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Cariprazine D3 Pharmacology — MRCPsych Paper B MCQ

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HardSchizophrenia & PsychosisCariprazine D3 PharmacologyMRCPsych Paper B

A 28-year-old woman with schizophrenia and persistent predominant negative symptoms is switched from aripiprazole to cariprazine. The clinical team discusses the receptor profile that distinguishes cariprazine within the dopamine partial-agonist antipsychotics. Which profile most accurately characterises cariprazine?

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Correct answer: D — D3-preferring D3/D2 receptor partial agonism with 5-HT1A partial agonism

Explanation lettering: D = shown as A · E = shown as B · A = shown as C · B = shown as D · C = shown as E

Cariprazine is characterised by **D3-preferring D3/D2 partial agonism**, together with partial agonism at 5-HT1A receptors. Its reported binding affinity is higher for D3 than D2 receptors, and clinically relevant D3 occupancy distinguishes it within the dopamine partial-agonist group. A reverses the dopamine preference and incorrectly assigns 5-HT1A antagonism. C incorrectly describes dopamine antagonism rather than partial agonism. D is wrong because cariprazine has no appreciable muscarinic affinity, and E describes a primarily serotonergic mechanism rather than cariprazine's dopaminergic action. A European RCT found greater improvement in predominant negative symptoms with cariprazine than risperidone, although this clinical result should not be equated with proven general cognitive enhancement.

Reference: Gedeon Richter (UK) Ltd. Reagila hard capsules, Summary of Product Characteristics, section 5.1 Pharmacodynamic properties. Text revised 2026. https://www.medicines.org.uk/emc/product/9487/smpc