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Vraylar vs Saphris
Introduction
For patients with bipolar disorder or schizophrenia, certain medications that alter the levels of brain compounds linked to mood and perception, known as neurotransmitters, can help in managing symptoms. Vraylar and Saphris are two such drugs that are prescribed for these conditions. Both drugs impact different neurotransmitters in the brain but have similar effects on psychosis management and mood stabilization.
Vraylar (cariprazine) is classified as a partial agonist at dopamine D2 receptors and serotonin 5-HT1A receptors, while it acts as an antagonist at serotonin 5-HT2A receptors. This means it works by helping restore balance to dopamine - a neurotransmitter responsible for motivation and reward - while also affecting serotonin levels which influence mood.
Saphris (asenapine), on the other hand, is classified as a second-generation antipsychotic medication that primarily blocks specific subtypes of dopamine-2 (D2) receptor sites in the brain along with specific serotonergic receptor sites. Thus Saphris also affects both dopamine and serotonin concentrations but through slightly different mechanisms compared to Vraylar.
Vraylar vs Saphris Side By Side
| Attribute | Vraylar | Saphris |
|---|---|---|
| Brand Name | Vraylar | Saphris |
| Contraindications | Should not be taken with cytochrome P450 inhibitors (CYP3A4) within the last two weeks; increased mortality in elderly patients with dementia-related psychosis | Should not be taken with cytochrome P450 inhibitors (CYP3A4) within the last two weeks; increased mortality in elderly patients with dementia-related psychosis |
| Cost | $1,200 for 30 tablets (1.5 mg) | $980 for a month's supply (10 mg, 60 tablets) |
| Generic Name | Cariprazine | Asenapine |
| Most Serious Side Effect | Thoughts of suicide or hurting oneself, severe skin reaction, vision problems, cardiovascular issues, symptoms of low sodium levels, serious nervous system response | Allergic reactions, severe skin reactions, changes in mood and behavior, neurological issues, visual disturbances, cardiovascular concerns, symptoms related to manic episodes |
| Severe Drug Interactions | Cytochrome P450 inhibitors (CYP3A4) | Cytochrome P450 inhibitors (CYP3A4) |
| Typical Dose | 1.5-6 mg/day | 5 mg twice daily, up to 10 mg twice daily |
What is Vraylar?
Cariprazine (the generic name for Vraylar) is an atypical antipsychotic that was first approved by the FDA in 2015. It works within the brain to balance certain chemicals, namely dopamine and serotonin, contributing to its efficacy in treating schizophrenia and bipolar disorder. Vraylar differs from other antipsychotics due to its unique influence on these neurotransmitters; it acts as a partial agonist at dopamine D3 receptors – a property not shared by any other antipsychotic.
On the other hand, Asenapine (Saphris), another type of atypical antipsychotic also used for similar conditions, was approved by the FDA earlier than Vraylar - in 2009. Saphris impacts multiple neurotransmitters including serotonin, norepinephrine and histamine receptors which may result in diverse side effects compared to those observed with Vraylar use. While both medications are used for similar conditions their mechanisms of action differ significantly which can lead to different therapeutic effects and side effect profiles for patients. Always consult with your healthcare provider before making decisions about medication changes or additions.
What conditions is Vraylar approved to treat?
Vraylar is approved for the treatment of various mental/mood disorders:
- Schizophrenia
- Bipolar disorder, specifically manic or mixed episodes in adults and pediatric patients aged 10 to 17 years old
- Depressive episodes associated with bipolar I disorder (bipolar depression) in adults.
How does Vraylar help with these illnesses?
Vraylar helps manage symptoms of bipolar disorder and schizophrenia by modulating the levels and activity of certain neurotransmitters in the brain, specifically dopamine and serotonin. It does this by acting as an antagonist at dopamine D2 receptors and serotonin 5-HT2A receptors, meaning it blocks these receptors from being activated, while also partially activating them (partial agonist), hence maintaining a balance in neurotransmitter activity. Dopamine plays critical roles in reward, motivation, motor function among others while Serotonin influences mood, appetite and sleep. In patients with bipolar disorder or schizophrenia, there are imbalances in these neurotransmitters' activities. By restoring balance to their activity via receptor modulation Vraylar can help alleviate the negative effects of these conditions helping patients better manage their symptoms.
