Key takeaways
- Rexulti is a prescription medication used to treat certain mental health conditions, such as depression.
- This drug can cause side effects, including weight gain, sleepiness, and feeling restless. More serious side effects are possible with Rexulti, but these are not common.
- Rexulti can interact with some medications, such as certain antibiotics.
If you’ve recently been prescribed Rexulti (brexpiprazole), you’ll likely have questions about how to take it and how it works. We’ve compiled this guide to help you know what to expect and how to take Rexulti safely.
Rexulti belongs to a group of drugs called second-generation antipsychotics, also called atypical antipsychotics. These are newer drugs that have fewer serious side effects than older antipsychotic drugs.
Experts aren’t sure exactly how Rexulti works, but it may help balance neurotransmitter levels in your brain, such as dopamine and serotonin.
Rexulti is approved to treat the following issues:
- Depression or major depressive disorder (MDD): Used as an adjunctive (add-on) therapy for adults with MDD alongside an antidepressant when an antidepressant alone has not been effective.
- Schizophrenia: Used to treat schizophrenia in adults and pediatric patients ages 13 years and older.
- Agitation associated with dementia due to Alzheimer’s disease: Used to manage agitation in adults with Alzheimer’s disease. It is prescribed for daily, ongoing use and is not approved as an “as needed” (prn) treatment.
Does Rexulti help with anxiety?
Rexulti is not approved by the Food and Drug Administration (FDA) to treat generalized anxiety disorder or other primary anxiety conditions.
However, doctors may sometimes prescribe Rexulti off-label for anxiety or mood symptoms.
In clinical trials, some people reported restlessness or anxiety as a potential side effect of Rexulti. If you experience heightened anxiety while taking Rexulti, speak with your doctor.
Rexulti comes as round, color-coded oral tablets in six strengths.
- 0.25 milligrams (mg)
- 0.5 mg
- 1 mg
- 2 mg
- 3 mg
- 4 mg
Your doctor will prescribe the right dose for you based on factors like your health and other medications you’re taking. You’ll start with a low dose to see how your body responds. This may increase until your symptoms improve.
The table below shows typical dosages in milligrams (mg).
| Condition | Starting dose | Target dose | Maximum daily dose |
|---|---|---|---|
| MDD (adults) | 0.5 mg or 1 mg once daily | 2 mg once daily | 3 mg once daily |
| Schizophrenia (adults) | 1 mg once daily (days 1 to 4) | 2 mg to 4 mg once daily | 4 mg once daily |
| Schizophrenia (ages 13 to 17) | 0.5 mg once daily (days 1 to 4) | 2 mg to 4 mg once daily | 4 mg once daily |
| Agitation with Alzheimer’s dementia | 0.5 mg once daily (days 1 to 7) | 2 mg once daily | 3 mg once daily |
FAQ: How to take Rexulti
Here are the answers to some frequently asked questions about taking Rexulti:
If you miss a dose of Rexulti, take it as soon as you remember. Do not take a double dose, as it can increase the risk of side effects. If it’s close to when you’d take your next dose, skip the missed dose, then take your usual dose at your regular time.
There’s no specific timeline for using Rexulti. You and your doctor will discuss your treatment plan. If Rexulti is working to reduce your symptoms, you may take it long term.
No, you should take Rexulti tablets whole. Crushing, chewing, or splitting the tablets may change how they work in your body. If you have difficulty taking Rexulti, try these tips for how to swallow pills.
You can take Rexulti with or without food. Eating around the time of your dose does not change how the drug works in your body.
It may take a few days to several weeks for Rexulti to start reducing your symptoms. How quickly the drug works depends on individual factors, such as your condition and how your body responds to Rexulti.
Yes, for schizophrenia and agitation associated with Alzheimer’s dementia, Rexulti is prescribed as monotherapy (taken on its own). However, for MDD, Rexulti must be taken as an adjunctive treatment alongside an antidepressant, such as:
- paroxetine (Paxil)
- sertraline (Zoloft)
- venlafaxine (Effexor XR)
- vortioxetine (Trintellix)
- duloxetine (Cymbalta)
Like most drugs, Rexulti may cause mild or serious side effects.
Rexulti’s common side effects
The most common side effects observed in clinical trials include:
- weight gain
- sleepiness or fatigue
- akathisia (feeling restless)
- dizziness
- nasopharyngitis (the common cold)
Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.
Experiencing side effects? After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you develop a side effect while taking this drug and want to tell the FDA about it, visit MedWatch or call 800-FDA-1088.
Rexulti’s serious side effects
Serious side effects from Rexulti are rare. They include:
- sexual side effects, such as compulsive behaviors including sexual urges
- problems with your metabolism, including type 2 diabetes and issues with lipids (fats)
- increased risk of stroke
- tardive dyskinesia, a disorder that causes involuntary movements
- neuroleptic malignant syndrome (NMS), a rare side effect that causes fast heart rate, high fever, and muscle rigidity
- low white blood cell level
- orthostatic hypotension (sudden drop in blood pressure when you’re standing up), which can lead to syncope (fainting) and falls
- seizures
- difficulty regulating body temperature
- difficulty swallowing
- slowed thinking or reflexes, which may cause problems while driving or operating heavy machinery
- boxed warnings:
- increased risk of death in older adults with psychosis related to dementia
- suicidal thoughts or behavior in children and adults ages 24 years and younger
- allergic reaction, which was not reported in studies of Rexulti, but can still occur
If you have serious side effects from Rexulti, call your doctor right away. If you think you’re having a medical emergency, call 911 or your local emergency number immediately.
