Rexulti is an atypical antipsychotic medication that belongs to a class of drugs known as dopamine receptor partial agonists. It is primarily used to treat adults with conditions such as schizophrenia and major depressive disorder (MDD). Rexulti works by restoring the balance of certain chemicals in the brain, thereby alleviating symptoms associated with these mental health disorders.

Rexulti acts as a partial agonist at the dopamine D2 and serotonin 5-HT1A receptors. By binding to these receptors, Rexulti can either activate or inhibit their activity, depending on the specific brain region. In schizophrenia, Rexulti helps to reduce dopamine activity in the mesolimbic pathway, which is believed to contribute to psychotic symptoms.

Rexulti also affects serotonin neurotransmission. By acting as a partial agonist at the serotonin 5-HT1A receptor, it helps to enhance serotonin signaling in certain brain regions. Serotonin is a neurotransmitter known to regulate mood, sleep, appetite, and other important functions. By modulating serotonin, Rexulti can help improve mood and reduce depressive symptoms in individuals with MDD.

By modulating both dopamine and serotonin neurotransmission, Rexulti works to restore the balance of these chemicals in the brain. This rebalancing effect helps to alleviate symptoms associated with schizophrenia and major depressive disorder, providing relief and improving overall well-being.

What is Rexulti Used For?

Rexulti is prescribed for the treatment of two main conditions: schizophrenia and major depressive disorder (MDD). Let’s explore the uses of Rexulti for each of these conditions:

Schizophrenia

Rexulti is approved by the U.S. Food and Drug Administration (FDA) as an adjunctive therapy for the treatment of schizophrenia. It can be used alongside other medications to reduce symptoms of schizophrenia, such as hallucinations, delusions, disorganized thinking, and emotional withdrawal.

Major Depressive Disorder (MDD)

In addition to treating schizophrenia, Rexulti is also used as an adjunctive treatment for adults with major depressive disorder (MDD). MDD is a severe form of depression that affects a person’s daily life, including their emotions, thoughts, and behavior. Rexulti can be prescribed alongside an antidepressant to help improve mood and alleviate depressive symptoms.

Warnings and Precautions

Rexulti works by affecting certain chemicals in the brain to help improve mood, thinking, and behavior. It is essential to be aware of the warnings and precautions associated with Rexulti to ensure its safe and effective use.