What is Saphris?
Saphris, which is a brand name for asenapine, acts as an antagonist of several neurotransmitter receptors in the brain. It functions by blocking dopamine and serotonin receptors, thereby reducing their actions. First approved by the FDA in 2009, Saphris is not a typical antipsychotic medication due to its unique pharmacological profile. Unlike some other antipsychotics that only block dopamine or serotonin receptors, Saphris blocks both types of these important pathways in the brain.
The side effect profile of Saphris differs from many traditional antipsychotics and even newer agents like Vraylar. For instance, it does not typically cause sedation nor significant weight gain - common issues with certain other medications used to treat psychiatric disorders such as schizophrenia or bipolar disorder. The ability to act on both dopamine and serotonin makes it potentially beneficial for patients who do not respond well to "typical" treatment options.
What conditions is Saphris approved to treat?
Saphris is an FDA-approved medication primarily used for the management of two mental health conditions:
- Schizophrenia, which is a long-term mental disorder involving a breakdown in the relation between thought, emotion, and behavior,
- Bipolar I disorder, where individuals experience episodes of mania (overly excited or irritable mood) and potentially also episodes of depression.
How does Saphris help with these illnesses?
Saphris, also known as asenapine, is an atypical antipsychotic that has a multi-receptor profile. It targets dopamine and serotonin receptors in the brain to alleviate symptoms associated with psychiatric disorders such as schizophrenia and bipolar disorder. While Vraylar solely acts on these two neurotransmitter systems, Saphris exerts its effects on other neurotransmitters like noradrenaline and histamine too. This broader action spectrum might provide added benefits for certain patients who do not respond adequately to the typical dopamine-serotonin antagonists or may be combined with them for enhanced therapeutic effect. Much like norepinephrine plays key roles in various body processes, so does dopamine in regard to mood regulation and reward-driven behavior making it crucial in managing psychiatric conditions.
How effective are both Vraylar and Saphris?
Both cariprazine (Vraylar) and asenapine (Saphris) have clear evidence of success in treating patients with bipolar disorder and schizophrenia, although their approval by the FDA was separated by several years. Both medications act on similar neurotransmitters but have different receptor binding profiles, which can lead to differing side effect profiles and may inform prescribing decisions.
The effectiveness of both cariprazine and asenapine were directly studied in several double-blind clinical trials. These studies showed that both drugs exhibit similar efficacy in managing symptoms associated with bipolar disorder and schizophrenia. Furthermore, they highlighted promising safety profiles for each medication.
Several meta-analyses indicate that cariprazine is effective from the first week of treatment at reducing manic symptoms in bipolar I disorder, demonstrating a favorable side-effect profile compared to many other antipsychotics. Beyond this specific indication, it also appears to reduce depressive symptoms within this patient population.
Asenapine has also been shown to be effective across multiple domains of psychiatric illness including mania associated with bipolar I disorder, agitation related to schizophrenia or bipolar mania, as well as maintaining symptom control after acute treatment. However, unlike Vraylar it's not currently indicated for depressive episodes associated with Bipolar I Disorder.
While either drug might be considered depending on the individual patient's needs and potential sensitivity to side effects such as weight gain or movement disorders (extrapyramidal symptoms), both represent important tools in managing complex psychiatric conditions like Bipolar Disorder or Schizophrenia.
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At what dose is Vraylar typically prescribed?
Oral dosages of Vraylar range from 1.5-6 mg/day, typically starting at 1.5 mg/day for treating schizophrenia and bipolar disorder in adults. Dosage may be increased after a week if necessary based on the clinical response and tolerability of the patient. On the other hand, Saphris is started at an initial dose of 5 mg twice daily for schizophrenia and a sublingual dose of 10mg once daily for bipolar disorder in adults. The dosage can be adjusted depending on the response but should not exceed a maximum dosage of 20 mg/day under any circumstances.
At what dose is Saphris typically prescribed?
Saphris treatment is generally started at a dosage of 5 mg twice daily. The dose can then be increased to 10 mg twice daily, depending on the patient's response and tolerance. Each dose should be taken under the tongue and allowed to dissolve completely which usually takes about one minute; it should not be chewed or swallowed whole. If there is no sufficient improvement in symptoms after a few weeks, your healthcare provider may decide to adjust the dosing regimen further. It's important that patients do not exceed a total of 20 mg/day.
