Abilify vs. Rexulti: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Abilify (aripiprazole) and Rexulti (brexpiprazole) are both atypical antipsychotics. Both drugs are approved by the United States Food and Drug Administration (FDA). Abilify is also available in its generic form of aripiprazole. Rexulti is not currently available in generic form.

Atypical antipsychotic drugs are also known as second-generation antipsychotics. First-generation antipsychotics, such as haloperidol, were developed in the 1950s. These medications had many more side effects, such as extrapyramidal symptoms. Extrapyramidal symptoms are caused by the blockade of dopamine. These symptoms include movement disorders such as uncontrolled and involuntary muscle movements, inability to sit still, tremors, and involuntary eye blinking.

Second-generation antipsychotics, like Abilify and Rexulti, are newer and have less extrapyramidal side effects. Because they are better tolerated, they are the preferred treatment over the first-generation antipsychotics.

How do atypical antipsychotics, like Abilify and Rexulti, work? The exact mechanism of action is not known. They are thought to work on D2 dopamine receptors and serotonin-5-HT1A and 5-HT2A receptors in the brain, helping symptoms of schizophrenia or other disorders. Rexulti is chemically and structurally similar to Abilify, which makes them similar, but not exactly the same. Continue reading to learn all about Abilify and Rexulti.

What are the main differences between Abilify and Rexulti?

Abilify and Rexulti are both atypical antipsychotic medications. Abilify (aripiprazole) is available in brand and generic form, and Rexulti (brexpiprazole) is currently available only in the brand name. Both medicines are available in tablet form. Abilify is also available in other dosage forms (see chart below for details).

Conditions treated by Abilify and Rexulti

Abilify and Rexulti are both indicated for the treatment of schizophrenia. They are also both approved as adjunctive therapy (in combination with antidepressant medication) for the treatment of major depressive disorder (MDD).

Additionally, Abilify can treat bipolar I disorder (acute treatment of manic and mixed episodes or maintenance treatment), Tourette’s disorder, and irritability due to autistic disorder. The injection form of Abilify is used for the acute treatment of agitation caused by schizophrenia or bipolar disorder.

Is Abilify or Rexulti more effective?

There is very little data comparing Abilify and Rexulti directly.

An article in Therapeutic Advances in Psychopharmacology looked at data and reviewed studies (a meta-analysis). The researchers concluded that Rexulti caused fewer side effects of akathisia (movement disorder), insomnia, restlessness, nausea, weight gain, and sedation because of its activity at specific receptors.

The movement-related side effects of Abilify, though, seemed to be mild and managed by having the prescriber lower the dose. The high cost of brand-name Rexulti could also be a factor for many patients, compared to the lower price of generic Abilify.

A small study compared Abilify and Rexulti in patients with acute schizophrenia (in a hospital setting) and found both drugs to be similarly effective. Patients taking Rexulti experienced less extrapyramidal side effects. It is important to note the limitation that this study was an open-label study (where both the researchers and patients knew which drug the patient was taking). An open-label study is not as high-quality as a double-blind study where there is no bias.

One study looked at the side effect of weight gain from Abilify and Rexulti. The study concluded that both drugs had a similar effect on body weight (an increase of about 5-10 lbs) after one year.

The most effective medicine is the one that works better for you and has the least (or most tolerable) side effects. Your healthcare provider can help you decide if Abilify or Rexulti is better for you, taking into account your medical conditions and history as well as other medications you take that could interact with Abilify or Rexulti.

Coverage and cost comparison of Abilify vs. Rexulti

Abilify is typically covered by insurance plans, Medicare Part D, and Medicare Advantage plans. The out-of-pocket cost for a typical one-month supply of generic 5 mg tablets would be about $700. A SingleCare card can bring the price down to approximately $98.

Rexulti is covered by most, but not all, insurance plans, Medicare Part D, and Medicare Advantage plans. If you pay out-of-pocket, a one-month supply of 2 mg tablets would cost about $240. Using a SingleCare coupon will bring the price to about $198.

Common side effects of Abilify vs. Rexulti

The most common side effects of Abilify in adults are nausea, vomiting, constipation, headache, dizziness, anxiety, insomnia, akathisia (a movement disorder due to antipsychotic medications), and agitation. Other side effects include indigestion, dry mouth, toothache, stomach discomfort, fatigue, stiffness, sedation, tremor, and cough.

The most common side effects of Rexulti listed in the prescribing information are headache, dizziness, anxiety, akathisia, weight gain, fatigue, and agitation/restlessness.

This list is not a full list of side effects—other side effects may occur. Consult your healthcare professional for a complete list of adverse effects of Abilify and Rexulti.

Source: DailyMed (Abilify), DailyMed (Rexulti)

Drug interactions of Abilify vs. Rexulti

Do not take Abilify and Rexulti with alcohol or medications that cause central nervous system (CNS) depression. Additive effects may occur, such as excess dizziness, drowsiness, and psychomotor impairment, leading to fatal accidents. Other drug interactions may include hypoventilation (which can be life-threatening), a decrease in blood pressure, or an increase in extrapyramidal symptoms (drug-induced movement disorders, causing tremors, rigidity, and slowed movement).

Abilify or Rexulti, in combination with blood pressure medications, may cause a decrease in blood pressure. Consult your prescriber if you have high blood pressure or take medicine for your blood pressure.

Abilify and Rexulti both interact with drugs metabolized by specific enzymes. Drugs that inhibit enzymes can increase levels of Abilify or Rexulti. Drugs that induce enzymes can lower levels of Abilify or Rexulti. If the interacting drug combination cannot be avoided, the prescriber will have to adjust dosing.

