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Exxua

gepirone
Used for Depression
Used for Depression

Exxua (gepirone) is an antidepressant used to treat major depressive disorder (MDD) in adults. This medication is the first in a new class of antidepressants called 5HT1A receptor agonists. It works by balancing the activity of serotonin, a chemical in the brain that regulates mood. Exxua (gepirone) is an extended-release tablet that's taken by mouth once daily with food. Common side effects of this medication include dizziness, nausea, and headache. Unlike other antidepressants, Exxua (gepirone) isn’t likely to cause sexual dysfunction.

Reviewed by:
reviewer
Emily Nailor, PharmD Candidate
reviewer
Connie Zheng, PharmD
reviewer
Cydnee Ng, PharmD
Last reviewed on April 16, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageContraindicationsAlternativesLatest newsReferencesPricesMedicare
basics-icon

What is Exxua (gepirone)?

What is Exxua (gepirone) used for?

How Exxua (gepirone) works

Exxua (gepirone) is the first in a new class of antidepressants called 5HT1A receptor agonists. The exact way Exxua (gepirone) helps with depression isn’t fully understood. But it’s thought to affect a chemical in the brain called serotonin. Serotonin plays a role in many aspects of our lives, including in our mood. Having the right balance of serotonin seems to be important for mental health.

Drug Facts

Common BrandsExxua
Drug ClassSerotonin (5-HT1A) Receptor Partial Agonist
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only

More on Exxua (gepirone) essentials

Pharmacy: man reading Rx bottles 1449180440

Exxua vs. Viibryd for Depression: 5 Differences Between These Antidepressants

Written by Niousha Nader, PharmD, BCCCP
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What are the side effects of Exxua (gepirone)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Dizziness (49%)
  • Nausea (35%)
  • Headache (31%)
  • Feeling sleepy or tired (15%)
  • Trouble sleeping (14%)
  • Diarrhea (10%)

Other Side Effects

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Suicidal thoughts or thoughts of self-harm
  • Serious heart rhythm problem (QT prolongation): dizziness, fainting, irregular or pounding heartbeat, or sudden collapse
  • Serotonin syndrome: fast heart rate, fever, dizziness, sweating, shakiness, muscle stiffness, uncoordinated movement, seizures, hallucinations, coma
  • Manic or hypomanic episode: feeling overly excited or energetic, having racing thoughts, talking very quickly, engaging in risky behaviors, or feeling irritable

Source: DailyMed

pros-and-cons

Pros and cons of Exxua (gepirone)

thumbs-up

Pros

Taken by mouth

Taken once daily

Possible option if other antidepressants haven’t worked well

Sexual side effects not reported in clinical studies, unlike with some other antidepressants

thumbs-down

Cons

Needs to be taken with food at the same time every day

Not studied in children

Not for use in individuals with bipolar disorder

Not available as a generic

pharmacist-tips

Pharmacist tips for Exxua (gepirone)

pharmacist

  • Take Exxua (gepirone) at the same time every day, along with food. Taking this medication with food helps your body absorb it better. Try to stay consistent in the type of foods you eat because changes in diet can also affect how your body absorbs this medication.

    • If you make any major changes to your diet, especially with the amount of fat in your diet, let your psychiatrist know. They might need to check in with you more often to see if Exxua (gepirone) is still working well for you or if you’re experiencing more side effects. Depending on how you feel, your psychiatrist might consider raising or lowering your dose of Exxua (gepirone).

      • Swallow the Exxua (gepirone) tablet whole and do not split, chew, or crush the tablets. Exxua (gepirone) is an extended-release medication, meaning the medication is released over a longer period of time inside your body. Splitting, chewing, or crushing an extended-release tablet might make the medication release into the body too quickly.

        • Exxua (gepirone) can cause dizziness, which can raise your risk of a fall. The risk is higher for older adults. If you feel dizzy, find a secure spot to sit or lie down. Don’t engage in high-risk activities, like driving or operating heavy machinery, until you know how this medication makes you feel.

          • Taking antidepressant medications, like Exxua (gepirone), can raise the risk of having thoughts of self-harm. Contact your provider right away if you or your loved ones notice any new or worsening changes in your behavior or mood while taking the medication.

            • Talk with your psychiatrist if you’re concerned about the risk for worsening mood problems with Exxua (gepirone). One thing to remember is that untreated depression can also lead to worsening symptoms, like suicidal thoughts and behaviors. So it’s important to receive help for depression. There are many treatment options to help with depression, ranging from therapy to medications.

              • Suddenly stopping or changing the dose of Exxua (gepirone) without talking to your psychiatrist can be harmful because it can lead to antidepressant discontinuation syndrome, also known as withdrawal. Symptoms include flu-like symptoms, sleep problems, upset stomach, and sensations like electrical shocks. If you want to stop Exxua (gepirone), your psychiatrist will help you do so safely by lowering your dose slowly over time.

                • Exxua (gepirone) can interact with many medications. For example, some medications (like azole antifungals or clarithromycin) can raise the level of Exxua (gepirone) in your body and put you at a high risk for side effects, such as dizziness or nausea. Other medications (like carbamazepine or phenytoin) can lower the levels of Exxua (gepirone) in your body and cause it to work less well in treating depression.