  • Allergic Reactions: If you have a known allergy to brexpiprazole or any other ingredients present in Rexulti, it is important to avoid using this medication. Allergic reactions to Rexulti can range from mild to severe and may include symptoms such as rash, itching, swelling, or difficulty breathing. In case of an allergic reaction, seek immediate medical attention.
  • Elderly Patients: Elderly patients may be more susceptible to the side effects of Rexulti, particularly movement disorders such as parkinsonism. Careful monitoring and dosage adjustment may be necessary for older individuals to minimize the risk of adverse effects.
  • Pregnancy and Breastfeeding: If you are pregnant, planning to become pregnant, or breastfeeding, it is essential to discuss the potential risks and benefits of using Rexulti with your healthcare provider. While there is limited data on the effects of Rexulti during pregnancy and breastfeeding, it is generally recommended to avoid using this medication unless the benefits outweigh the risks.
  • Suicidal Thoughts and Behavior: In some cases, antidepressant medications, including Rexulti, have been associated with an increased risk of suicidal thoughts and behavior, especially in children, adolescents, and young adults. If you or your loved ones experience worsening depression, thoughts of self-harm, or any unusual changes in behavior, seek immediate medical attention.
  • Central Nervous System Effects: Rexulti may cause drowsiness or dizziness. Avoid driving, operating heavy machinery, or engaging in activities that require mental alertness until you know how this medication affects you. It is advisable to start with a low dose and gradually increase it to minimize these effects.
  • Weight Gain and Metabolic Effects: Some individuals may experience weight gain, increased cholesterol levels, or elevated blood sugar levels while taking Rexulti. Regular monitoring of weight, cholesterol, and blood glucose levels is recommended during treatment. Adopting a healthy lifestyle, including a balanced diet and regular exercise, can help manage these potential side effects.
  • Seizures: Rexulti may lower the seizure threshold, increasing the risk of seizures, especially in individuals with a history of seizures or epilepsy. If you have a seizure disorder, discuss the potential risks and benefits of Rexulti with your healthcare provider before starting treatment.
  • Heat Exposure: Rexulti may impair the body’s ability to regulate temperature. Avoid exposure to extreme heat, such as saunas or prolonged sun exposure, as it can increase the risk of heatstroke or dehydration. Stay hydrated and seek shade or air-conditioned environments during hot weather.
  • Liver Function: Rexulti may affect liver function. Regular liver function tests may be necessary during treatment to monitor for any abnormalities. If you have a history of liver disease or alcohol abuse, inform your healthcare provider before starting Rexulti.
  • Blood Pressure Changes: Rexulti may cause changes in blood pressure, including orthostatic hypotension (a sudden drop in blood pressure upon standing). To minimize the risk of dizziness or fainting, rise slowly from a seated or lying position. If you experience persistent dizziness or lightheadedness, consult your healthcare provider.
  • Movement Disorders: Some individuals may experience movement disorders, such as tremors, stiffness, or uncontrollable muscle movements, while taking Rexulti. If you notice any abnormal movements, inform your healthcare provider immediately.
  • Eye Disorders: Rexulti may cause blurred vision or other changes in vision. If you experience any visual disturbances while taking this medication, consult your healthcare provider.
  • Renal Impairment: Patients with severe renal impairment may require dosage adjustments when taking Rexulti. Discuss your kidney function with your healthcare provider to ensure safe and effective use of this medication.
  • Hypersensitivity Reactions: Rarely, Rexulti may cause severe allergic reactions, including anaphylaxis. Seek immediate medical attention if you experience symptoms such as difficulty breathing, swelling of the face or throat, or severe skin rash.
  • Withdrawal Symptoms: Abruptly discontinuing Rexulti may result in withdrawal symptoms such as dizziness, nausea, irritability, and insomnia. If you and your healthcare provider decide to stop Rexulti, a gradual dose reduction is typically recommended.
  • Pediatric Use: Rexulti is not approved for use in children and adolescents under the age of 18 for any indication. The safety and effectiveness of Rexulti in this age group have not been established.
  • Geriatric Use: While Rexulti can be used in elderly patients, caution is advised due to the increased risk of movement disorders and other side effects. Dosage adjustments and close monitoring are often necessary for older individuals.

Side Effects

When it comes to understanding the potential side effects of medication, it is crucial to gather reliable information to make informed decisions.

Common Side Effects

  • Nausea: Some individuals may experience a feeling of queasiness or discomfort in the stomach after taking Rexulti. This side effect is usually mild and temporary.
  • Diarrhea: In some cases, Rexulti can lead to loose or watery stools. It is advisable to stay hydrated and consult your healthcare provider if this side effect persists.
  • Headaches: Certain individuals may experience headaches as a side effect of Rexulti. These headaches are typically mild and can be relieved with over-the-counter pain medications.
  • Dizziness: Some people may feel lightheaded or dizzy when starting Rexulti. It’s important to take precautionary measures and avoid activities that require focus or coordination until these symptoms subside.
  • Insomnia: Rexulti can sometimes interfere with sleep patterns, leading to difficulty falling asleep or staying asleep. If you experience sleep disturbances, discuss it with your doctor who may suggest adjusting the timing or dosage of the medication.
  • Weight Gain: A potential side effect of Rexulti is weight gain. It is advisable to monitor your weight while taking this medication and consult your healthcare provider if you notice any significant changes.
  • Dry Mouth: Dryness of the mouth is a common side effect associated with Rexulti. Staying hydrated and chewing sugarless gum can help alleviate this symptom.