Like Rexulti, the following medications are also atypical (second-generation) antipsychotics:
These medications work by helping balance key neurotransmitters in the brain and carry a lower risk of certain severe side effects than older first-generation antipsychotics.
However, each drug has a different active ingredient, a unique set of FDA-approved uses, and is metabolized differently in the body.
Your doctor can help determine the right fit for your health history and treatment goals.
The table below shows how the form, active ingredients, and uses of these medications compare.
| Drug name | Active ingredient | Form | Uses |
|---|---|---|---|
| Rexulti | brexpiprazole | oral tablet | • depression (when taken together with an antidepressant) • schizophrenia • agitation caused by dementia due to Alzheimer’s disease |
| Vraylar | cariprazine | oral capsule | • depression (when taken together with an antidepressant) • schizophrenia • depression due to bipolar I disorder • manic or mixed episodes of bipolar I disorder |
| Seroquel | quetiapine | oral tablet | • schizophrenia • depression due to bipolar I disorder or bipolar II disorder • manic or mixed episodes of bipolar I disorder |
| Abilify | aripiprazole | oral tablet | • depression (when taken together with an antidepressant) • schizophrenia |
| Latuda | lurasidone hydrochloride | oral tablet | • schizophrenia • depression due to bipolar I disorder |
The cost of Rexulti can vary depending on your prescription drug coverage and the pharmacy you choose.
- Commercial insurance: If you have commercial insurance (paid for privately by you or your employer), you may qualify for the Rexulti savings card, which reduces out-of-pocket copays.
- Uninsured or underinsured: If you don’t have insurance or your plan doesn’t cover Rexulti, you can apply for financial assistance through the Otsuka Patient Assistance Foundation.
- Medicare and Medicaid: The price you’ll pay for Rexulti depends on your plan’s drug formulary and Part D phase. Contact your insurer to determine your coverage.
You should not take Rexulti if you have a known allergy or hypersensitivity to brexpiprazole or any of its inactive ingredients.
Rexulti is broken down in the liver by specific enzymes (CYP3A4 and CYP2D6), so combining it with certain medications or supplements can alter its levels in your body and cause serious interactions.
Drugs to avoid with Rexulti include:
- Strong CYP3A4 inhibitors: Certain antibiotics, such as clarithromycin, or antifungal drugs like fluconazole (Diflucan) increase Rexulti exposure and may require a dosage reduction.
- Strong CYP2D6 inhibitors: Drugs such as quinidine, duloxetine (Cymbalta), or paroxetine (Paxil) increase Rexulti levels, which may also require lowering your dose.
- Strong CYP3A4 inducers: Medications like rifampin, carbamazepine (Tegretol, Equetro), and phenytoin (Phenytek, Dilantin) clear Rexulti faster from your system, making it less effective and requiring dosage adjustments.
- Herbal supplements: St. John’s wort reduces Rexulti’s effectiveness and should not be taken during treatment.
Always share a complete list of your prescription drugs, over-the-counter products, vitamins, and herbal supplements with your doctor or pharmacist before starting Rexulti.
Medical PerspectiveWill I need to stop taking Rexulti if I’m taking an antibiotic for an infection?
“It depends on which antibiotic you’re taking. Some antibiotics, particularly macrolides such as clarithromycin and erythromycin, can interact with Rexulti (brexpiprazole) and may require to change your dose. Don’t stop taking Rexulti on your own. Ask your doctor or pharmacist to confirm whether the antibiotic you’re taking is safe to take.”
— Alex Nguyen, PharmD, RPh, CPh
Read more: What Not to Take with Rexulti: An Interaction Safety Guide
Quotes represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
If you’ve recently been prescribed Rexulti, here are some next steps to help you feel prepared:
- Establish a routine: Choose a time of day to take your tablet that is easy to remember, like at bedtime or after breakfast. Set an alarm on your phone or use a medication reminder app to help.
- Track your symptoms and side effects: In a diary or on your phone, make daily notes of your mood, weight, energy levels, or restlessness. Bring these notes to your follow-up appointments to discuss with a doctor.
- Explore financial support: Contact your insurer if you have one to see if your plan covers Rexulti. Check your eligibility for the Rexulti Savings Card or patient assistance programs before filling your first prescription.
Disclaimer: While Healthline strives for factual, comprehensive, and current consumer drug information, this article is not a substitute for a licensed healthcare professional’s expertise. Always consult a doctor before taking or discontinuing any medication. Drug information is subject to change and may not cover all uses, directions, precautions, warnings, interactions, reactions, or adverse effects. The lack of a warning does not guarantee a drug’s safety, effectiveness, or appropriateness for all patients or specific uses. Learn more about our approach to content integrity.
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