Jeffrey Panko NP Psychiatry · Patient education
Brexpiprazole
Rexulti / Oral tablets
A guide for adults taking brexpiprazole.
Follow the directions on your prescription and your provider's recommendations.
Formulations: Tablets are taken once daily. The dose and maximum differ by diagnosis, kidney or liver function, and interacting medications.
What it is used for
Brexpiprazole treats schizophrenia, is added to an antidepressant for major depression, and treats agitation associated with Alzheimer dementia. For Alzheimer-related agitation, it is scheduled treatment—not an as-needed calming dose.
How it works
It partially activates dopamine D2 and serotonin 5-HT1A receptors and blocks serotonin 5-HT2A receptors. These actions affect mood and psychotic symptoms, with possible effects on movement, appetite, and alertness.
What to expect over time
Some symptoms improve earlier than others. Changes in hallucinations, mood, or organized thinking often develop over several weeks. Track practical goals, such as regular sleep and daily activities, and report side effects or limited benefit.
Taking your medication
- Take once daily, with or without food. Increase only as prescribed.
- If you miss a dose, take it when you remember unless it is almost time for the next dose. Then skip it. Do not double a dose.
- Contact your provider before restarting after several missed days.
- Discuss dose timing if you feel sleepy or activated.
When to get help
Emergency symptoms. Get emergency care for fever with severe muscle stiffness and confusion, a seizure, fainting with an irregular heartbeat, or trouble breathing. Fever and stiffness can signal neuroleptic malignant syndrome, a rare but serious reaction.
Prompt medical advice. Contact your provider promptly for new involuntary movements, trouble swallowing, severe restlessness, or symptoms of high blood sugar such as unusual thirst and frequent urination.
If you feel unsafe or have thoughts of self-harm, call 911 or go to an emergency department.
Possible side effects
- Weight gain or increased appetite
- Restlessness or difficulty sitting still
- Sleepiness, fatigue, or dizziness
Keeping track of treatment
Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.
Expect periodic checks of weight, blood pressure, blood sugar, cholesterol, and movement symptoms. Some changes, such as higher blood sugar, may occur before you feel different.
Report new mouth, tongue, face, or limb movements. Tardive dyskinesia is a movement disorder that can persist after medication is stopped.
Report new difficult-to-control urges involving gambling, shopping, eating, or sex. When used with an antidepressant, monitor worsening mood or suicidal thoughts, especially under age 25.
If you take too much
For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.
Before you start
Discuss diabetes, heart-rhythm problems, fainting, seizures, low blood counts, swallowing difficulties, and kidney or liver disease. Antipsychotics increase the risk of death in older adults with dementia-related psychosis.
Discuss pregnancy, pregnancy plans, and breastfeeding with your provider. Treatment decisions should consider both the medication and the condition being treated.
Medicines and interactions
Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.
Alcohol, opioids, sleeping pills, and sedating allergy medicines can increase impairment. Blood-pressure medicines may add lightheadedness or falls.
Medicines that affect heart rhythm or dopamine signaling need particular review. Some antibiotics, antifungals, and seizure medicines change antipsychotic levels.
CYP2D6 and CYP3A medicines can change exposure. The adjustment rules depend on the indication; do not assume that every antidepressant combination requires the same dose reduction.
Everyday tips
Stand up slowly. Avoid driving until you know how the medication affects alertness and coordination.
Stay hydrated and take breaks in hot weather. Some antipsychotics interfere with temperature regulation.
Discuss appetite or weight changes early, and keep scheduled monitoring visits.
Your questions answered
Can I stop when I feel better?
Consult with your provider. Continuing treatment may prevent symptoms from returning. Abrupt stopping can cause withdrawal symptoms or a relapse.
What if I cannot sit still?
An inner urge to keep moving can be akathisia, a medication side effect. Tell your provider promptly; it can be mistaken for worsening anxiety.
Storage and safety
Keep medication in its labeled container, away from excess heat and moisture and out of reach of children and pets. Do not share it. Ask a pharmacy about disposal of unused medication.
Sources
About this information
Educational handout; does not replace your prescription or provider's recommendations.
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.