[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Second-generation antipsychotics](https://durgical.com/en/pharmacology/classes/second-generation-antipsychotics/) › Cariprazine

# Cariprazine

## Second-generation antipsychotics?

Second-generation antipsychotics

A D2 and D3 partial agonist that prefers D3; used in schizophrenia, bipolar disorder and depression. Its active metabolite lingers for weeks.

Updated Nov 1, 2026

## Quick facts

**Group**
[Second-generation antipsychotics](https://durgical.com/en/pharmacology/classes/second-generation-antipsychotics/)

**Target**
Dopamine D3 and D2 receptors (partial agonist); D3 shown

**Used for**
Schizophrenia · Bipolar I disorder

**Key effects**
Akathisia · Extrapyramidal effects · Tiredness

**Monitor**
Akathisia and extrapyramidal signs · Weight

**ATC**
N05AX15

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◎**Dopamine D3 and D2 receptors (partial agonist); D3 shown**Cariprazine

ⓘ The figure shows cariprazine bound to the human dopamine D3 receptor (with its G protein), the receptor it prefers.

**Target in 3D:** Dopamine D3 and D2 receptors (partial agonist); D3 shown. PDB structure 9T8C (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/9T8C) · Drag to rotate · pinch to zoom

Cariprazine is a partial agonist at dopamine D2 and D3 receptors with higher affinity for D3. Like other partial agonists it lowers dopamine signalling where it is excessive. D3 receptors are concentrated in limbic areas, and its D3 action has been linked to effects on negative symptoms and cognition in some studies. CYP3A4 turns it into two active metabolites; one of them (DDCAR) is eliminated very slowly.

- Cariprazine partly activates D3 (preferred) and D2
- Lowers excessive dopamine signalling: less psychosis and mania
- CYP3A4 makes active metabolites; DDCAR lasts for weeks
- Common side effects: akathisia and restlessness

## Indications

- Schizophrenia [Schizophrenia →](https://durgical.com/en/conditions/schizophrenia/)
- Bipolar I disorder: manic or mixed episodes and depressive episodes [Bipolar disorder →](https://durgical.com/en/conditions/bipolar-disorder/)
- Major depressive disorder [Major depressive disorder →](https://durgical.com/en/conditions/major-depressive-disorder/)

## Adverse effects

### Common

- Akathisia, restlessness and insomnia
- Extrapyramidal effects: unusual movements, stiffness, poor balance
- Tiredness, dizziness, nausea, constipation
- Increased appetite and weight gain

### Serious (rare, important)

- Higher mortality in older people with dementia-related psychosis (boxed warning)
- Suicidal thoughts in young people treated for depression (boxed warning)
- Neuroleptic malignant syndrome; tardive dyskinesia
- Hyperglycaemia and diabetic ketoacidosis
- Low white cell count; seizures; orthostatic hypotension

## Contraindications

- Hypersensitivity to cariprazine

## Key interactions

**Strong CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin)**
Several-fold higher cariprazine exposure; the amount is reduced

**CYP3A4 inducers (rifampicin, carbamazepine, St John's wort)**
Not recommended: unpredictable, lower levels

## What is monitored

- Akathisia and extrapyramidal signs, which may appear weeks after a change
- Weight, glucose and lipids
- Mood and suicidal thoughts in young people

## Administration and safety

- Because of the long-lived metabolite, the effects of a change and side effects appear and fade over weeks
- Every new drug is checked for CYP3A4 inhibition or induction

## Pregnancy and breastfeeding

Newborns exposed in the third trimester may have extrapyramidal or withdrawal symptoms; use weighs benefit and risk.

## Nursing care

- Asks about restlessness, the urge to move, tremor and stiffness, also several weeks after a change
- Records weight, glucose and lipids
- Teaches the patient to report thirst, frequent urination or blurred vision (high glucose)
- Advises getting up slowly and drinking enough fluids in hot weather

## Pharmacokinetics

**Absorption**
Taken by mouth, with or without food

**Metabolism**
Liver, by CYP3A4 (CYP2D6 minor) to the active metabolites DCAR and DDCAR

**Half-life**
Parent drug about 1 to 3 days; DDCAR about 13 to 19 days, so about half is still present a week after stopping

## Memory aid

«CARIprazine CARRIES on»: it prefers D3, and its metabolite carries on for weeks after the last capsule.

## Test yourself

Think of the answer, then tap the question to see it.

## Which dopamine receptor does cariprazine prefer?

D3 (it is a partial agonist at D3 and D2, with higher affinity for D3).

## Why can side effects of cariprazine appear or persist weeks after a change?

Its active metabolite DDCAR has a half-life of about two weeks.

## What is the most typical movement side effect?

Akathisia (inner restlessness).

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/cariprazine/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 2

- [Aripiprazole](https://durgical.com/en/pharmacology/aripiprazole/)
- [Brexpiprazole](https://durgical.com/en/pharmacology/brexpiprazole/)

## Related conditions 3

- [Schizophrenia](https://durgical.com/en/conditions/schizophrenia/)
- [Bipolar disorder](https://durgical.com/en/conditions/bipolar-disorder/)
- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)

[← Back to the class: Second-generation antipsychotics](https://durgical.com/en/pharmacology/classes/second-generation-antipsychotics/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Cariprazine: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a615050.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N05AX15) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/cariprazine/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/cariprazine/