Rexulti
Rexulti (brexpiprazole) is an atypical antipsychotic used to treat depression and schizophrenia. It can also help manage dementia-related agitation from Alzheimer's disease. The medication works by balancing chemicals in your brain to regulate your mood. Rexulti (brexpiprazole) comes as a tablet you take by mouth, usually once a day. Common side effects include weight gain, sleepiness, and dizziness. Although generic versions have been approved, they aren't yet available in pharmacies.
What is Rexulti (brexpiprazole)?
What is Rexulti (brexpiprazole) used for?
Add-on treatment for depression in adults
Schizophrenia in adults and teens 13 years and older
Dementia-related agitation from Alzheimer's disease
How Rexulti (brexpiprazole) works
Rexulti (brexpiprazole) is an atypical antipsychotic. While experts aren’t exactly sure how it works, it’s thought to help by balancing brain chemicals like dopamine and serotonin. This balance can help improve your mood, thoughts, and behavior.
Drug Facts
More on Rexulti (brexpiprazole) essentials
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What are the side effects of Rexulti (brexpiprazole)?
Common Side Effects
- Fidgeting (9%)
- Weight gain (7%)
- Headache (7%)
- Sleepiness (5%)
- Fidgeting (6%)
- Headache (8%)
Other Side Effects
- Tremor
- Dizziness
- Anxiety
- Tiredness
- Common cold symptoms
- Weight gain
- Diarrhea
- Tremor
- Sleepiness
- Indigestion
- Dizziness
- Sleepiness
- Trouble sleeping
- Urinary tract infection (UTI)
- Common cold symptoms
Serious Side Effects
- Suicidal thoughts or behaviors: thoughts about suicide or dying, new or worsening depression, agitation, trouble sleeping, aggression, new or worsening anxiety, panic attacks, mood changes
- Neuroleptic malignant syndrome (NMS): high fever, sweating, confusion, stiffness, changes in heart rate
- Uncontrolled body movements (tardive dyskinesia): involuntarily sticking out your tongue, puffing out your cheeks, puckering your mouth, lip smacking, chewing, and foot tapping
- High blood sugar levels: feeling very hungry or thirsty, urinating more often, stomach pain, weakness, fruity-smelling breath
- Impulse control problems: sexual urges, binge eating, shopping urges, gambling urges
- Seizures
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- High blood sugar (hyperglycemia)—increased thirst or amount of urine, unusual weakness or fatigue, blurry vision
- High fever, stiff muscles, increased sweating, fast or irregular heartbeat, and confusion, which may be signs of neuroleptic malignant syndrome
- Infection—fever, chills, cough, sore throat
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
- Pain or trouble swallowing
- Seizures
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
- Uncontrolled and repetitive body movements, muscle stiffness or spasms, tremors or shaking, loss of balance or coordination, restlessness, shuffling walk, which may be signs of extrapyramidal symptoms (EPS)
- Urges to engage in impulsive behaviors such as gambling, binge eating, sexual activity, or shopping in ways that are unusual for you
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Constipation
- Drowsiness
- Headache
- Weight gain
Pros and cons of Rexulti (brexpiprazole)
Pros
Only need to take once a day
Less likely to cause weight gain compared to older antipsychotics
Available in many strengths
Cons
Can take a couple of months to fully work
Interacts with many medications
Not known if safe in pregnancy
Pharmacist tips for Rexulti (brexpiprazole)
You can take Rexulti (brexpiprazole) with or without food. Follow your prescriber’s instructions as they adjust your dose.
Tell your prescriber about any changes to your current medications, including over-the-counter products. Rexulti (brexpiprazole) can interact with many medications and might cause side effects if not managed properly.
When starting Rexulti (brexpiprazole) or increasing your dose, you might feel dizzy or unsteady. Stand up slowly to help prevent falls. This usually gets better as your body adjusts, but let your prescriber know if it continues.
Rexulti (brexpiprazole) can make you feel sleepy or drowsy. Avoid driving or doing anything that requires full attention until you know how the medication affects you.
While taking Rexulti (brexpiprazole), your weight, blood sugar, and cholesterol might go up. Let your prescriber know if you gain weight quickly or notice signs of high blood sugar, like feeling very thirsty or tired.
You or your caregiver should watch for signs of suicidal thoughts, especially when starting Rexulti (brexpiprazole) or changing your dose. Tell your prescriber right away if you have new or worsening depression, mood changes, or thoughts of self-harm.
In rare cases, Rexulti (brexpiprazole) can cause a life-threatening condition called neuroleptic malignant syndrome (NMS). If you have a high fever, stiff muscles, confusion, or your heart is beating fast, get medical help right away.