Rare Side Effects

  • Allergic Reactions: While rare, some individuals may experience an allergic reaction to Rexulti. Symptoms may include hives, difficulty breathing, or swelling of the face, lips, tongue, or throat. If you experience any signs of an allergic reaction, seek immediate medical attention.
  • Restlessness: In rare cases, Rexulti may cause restlessness or an uncontrollable urge to move. This condition, known as akathisia, can be distressing. Inform your healthcare provider if you experience these symptoms.
  • Muscle Stiffness: Rexulti may lead to muscle stiffness or rigidity. This side effect requires medical attention, as it could be a sign of a serious condition called extrapyramidal symptoms.
  • Depression: While Rexulti is primarily used to treat depression, it may, paradoxically, cause or worsen depressive symptoms in some individuals. Monitor your mood closely and consult your doctor if you notice any significant changes.
  • Suicidal Thoughts: In rare cases, Rexulti may trigger or intensify suicidal thoughts. It’s essential to seek immediate medical help if you experience suicidal ideation or notice such changes in yourself or a loved one.
  • Irregular Heartbeat: Rarely, Rexulti may cause an irregular heartbeat, also known as arrhythmia. If you experience heart palpitations, chest pain, or any other signs of an irregular heartbeat, seek medical attention promptly.

Severe Side Effects

  • Neuroleptic Malignant Syndrome (NMS): Although rare, Rexulti may lead to a severe condition called neuroleptic malignant syndrome. Symptoms may include high fever, stiff muscles, confusion, and changes in blood pressure. If you experience these symptoms, seek immediate medical attention.
  • Tardive Dyskinesia (TD): Tardive dyskinesia is a serious side effect that can occur after long-term use of antipsychotic medications like Rexulti. It manifests as repetitive, involuntary movements, usually of the face, lips, or limbs. If you notice any unusual movements, inform your healthcare provider.
  • Hyperglycemia and Diabetes: In rare cases, Rexulti may cause high blood sugar levels (hyperglycemia) or contribute to the development of diabetes. It is essential to monitor your blood sugar levels regularly, especially if you have a pre-existing condition or are at risk for diabetes.
  • Seizures: While uncommon, seizures can occur as a severe side effect of Rexulti. If you have a history of seizures or are at risk for seizures, discuss it with your healthcare provider before starting this medication.
  • Low White Blood Cell Count: Rexulti may rarely cause a decrease in white blood cells, which are essential for fighting off infections. If you experience signs of infection such as fever, sore throat, or flu-like symptoms, seek medical attention promptly.
  • Serotonin Syndrome: In rare cases, Rexulti may lead to serotonin syndrome when combined with other medications that increase serotonin levels. Symptoms may include agitation, hallucinations, rapid heartbeat, and increased body temperature. If you experience these symptoms, seek immediate medical attention.
  • Elevated Prolactin Levels: Rexulti can cause an increase in prolactin levels, leading to symptoms such as breast enlargement, breast pain, or changes in menstrual periods. If you notice these symptoms, consult your doctor.
  • Vision Problems: Severe vision problems, including blurred vision or difficulty focusing, are rare but possible side effects of Rexulti. If you experience any changes in your vision, inform your healthcare provider.
  • Liver Problems: In rare instances, Rexulti may lead to liver problems. Symptoms may include jaundice (yellowing of the skin and eyes), dark urine, or persistent nausea. If you notice any of these symptoms, seek medical attention.
  • Allergic Skin Reactions: Some individuals may develop an allergic skin reaction to Rexulti. Symptoms may include a rash, itching, or swelling. Discontinue the medication and consult your healthcare provider if you experience these symptoms.
  • Fainting: Rexulti can rarely cause fainting or a sudden loss of consciousness. It is essential to be cautious when getting up from a lying or sitting position to prevent injuries from falls.
  • Difficulty Swallowing: In rare cases, Rexulti may lead to difficulty swallowing or a feeling of something being stuck in the throat. If you experience these symptoms, seek medical attention.
  • Sexual Side Effects: Rexulti may affect sexual function in some individuals. Common sexual side effects include decreased libido, difficulty achieving orgasm, or erectile dysfunction. Discuss any concerns with your doctor.
  • Withdrawal Symptoms: If you abruptly stop taking Rexulti, you may experience withdrawal symptoms such as nausea, vomiting, insomnia, anxiety, or irritability. It’s essential to gradually reduce the dosage under medical supervision when discontinuing the medication.
  • Cognitive Impairment: While rare, Rexulti may cause cognitive impairment, including confusion or memory problems. If you notice any changes in your cognitive function, inform your healthcare provider.

Drug Interactions

Rexulti is a commonly prescribed medication for the treatment of various mental health disorders. However, it’s important to be aware of the potential drug interactions that can occur when taking Rexulti alongside other medications.

  • Selective Serotonin Reuptake Inhibitors (SSRIs): Drugs such as fluoxetine, sertraline, and escitalopram, commonly prescribed for depression and anxiety, can interact with Rexulti and increase the risk of serotonin syndrome—a potentially life-threatening condition characterized by agitation, hallucinations, rapid heartbeat, and high body temperature.
  • Monoamine Oxidase Inhibitors (MAOIs): The concurrent use of Rexulti with MAOIs, often prescribed for depression, can lead to a dangerous increase in blood pressure, potentially resulting in a hypertensive crisis.
  • CYP2D6 Inhibitors: Medications that inhibit the CYP2D6 enzyme, responsible for metabolizing Rexulti, can increase the drug’s blood levels. Examples include paroxetine, fluoxetine, and bupropion.
  • Antihypertensive Medications: Certain blood pressure medications, such as beta-blockers or alpha-blockers, may interact with Rexulti and lead to an additive effect, causing excessive lowering of blood pressure.
  • Anticonvulsant Drugs: Drugs like carbamazepine and phenytoin, used to manage epilepsy, may decrease the blood levels of Rexulti, reducing its effectiveness.
  • Benzodiazepines: Combining Rexulti with benzodiazepines, such as alprazolam or diazepam, can lead to increased sedation, drowsiness, and impaired coordination.
  • Opioids: The concurrent use of Rexulti with opioids, including oxycodone and hydrocodone, can enhance respiratory depression, increasing the risk of overdose and other serious complications.
  • Anticoagulants: Certain blood thinners, like warfarin or rivaroxaban, may interact with Rexulti, potentially increasing the risk of bleeding.
  • St. John’s Wort: This herbal supplement can induce enzymes responsible for Rexulti metabolism, leading to reduced blood levels and potentially decreasing the drug’s effectiveness.
  • Proton Pump Inhibitors (PPIs): Drugs like omeprazole or lansoprazole, used to reduce stomach acid, can decrease the absorption of Rexulti, reducing its therapeutic effects.
  • Antacids: The concurrent use of antacids containing aluminum or magnesium hydroxide can decrease the absorption of Rexulti, potentially leading to a reduced response.

Dosing

As with any medication, it is crucial to understand the proper dosing guidelines to ensure optimal therapeutic outcomes and minimize the risk of adverse effects.

Starting Rexulti Dose

The starting dose of Rexulti typically depends on the condition being treated. For the management of schizophrenia, the usual initial dose is 1 mg once daily. In the case of major depressive disorder, the starting dose is usually 0.5 mg to 1 mg once daily. Your healthcare provider will determine the most appropriate starting dose based on your specific needs.

Titration of Rexulti Dose

After starting Rexulti, your healthcare provider may choose to gradually increase your dose to achieve the desired therapeutic effect. This process is known as titration. Titration helps minimize the risk of side effects and allows your body to adjust to the medication gradually. Your healthcare provider will monitor your response to the medication closely during this phase and make adjustments as necessary.

Maximum Recommended Rexulti Dose

The maximum recommended dose of Rexulti depends on the condition being treated. For schizophrenia, the maximum daily dose is typically 4 mg. For major depressive disorder, the maximum daily dose is generally 3 mg. It is important to adhere to the prescribed maximum dose and not exceed it without consulting your healthcare provider.

Missed Dose of Rexulti

If you accidentally miss a dose of Rexulti, it is important to take it as soon as you remember. However, if it is close to the time for your next scheduled dose, it is best to skip the missed dose and resume your regular dosing schedule. Do not double the dose to make up for a missed one, as this can increase the risk of side effects.

