Clinical Studies in Schizophrenia – Basis for The Safety and Tolerability Profile of Cariprazine
The safety and tolerability of cariprazine was evaluated in all of the clinical studies in the cariprazine development program: a short-term, phase 2 exploratory study, three short-term, phase 3 studies, one long-term, relapse prevention study, two open-label safety studies and one negative symptom study5. The total number of cariprazine-treated patients who were included in the safety dataset was 2728; of these patients, 2048 patients were in the most relevant therapeutic dose range group of 1.5-6 mg/d5.
Excursion: Adverse Events vs. Side Effects
Side effects (adverse reactions) are very common with antipsychotic treatment. Overall, the safety data from the cariprazine studies demonstrated that it was generally safe and well tolerated in patients with schizophrenia1-3. Most of the side effects that were observed with cariprazine are common with antipsychotic treatment and are expected to be familiar to the practicing clinicians. Additionally, many of the events respond to treatment or are transient. The most frequently reported side effects with cariprazine in the therapeutic dose range (1.5-6 mg) were akathisia (19%) and parkinsonism (17.5%)6. Most events however were mild to moderate in severity6.
Table 1. Side effects6
Sleep disorders (insomnia)
Hepatic enzymes increased
Blood creatine phosphokinase increased
Thyroid stimulating hormone decreased
Blood sodium abnormal
Blood glucose increased
Intraocular pressure increased
Visual acuity reduced
Cardiac conduction disorders
T wave abnormal
Blood bilirubin increased
The adverse event profile of cariprazine in the therapeutic 1.5-6 mg/d dose range shows that akathisia, insomnia, and headache occur at relatively high rates, but only the rate of akathisia is substantially higher with cariprazine than with placebo5. Most events of akathisia were considered mild or moderate in severity6.
Reference: Adapted from data in the Reagila Assessment Report EMA. Reagila Assessment Report5 https://www.ema.europa.eu/en/documents/assessment-report/reagila-epar-public-assessment-report_en.pdf.
Highlights of the Safety Profile for Cariprazine
The general safety profile of cariprazine has some benefits compared with other antipsychotics. These include treatment-related changes related to prolactin levels, sexual dysfunction, weight gain and QT prolongation.
- Cariprazine does not cause hyperprolactinemia5; no TEAEs related to elevation of prolactin levels were reported in cariprazine-treated patients in the clinical studies5
- The incidence of sexual dysfunction was low in patients treated with cariprazine(1.0%)5
- Changes in body weight are a known class effect of antipsychotic medications; in the short term studies, there were slightly greater mean increases in body weight in the cariprazine group (1 kg) compared with the placebo group (0.3 kg); in the long term maintenance of effect study, there was no clinically relevant difference in change of body weight from baseline to end of treatment for cariprazine (1.1 kg) and placebo (0.9 kg)6
- Cariprazine is metabolically neutral: rates of hyperlipidemia, hyperglycemia, and diabetes mellitus were comparable to placebo5
- Frequencies of cognition-related adverse events were similar to placebo and uncommon5 some evidence suggests that cariprazine may improve cognition7
- Cariprazine does not cause serious or severe QT prolongation6
- Cariprazine causes less sedation than many other antipsychotics, with rates for cariprazine (3.8%) that are similar to placebo (3.1%)5
- Throughout the cariprazine development program, 6 deaths occurred due to completed suicide, but none were judged to be related to cariprazine5
- Nasrallah, H. A. et al. The safety and tolerability of cariprazine in long-term treatment of schizophrenia: A post hoc pooled analysis. BMC Psychiatry (2017) doi:10.1186/s12888-017-1459-z.
- Earley, W. et al. 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. Int. Clin. Psychopharmacol. 32, 319–28 (2017).
- Németh, G. et al. Cariprazine versus risperidone monotherapy for treatment of predominant negative symptoms in patients with schizophrenia: a randomised, double-blind, controlled trial. Lancet 389, 1103–1113 (2017).
- Acosta, F. J. Medication adherence in schizophrenia. World J. Psychiatry 2, 74–82 (2012).
- EMA. Reagila Assessment Report. https://www.ema.europa.eu/en/documents/assessment-report/reagila-epar-public-assessment-report_en.pdf.
- Reagila SmPC.
- Fleischhacker, W. et al. The efficacy of cariprazine in negative symptoms of schizophrenia: Post hoc analyses of PANSS individual items and PANSS-derived factors. Eur. Psychiatry 58, 1–9 (2019).