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Rexulti
Rexulti (generic name: brexpiprazole) is a prescription atypical antipsychotic medication used to treat schizophrenia and as an adjunct treatment for major depressive disorder (MDD) in adults. It works by balancing certain neurotransmitters in the brain, particularly dopamine and serotonin, to improve mood, thinking, and behavior. Rexulti is effective in reducing the symptoms of schizophrenia, such as hallucinations and delusions, and is also prescribed to improve depressive symptoms when antidepressants alone are not sufficient.
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Frequently Asked Questions
How long does it take for Rexulti to start working?
It may take several weeks to notice the full effects of Rexulti, although some improvement in mood or psychotic symptoms may be seen within the first 1 to 2 weeks of treatment.
Can I take Rexulti with my antidepressant?
Yes, Rexulti is often prescribed as an adjunct to antidepressants for the treatment of major depressive disorder when antidepressants alone are not sufficient. Always follow your doctor’s recommendations for combining medications.
Does Rexulti cause weight gain?
Weight gain is a common side effect of Rexulti. Monitoring your weight and discussing any significant changes with your doctor is important.
What should I do if I miss a dose of Rexulti?
If you miss a dose, take it as soon as you remember unless it’s close to your next scheduled dose. Do not double up on doses to make up for a missed one.
Can Rexulti cause drowsiness?
Yes, Rexulti may cause drowsiness or sedation in some individuals. Avoid driving or operating heavy machinery until you know how the medication affects you.
Comprehensive Drug Guide
How Does Rexulti Work?
Rexulti works by acting as a partial agonist at dopamine D2 receptors and serotonin 5-HT1A receptors, while antagonizing serotonin 5-HT2A receptors. This action helps to regulate mood, improve depressive symptoms, and reduce psychotic symptoms such as hallucinations and delusions. Rexulti's dual action on both dopamine and serotonin pathways helps balance neurotransmitter activity, making it effective for treating both schizophrenia and depression.
Common Dosages
- 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, and 4 mg tablets.
Typical Dosing
- For schizophrenia: The recommended starting dose is 1 mg once daily. The dose is usually increased to a target dose of 2 to 4 mg once daily.
- For adjunctive treatment of major depressive disorder: The starting dose is 0.5 mg to 1 mg once daily. The dose can be increased to a maximum dose of 3 mg once daily depending on the response and tolerability.
- Rexulti can be taken with or without food.
Typical Dosing
FDA Approved Indications
- Treatment of schizophrenia in adults.
- Adjunctive therapy for major depressive disorder (MDD) in adults when antidepressants alone are not effective.
Who Shouldn't Take Rexulti?
- Known hypersensitivity to brexpiprazole or any component of the formulation.
Advice From The Pharmacist
- Rexulti should be taken at the same time every day, with or without food. Consistency in dosing helps maintain stable drug levels in the body.
- Avoid consuming alcohol while taking Rexulti, as it can enhance the sedative effects and impair thinking or motor skills.
- If you miss a dose, take it as soon as you remember. If it’s close to the time for your next dose, skip the missed dose and continue with your regular schedule. Do not double up on doses.
- It may take several weeks for Rexulti to have its full effect. Continue taking the medication even if you don’t feel immediate improvement in your symptoms.
- Store Rexulti at room temperature, away from moisture and heat.
Side Effects of Rexulti
Common Side Effects
- Weight gain
- Restlessness or inability to sit still (akathisia)
- Drowsiness
- Dizziness
- Fatigue
Uncommon/Severe Side Effects
- Increased risk of suicidal thoughts or behaviors in young adults and adolescents with depression
- Neuroleptic malignant syndrome (NMS), a rare but life-threatening reaction characterized by muscle stiffness, fever, and confusion
- Tardive dyskinesia, involuntary muscle movements that can become permanent
- Orthostatic hypotension, or sudden drops in blood pressure when standing
Risks and Warnings of Rexulti
- Increased Mortality in Elderly Patients with Dementia-Related Psychosis: Rexulti is not approved for use in elderly patients with dementia-related psychosis due to an increased risk of death.
- Suicidal Thoughts and Behaviors: Antidepressants, including Rexulti when used for MDD, may increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Close monitoring is essential during the early stages of treatment.
- Metabolic Changes: Rexulti can cause weight gain, increases in blood sugar, and changes in cholesterol levels. Regular monitoring of these factors is recommended.
- Tardive Dyskinesia: Prolonged use of antipsychotic medications, including Rexulti, may cause tardive dyskinesia, which involves involuntary, repetitive movements of the face and body.
Interactions with Rexulti
Common Drug Interactions
- CYP3A4 inhibitors (e.g., ketoconazole) and CYP2D6 inhibitors (e.g., fluoxetine): These drugs may increase the levels of Rexulti in the blood, requiring a lower dose.
- CYP3A4 inducers (e.g., rifampin): These medications can decrease the effectiveness of Rexulti by reducing its levels in the bloodstream, which may require a dose adjustment.
- Other CNS depressants: Combining Rexulti with alcohol, opioids, or sedatives can increase the risk of drowsiness and impair cognitive and motor functions.
Alternatives to Rexulti
- Abilify (aripiprazole): Another atypical antipsychotic used for schizophrenia and as an adjunct for depression.
- Latuda (lurasidone): An atypical antipsychotic used to treat schizophrenia and bipolar depression.
- Seroquel (quetiapine): Atypical antipsychotic used for schizophrenia, bipolar disorder, and as an adjunct for depression.
- Zyprexa (olanzapine): Another antipsychotic used for schizophrenia and bipolar disorder.
