Rexulti (Brexpiprazole ) | Add On Depression Medication
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Rexulti Brexpiprazole
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What is Rexulti (brexpiprazole)?

Rexulti (also known as brexpiprazole) is a prescription medication classified as an atypical antipsychotic used to treat mood disorders such as Major Depressive Disorder (MDD) and Schizophrenia. It can be taken on its own or as an add-on when other first-choice medications are not enough.

How does Rexulti Work?

Rexulti is an atypical antipsychotic. Rexulti works by balancing neurotransmitters in your brain. Balancing chemicals like dopamine and serotonin can help with achieving desired changes in thoughts, behaviors, and mood.

Atypical antipsychotics are a form of second-generation antipsychotic treatment, made to improve upon the safety and efficacy of first-generation antipsychotics. They are also known to have fewer neurological side effects, like movement disorders. They work by blocking the excitatory activity of neurotransmitters, helping to regulate mood, behavior, learning, and memory, among other things.

Dosage

Rexulti comes in the following dosages and strengths.

Oral tablet

  • 0.25 mg
  • 0.5 mg
  • 1 mg
  • 2 mg
  • 3 mg
  • 4 mg

For adjunctive treatment of depression, the starting dosage is usually a 0.5 to 1 mg oral tablet once daily, with a target dose of 2 mg daily. Depending on how well the medication works for you, your provider may increase your dosage each week as you adjust to the medication. The maximum daily dose for depression is 3 mg.

For the treatment of schizophrenia, the starting dosage is typically 1 mg once daily on days 1 to 4, then increased to 2 mg once daily on days 5 to 7. The target dose is 4 mg once daily. Your provider will make adjustments or increase your dosage every few days, depending on how well Rexulti works for you. The maximum daily dose for schizophrenia is 4 mg.

Only your healthcare provider can determine the dosage that is best for you and manage your symptoms. If you are elderly, have kidney or liver problems, or take other medications that may interact with Rexulti, your recommended dose may differ.

Do not stop taking Rexulti or adjust your dosage without consulting your healthcare provider first.

Overdose

If someone experiences symptoms, namely fainting or trouble breathing, call emergency services (911) or a poison control center immediately. US resident can call 1-800-222-1222 to reach their local poison control center.

Missed Doses

If you miss your dose of Rexulti, take it as soon as you remember. If it’s nearly time for your next dose, skip the missed dose and take the next dose at your regular time. Do NOT double the dose to catch up.

Side Effects

Common side effects include weight gain and akathisia, or an inability to remain still. This sense of inner restlessness often affects the lower extremities. If Rexulti causes uncontrolled, unusual, or repetitive movements of your face, arms, or legs, contact your healthcare provider, as these may be signs of tardive dyskinesia, which can become permanent.

Monitor your weight carefully while taking Rexulti and notify your provider if you notice significant weight gain, as excessive weight gain may cause other health problems, such as heart or blood sugar conditions. While taking this medication, you may occasionally have bloodwork done to monitor blood sugar, cholesterol, and other health metrics.

Rexulti may impact your body’s ability to thermoregulate. Be sure to drink water to maintain hydration, especially if you are exercising or spending time in hot climates.

When first starting or increasing your dosage of Rexulti, you may experience drops in blood pressure. Dizziness and lightheadedness associated with low blood pressure can increase your risk of falls. When getting up from sitting or lying down, be sure to get up slowly to prevent falling and injury. As you adjust to the medication and dosage, this side effect may lessen. If it persists, talk with your provider.

Sleepiness has been reported in people taking Rexulti. When you are first taking Rexulti or adjusting your dose, be careful and avoid activities where you must be alert. Do not drive a car or operate heavy machinery until you know how it affects you.

If you experience very serious side effects, such as a seizure, get medical help immediately. Other serious side effects, including fainting, trouble swallowing or breathing, as well as increases in impulsive behavior (e.g., gambling, sexual urges, suicidal ideation), should be reported to a doctor right away.

