Vraylar vs. Invega

See how Vraylar and Invega compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Vraylar is FDA-approved for four conditions (schizophrenia, bipolar mania, bipolar depression, and add-on MDD), while Invega covers only schizophrenia and schizoaffective disorder.

  • Invega offers long-acting injectable versions given monthly, every three months, or every six months, while Vraylar comes only as a daily oral capsule.

  • Both drugs carry a boxed warning for increased risk of death in elderly patients with dementia-related psychosis, a use neither is approved for.

Vraylar vs. Invega Drug Summary

Vraylar

Vraylar (cariprazine) is an atypical antipsychotic taken as a once-daily oral capsule, with or without food. It is FDA-approved for schizophrenia, manic or mixed episodes of bipolar I disorder, depressive episodes of bipolar I disorder, and as an add-on to antidepressants for major depressive disorder.

Invega

Invega (paliperidone) is an atypical antipsychotic taken as a once-daily oral extended-release tablet. It is FDA-approved for schizophrenia in adults and adolescents ages 12 to 17, and for schizoaffective disorder in adults, as monotherapy or added to mood stabilizers and antidepressants.

Vraylar vs. Invega Side Effects

Vraylar

Most common
Extrapyramidal symptoms (up to 19%)
Akathisia (up to 13%)
Somnolence (up to 7%)
Restlessness (up to 7%)

Invega

Most common
Extrapyramidal symptoms (up to 13%)
Akathisia (up to 12%)
Insomnia (up to 15%)
Sedation/somnolence (up to 7%)

Vraylar vs. Invega Dosage

Vraylar

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1.5 mg once daily Day 1
Maximum dose 6 mg once daily If needed
Dose changes 3 increases Every day

Invega

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 3 mg once daily At the start
Maximum dose 12 mg once daily If needed
Dose changes 3 increases As tolerated

Vraylar vs. Invega Indications

Vraylar

Vraylar covers a broad range of approved uses: schizophrenia, bipolar I mania or mixed episodes, bipolar I depression, and add-on therapy for major depressive disorder. It is approved for adults, with additional pediatric indications for schizophrenia and bipolar mania.

  • Schizophrenia in adults and adolescents 13+

  • Manic or mixed bipolar I episodes (adults and youth 10+)

  • Depressive episodes of bipolar I disorder (adults)

  • Add-on therapy for major depressive disorder (adults)

  • Not approved for schizoaffective disorder (off-label only)

Invega

Invega is approved for schizophrenia in adults and adolescents ages 12 to 17, and for schizoaffective disorder in adults, either alone or combined with mood stabilizers and antidepressants. It has been available since 2006 and also comes in long-acting injectable versions for maintenance treatment.

  • Schizophrenia in adults and adolescents 12-17

  • Schizoaffective disorder in adults, as monotherapy

  • Schizoaffective disorder as add-on to mood stabilizers/antidepressants

  • Not approved for bipolar disorder or depression

  • Not approved for dementia-related psychosis

Vraylar vs. Invega Pros and Cons

Vraylar

Vraylar's broad FDA approval across schizophrenia, bipolar mania, bipolar depression, and adjunctive MDD gives prescribers more flexibility than most antipsychotics. As a newer brand-only drug, it has no generic option, which can affect insurance coverage for some patients.

Pros

  • FDA-approved for bipolar depression and add-on MDD, not just schizophrenia

  • D3-receptor activity may help with negative symptoms of schizophrenia

  • Long half-life means a single missed dose is less likely to cause a gap in coverage

Cons

  • Only available as a daily oral capsule, no long-acting injectable option

  • No generic version currently available, unlike many older antipsychotics

  • Not approved for schizoaffective disorder; that use is off-label only

Invega

Invega's OROS tablet and long-acting injectable formulations make it a flexible option for patients who struggle with daily pill-taking. Its narrower FDA approval covers schizophrenia and schizoaffective disorder only, without coverage for mood episodes.

Pros

  • Available as long-acting injectables given monthly, every 3, or every 6 months

  • FDA-approved for schizoaffective disorder, unlike Vraylar

  • Longer track record, FDA-approved since 2006

Cons

  • Not approved for bipolar disorder or major depressive disorder

  • Requires dose adjustment based on kidney function

  • Tablet shell may pass intact into stool, which can concern some patients

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