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Brexpiprazole Warnings: The Potential Side Effects of Rexulti

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Originally Posted On: Brexpiprazole Warnings: Side Effects of Rexulti | Alternative to Meds


There are many atypical antipsychotic medications for depression, schizophrenia, mood disorders, and other mental disorders. It’s essential to review any medication for its benefits and potential side effects before starting one. After reading this, you should be able to answer some basic questions: What is Rexulti, what are Rexulti uses, what are Rexulti side effects, what are Rexulti alternatives, and how does Rexulti make you feel?

A Brief Overview of Rexulti (Brexpiprazole)

Rexulti is an antipsychotic medication that is prescribed for use in conjunction with other antidepressants to address major depressive disorder. It is also approved for use in the treatment of schizophrenia.1 There are many benefits to this medication, but it is important to look at the costs and all potential side effects. Rexulti helps a patient feel less nervous, clears some mental fog, decreases hallucinations, and improves mood, sleep, energy levels, and appetite.

What Is Rexulti Used for and How Is It Used?

Physicians prescribe Rexulti in situations where current antidepressant medications alone are unable to successfully relieve depressive symptoms in their patients. It is often used as an add on in treating major depressive disorder (MDD) Doctors also prescribe Rexulti for treatment of schizophrenia.

Rexulti is taken orally. It does not need to be taken with food. Typically, one dose is taken per day. It must be taken exactly as prescribed, and it needs to be titrated at the beginning and tapered at the end of use. Do not start or stop taking Rexulti without direction from your prescribing physician.

Rexulti needs to build up in a patient’s system to be most effective. It is not a cure for anything. It is a medication that may need to be taken for an extended time.

Start Rexulti at Low Dose

There are many side effects a patient may encounter from taking Rexulti. It is important to recognize the side effects and discuss any concerns with a physician before beginning any new medication. Due to the severity of certain side effects, this medication is often given at a low dose to start. This initial low dose will be increased in steps to lower the risk of any potential side effects. It is imperative that you listen to your physician and follow their directions.

It is vital for patients to continue taking this medication exactly as prescribed, even if they feel better. When patients are going to stop taking Rexulti, tapering off is very important for preventing or minimizing withdrawal side effects, including restlessness, agitation, sleep disturbances, and muscle problems.


How Does Rexulti Work?

Rexulti works in the brain by balancing chemicals. More specifically, it is a serotonin-dopamine activity modulator (SDAM) that works with the dopamine and serotonin receptors inside the brain. Serotonin and dopamine are important neurotransmitters that nerve cells release and receptors in the brain pick up. Both serotonin and dopamine play a role in depression, but each works a little differently.

Dopamine Is a Motivator

Increasing dopamine may help with some depression symptoms, including low motivation, a loss of interest in things that used to be enjoyable, and thoughts of helplessness. This is because dopamine is the motivation and reward chemical. It’s why you get a rush when you complete a task. Dopamine helps people enjoy all kinds of activities. From food to sex, dopamine being released in the brain helps us enjoy those experiences. Unfortunately, it’s also what leads to addictions, including drugs, gambling, and shopping.

Dopamine Can Cause Problems for Users

Dopamine does not always get released at the same level. An activity that once brought a rush to a person may not be as exciting after a while. This means that a person may “use” more than they once did to get the same rush, whether it is a drug or another addiction. Dopamine dysfunction has been tied to bipolar disorder, major depressive disorder, attention deficit hyperactivity disorder (ADHD), and schizophrenia.


Rexulti Moderates Serotonin Activity Too


Serotonin can affect a person’s overall mood because serotonin helps a person process their emotions. Low serotonin levels were thought to be the cause of depression, but several decades of research have suggested that it is not quite that simple. The most effective non-holistic medicinal approach to depression is to increase serotonin levels in the brain by using selective serotonin reuptake inhibitors (SSRIs). Forty to 60 percent of people with moderate to severe depression who start SSRIs feel they are improving within six to eight weeks.2 That leaves a lot of patients not responding to the SSRIs. That’s why doctors may prescribe Rexulti (brexpiprazole) in addition to an SSRI for major depressive disorder.

Increased serotonin in the brain does not always equate to less depression. Instead, increased serotonin helps with positive emotional processing. Over time, that can result in an overall improvement in mood.

Serotonin has been linked to autism spectrum disorders, bipolar disorder, anxiety disorders, obsessive-compulsive disorder (OCD), and social anxiety disorder.1

Not only do serotonin and dopamine affect a person’s mood, they can also affect a person’s sleep and digestion.


Uses for Rexulti

Rexulti alters the serotonin and dopamine receptors in the brain, and because both serotonin and dopamine involve so many different functions, there are a number of situations where the use of Rexulti is not appropriate due to potential side effects.

