What To Know About Rexulti (Brexpiprazole)

An Antipsychotic Medication Used to Treat Depression and Schizophrenia

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Rexulti (Brexpiprazole) is an antipsychotic medication used to treat mental disorders like depression and schizophrenia. The main component of Rexulti is brexpiprazole.

It’s not completely understood how the medication works, but scientists believe that it helps balance chemical messengers like dopamine and serotonin in your brain, which in turn helps to improve some symptoms of depression and schizophrenia.

Uses

Rexulti is approved by the FDA for the treatment of the following disorders: 

  • Major Depressive Disorder (MDD): Rexulti is prescribed as adjunct treatment for people with MDD who aren’t responding well to antidepressant medications. It is used alongside anti-depressant medication and not instead of it. 
  • Schizophrenia: Rexulti isn’t a cure for schizophrenia, instead it’s used to manage symptoms of the condition. The most common symptoms of schizophrenia include hallucinations, delusions, and difficulty thinking. Rexulti is used to reduce the severity of these symptoms. 

Off-Label Uses 

Even though Rexulti is only approved by the FDA for the treatment of MDD and schizophrenia, the medication is currently being studied by researchers and medical experts for the treatment of the following conditions: 

  • Borderline Personality Disorder: Some research shows that Rexulti might help improve symptoms of mood instability and impulsivity in people with borderline personality disorder. 
  • Bipolar Disorder: The medication is sometimes used off-label to treat the mood and thought symptoms of bipolar disorder.

Before Taking

Rexulti is a prescription-only medication, which means it can’t be bought over the counter and can only be prescribed to you by a doctor.

Before your doctor prescribes Rexulti, a thorough examination of your medical and family history will be conducted.

People who have a medical history of diabetes, seizures, low or high blood pressure, or a low white blood cell count require added caution or may not be administered Rexulti.

Precautions and Contraindications

If you have a history of a brexpiprazole allergy, you should not be taking Rexulti.

Signs of an allergic reaction to brexpiprazole are difficulty breathing, itching, hives, swelling of the mouth, face, or tongue.

Using Rexulti might raise your temperature and cause you to become dehydrated more quickly, especially in hotter weather.

Remember to keep hydrated at all times and avoid situations that could cause your body to overheat such as sitting too long in the sun.

Dosage

The dosage your doctor will prescribe usually depends on a number of factors which include the severity of your condition, your tolerability for the drug, other medical conditions you might have, and any medications you might be taking.

Your doctor is most likely to start you off with a low dosage and steadily increase it as your treatment progresses.

MDD

Rexulti is used as an adjunctive treatment for treating MDD. This means that it is usually prescribed alongside other medications for depression.

Your doctor would typically recommend you start at 0.5 milligrams to 1 milligram once a day.

Your medical condition and its symptoms will be closely monitored during this period. If this dosage is ineffective for you, your doctor might up it to a maximum of 3 milligrams, which should be taken once a day. 

Schizophrenia

For the treatment of schizophrenia the typical recommended starting dose is 1 milligram, which is taken once a day.

Your doctor will closely monitor your progress with the treatment and up your dosage if required. However, the maximum dosage that can be given is 4 milligrams, taken once a day. 

How to Take and Store

It’s important to follow your doctor’s exact prescription when taking Rexulti. Even when you start to feel better when using this medication, you shouldn’t discontinue use without first consulting with your doctor.

Doing this might cause your symptoms to reoccur, sometimes even more aggressively than before. 

You might take the medication with or without food. You should store this medication in a cool and dry place, at room temperature.

If you miss a dose of your medication, don’t worry, just take it as soon as you remember. If you remember when it’s time for your next dose, don’t take two doses, just skip the missed dose.

Side Effects 

You might experience some side effects when using Rexulti. In most cases, they will be able to be managed. However, you should speak to your doctor if you are experiencing any problematic side effects. 

Common

Some of the most common side effects of Rexulti include:

  • Weight gain
  • Headache 
  • Drowsiness 
  • Anxiety
  • Constipation
  • Fatigue
  • Restlessness 

Severe

In rare cases, some severe side effects that may occur while using Rexulti include: 

  • Increased risk of strokes in elderly people with dementia
  • Uncontrolled body movements 
  • Neuroleptic malignant syndrome (NMS), which is a condition that occurs as a reaction to antipsychotic drugs. Symptoms of NMS include a high fever, stiff muscles, excessive sweating, confusion, and changes in your heart rate and blood pressure. 
  • Increase in blood sugar
  • Seizures 
  • Low white blood cell count 

If you experience any of these symptoms you should report it to your doctor as soon as you can. 

Warnings and Interactions

The effects of Rexulti in people under the age of 18 hasn’t been studied.

Research suggests that antipsychotic medication like Rexulti can increase the risk of death when used in people with dementia-related psychosis.

One of the more serious side effects of this medication is an increase in blood sugar, if you are diabetic or have a family history of diabetes, you should check your blood sugar frequently when using this medication. 

When using Rexulti as an adjunct to antidepressants, antidepressant medications may increase suicidal thoughts or behaviors in children, teenagers, and young adults. It’s important to talk to your doctor or someone you trust if you start having these thoughts.

If a loved one just started using Rexulti, it’s important to monitor them closely for any changes in their moods and behaviors.

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5 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Diefenderfer LA, Iuppa C. Brexpiprazole: A review of a new treatment option for schizophrenia and major depressive disorder. Ment Health Clin. 2018;7(5):207-212.

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  4. National Alliance on Mental Illness. Brexpiprazole (Rexulti). Updated February 2020.

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