In rare instances, individuals may experience a condition called tardive dyskinesia. Tell your provider immediately if you develop unusual or uncontrollable movements in your face, lips, tongue, arms, or legs.

Serious allergic reactions to this drug are rare. However, if you notice symptoms of an allergic reaction, such as itchiness, rash, swelling/inflammation, dizziness, or trouble breathing, seek emergency help immediately.

Remember that this medication is prescribed because your provider has determined that its benefits are greater than any risks or side effects it may produce. Many people who use Rexulti do not have severe side effects and experience significant improvement in their symptoms.

Warnings & Precautions

It is not known whether Rexulti is safe or effective for children with Major Depressive Disorder.

Rexulti is not a recommended treatment for anyone with dementia-related psychosis. Dementia can cause symptoms of schizophrenia, such as hallucinations and delusions, which should not be treated with Rexulti. It can increase the risk of death for older adults with memory loss (dementia) or other cognitive decline, as it may cause heart problems, stroke, or infections. Let your doctor know if you or a loved one has dementia before starting.

Antidepressants can increase the risk of suicidal thoughts and actions, especially within the first few months of use. When dosages change, children, adolescents, and young adults under the age of 25 may experience a higher risk of suicidal thoughts and actions. Individuals taking new antidepressant medications – as well as their caregivers—should closely monitor for new or worsening symptoms, namely changes in moods, behaviors, thoughts, and feelings. Should these symptoms occur, these changes should be reported to a medical professional immediately.

Difficulty controlling muscle movements is another risk factor of taking Rexulti, particularly for older adults, females aged 65 or older, individuals taking higher than recommended doses, or taking it for an extended period of time. Using the lowest possible dose of Rexulti is the best way to mitigate risk for movement disorders like tardive dyskinesia. If you notice unusual or uncontrollable muscle movements, get medical help immediately. It is possible that this side effect may persist even after cessation of the medication.

Another rare but possible condition associated with taking antipsychotic medication is neuroleptic malignant syndrome (NMS). This condition can lead to death. Symptoms include high fever, muscle stiffness, difficulty thinking clearly, tachycardia (fast heartbeat), heart palpitations, and sweating. Stop taking Rexulti and consult a medical professional right away if any of these symptoms are present.

As a reminder, Rexulti will not cure your condition, but it can help you control your symptoms. Taking medication is one of several available approaches for the treatment of behavioral health disorders.

Storage & Safety

Store your prescription at room temperature. Keep it away from light and high moisture (e.g., away from your bathroom). Keep all medications out of reach of children and pets.

Do not flush or pour medications down the toilet or drain (unless you are told to do so). If this product is no longer needed or has expired, consult your pharmacist or local waste disposal company on how to properly discard your medication.

Drug Interactions

Before taking a new medication, be sure to consult with your provider on all other medications you are currently on. This includes supplements and over-the-counter medications, as they might have active ingredients that interact with the drug.

Consulting with a medical professional can help limit unwanted side effects or drug interactions that may be very risky or even fatal. Be sure to keep a list of all the products you use and share it with your doctor or pharmacist so they can determine the right dosage for you.

Rexulti is known to interact with the following medications:

  • Metoclopramide – both medications can cause abnormal muscle movements a potentially life-threatening condition called neuroleptic malignant syndrome (NMS). Taking multiple medications that cause these effects can increase the risk of developing conditions like NMS. Symptoms of NMS include high fever, racing or uneven heartbeat, stiff muscles, sweating, and other life-threatening symptoms. If these occur, get emergency help right away.

If you are taking other products that cause drowsiness, like opioid pain or cough relievers that contain codeine, depressants such as alcohol, drugs for sleep or anxiety, muscle relaxants, or antihistamines, notify your doctor or pharmacist.

When taking medicines with ingredients that cause drowsiness, ask your pharmacist for advice on how to use those products in a safe manner. By consulting with a medical professional, you can offset or reduce any unwanted symptoms and side effects. If you notice unwanted or severe symptoms, always consult a medical professional.