Other drug interactions may occur. Consult your healthcare provider for a full list of drug interactions before you take Abilify or Rexulti.

Warnings of Abilify and Rexulti

Because Abilify and Rexulti are similar, they have the same warnings:

• There is a black box warning, which is the strongest warning required by the FDA.
• Abilify and Rexulti are not approved to treat elderly patients with dementia-related psychosis. These patients are at an increased risk of death. Antidepressant medications increase the risk of suicidal thoughts and behavior in patients 24 years and younger. Closely monitor patients of all ages who take antidepressants for worsening of depression, changes in behavior, and suicidal thoughts/behaviors.

Other warnings of Abilify and Rexulti include:

• There is an increased incidence of cerebrovascular events, such as stroke or transient ischemic attack, in elderly patients with dementia-related psychosis.
• If the patient develops neuroleptic malignant syndrome (potentially fatal), immediately stop Abilify or Rexulti and monitor the patient. Signs and symptoms of neuroleptic malignant syndrome include fever, altered mental status, rigidity, and heart rate or blood pressure changes.
• If the patient develops tardive dyskinesia (involuntary, repetitive movements like grimacing or eye blinking), discontinue Abilify or Rexulti if appropriate.
• Atypical antipsychotics can cause metabolic changes, including increased blood sugar/diabetes, increased cholesterol, and weight gain. Monitor patients for these changes.
• Abilify or Rexulti may cause pathological gambling and other compulsive behaviors (urge to shop, binge eat, and have sex). These behaviors may require a lower dose or discontinuation of the drug.
• Monitor heart rate and blood pressure. Orthostatic hypotension (low blood pressure when you stand up) or fainting can occur.
• Falls leading to injuries and fractures may occur. The healthcare provider should complete a fall risk assessment when beginning the medication and recurrently.
• Esophageal problems and aspiration may occur. Use with caution in patients at risk for aspiration.
• Changes in white blood cell counts may occur. Complete blood counts should be monitored frequently during the first few months for patients with a history of low white blood cell counts.
• Use Abilify or Rexulti carefully in patients with a history of seizures.
• Use caution when driving or operating machinery until you know how Abilify or Rexulti affects you.
• There is an increased risk of suicide in patients with schizophrenia and bipolar disorder. Closely supervise these patients.
• Because of the potential for drug interactions, inform your prescriber of any other medications you take, both prescription and over-the-counter.
• Avoid overheating and dehydration.
• Notify your healthcare provider if you become pregnant while taking Abilify or Rexulti. These drugs can cause extrapyramidal or withdrawal symptoms in the neonate.

Frequently asked questions about Abilify vs. Rexulti

What is Abilify?

Abilify (aripiprazole) is an atypical antipsychotic, available in brand and generic. Abilify is used to treat schizophrenia, depression (combined with an antidepressant drug), bipolar I disorder, Tourette’s disorder, irritability caused by an autistic disorder, and agitation due to schizophrenia or bipolar disorder.

What is Rexulti?

Rexulti (brexpiprazole) is an atypical antipsychotic, available in brand name. It is used to treat depression (in combination with an antidepressant medication) and schizophrenia.

Are Abilify and Rexulti the same?

Both drugs are chemically similar and are second generation, atypical antipsychotics. They have some similarities and some differences, outlined in the information above.

Is Abilify or Rexulti better?

There is little data comparing the two drugs. To be FDA approved, both drugs have undergone clinical trials for efficacy and safety. Your healthcare provider can decide if Abilify or Rexulti is better for you based on your medical conditions, history, and other medicines you take that could interact with Abilify or Rexulti.

Can I use Abilify or Rexulti while pregnant?

Neonates exposed to atypical antipsychotics during the third trimester of pregnancy are at increased risk for extrapyramidal symptoms (some requiring extended hospitalizations) and withdrawal symptoms after delivery.

There are risks with using the medications in pregnancy, and there are risks to not treating mental health conditions as well. Consult your healthcare provider for medical advice. If you are already taking Abilify or Rexulti and find out that you are pregnant, contact your healthcare provider.

The National Pregnancy Registry for Psychiatric Medications monitors pregnancy outcomes in patients who take psychiatric medicines while pregnant.

Can I use Abilify or Rexulti with alcohol?

No. You should not drink alcohol if you take Abilify or Rexulti. The combination can increase the risk of CNS depression (excess sedation, psychomotor impairment, which could lead to accidents) and respiratory depression (breathing slows or can even stop) and low blood pressure.

Does Rexulti increase dopamine?

Atypical antipsychotics like Rexulti (and Abilify) have partial agonist activity on the D2 dopamine receptors. A partial agonist means that the drug binds to the receptor and activates it, but it is only partially effective (compared to a full agonist). So, these drugs partially activate dopamine receptors, which increases dopamine levels. These drugs also work on serotonin receptors.

Is Rexulti an antipsychotic?

Yes. Rexulti is a second-generation antipsychotic. Second-generation antipsychotics are newer and cause fewer side effects than first-generation antipsychotics. Besides Abilify and Rexulti, other second-generation antipsychotics include:

• Geodon (ziprasidone)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Latuda (lurasidone)
• Vraylar (cariprazine)
• Zyprexa (olanzapine)
• Clozaril (clozapine) has restricted distribution in the US because of its severe side effects.

Does Rexulti help anxiety?

Rexulti is currently approved for schizophrenia and depression (in combination with an antidepressant). One study looked at patients with depression and anxiety symptoms and found Rexulti to help depressive symptoms (and was well-tolerated) in patients with anxiety. Patients took Rexulti in combination with an antidepressant when an antidepressant alone did not help. Consult your healthcare provider if you have anxiety. He or she can determine the appropriate treatment for you.