Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Rexulti is a prescription medication approved by the Food and Drug Administration (FDA) to treat schizophrenia, and to treat depression when combined with other drugs.
The generic version of the drug is called brexpiprazole, and we’ll use these terms interchangeably throughout this article because they refer to the same active drug ingredient.
But is Rexulti proven to be effective for both depression and schizophrenia? Is it more effective for one or the other? Does it cause concerning side effects? And can Rexulti cause weight gain?
In this article we'll answer all of these questions and more, as we review research studies on Rexulti to determine whether or not it's effective for depression and schizophrenia.
We'll also discuss the potential for side effects, explain whether or not Rexulti causes weight gain, and share our thoughts about whether or not the generic version is a better option.
Key takeaways:
- Improves anti-depressant effects when taken with another anti-depressant
- Clinically shown to be effective against schizophrenia
- May cause weight gain based on early side effect data
Does Rexulti Relieve Depression?
As referenced in the intro to this article, Rexulti is only approved by the FDA to treat depression as an adjunctive therapy, meaning it’s taken in combination with another antidepressant. It is not approved to treat depression when used in isolation.
A medical review published in the CNS Drugs journal examined the efficacy of Rexulti as an adjunctive therapy for major depressive disorder (MDD). The researchers analyzed data from over 30 clinical trials.
The study authors found that Rexulti combined with an antidepressant was more effective for treating depression than an antidepressant alone. They noted that Rexulti adjunctive use “significantly improved the symptoms of depression.”
Not only did adjunctive Rexulti improve symptoms of depression, but the drug also caused improvements in anxiety, irritability and sleep.
A 2016 meta-study analyzed whether adjunctive Rexulti was effective for treating depression in patients with both anxiety and depression. The drug was found effective at a dose range between 2 milligrams (mg) and 3 mg daily.
We will conclude from the available medical research that Rexulti is effective for treating depression when taken with another antidepressant, which is unsurprising given that the drug is approved by the FDA for that indication.
Does Rexulti Relieve Schizophrenia?
Unlike its use in the treatment of depression, Rexulti can be prescribed as a standalone treatment for schizophrenia.
A medical review published in the Drugs journal analyzed data from many clinical trials on Rexulti as a schizophrenia treatment.
The medication was found to be effective, increasing patient response rate by 10%. This means that around 10% more patients experienced reductions in schizophrenia symptoms on Rexulti than on placebo pills.
A more recent medical review replicated these positive results, finding Rexulti to be effective in schizophrenic patients.
Patients taking Rexulti experienced fewer psychiatric symptoms related to schizophrenia, and relapsed fewer times over the course of the treatment than those taking placebo pills.
We will conclude from the available research that Rexulti is effective for treating schizophrenia, which is to be expected since it's approved by the FDA for that outcome.
Does Rexulti Cause Side Effects?
Rexulti causes side effects in some patients, and these side effects can be severe.
The "black box" warning on this drug's label is shown below:
A 2017 meta-study documented the most common side effects of the drug. Restlessness was experienced by 4-14% of Rexulti patients, headache by 4-10% of patients, sleepiness by 2-6% of patients, and tremor by 2-5% of patients.
These side effects are relatively mild. However Rexulti may cause more severe side effects in some patients.
Rexulti’s FDA label has a “black box” warning, shown above, which is the most severe type of warning issued by the FDA.
The black box warning indicates that Rexulti may increase the mortality rate in elderly patients with dementia-related psychosis, and can increase suicide risk in patients aged 24 and younger.
In light of this information, it may be beneficial for patients aged 24 and under and elderly patients to speak with their doctor about alternative schizophrenia or depression medication which doesn’t confer this risk.
Does Rexulti Cause Weight Gain?
Patients are often curious about whether Rexulti causes weight gain as a side effect.
This is a logical concern, given that some antipsychotic medications do cause weight gain as we documented in our aripiprazole reviews article on another drug used for schizophrenia.
Rexulti does appear to cause weight gain based on results from clinical trials.
A review published in the International Clinical Psychopharmacology journal examined the effects of Rexulti on body weight in patients using the drug for depression and for schizophrenia.
Both groups experienced weight gain, but average weight gain was lower in the group using Rexulti for depression than for schizophrenia.
Depressed patients gained an average of 4.63 pounds after one year on Rexulti. Schizophrenic patients gained an average of 7.05 pounds after a year on the drug.
This data suggests that overweight and obese patients may wish to speak with their doctor about alternative schizophrenia or depression medications that are not associated with weight gain.
Is the Generic Version Cheaper?
Patients are often curious about whether they should take the generic or branded version of a drug, given that generic versions often have a much lower retail price.
This consideration is typically more significant for patients without health insurance.
In the case of Rexulti, the generic version of the drug is not yet commercially available according to GoodRx.
Sometimes drug manufacturers hold a patent that allows them to be the exclusive retailer of a medication for a set number of years.
We recommend that patients on Rexulti speak with their doctor every year or so about whether a generic version has become available, because medical research proves that generic versions of drugs are equally effective to branded versions, and can be significantly cheaper.
If a patient is based in the US, the cost of Rexulti will vary significantly depending on whether or not they have health insurance.
According to Rexulti’s official website, patients with health insurance through a private program will pay an average of $31.15 per month.
The above-linked Cost resource page on Rexulti’s site suggests that patients on government health programs typically pay less than patients on private health programs.
For patients without health insurance, the retail price of Rexulti is currently around $1,500 according to GoodRx.
Rexulti Dosage
The dosage of Rexulti varies based on the condition it’s being used to treat.
According to the FDA label linked previously in this article, the typical starting dose of Rexulti for depression is 0.5 mg per day, and the maximum dose is 3 mg per day.
The typical starting dose of Rexulti for schizophrenia is 0.5 mg per day, and the maximum dose is 4 mg per day.
Doctors will typically start patients on the lowest dose in the therapeutic range because this can minimize the risk of side effects.
If the patient experiences benefit on the lowest dose, this is a beneficial outcome and they can typically continue using that dose. Some patients may experience no benefit on the lower doses, and their doctor may titrate their dose up to the maximum allowed dose over the course of weeks or months.
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