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Cariprazine D3 Agonism — MRCPsych Paper B MCQ

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HardSchizophrenia & PsychosisCariprazine D3 AgonismMRCPsych Paper B

A patient with schizophrenia has stable positive symptoms but persistent predominant negative symptoms, without moderate-to-severe depression or clinically relevant parkinsonism. Which statement best links cariprazine's receptor pharmacology with the relevant clinical evidence?

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Correct answer: C — It is a D3-preferring D3/D2 partial agonist; it outperformed risperidone for predominant negative symptoms.

Cariprazine is a dopamine D3-preferring D3/D2 receptor partial agonist, with additional 5-HT1A partial agonism and 5-HT2A/5-HT2B antagonism. In a 26-week trial involving patients with persistent predominant negative symptoms and limited secondary causes, it improved negative symptoms significantly more than risperidone. D3 preference has been proposed as relevant to this effect, although a direct causal mechanism is not established. It is therefore not a pure D2 antagonist. H1 antagonism is present but is not its predominant action, and sedation does not explain the trial result. Cariprazine has no appreciable muscarinic affinity and is not a selective 5-HT2A antagonist.

Reference: Gedeon Richter (UK) Ltd. Reagila Summary of Product Characteristics, sections 5.1 ‘Mechanism of action’ and ‘Efficacy in predominantly negative symptoms of schizophrenia’, text revised 2026. https://www.medicines.org.uk/emc/product/9487/smpc