                  • Inform your psychiatrist if you're breastfeeding. Exxua (gepirone) might pass into breast milk and cause side effects in your baby, like irritability, restlessness, or poor feeding. Your psychiatrist can recommend a safer alternative medication if you're nursing.

                    faqs

                    Frequently asked questions about Exxua (gepirone)

                    How long does it take for Exxua (gepirone) to start working?
                    Based on clinical studies, you might need to take Exxua (gepirone) for about 2 months to experience more noticeable changes in your mood. That’s why it’s important to keep taking Exxua (gepirone) as prescribed by your psychiatrist, even if you don’t feel better right away. One thing to remember is that if you’re starting Exxua (gepirone) for the first time, your psychiatrist will start you with a lower dose and raise it slowly over time. So it might take some time before you and your care team find the right dose that works best for you. Talk to your provider if you’ve been taking your antidepressant for one month or longer and haven’t noticed any benefits. They might be able to change your dosage or switch you to a different kind of antidepressant.
                    How well does Exxua (gepirone) work in treating depression?
                    Results from two clinical studies showed that people with depression who took Exxua (gepirone) had greater improvement in their HAM-D scores after 2 months of treatment than those who took placebo (a pill without active medication). HAM-D is a survey that clinicians use to evaluate depression. Improvements in HAM-D scores suggest a treatment is working. Keep in mind that how well Exxua (gepirone) works can vary from person to person. It’s important to talk to your provider about how you’re feeling while taking Exxua (gepirone). They’ll let you know whether you need any adjustments, like changes to your dose or a switch to a different medication.
                    Can Exxua (gepirone) cause erectile dysfunction?
                    Exxua (gepirone) doesn’t appear to cause erectile dysfunction (ED) because people who took this medication in clinical studies didn’t report it as a side effect. Because of this, psychiatrists might consider Exxua (gepirone) an option for people who experienced ED with other antidepressants. If you’re concerned about ED or experience ED while taking Exxua (gepirone), talk with your psychiatrist. They can offer personalized advice and try to help you figure out what’s causing ED. One thing to remember is that sometimes, having sexual problems might be related to depression and not always a side effect of antidepressants. Having depression can have an impact on your sex life by causing problems like trouble reaching orgasm, difficulty getting or keeping an erection, or not feeling interested in sex at all.
                    Does Exxua (gepirone) cause weight gain?
                    A few people who took Exxua (gepirone) in clinical studies reported weight gain and feeling hungrier as side effects. While weight gain is a known side effect of certain other antidepressants, such as paroxetine (Paxil) and mirtazapine (Remeron), more research is needed to understand the link between Exxua (gepirone) and body weight. If you’re concerned about the risk of weight gain while taking Exxua (gepirone), talk with your healthcare team. They can help you come up with a plan to maintain a healthy body weight while you’re receiving treatment. For example, they might recommend eating a balanced diet with nutritious foods, like fruits, vegetables, lean proteins, and whole grains. They can talk with you about prepping meals with healthy portion sizes. They can also help you plan ways to stay active with regular exercise that's appropriate for you.
                    Does Exxua (gepirone) treat anxiety?
                    Exxua (gepirone) isn't FDA approved to treat anxiety. Limited studies suggest that Exxua (gepirone) might ease certain symptoms related to anxious depression. But we need more research to understand whether or not Exxua (gepirone) can help with anxiety. Talk to your provider about approved medications and treatments used to help with anxiety.
                    Can I drink alcohol while taking Exxua (gepirone)?
                    More research is needed to understand how Exxua (gepirone) and alcohol might interact. But in general, people who have depression should avoid drinking alcohol. This is because alcohol can worsen depression or bring on new symptoms of depression. Plus, drinking alcohol might cause antidepressants to work less well in treating depression, which could mean your symptoms might stick around for longer and slow down your recovery. Be sure to speak with your provider if you’re worried about how alcohol might be affecting your mood or your medications.
                    Can I take Exxua (gepirone) while pregnant?
                    Talk with your psychiatrist if you’re pregnant or thinking of becoming pregnant before you start Exxua (gepirone). This medication hasn't been studied in human pregnancy. But animal studies suggest Exxua (gepirone) might not be safe to take during pregnancy. It’s important that you talk with your provider about safer antidepressant options during pregnancy. This is because if your depression isn’t treated and your condition worsens, it can also lead to harm for you and your baby. If you're taking Exxua (gepirone) and become pregnant, you’re encouraged to enroll in the National Pregnancy Registry for Antidepressants (NPRAD). The NPRAD is a project that helps understand how antidepressant medications may affect pregnant individuals and their babies.
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                    What are the risks and warnings for Exxua (gepirone)?

                    Exxua (gepirone) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                    risk-warning

                    Suicidal thoughts and worsening depression

                    • Risk factors: People ages 24 years and younger

                      Some research suggests that taking an antidepressant, like Exxua (gepirone), might worsen depression or thoughts of self-harm, especially for people ages 24 years or younger. But results from other studies are more mixed.

