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What is Rexulti (brexpiprazole)?
Rexulti (also known as brexpiprazole) is a prescription antidepressant drug often utilized for treatment of mood disorders like 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 less 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.
Rexulti comes in the following dosages and strengths.
- 25 mg
- 5 mg
- 1 mg
- 2 mg
- 3 mg
- 4 mg
For treatment of depression, the starting dosage is usually a 0.5 to 1 mg oral tablet, taken 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 treatment of schizophrenia, the starting dosage is typically a 1 mg oral tablet, taken daily. Your provider make adjust 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 managing 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 with your healthcare provider first.
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.
If you miss your dose of Rexulti, take it as soon as you remember. If it nearly time for your next dose, skip the missed dose and take next dose at your regular time. Do NOT double the dose to catch up.
Common side effects include weight gain and akathisia, or an inability to remain still. This sense of inner restlessness often affects lower extremities. If Rexulti causes uncontrolled, unusual, or repetitive movements of your face, arms, or legs, contact your healthcare provider, as they 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 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 noticed 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 benefit is 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 risk of suicidal thoughts and actions, especially within the first few months of use. When dosages change, children, adolescents, and adults may experience 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 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 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 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 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 from 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 expired, consult your pharmacist or local waste disposal company on how to properly discard your medication.
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 noticed unwanted or severe symptoms, always consult a medical professional.
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 treatment of schizophrenia, Tourette’s syndrome, and other behavioral disorders. Haldol tends to have a high risk for side effects, but is a lower-cost option because it is generic. Rexulti is 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: Ability (aripiprazole) is used for treatment of depression, schizophrenia, bipolar disorder, Tourette’s, and irritability associated with Autism spectrum disorders.
Medications that are similar to Rexulti and used treatment of depression or schizophrenia include: