Medication Guide
Brexpiprazole (Rexulti) Side Effects and Uses
A plain-language guide to Brexpiprazole, an atypical antipsychotic. Learn how it helps, what it treats, how to take it and which side effects to know about.
Quick answer. Brexpiprazole (Rexulti) is an atypical antipsychotic. Common brexpiprazole side effects include weight gain, sleepiness or tiredness, restlessness and headache. The rare but serious ones, and when to get help, are listed under brexpiprazole side effects below. Never stop or change your dose on your own.
How Brexpiprazole Can Help You
Brexpiprazole is sold as Rexulti. It is a partial dopamine agonist, built on the same idea as aripiprazole. It was made to cause less restlessness and feeling wired. It is most often added to an antidepressant when depression has only partly improved. It also treats schizophrenia. And it treats agitation linked to Alzheimer's dementia.
When added for depression, many people notice the leftover heaviness lifting in one to two weeks. Fuller benefit often comes by four to six weeks. People describe more energy and a wider range of feelings. They feel the antidepressant is finally finishing the job.
For schizophrenia, gains build over several weeks of steady use. Most people find brexpiprazole easy to take. It causes modest weight gain and fairly low rates of sleepiness and restlessness.
Uses for Brexpiprazole
- Add-on care for major depression
- Schizophrenia
- Agitation linked to Alzheimer's dementia
- Bipolar disorder (off-label)
- PTSD (off-label, studied with sertraline)
How to Take Brexpiprazole
Brexpiprazole is taken once a day, with or without food. Your prescriber decides the dose. They start low and change it over time. Its long half-life means levels build slowly. Give each dose change one to two weeks before you judge it.
Your prescriber will check weight, blood sugar and cholesterol from time to time. They will also watch for restlessness or odd movements. These are less common than with aripiprazole. But they can happen. The dose may need to change if you take drugs that affect liver enzymes. It may also change if you have kidney or liver problems.
If you miss a dose, take it when you remember, unless the next dose is near. Never double up. Do not stop without talking to your prescriber.
Brexpiprazole Side Effects
Common Side Effects
- Weight gain
- Sleepiness or tiredness
- Restlessness (akathisia)
- Headache
- Bigger appetite
- Tremor
- Anxiety
- Constipation
Serious: Get Medical Help Promptly
- Death risk in older adults with dementia and psychosis (boxed warning)
- Suicidal thoughts in young people (boxed warning)
- Tardive dyskinesia (movements you cannot control, which may last)
- Neuroleptic malignant syndrome (high fever, stiff muscles, confusion)
- New urges to gamble, shop, binge eat or have sex
- Big changes in blood sugar or cholesterol
How Brexpiprazole Works
Brexpiprazole partly turns on dopamine D2 and serotonin 5-HT1A receptors. It blocks serotonin 5-HT2A receptors. It turns dopamine up less than aripiprazole does. That gentler push is thought to be why it causes less restlessness for many people.
As an add-on, it works on brain pathways the antidepressant may not reach. That can help finish the response when an antidepressant has helped only part of the way. Your prescriber explains how it fits with the rest of your plan.
Brexpiprazole Half-Life and How Long It Takes to Work
Brexpiprazole has a half-life of about 91 hours. Its main breakdown product lasts about as long. Levels reach a steady state in about 10 to 12 days. That is why dose changes take a while to show. It is also why it leaves the body slowly after the last dose.
When it is added for depression, many people feel better in one to two weeks. Give it about four to six weeks before you judge the full effect. Tell your prescriber right away about new or worse suicidal thoughts. If you are thinking about harming yourself, call or text 988, or call 911.
Before You Start Brexpiprazole
Share every medicine you take. Some antidepressants can raise brexpiprazole levels. Fluoxetine and paroxetine are examples. So can some drugs for fungal infections. Others, such as rifampin, can lower it. Your prescriber may change the plan when one of these starts or stops.
Tell your prescriber about diabetes, seizures, heart disease and kidney or liver problems. Share any history of gambling or impulse problems. Brexpiprazole can make it harder to cool down. So drink enough fluids in hot weather. Our medication management visits happen by secure telehealth video from anywhere in California.
Is Brexpiprazole Right for You?
Only a full evaluation with a prescriber can tell you if Brexpiprazole fits your symptoms, history and goals. Harpal Singh, PMHNP-BC offers psychiatric evaluations and ongoing medication management by telehealth anywhere in California.
SCHEDULE AN APPOINTMENT CALL (888) 457-8124
Related Medication Guides
Other guides in the same group, written the same simple way. Being in one group does not mean you can swap one medicine for another.
- Olanzapine (Zyprexa), atypical antipsychotic
- Paliperidone (Invega), atypical antipsychotic
- Quetiapine (Seroquel), atypical antipsychotic
- Risperidone (Risperdal), atypical antipsychotic
- Ziprasidone (Geodon), atypical antipsychotic
- Aripiprazole (Abilify), atypical antipsychotic
FAQ
Questions About Brexpiprazole
How long does it take for Rexulti to work?
When added for depression, many people notice improvement within one to two weeks. Give it about four to six weeks to judge the full effect. For schizophrenia, benefits build over several weeks.
What is the half-life of brexpiprazole?
The half-life of brexpiprazole is about 91 hours. It takes about 10 to 12 days to reach a steady level in the body. That is why dose changes take a while to show.
What is brexpiprazole approved for?
Brexpiprazole is FDA approved as an add-on treatment for major depression in adults and for schizophrenia. It is also approved for agitation linked to Alzheimer's dementia. Your prescriber explains which use fits your plan.
How is brexpiprazole different from aripiprazole (Abilify)?
Both are partial dopamine agonists. Brexpiprazole turns dopamine up less and acts more on serotonin, which means less restlessness for many people. The tradeoff can be a bit more weight gain and sleepiness than aripiprazole.
I am already on an antidepressant. Why add brexpiprazole?
When an antidepressant helps partly but not fully, adding brexpiprazole can help complete the response. It works on brain pathways the antidepressant does not reach. Clinical trials support this approach, and improvement often shows within one to two weeks.
Will brexpiprazole make me gain weight?
Modest weight gain is one of its more common side effects, though usually less than with olanzapine or quetiapine. Your prescriber will track your weight and metabolic labs. Bring up any steady weight climb early.
What are the impulse-control warnings about?
Rarely, drugs like brexpiprazole have been linked to new urges to gamble, shop, binge eat or act on sexual urges. These urges usually stop when the medicine is adjusted. Loved ones sometimes notice first, so report any unusual new urges to your prescriber.
Can I drink alcohol while taking brexpiprazole?
It is best to avoid alcohol or keep it to a strict limit. Alcohol adds to sleepiness and dizziness and can make depression worse. Ask your prescriber what is safe for you.