Who Should Not Take Rexulti?

  • Elderly patients who are suffering from dementia related psychosis should not take Rexulti. Antipsychotics have been shown to increase the risk of death in this group.4
  • Patients under the age of 24 should be closely monitored by the prescribing physician for any increase in the occurrence of suicidal thoughts and behaviors that may occur with an antidepressant.5
  • Rexulti is not approved for use in pediatric treatment.6
  • Older patients may experience more severe side effects, especially drowsiness and lightheadedness, increasing the risk of falls.
  • Women who are pregnant should use this medication only after discussing it with their physicians. There are some rare symptoms that may be passed to the fetus and can result in side effects in the newborn, including muscle stiffness or shakiness, drowsiness, feeding difficulties, breathing difficulties, and constant crying.

Individuals who are taking other medications that may cause an interaction may not want to take this medication. It is essential to discuss all medications and other substances that a patient ingests. This includes regular alcohol and marijuana use. Medicines that may cause drowsiness may cause added drowsiness because of the interaction with Rexulti.

These medications can include but are not limited to:

  • Obesity
  • Diabetes
  • Excessive fat in the bloodstream
  • Low levels of granulocytes (type of white blood cell)
  • Low levels of white blood cells
  • Confusion
  • Suicidal thoughts
  • Alzheimer’s disease
  • Parkinson’s
  • Tardive dyskinesia (involuntary movements of the face, mouth, and tongue)
  • Extrapyramidal disease
  • Neuroleptic malignant syndrome (muscle rigidity, fever, and confusion)
  • Low seizure threshold
  • Low supply of oxygen in the blood
  • Abnormal heart rhythm
  • Chronic heart failure
  • A disorder of the blood vessels of the brain
  • Orthostatic hypotension (a type of low blood pressure)
  • Low blood pressure
  • Liver problems
  • Decreased kidney function
  • Seizures
  • Weight gain
  • Breathing fluids into lungs
  • Pregnancy
  • Issues with food going through the esophagus
  • Dementia in elderly people
  • Poor metabolizer of CYP2D6


What Are Its Potential Side Effects?

It is essential to understand all the known side effects of a medication before starting it and to discuss any side effects with your physician. It is often beneficial when starting a new mental health medication to keep a journal to track medication benefits as well as any side effects.

Rexulti may cause any of the following:

  • Drowsiness
  • Dizziness
  • Lightheadedness
  • Shaking
  • Increased appetite
  • Weight gain
  • Restlessness
  • Inability to keep still
  • Serious drop in blood pressure
  • Falling due to dizziness or lightheadedness
  • Trouble swallowing
  • Fainting
  • Interrupted breathing during sleep
  • Unusually strong urges (i.e., gambling, sexual urges)
  • Tardive dyskinesia
  • Increased blood sugar levels, which may cause or worsen diabetes
  • Increased thirst
  • Increased urination
  • Increased triglyceride (cholesterol) levels
  • Increased risk for developing heart disease
  • Increased prolactin hormone
  • In women, it may cause unwanted breast milk, fertility issues, and missed or unusual periods.
  • In men, there may be decreased sexual ability, sperm production problems, or enlarged breasts.
  • Seizures, Contact your doctor immediately.
  • Neuroleptic malignant syndrome (NMS). Pursue medical attention immediately if you experience any muscle stiffness, muscle pain, tenderness, or weakness; fever; severe tiredness or confusion; sweating; fast/irregular heartbeat; signs of kidney problems, such as changing amounts of urine and frequency of urination, or dark urine.
  • Allergic reactions. While rare, get medical attention immediately if you experience any rash, itching, swelling, severe dizziness, trouble breathing.
  • Less sweat, which can lead to heatstroke


Alternatives to Rexulti

Rexulti is a second-generation antipsychotic. Other second-generation antipsychotic medications include:

  • Abilify (aripiprazole)
  • Geodon (ziprasidone)
  • Risperdal (risperidone)
  • Seroquel (quetiapine)
  • Latuda (lurasidone)
  • Vraylar (cariprazine)
  • Zyprexa (olanzapine)
  • Clozaril (clozapine)

Alternatives to Prescription Medications

There are several different therapies that may help patients that are alternatives to prescription medications.

CBT Therapies

Cognitive behavioral therapy (CBT) is premised on the belief that negative thoughts and feelings can suck you into an unhealthy cycle. By looking at your thoughts, feelings, physical interactions, and actions as interconnected, you can conquer overwhelming problems by breaking them down into separate parts.

DBT Therapy.

Dialectical behavioral therapy (DBT) is an evidence-based type of CBT that breaks into four modules:

  • Mindfulness
  • Interpersonal effectiveness
  • Distress tolerance
  • Emotional regulation

EMDR Therapy.

