This article is Part II of Trying Rexulti as a New Medication. You can read Part I here.
My psychiatrist recently decided to change my medication regimen almost completely. I was taken off aripiprazole (Abilify) and sertraline (Zoloft) completely, my dose of lamotrigine (Lamictal) was lowered and she added a fairly new medication called brexpiprazole (Rexulti). There are several concerns when making medication changes including withdrawal effects, new side effects and the possibility of causing relapse or exacerbating symptoms. Rexulti is not currently approved for treating bipolar disorder, so I am sharing my experiences for others who may be prescribed this medication.
Rexulti is currently only approved for treating schizophrenia as well as an add-on treatment for antidepressants used in treating major depressive disorder. Research on treating bipolar disorder with Rexulti is limited mostly to suggesting it may be effective for uses other than currently approved usage. It is an atypical antipsychotic, which are frequently used to treat bipolar disorder, so prescribing it to treat bipolar disorder is not a far reach.
I have now been taking Rexulti for two weeks. The first week was a little rough. I still dealt with some manic symptoms and possible withdrawal because of the reduction of lamotrigine. However, most psychiatric drugs used for maintenance therapy can take weeks to see results, so Im being patient.
Thankfully week two has already shown a significant improvement in my symptoms. My head has cleared up, my thoughts have slowed to a normal pace. Im less anxious and irritable and have gained more control of my binge eating disorder. There have even been small victories like no longer biting my nails. Its a relief.
That being said, Im not completely well. Im still taking a very low dose of the medication and its possible my psychiatrist may increase the dose in the future. For the next month, at least, I will be taking 1mg per day.
Now the main issue to look out for is side effects. One of the top five reasons people discontinue antipsychotics is because of the frequency and severity of side effects. Generally, side effects of antipsychotics can include:
- Weight gain
- Dry mouth
- Blurred vision
- Low blood pressure
- Uncontrollable movements, such as tics and tremors (the risk is higher with typical antipsychotic medicines)
- A low number of white blood cells, which fight infections
- Loss of bone density
These might not all pertain to all antipsychotics, so its important to check drug information for your specific medication to know what to look for. As far as Rexulti, the side effects most commonly experienced are weight gain and restlessness. There are other possible side effects as well. These include:
- Increased risk of death in elderly people with dementia-related psychosis (Rexulti is not approved for use in patients with dementia-related psychosis)
- Increased thoughts of suicide in children or young adults (Rexulti is not approved for use in people under 18 years of age)
- Stroke in elderly people
- Neuroleptic Malignant Syndrome
- Uncontrolled body movements (tardive dyskinesia)
- Increased levels of cholesterol & triglycerides
- Weight gain
- Low white blood cell count
- Decreased blood pressure
- Body temperature feeling too warm
- Difficulty swallowing
Thankfully I have not yet experienced any of these side effects, but the chances increase with higher dosage. I will continue to monitor any symptoms and side effects as I continue to take this drug, just as I would any other. If I do experience any of these side effects, Ill call my doctor right away. I will not discontinue the drug without the direction of a doctor. Thats dangerous.