What are the most common side effects for Vraylar?
Common side effects that may occur when taking Vraylar include:
- Restlessness, anxiety
- Insomnia
- Sleepiness/drowsiness
- Indigestion or stomach discomfort
- Nausea, vomiting
- Diarrhea or constipation
- Dry mouth, increased salivation
- Decreased appetite
- Weight gain
- Uncontrollable movements, such as tremors and shaking (extrapyramidal symptoms)
- Dizziness
Comparatively, Saphris may cause:
- Increased weight and cholesterol levels
- Drowsiness/sleepiness which can impair your reactions
- Dizziness upon standing (orthostatic hypotension)
- Unusual mouth sensations; numbness or a tingling sensation in the mouth after using sublingual tablets
- Disturbances of movement coordination (extrapyramidal symptoms), muscle stiffness
- Abnormal taste
The same medication can affect people differently. Always consult a medical professional before starting any new medication regimen.
Are there any potential serious side effects for Vraylar?
While using Vraylar, some individuals may experience serious side effects such as:
- Thoughts of suicide or hurting oneself
- Allergic reactions: hives, difficulty breathing, swelling in your face or throat
- Severe skin reaction: fever, sore throat, burning sensation in the eyes, skin pain followed by a red or purple rash that spreads and causes blistering and peeling
- Vision problems: blurred vision, eye pain or swelling
- Cardiovascular issues: fast or pounding heartbeats; shortness of breath; sudden dizziness (like you might pass out)
- Symptoms of low sodium levels – headaches; confusion; slurred speech; severe weakness; vomiting; loss of coordination and balance
- Serious nervous system response – rigid muscles accompanied by high fever, sweating and confusion with rapid uneven heart rates leading to tremors where one feels they might faint.
If you observe any signs suggestive of serotonin syndrome like agitation/ restlessness/uncontrolled movements/hallucinations/high body temperature/excessive sweating/shivering/fast heartbeat/muscle stiffness/twitching/loss of physical coordination/diarrhea/vomiting. Please seek immediate medical attention if you notice any symptoms mentioned above while taking Vraylar.
What are the most common side effects for Saphris?
Saphris, similar to Vraylar, is used in the treatment of schizophrenia and bipolar disorder. However, Saphris may have its own set of side effects that individuals should be aware of:
- Dry mouth or increased salivation
- Numbness or tingly feeling in your mouth
- Weight gain
- Feeling restless or being unable to sit still
- Sleep problems (insomnia)
- Dizziness, drowsiness, tiredness
- Constipation
- Increased appetite
It's important to note that each individual may experience these different side effects to varying degrees. Always consult with a healthcare professional before starting on any new medication regimen.
Are there any potential serious side effects for Saphris?
Saphris, like any medication, can cause a range of side effects. Some symptoms that warrant immediate medical attention include:
- Signs of an allergic reaction such as hives, itching, trouble breathing or swelling in your face or throat
- Rash or other severe skin reactions including peeling or blistering
- Changes in mood and behavior such as increased aggression, suicidal thoughts or worsening depression
- Neurological issues such as seizures (convulsions), confusion, problems with balance and movement
- Visual disturbances like blurred vision and seeing halos around lights
- Cardiovascular concerns including fast irregular heartbeats
- Symptoms related to manic episodes: hyperactivity, feeling unusually euphoric or irritable; talking more than usual; having trouble sleeping.
If you experience any of these symptoms while on Saphris therapy, it is imperative to seek immediate medical help.
Contraindications for Vraylar and Saphris?
Both Vraylar and Saphris, like most antipsychotic medications, may intensify symptoms of depression in some individuals. If you observe your depression worsening, or experience an increase in suicidal thoughts or behaviors, please seek immediate medical help.
Neither Vraylar nor Saphris should be taken if you are using, or have recently used medications known as cytochrome P450 inhibitors (CYP3A4) within the last two weeks. Always disclose to your physician any medications you are currently taking; CYP3A4 inhibitors need a washout period of about 2 weeks from your system to prevent harmful interactions with Vraylar and Saphris.