Rexulti (brexpiprazole) can cause unusual movements in your eyes, tongue, face, arm, or legs. These might be signs of a serious condition called tardive dyskinesia, which can sometimes be permanent. Contact your prescriber right away if this happens.
Rexulti (brexpiprazole) might make it hard for your body to control its temperature. Drink plenty of water to stay hydrated, especially when it’s hot or when you’re exercising.
Some people taking Rexulti (brexpiprazole) have experienced strong urges they can’t control, like gambling, shopping, overeating, or sexual behavior. Let your prescriber know if you notice any new or unusual behaviors.
Frequently asked questions about Rexulti (brexpiprazole)
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What are the risks and warnings for Rexulti (brexpiprazole)?
Rexulti (brexpiprazole) 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.
Higher risk of death in older adults with dementia-related psychosis
Risk factors: Older adults with dementia-related psychosis
Older adults with dementia sometimes have symptoms like hallucinations or delusions, which is called dementia-related psychosis. People with this condition who take antipsychotic medications like Rexulti (brexpiprazole) have a higher risk of death, usually from heart problems or infections. Studies have also shown that older adults with dementia who took similar medications had a higher chance of having a stroke.
Rexulti (brexpiprazole) isn't approved to treat dementia-related psychosis unless it's for agitation caused by Alzheimer’s disease. If you have questions about the risks, talk to your prescriber.
Suicidal thoughts and behaviors
Risk factors: People age 24 or younger | Taking antidepressants
Taking Rexulti (brexpiprazole) can put you at risk for having suicidal thoughts and behaviors. Your risk is higher if you're 24 years old or younger, or taking antidepressants like sertraline (Zoloft) or fluoxetine (Prozac). Look out for worsening depression or sudden changes in your mood, behavior, thoughts, or feelings, especially during the first few months of treatment or after a dose changes. Family members and caregivers should also watch for any unusual behavior and contact your prescriber right away if they’re concerned.
Neuroleptic malignant syndrome (NMS)
Rexulti (brexpiprazole) can cause neuroleptic malignant syndrome (NMS), a rare but serious condition that can be life-threatening. Symptoms include a very high fever, stiff muscles, confusion, a fast or uneven heartbeat, and sweating. Stop taking Rexulti (brexpiprazole) and get medical attention right away if you have these symptoms.
Uncontrolled body movements (tardive dyskinesia)
Risk factors: Older adults | Women | Higher than recommended doses of Rexulti (brexpiprazole) | Taking Rexulti (brexpiprazole) for a long time
Rexulti (brexpiprazole) can cause uncontrolled and possibly permanent muscle movements in your face, tongue, arms, or legs. This is known as tardive dyskinesia). To lower your risk, your mental health provider will prescribe the lowest dose needed to manage your symptoms. Get medical help right away if you notice any unusual movements you can't control. This side effect can sometimes occur even after you stop the medication.
High blood sugar, high cholesterol, and weight gain
Rexulti (brexpiprazole) can raise your blood sugar levels, and in some cases, this might lead to diabetes. Let your prescriber know if you notice symptoms like feeling very hungry or thirsty, urinating more often, stomach pain, weakness, or fruity-smelling breath.
Rexulti (brexpiprazole) can also cause high cholesterol and triglycerides (fat), which can raise your risk of heart problems. The medication can also cause weight gain.
Your prescriber will likely check your blood sugar, cholesterol, and weight before you start and regularly while you’re taking this medication.
Impulse control problems
Rexulti (brexpiprazole) can make it harder to control your actions and might lead to strong urges or behaviors like gambling, eating, shopping, or sex. Many people don’t realize these behaviors are unusual, so it’s important for you and your loved ones to watch for any new or intense urges. If you notice this happening while taking Rexulti (brexpiprazole), tell your prescriber right away. In some cases, the urges went away when the dose was lowered or the medication was stopped. If left untreated, these behaviors can cause harm to you or others.
Low white blood cell count
Risk factors: History of low white blood cell counts | Taking other medications that lower white blood cell counts
Rexulti (brexpiprazole) can lower your white blood cells count, which can raise your risk for serious infection. You might need to get lab work done regularly to make sure your white blood cell count is healthy. If your levels drop too low, your prescriber might need to stop the medication. Talk to your prescriber right away if you experience symptoms of an infection, including fever, weakness, or sore throat, while taking Rexulti (brexpiprazole).
Falls and fainting
Risk factors: Starting Rexulti (brexpiprazole) for the first time | Higher dose of Rexulti (brexpiprazole) | Older adults | History of dehydration | Not enough fluids in your body | History of heart problems | Taking medications that lower blood pressure
Rexulti (brexpiprazole) can cause sleepiness, dizziness, balance problems, and a drop in blood pressure when you sit up or stand up too quickly. This can result in fainting and falling. Your risk of falls is higher if you have heart problems, are dehydrated, or are also taking blood pressure lowering medications. To lower your risk, sit or stand up slowly — especially in the first few days after starting the medication or if your dose has been raised. Talk to your prescriber if you keep feeling dizzy while taking this medication.