Alternative Medications

Aside from Rexulti, other antipsychotic drugs can be used to manage symptoms of major depressive disorder and schizophrenia. If you are interested in alternatives to Rexulti, you can discuss the following alternatives with your doctor or psychiatrist.

Haldol: Haldol (haloperidol) is used for the treatment of schizophrenia, Tourette’s syndrome, and other behavioral disorders. Haldol tends to have a high risk for side effects, but it is a lower-cost option because it is generic. Rexulti is a brand name only, so it tends to be more expensive.

Risperdal: Risperdal (or risperidone) treats symptoms of schizophrenia, bipolar disorder, irritability associated with autism spectrum disorder, depression, post-traumatic stress disorder, Tourette syndrome, and behavioral symptoms associated with dementia.

Abilify: Abilify (aripiprazole) is used for the treatment of depression, schizophrenia, bipolar disorder, Tourette’s, and irritability associated with Autism spectrum disorders.

Medications that are similar to Rexulti and used to treat depression or schizophrenia include:

  • Bupropion
  • Cymbalta
  • Sertraline
  • Lexapro
  • Citalopram
  • Fluoxetine

Frequently Asked Questions

The primary difference between typical (1st generation) and atypical (2nd generation) antipsychotics is the type of side effects they may cause. Atypical antipsychotics, like Rexulti, are less likely to cause uncontrolled movements than typical antipsychotics.

Since everyone responds differently, results may vary. In some studies, people have noticed a difference one-to-two weeks after starting treatment, though the full effects of the medication may take up to six weeks.

Rexulti changes the level of chemicals in your body, not only impacting mood and behavior, but other hormones that control appetite, blood sugar, and cholesterol. When taking Rexulti, your provider might monitor your weight, blood sugar, and cholesterol to ensure your levels are not too high. If you presently have diabetes, high cholesterol, or other health concerns that may increase your risk for heart disease, you should plan to discuss the risks and benefits of taking Rexulti with your doctor.

Use of Rexulti while pregnant is not recommended because it has not been studied. Babies born to mothers taking similar medications have developed movement or withdrawal symptoms at birth, namely tremors, agitation, and difficulty nursing. In the even you take Rexulti while pregnant, you are encouraged to report your experience by joining the National Pregnancy Registry for Psychiatric Medications. This registry was developed to monitor use of certain medications throughout pregnancy. If you have questions or concerns about treatment for schizophrenia or depression during pregnancy, consulting your provider(s) is highly recommended.

Feeling fatigued is a possible side effect of taking Rexulti. Lack of energy has been reported in studies of people taking Rexulti to treat depression. In many cases for depression treatment, Rexulti is taken alongside other antidepressant medication which can also cause drowsiness. Side effects related to being tired may improve after several weeks or months of using Rexulti. You should not drive or operate heavy machinery until you have a sense of how Rexulti affects you. If your tiredness or fatigue does not go away or becomes more severe, consult a medical professional.

Sometimes, this medication can increase levels of prolactin in your blood. In turn, this might cause symptoms like unwanted breast milk, missed or stopped menstrual periods, or difficulty becoming pregnant in females. In males, it may result in decreased libido, inability to produce sperm, or enlargement of breasts. If any of these symptoms occur, tell your doctor as soon as possible.

Disclaimer

Pharma Giant provides medical information to help you better understand medications and medical conditions.This content is for informational use only and does not replace advice from a licensed medical practitioner. Consult your doctor or pharmacist before starting or changing any medication. All our partners follow strict safety standards set by their country’s health authorities to make sure you receive safe and high-quality medications.

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Kenneth Fill, PharmD, MBA Fill

Kenneth Fill, PharmD, MBA, is a clinical pharmacist specialist and medical writer with a strong background in ambulatory care, pharmacogenomics, and medical content development. Based in the state of Michigan, he provides expert guidance on chronic disease state management. Kenneth completed his PharmD and MBA at the University of Toledo and pursued post-graduate residency training in ambulatory care and community-based pharmacy. His diverse background also includes academic detailing, clinical education, and interdisciplinary collaboration to enhance patient outcomes.