Eye movement desensitization and reprocessing (EMDR) is a therapy that deals with traumatic experiences.

Sound, music, and art therapy.

Get creative. What helps you? Anything that can invoke feelings may be used in therapy. Expand your horizons to involve music, dance, sounds, art, etc.

Practices to Help Manage the Symptoms

There are also many practices that you can do in addition to formal therapeutic methods to help manage the symptoms of mental health conditions.

Exercise and diet

Exercise releases endorphins, which help with mood. Equally important, a healthy diet can help with balancing different nutrients in your body to help with energy levels and tiredness.

This may include taking vitamin supplements that can also help with depression symptoms.


Acupuncture is a great alternative medicine practice that has been around for centuries. Acupuncture involves lightly piercing the body in certain points, which triggers endorphins to relieve tension in the body.

Fresh air and sunshine

Get outside. Let the sun shine on you. Spend time in your own thoughts. Fresh air and sunlight are free. Use them frequently.


Sometimes incorporated with some meditation, stretching, and breathing exercises help release built-up tension.


Meditation has been around for centuries. Meditation is personal; it is whatever you want to make it. It can involve music, sounds of nature, or silence. Whatever relaxes you the most. Some meditation can also include breathing exercises and stretches. It can be dark, light, whatever you want. You can meditate any time you want. It is free. There are many helpful guided meditations available for free on the internet.

Herbal medicines and herbal supplements

Always consult a doctor before starting any new supplements, but different supplements help with mental health problems. Some indirectly help by providing extra energy throughout the day.


People have been journaling about their feelings for generations. Writing your thoughts or feelings down helps get them out and helps you deal with them. There are many different ways to journal; it is a personal choice. Try it. What works for you?

Breathing Exercises

Breathing exercises can help with anxiety, depression, and other mental health disorders. It usually involves controlled breathing where a person breathes in for a certain count, holds for a certain count, and exhales to a certain count. Breathing exercises are free and can be done anywhere.

Grounding exercises

Another quick tip for calming anxiety is to do exercises that help ground yourself. When a panic attack makes it feel like the world is caving in, your senses are often the only thing that can remind you it’s still standing and you’re still in it. Identifying various things you can see, hear, smell, feel, and taste can help you use your senses as a tether to pull yourself back from the depths of anxiety, depression, and other overwhelming mental states.

There are several types of grounding exercises, but the most common one involves engaging all of the five senses, not only to distract from the cause of anxiety or panic, but also to return the body to a neutral state. When done right, this technique can help a person in the midst of a panic attack to stop hyperventilating and unclench tense muscles, as well as bring their heart rate and blood pressure back to normal.

This five step method involves the following steps:

  • Look around the room and name five things you can see.
  • Listen to the environment around you and name four things you can hear.
  • Breathe deeply and name three things you can smell.
  • Touch things near to you and name two things you can feel.
  • Think about and name one thing you can taste.

An important note for this grounding technique is not to judge anything you perceive during this exercise. Don’t allow yourself to be derailed if one of the things you can see is dirty laundry or your to-do list. Don’t feel bad if any of the senses brings something unpleasant, just acknowledge it and move on to the next observation.

Is Rexulti Right for You?

Rexulti may be beneficial; however, you should consider some of the serious side effects before starting it or any other prescription medications. There are also a lot of options that can be tried before turning to prescription medications. Many options are free, such as exercise, diet, meditation, breathing exercises, yoga, grounding exercises. Contact Alternative to Meds for more information.

 1 (800) 301-3753 for Antipsychotic Alternatives Help


  1. FDA prescribing information REXULTI® (brexpiprazole) [ 2015] [online] [cited 2021 May 5]
  2. [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: How effective are antidepressants? [Updated 2020 Jun 18] [cited 2021 May 5]
  3. Murphy DL, Moya PR, Fox MA, Rubenstein LM, Wendland JR, Timpano KR. Anxiety and affective disorder comorbidity related to serotonin and other neurotransmitter systems: obsessive-compulsive disorder as an example of overlapping clinical and genetic heterogeneity. Philos Trans R Soc Lond B Biol Sci. 2013;368(1615):20120435. Published 2013 Feb 25. doi:10.1098/rstb.2012.0435 [cited 2021 May 5]
  4. FDA prescribing information REXULTI® (brexpiprazole) [ 2015] [online] [cited 2021 May 5]
  5. FDA prescribing information REXULTI® (brexpiprazole) [ 2015] [online] [cited 2021 May 5]
  6. FDA prescribing information REXULTI® (brexpiprazole) [ 2015] [online] [cited 2021 May 5]

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