Remember that antipsychotics can also cause side effects such as dizziness upon standing up quickly due to blood pressure changes (orthostatic hypotension), weight gain or metabolic changes which may lead to diabetes. The risk for these side effects might be higher with Saphris compared to Vraylar.
Also note that both drugs carry a black box warning regarding increased mortality in elderly patients with dementia-related psychosis; they are not approved for this use.
How much do Vraylar and Saphris cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Vraylar (1.5 mg) averages around $1,200, which works out to approximately $40/day.
- The cost for a month's supply of Saphris (10 mg), 60 tablets in total, is about $980 or roughly $32/day.
Therefore, if you are taking a standard dose (i.e., not exceeding the recommended daily limit), then brand-name Saphris tends to be less expensive on a per-day treatment basis compared with Vraylar. However, it's important to remember that cost shouldn't be your primary consideration when determining which of these medications is best suited for you.
As it stands currently, there aren't any generic versions available for either Vraylar (cariprazine) or Saphris (asenapine). Both are still under patent protection and only available as brand-name drugs. As such their costs remain relatively high compared to many other psychiatric medications available in generic forms.
Popularity of Vraylar and Saphris
Cariprazine, commonly known by the brand name Vraylar, was estimated to have been prescribed to about 1 million people in the US in 2020. Cariprazine accounted for just over 2% of antipsychotic prescriptions in the US. However, it appears to be a rising choice among atypical antipsychotics (also referred to as second generation antipsychotics). The prevalence of cariprazine has been generally increasing since its approval by FDA in 2015.
Asenapine, including branded versions such as Saphris, was prescribed to approximately half a million people in the USA during 2020. In terms of overall prescriptions for atypical antipsychotics within the US market share, asenapine accounts for slightly under one percent. Despite this relatively small share and competition from other newer drugs like cariprazine (Vraylar), it remains a trusted option with steady usage rates over recent years due to its unique sublingual administration route offering an alternative method compared to traditional oral tablets or injectables.
Conclusion
Both Vraylar (cariprazine) and Saphris (asenapine) are antipsychotic medications used in the treatment of schizophrenia, bipolar disorder, and other mental health disorders. They have been shown to be effective in managing symptoms through multiple clinical studies and meta-analyses. While they may sometimes be combined under careful medical supervision, these two drugs also interact with each other, so concomitant use requires close monitoring by a healthcare provider.
Vraylar acts primarily on dopamine D2/D3 receptors and serotonin 5-HT1A receptors while Saphris mainly targets various subtypes of serotonin as well as alpha-adrenergic receptors. Consequently, they might be prescribed under different circumstances: for example, Vraylar has approval for the acute treatment as well as maintenance therapy in both manic or mixed episodes associated with bipolar I disorder whereas Saphris is approved only for acute management.
Currently there's no generic form available for either medication which could represent significant cost implications especially for those who must pay out-of-pocket. Both Vraylar and Saphris may need an adjustment period before effects become noticeable.
Their side effect profiles are similar but not identical; common side effects include weight gain, sleepiness, restlessness etc., although some patients taking Vraylar experience fewer metabolic side effects compared to other atypical antipsychotics including Saphris. It's important that patients monitor their moods closely when starting treatment with either drug since worsening of mood or suicidal thoughts warrant immediate medical attention.
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Refrences
- Garnock-Jones, K. P. (2017, May 30). Cariprazine: A Review in Schizophrenia. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40263-017-0442-z
- 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
- Hopkins, C. R. (2010, April 21). ACS Chemical Neuroscience Molecule Spotlight on Saphris. ACS Chemical Neuroscience. American Chemical Society (ACS).http://doi.org/10.1021/cn100022a
- Sajatovic, M., Scheidemantel, T., Korobkova, I., & Rej, S. (2015, December). Asenapine for bipolar disorder. Neuropsychiatric Disease and Treatment. Informa UK Limited.http://doi.org/10.2147/ndt.s78043
- Citrome, L. (2018, October). Cariprazine for acute and maintenance treatment of adults with schizophrenia: an evidence-based review and place in therapy. Neuropsychiatric Disease and Treatment. Informa UK Limited.http://doi.org/10.2147/ndt.s159704