Understanding Rexulti and Its Purpose
Rexulti, with the generic name brexpiprazole, is an atypical antipsychotic medication approved by the FDA to treat several conditions [1.11.2]. It is primarily prescribed for:
- Schizophrenia in adults and children aged 13 years and older [1.11.2].
- As an adjunctive treatment for Major Depressive Disorder (MDD) in adults, meaning it's taken alongside another antidepressant [1.11.2].
- Agitation associated with dementia due to Alzheimer's disease [1.11.2].
Rexulti works as a serotonin-dopamine activity modulator (SDAM) [1.12.1]. Its exact mechanism isn't fully understood, but it's believed to help balance the levels of these crucial neurotransmitters in the brain, which can improve mood, thinking, and behavior [1.12.3, 1.11.3].
Temporary vs. Persistent Side Effects
When starting any new medication, it's common for the body to need an adjustment period. For many people taking Rexulti, some of the initial side effects are temporary and may diminish or disappear entirely within a few days to a few weeks [1.2.2, 1.5.2].
Side Effects That Often Go Away
Clinical studies and patient information indicate that the following mild side effects frequently improve over time as your body gets used to the medication [1.5.3, 1.2.1]:
- Headache
- Upset stomach or indigestion
- Diarrhea
- Constipation
- Drowsiness or fatigue
If these effects are mild and last only a short time, they are generally not a cause for major concern. However, if they persist or become bothersome, it is important to speak with a healthcare provider [1.2.1].
Side Effects That May Persist
Unfortunately, not all side effects of Rexulti are temporary. Some may continue for as long as you are taking the medication and may require active management or a change in treatment [1.5.3]. These can include:
- Akathisia: This is a feeling of inner restlessness and a compelling urge to move. It was one of the more common side effects noted in clinical trials and may not go away on its own [1.2.1, 1.14.3].
- Weight Gain: Gaining weight is a common side effect associated with Rexulti and other atypical antipsychotics. This effect can persist and often requires management through diet and exercise [1.16.3, 1.5.3]. In long-term studies, the mean weight gain was around 2-3 kg after a year [1.10.3].
- Metabolic Changes: Rexulti can cause long-term changes to your metabolism, including increased blood sugar (hyperglycemia), and elevated cholesterol and triglyceride levels [1.8.2, 1.16.2]. These require regular monitoring by a doctor and may need long-term management even after stopping the medication [1.6.1].
- Tardive Dyskinesia (TD): This is a serious, potentially irreversible side effect characterized by uncontrollable, repetitive movements, often in the face, tongue, or other body parts [1.15.1, 1.4.1]. The risk increases with prolonged use, though second-generation antipsychotics like Rexulti are considered to have a lower risk than older medications [1.15.2].
Serious Side Effects Requiring Immediate Attention
Rexulti carries boxed warnings from the FDA for increased risk of death in elderly patients with dementia-related psychosis and increased risk of suicidal thoughts and actions in children and young adults [1.4.1, 1.11.2].
Beyond these warnings, you should contact your doctor immediately or seek emergency medical help if you experience signs of:
- Neuroleptic Malignant Syndrome (NMS): Symptoms include high fever, muscle stiffness, confusion, and changes in pulse or blood pressure [1.4.1].
- Uncontrolled Body Movements (Tardive Dyskinesia): Any new, uncontrollable jerking or twisting movements [1.3.1].
- High Blood Sugar (Hyperglycemia): Symptoms like increased thirst, frequent urination, confusion, or fruity-smelling breath [1.3.1].
- Severe Allergic Reaction: Rash, itching, hives, or swelling of the face, lips, or tongue [1.4.2].
Comparison with a Similar Medication: Rexulti vs. Abilify
Rexulti (brexpiprazole) is chemically similar to Abilify (aripiprazole). While both are effective, their side effect profiles have some differences that might make one a better choice for certain individuals.
| Feature | Rexulti (Brexpiprazole) | Abilify (Aripiprazole) |
|---|---|---|
| Akathisia (Restlessness) | Tends to have a lower risk compared to Abilify [1.7.1, 1.7.3]. | Higher incidence reported in some studies [1.7.2]. |
| Weight Gain | Both medications can cause weight gain, with studies showing similar effects of about 5-10 lbs after one year [1.7.2]. Rexulti has a moderate weight gain profile [1.7.3]. | Similar to Rexulti, can cause an increase in body weight [1.7.2]. |
| Metabolic Issues | Considered to have a more favorable profile with a lower risk of metabolic issues than some other antipsychotics [1.7.3]. | Carries risks for metabolic changes, similar to other drugs in its class [1.7.2]. |
| Other Common Side Effects | Headache, dizziness, fatigue, and agitation are common [1.7.2]. | Nausea, vomiting, constipation, and insomnia are common [1.7.2]. |
| Availability | Brand-name only [1.7.2]. | Available in a generic form, which is often cheaper [1.7.2]. |
Managing Rexulti Side Effects
If you experience persistent or bothersome side effects, it's crucial not to stop taking Rexulti abruptly without consulting your doctor [1.6.2]. They can offer strategies to help manage them:
- For Weight Gain: Your doctor will monitor your weight regularly. A balanced diet and consistent exercise can help manage this side effect [1.6.1].
- For Drowsiness: This may improve over time. Avoid driving or operating heavy machinery until you know how Rexulti affects you [1.6.2].
- For Akathisia: Your doctor might suggest lowering the dose or switching to a different medication [1.2.1].
- For Headaches: Over-the-counter pain relievers like acetaminophen or ibuprofen may help, but check with your doctor first. Staying hydrated and getting enough rest can also be beneficial [1.6.1].
Conclusion
In summary, whether side effects of Rexulti go away depends on the individual and the specific effect. Many of the initial, milder side effects like headaches and nausea often subside within weeks [1.5.3]. However, more significant side effects like weight gain, akathisia, and metabolic changes can be long-lasting and require ongoing management in partnership with a healthcare provider [1.6.1, 1.5.3]. Potentially permanent conditions like tardive dyskinesia, while less common with Rexulti than older antipsychotics, remain a risk with long-term use [1.15.2]. Open and continuous communication with your doctor is the most effective way to monitor your health, manage side effects, and ensure the treatment remains safe and beneficial for you. For more information on managing side effects through a healthy lifestyle, you may find this resource from HelpGuide.org useful.
