Rexulti: An Atypical Antipsychotic
Rexulti, known by its generic name brexpiprazole, is classified as a second-generation or atypical antipsychotic. This class of medications is generally associated with a different side effect profile compared to older, first-generation antipsychotics, which often cause more severe movement-related issues. As an atypical antipsychotic, Rexulti is utilized for several psychiatric conditions, often when first-line treatments are insufficient or poorly tolerated. It is available as an oral tablet and is typically taken once daily.
The Unique Mechanism of Action: How Rexulti Works
Unlike many medications that either block or activate receptors, Rexulti functions as a "serotonin-dopamine activity modulator" (SDAM). Its specific mechanism is not fully understood, but it is known to influence the balance of brain chemicals called neurotransmitters, particularly serotonin and dopamine.
- Partial Agonist: Rexulti acts as a partial agonist at serotonin 5-HT1A and dopamine D2 receptors. A partial agonist binds to a receptor and produces a less potent effect than a full agonist, essentially fine-tuning the activity rather than fully activating it.
- Antagonist: The drug also acts as an antagonist at the serotonin 5-HT2A and noradrenaline alpha1B/2C receptors, which helps to further regulate and rebalance the affected brain pathways.
This specific combination of partial agonism and antagonism helps to regulate mood, thinking, and behavior, making it effective in treating its approved conditions.
FDA-Approved Uses for Rexulti
As of its approval, Rexulti is indicated for the treatment of several specific conditions:
- Schizophrenia: This condition affects a person's thoughts, feelings, and behavior. For this indication, Rexulti is approved for adults and children aged 13 years and older. It can help reduce symptoms such as hallucinations, delusions, and disorganized thinking.
- Adjunctive Treatment for Major Depressive Disorder (MDD): For adults with MDD who have not achieved a sufficient response with their current antidepressant medication, Rexulti can be added to their existing treatment. It is not used as a standalone treatment for depression.
- Agitation Associated with Dementia Due to Alzheimer's Disease: Rexulti is approved to treat agitation in adults with this specific form of dementia, which includes symptoms like irritability and restlessness. It is important to note that it is not approved for psychosis related to dementia without agitation.
Important Considerations and Potential Side Effects
Before taking Rexulti, patients and healthcare providers should be aware of potential side effects and specific warnings.
Common Side Effects
Common side effects can include:
- Restlessness (akathisia)
- Weight gain
- Headache
- Dizziness
- Sleepiness or unusual drowsiness
- Increased appetite
Serious Warnings (Boxed Warnings)
Rexulti carries two serious boxed warnings issued by the FDA.
- Increased Risk of Death in Elderly Patients with Dementia-Related Psychosis: Studies have shown an increased risk of death in elderly people with psychosis related to dementia who are treated with antipsychotic drugs, primarily from cardiovascular issues or infection.
- Increased Risk of Suicidal Thoughts and Actions: Like other drugs used to treat depression, Rexulti can increase the risk of suicidal thoughts and behaviors in children and young adults aged 24 and younger, especially at the start of treatment or when the dosage is changed.
Comparison of Rexulti to Other Atypical Antipsychotics
Many atypical antipsychotics are available, and a comparison can help highlight the different benefits and risks associated with each. Here is a brief comparison of Rexulti with other common options.
| Feature | Rexulti (brexpiprazole) | Abilify (aripiprazole) | Zyprexa (olanzapine) | Seroquel (quetiapine) |
|---|---|---|---|---|
| Mechanism | SDAM (Partial agonist at D2, 5-HT1A; antagonist at 5-HT2A) | Partial agonist at D2, 5-HT1A; antagonist at 5-HT2A | Antagonist at D2 and 5-HT2A | Antagonist at D2, 5-HT2A |
| Indications | Schizophrenia, MDD (adjunctive), Dementia Agitation | Schizophrenia, MDD (adjunctive), Bipolar Disorder | Schizophrenia, Bipolar Disorder | Schizophrenia, Bipolar Disorder, MDD (adjunctive) |
| Dosing Frequency | Once daily | Once daily | Once or twice daily | Multiple times a day (extended-release available) |
| Weight Gain Risk | Lower than many others | Moderate | High | High |
| Extrapyramidal Symptoms | Lower risk than older antipsychotics | Moderate risk, similar to Rexulti | Lower risk | Lower risk |
Navigating Treatment with Rexulti
Finding the right medication for a mental health condition is a process that requires close collaboration with a healthcare provider. Rexulti might be an appropriate option for those who have not responded adequately to other treatments or who are seeking a medication with a different side effect profile. Consistent daily use is key, and it may take several weeks to months before the full benefits are realized.
Regular monitoring by a doctor is crucial to track progress, manage potential side effects, and ensure the treatment plan remains effective. Patients should never stop taking Rexulti or adjust their dosage without consulting their healthcare provider, as this can worsen symptoms. National Alliance on Mental Illness (NAMI) provides comprehensive resources on Rexulti and other mental health medications.
Conclusion
Rexulti (brexpiprazole) is a valuable tool in the treatment of mental health conditions as an atypical antipsychotic. By acting as a serotonin-dopamine activity modulator, it provides a unique way to help regulate brain chemistry for individuals with schizophrenia, major depressive disorder (when used adjunctively), and agitation associated with Alzheimer's dementia. However, due to its boxed warnings and potential side effects, its use must be carefully managed by a healthcare provider, who can determine if the benefits outweigh the risks for each individual patient.