                      If you start Exxua (gepirone), let your caregivers or loved ones know about the risk for worsening depression and thoughts of self-harm to be safe. Ask them to watch for any changes in your mood, behavior, thoughts, or feelings, especially in the months when you first start Exxua (gepirone).

                      It’s important to tell your psychiatrist or get medical help right away if you have increased anxiety, panic attacks, increased irritability, trouble sleeping, or thoughts about suicide. The 988 Suicide & Crisis Lifeline is a helpful resource and provides 24/7 support for individuals in crisis. The lifeline can also offer guidance on supporting loved ones with suicidal ideation.

                      risk-warning

                      Serious heart rhythm problem (QT prolongation)

                      • Risk factors: Blood electrolyte levels out of balance | Liver problems | Existing heart rhythm problems | Family history of long QT syndrome | Taking other medications that can also cause heart rhythm problems

                        Exxua (gepirone) may cause a side effect called QT prolongation, which is a change in heart rhythm that can be life-threatening. QT prolongation can happen when the time it takes for the heart to pump and then relax becomes longer. Most of the time, QT prolongation doesn’t have any noticeable symptoms. But let your doctor know right away if you feel like your heart is fluttering, pounding, or beating irregularly while taking Exxua (gepirone).

                        To check for QT prolongation, your psychiatrist will use a test called an electrocardiogram (ECG) to monitor the electrical activity of your heart. They’ll also check your body’s electrolyte levels with blood tests before and during treatment with Exxua (gepirone). This is because having low blood potassium or magnesium levels can put you at risk for heart rhythm problems. Your psychiatrist may check your electrolyte levels more often during treatment if you have certain conditions like heart failure, slow heart rate, or abnormal electrolyte levels or if you’re taking other medications that affects your heart rhythm.

                        risk-warning

                        Serotonin syndrome

                        Serotonin syndrome is a rare, but serious condition that occurs when there’s too much serotonin in the brain. The risk of developing serotonin syndrome is higher if you take Exxua (gepirone)) along with other medications that can raise your serotonin levels, such as certain antidepressants, pain medications, or migraine medications. It’s important to inform your healthcare provider about all the medications you are taking before starting Exxua (gepirone). Additionally, never start any new medications without consulting your care team first. Symptoms of serotonin syndrome include a fast heart rate, sweating, muscle stiffness or spasms, fever, or confusion. If you experience any of these symptoms, seek medical help immediately.

                        risk-warning

                        Not for people with bipolar disorder

                        People who have bipolar disorder shouldn’t take Exxua (gepirone). Research suggests that taking antidepressants can trigger a manic episode in people with bipolar disorder. Your psychiatrist will screen you for bipolar disorder before prescribing Exxua (gepirone). They’ll also ask you about your family history of bipolar disorder. If you do have bipolar disorder, your psychiatrist will talk with you about safer medication options to treat your depression. If you or your loved ones observe any symptoms of bipolar disorder, such as racing thoughts, restlessness, easily getting distracted, or excessive talkativeness, get medical help right away.

                        dosage

                        Exxua (gepirone) dosage forms

                        Typical dosing for Exxua (gepirone)

                        • Adults: The recommended starting dose is 18.2 mg by mouth once daily. Your psychiatrist might raise your dose every few days over the course of 2 weeks, depending on how well this medication works and whether you experience any side effects. The maximum recommended dose is 72.6 mg once daily.

                        If you have kidney or liver problems, your psychiatrist may prescribe a different dose for you because of differences in the way your body processes and removes the medication from your system.

                        contraindications-icon

                        Exxua (gepirone) contraindications

                        Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Exxua (gepirone) will not be safe for you to take.
                        alternatives

                        What are alternatives to Exxua (gepirone)?

                        There are a number of medications that your doctor can prescribe in place of Exxua (gepirone). Compare a few possible alternatives below.
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                        References

                        Best studies we found

                        Alpert, J. E., et al. (2004). Gepirone extended-release treatment of anxious depression: Evidence from a retrospective subgroup analysis in patients with major depressive disorder. The Journal of Clinical Psychiatry.

                        Bains, N., et al. (2023). Major depressive disorder. StatPearls.

                        Fabre Kramer Pharmaceuticals, Inc. (2024). Exxua- gepirone tablet, extended release [package insert]. DailyMed.

                        View All References (5)

                        Farzam, K., et al. (2023). QT prolonging drugs. StatPearls.

                        Fornaro, M., et al. (2019). The FDA "black box" warning on antidepressant suicide risk in young adults: More harm than benefits? Frontiers in Psychiatry.

                        Hamilton, M. (1967). Development of a rating scale; for primary depressive illness. British Journal of Clinical Psychology.

                        Pompili, M., et al. (2010). Antidepressants and suicide risk: A comprehensive overview. Pharmaceuticals.

                        Zhou, S., et al. (2005). Mechanism-based inhibition of cytochrome P450 3A4 by therapeutic drugs. Clinical Pharmacokinetics.

                        GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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