Overdose Symptoms of Rexulti

An overdose of Rexulti can be dangerous and may require immediate medical attention. Symptoms of an overdose may include extreme drowsiness, confusion, agitation, rapid heartbeat, hallucinations, and seizures. It is crucial to seek emergency medical assistance if you suspect an overdose or experience any severe symptoms.

In the case of a Rexulti overdose, it is essential to seek immediate medical help. Contact your local emergency services or go to the nearest emergency room. It is helpful to have the medication packaging or information readily available to provide healthcare professionals with accurate details about the medication taken and the dosage.

Storage

When it comes to storing medications, proper storage is essential to maintain their effectiveness and safety.

  • Storing Rexulti at the Right Temperature: Rexulti should be stored at room temperature, ideally between 68°F and 77°F (20°C and 25°C). It is important to avoid storing the medication in areas prone to extreme temperatures, such as near windows, heaters, or in the bathroom. Fluctuations in temperature can affect the stability and potency of Rexulti, rendering it less effective. Hence, it is crucial to store Rexulti in a cool and dry place.
  • Avoiding Exposure to Moisture: Moisture can degrade the quality of Rexulti and compromise its efficacy. Therefore, it is essential to keep the medication away from humid environments like bathrooms and kitchens. Always store Rexulti in its original packaging and ensure that the container is tightly sealed after each use. If the original packaging becomes damaged, consider transferring the tablets to a moisture-resistant container with a desiccant packet to absorb excess moisture.
  • Protecting Rexulti from Light: Exposure to light, especially direct sunlight and artificial light sources, can have a negative impact on the stability of Rexulti. To maintain its effectiveness, store the medication in a dark and opaque container that shields it from light. Avoid leaving Rexulti exposed on countertops or near windows. Keeping it in a closed drawer or cupboard is a good way to protect it from light sources.
  • Proper Handling and Packaging: When handling Rexulti, it is essential to wash your hands thoroughly before and after touching the medication. This helps prevent any potential contamination and ensures the medication remains free from germs and bacteria. Additionally, always use the original packaging or a pill organizer specifically designed for storing medication. This helps maintain the integrity of the tablets and prevents them from being crushed or damaged.
  • Storing Rexulti Away from Children: To prevent accidental ingestion and ensure the safety of children, it is crucial to store Rexulti in a secure location that is out of their reach. Choose a storage area that is both cool and inaccessible, such as a locked medicine cabinet or a high shelf. Educate your family members about the importance of keeping medications out of the reach of children to avoid any potential harm.
  • Storing Rexulti Away from Pets: Pets, especially dogs, have a tendency to chew on objects, including medication containers. Rexulti should be stored in a place that is inaccessible to pets, as ingestion of this medication can be harmful to them. It is recommended to store Rexulti in a secure location, away from your furry friends, to ensure their safety.
  • Traveling with Rexulti: If you need to travel with Rexulti, it is important to plan ahead and ensure the medication remains safe and effective throughout your journey. Keep Rexulti in its original packaging and store it in a cool and dry place, away from direct sunlight and extreme temperatures. If you are traveling by air, it is advisable to keep Rexulti in your carry-on bag to protect it from fluctuations in temperature that can occur in the cargo hold.
  • Storing Rexulti During Power Outages: Power outages can be a concern when it comes to storing medication that requires specific temperature conditions. If you experience a power outage, it is important to keep the refrigerator and freezer closed as much as possible to maintain a stable temperature. If the outage is prolonged, you may need to consider alternative storage methods, such as using a cooler with ice packs or seeking temporary storage at a friend or family member’s place.
  • Proper Disposal of Expired Rexulti: Expired or unused Rexulti should not be kept indefinitely. It is crucial to dispose of it properly to prevent accidental ingestion or misuse. Follow local guidelines for medication disposal or consult your pharmacist for guidance. Do not flush Rexulti down the toilet or throw it in the regular trash. Proper disposal ensures the safety of others and helps protect the environment.

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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