Are there any potential serious side effects for Lithium?
In some cases, Lithium can cause serious side effects which require immediate medical attention. These may include:
- Signs of an allergic reaction such as hives, difficulty breathing, swelling in your face or throat
- Increased suicidal thoughts or behaviors
- Confusion or trouble concentrating
- Uncontrolled movements (tremors), especially if they are new or worsening
- Severe nausea, vomiting and diarrhea leading to dehydration
- Weakness, dizziness or feeling light-headed due to low sodium levels in your body (hyponatremia)
- Abnormal heart rhythm: slow, fast or irregular heartbeat.
If you experience any of the above symptoms while on lithium therapy, it's crucial that you seek medical help immediately.
Contraindications for Vraylar and Lithium?
Both Vraylar and Lithium, like other medications used to treat bipolar disorder and schizophrenia, may worsen symptoms of depression in some individuals. If you notice your depressive symptoms worsening, or an increase in suicidal thoughts or behavior while taking these drugs, please seek immediate medical attention.
Neither Vraylar nor Lithium should be taken if you are using diuretics or angiotensin-converting enzyme (ACE) inhibitors due to possible dangerous interactions leading to lithium toxicity. Always inform your healthcare provider about the medications you are currently taking; discontinuation of certain drugs may require a specific period for clearance from the body before initiating treatment with Vraylar or Lithium.
How much do Vraylar and Lithium cost?
For the brand name versions of these drugs:
- The price for 30 capsules of Vraylar (3 mg) averages around $1,300, which works out to approximately $43/day.
- The price for a bottle of Lithium Carbonate (contains about 100 tablets of 300mg each) is about $10-$20, working out to roughly $0.10 - $0.20 per day.
Thus, if you are on a standard dose for Vraylar (i.e., typically between 1.5 mg and 6 mg per day), then brand-name Lithium Carbonate is significantly less expensive on a per-day treatment basis. Please note that cost should not be the primary consideration in determining which of these drugs is right for you.
For their generic versions:
- Cariprazine (generic version equivalent to Vraylar) is relatively new on the market and may not have significant cost savings yet.
- Generic lithium carbonate continues to be very affordable with costs ranging from as low as $.05/day up to about $.15/day depending on your specific dosage requirements. Remember that both medications require regular monitoring by your healthcare provider due to potential side effects and interactions with other medications or conditions.
Popularity of Vraylar and Lithium
Cariprazine, known by the brand name Vraylar, was estimated to have been prescribed to about 1.2 million people in the US in 2020. Cariprazine accounted for roughly a minor percentage of total antipsychotic prescriptions in the US but has been growing rapidly since its approval by FDA in 2015. It belongs to a newer class of atypical antipsychotics offering lower risks of side effects such as extrapyramidal symptoms.
Lithium, an older mood stabilizer primarily used for bipolar disorder treatment, was prescribed to around 1.7 million people in the USA during the same year. In terms of overall mood stabilizer prescriptions, lithium accounts for just over a significant amount while it's usage has remained relatively steady over past decades due to proven efficacy and affordability despite potential kidney and thyroid-related side effects that require regular monitoring.
Conclusion
Both Vraylar (cariprazine) and lithium have well-established records of usage in patients with bipolar disorder, both being backed by numerous clinical studies indicating that they are more effective than placebo treatments. In some cases, the drugs may be combined, but this is subject to careful consideration by a physician due to their different side effect profiles and mechanisms of action. With Vraylar acting primarily on dopamine receptors D2/D3 as an agonist/antagonist and lithium working through multiple pathways including inhibition of inositol monophosphatase, they tend to be prescribed under different circumstances.
Lithium has been considered a first-line treatment for acute manic episodes and maintenance therapy in bipolar disorder for many years. On the other hand, Vraylar would usually be considered as an option when patients do not respond well to first-line therapies or if there's need to avoid common potential side-effects associated with lithium such as tremor or renal impairment.
While generic forms of lithium are available offering significant cost savings especially for out-of-pocket paying patients; Vraylar currently does not have a generic version which could potentially make it more expensive.
The side effect profile varies between these two drugs: while both can cause weight gain, sedation and gastrointestinal upset among others; Lithium use requires regular blood level monitoring due its narrow therapeutic index whereas Vraylar is less likely to affect kidney function but might increase risk for movement disorders. For either drug, close medical supervision is required especially during initiation phase or dosage adjustment period.
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Refrences
- McCormack, P. L. (2015, October 28). Cariprazine: First Global Approval. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-015-0494-7
- Vacheron-Trystram, M.-N., Braitman, A., Cheref, S., & Auffray, L. (2004, October). Antipsychotiques et troubles bipolaires. L'Encéphale. Elsevier BV.http://doi.org/10.1016/s0013-7006(04)95456-5
- Aziz, R., Lorberg, B., & Tampi, R. R. (2006, December). Treatments for late-life bipolar disorder. The American Journal of Geriatric Pharmacotherapy. Elsevier BV.http://doi.org/10.1016/j.amjopharm.2006.12.007
- Can, A., Schulze, T. G., & Gould, T. D. (2014, August). Molecular actions and clinical pharmacogenetics of lithium therapy. Pharmacology Biochemistry and Behavior. Elsevier BV.http://doi.org/10.1016/j.pbb.2014.02.004
- Pinto, J. V., Saraf, G., Vigo, D., Keramatian, K., Chakrabarty, T., & Yatham, L. N. (2019, November 19). Cariprazine in the treatment of Bipolar Disorder: A systematic review and meta‐analysis. Bipolar Disorders. Wiley.http://doi.org/10.1111/bdi.12850