Seizures
Risk factors: History of seizures | Health conditions that raise the risk of seizures | Older adults
Like other antipsychotic medications, Rexulti (brexpiprazole) can cause seizures. The risk is higher if you’ve had seizures before or have health problems that make seizures more likely. Let your care team know if you have a history of seizures or start to feel unusual symptoms while taking this medication.
Trouble controlling body temperature
Atypical antipsychotics like Rexulti (brexpiprazole) can make it harder for your body to cool down properly. Things like intense exercise, hot weather, dehydration, or taking other medications that affect body temperature can make this worse. Talk to your prescriber if you have questions or notice problems with staying cool.
Difficulty swallowing
Rexulti (brexpiprazole), like other antipsychotic medications, can cause trouble swallowing and raise your risk of aspiration, which is when food or liquid accidentally goes into your lungs instead of your stomach. Let your care team know if you notice trouble swallowing while taking this medication.
Problems with thinking and movement
Rexulti (brexpiprazole) can cause drowsiness and might affect your judgment, thinking, or movement. Be careful with activities that need you to stay alert, like driving or using heavy machinery, until you know how this medication affects you. Talk to your prescriber if you feel very sleepy or have trouble thinking clearly while taking this medication.
Rexulti (brexpiprazole) dosage forms
Typical dosing for Rexulti (brexpiprazole)
Depression: The typical starting dose is 0.5 mg to 1 mg by mouth once a day, as an add-on to other antidepressants. Your prescriber might raise your dose weekly, if needed. The maximum daily dose is 3 mg.
Schizophrenia:
Adults: The typical starting dose is 1 mg by mouth once a day. If needed, your prescriber might raise your dose every few days. The maximum daily dose is 4 mg.
Teens 13 to 17 years old: The typical starting dose is 0.5 mg by mouth once a day. If needed, your prescriber might raise your dose every few days. The maximum daily dose is 4 mg.
Dementia-related agitation: The typical starting dose is 0.5 mg by mouth once a day. Your prescriber might raise your dose weekly, if needed. The maximum daily dose is 3 mg.
Your dose might differ if you have kidney problems, liver problems, or if you take other medications that interact with Rexulti (brexpiprazole).
How much does Rexulti (brexpiprazole) cost?
What are alternatives to Rexulti (brexpiprazole)?
Add-on treatment for depression in adults
Schizophrenia in adults and teens 13 years and older
Dementia-related agitation from Alzheimer's disease
Schizophrenia in adults and children ages 13 years and older
Bipolar disorder in adults and certain children ages 10 years and older
Depression in adults, as an add-on to other antidepressants - extended-release only
Tourette syndrome in children
Depression (add-on treatment)
Irritability associated with autistic disorder in children
What is the latest news about Rexulti (brexpiprazole)?
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References
Best studies we foundCorrell, C. U., et al. (2015). Efficacy and Safety of Brexpiprazole for the Treatment of Acute Schizophrenia: A 6-Week Randomized, Double-Blind, Placebo-Controlled Trial. The American Journal of Psychiatry.
Food and Drug Administration. (2023). FDA Approves First Drug to Treat Agitation Symptoms Associated with Dementia due to Alzheimer’s Disease.
Grossberg, G. T., et al. (2020). Efficacy and Safety of Brexpiprazole for the Treatment of Agitation in Alzheimer's Dementia: Two 12-Week, Randomized, Double-Blind, Placebo-Controlled Trials. The American Journal of Geriatric Psychiatry.
Keepers, G. A., et al. (2021). Practice guideline for the treatment of patients with schizophrenia. American Psychiatric Association.
Massachusetts General Hospital Center for Women’s Mental Health. (n.d.). National Pregnancy Registry for Psychiatric Medications.
McQuade, R. D., et al. (2015). Efficacy and Safety of Adjunctive Brexpiprazole 2 mg in Major Depressive Disorder: A Phase 3, Randomized, Placebo-Controlled Study in Patients With Inadequate Response to Antidepressants. The Journal of Clinical Psychiatry.
Otsuka America Pharmaceutical, Inc. (2023). REXULTI- brexpiprazole tablet REXULTI- brexpiprazole kit [package insert]. DailyMed.
U.S. Food and Drug Administration. (2023). FDA approves first drug to treat agitation symptoms associated with dementia due to Alzheimer’s disease.
Ward, C., et al. (2025). Efficacy and safety of brexpiprazole in adolescents with schizophrenia: a multicountry, randomised, double-blind, placebo-controlled, phase 3 trial with an active reference. The Lancet.
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