Rexulti alternatives: What can I take instead of Rexulti?

In this article:

• What can I take in place of Rexulti?
• Compare Rexulti alternatives
• Other alternatives to Rexulti
• Top 5 Rexulti alternatives
• Natural alternatives to Rexulti
• How to switch to a Rexulti alternative
• Expert takeaway

In this article

• What can I take in place of Rexulti?
• Compare Rexulti alternatives
• Other alternatives to Rexulti
• Top 5 Rexulti alternatives
• Natural alternatives to Rexulti
• How to switch to a Rexulti alternative
• Expert takeaway

Rexulti (brexpiprazole) is a brand-name prescription drug made by Otsuka America Pharmaceutical. Rexulti is approved by the Food and Drug Administration (FDA) as an adjunct to be used along with an antidepressant medicine to treat major depressive disorder (MDD, also known as depression) in adults. It is also FDA approved to treat schizophrenia in adults and children ages 13 and older, and to treat agitation that may occur with dementia due to Alzheimer’s disease. Rexulti is part of a group of drugs known as atypical or second-generation antipsychotics.

While Rexulti is an effective treatment for many people, some may have better options. For various reasons, such as cost, side effect profile, or allergy to the active or inactive ingredients, discussing an alternative medicine with one’s healthcanare provider may be necessary.

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What can I take in place of Rexulti?

There are other antipsychotic drugs available to treat MDD, schizophrenia, or agitation from dementia due to Alzheimer’s disease if symptoms do not improve with Rexulti or if it cannot be tolerated. The table below compares Rexulti with some of the other FDA-approved atypical antipsychotic drugs.

*Dosage may vary by factors such as age, weight, and reason for use.

Other alternatives to Rexulti

Rexulti is an atypical, or second-generation, antipsychotic. This group of antipsychotics is newer and causes fewer movement-related side effects than the first-generation or typical antipsychotics. Examples of typical antipsychotics include:

•  Haldol (haloperidol)
• Loxitane (loxapine)
• Mellaril (thioridazine)
• Navane (thiothixene)
• Prolixin (fluphenazine)
• Stelazine (trifluoperazine)
• Trilafon (perphenazine)
• Thorazine (chlorpromazine)

Top 5 Rexulti alternatives

The following are some of the most common alternatives to Rexulti.

1. Abilify (aripiprazole) 

Abilify is approved for the treatment of schizophrenia and as adjunctive therapy (in combination with antidepressant medication) for the treatment of MDD. Abilify is also approved to treat manic and mixed episodes associated with bipolar I disorder, irritability associated with autistic disorder, and Tourette’s disorder. Whereas Rexulti is only available in tablet form, Abilify is available as an oral tablet, an orally disintegrating tablet, an oral solution, and an injectable form. Aripiprazole is also available as a lower-cost generic version.

The most common side effects of Abilify are nausea, vomiting, constipation, headache, blurred vision, dizziness, anxiety, drowsiness, insomnia, restlessness (akathisia), and agitation. Rexulti has a black box warning, which is the most serious warning required by the FDA. It states that Rexulti should not be used in older adults with dementia-related psychosis due to an increased risk of death. The warning also states that antidepressants may increase the risk of suicidal thoughts and behaviors, especially in young adults, children, and adolescents. Abilify has the same boxed warning as Rexulti. 

An article reviewing clinical trials concluded that Abilify patients experienced more side effects of akathisia (movement disorder), insomnia, restlessness, nausea, weight gain, and sedation than those on Rexulti. However, the movement-related side effects of Abilify seemed to be mild and could be managed by reducing the dose. 

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

2. Risperdal (risperidone)

Risperdal is approved to treat schizophrenia. It is also approved to treat bipolar mania (alone or in combination with other medications) and irritability associated with autism. Risperdal is available as a lower-cost generic in multiple dosage forms, including an oral tablet, an orally disintegrating tablet, and an oral solution. It is typically given once daily or in a divided dose twice daily.

Common side effects of Risperdal include movement disorders, sedation, dizziness, anxiety, vision disturbances, stomach problems (discomfort, nausea, vomiting, indigestion, diarrhea, constipation), dry mouth, and increased appetite and weight. Risperdal shares the same boxed warning as Rexulti regarding not using it in older adults with dementia-related psychosis. Because it’s not used for depression, Risperdal does not have the warning related to suicidal thoughts and behaviors. 

3. Vraylar (cariprazine)

Vraylar is approved to treat schizophrenia and MDD (along with an antidepressant medicine), as well as depressive and manic episodes associated with bipolar disorder. Vraylar is available as an oral capsule and is usually dosed once daily with or without food at a starting dose of 1.5 mg, which is increased based on patient response.

Extrapyramidal side effects (EPS), commonly referred to as drug-induced movement disorders, are common with Vraylar. These include difficulty moving or slow movements, tremors, and uncontrolled body movements. Other common side effects include sleepiness, nausea, vomiting, indigestion, constipation, tiredness, trouble sleeping, increased appetite, and dizziness.

Vraylar, like Rexulti, has a boxed warning that it should not be used in older adults with dementia-related psychosis and that it may cause suicidal thoughts and behaviors.

4. Zyprexa (olanzapine)

Zyprexa is approved to treat schizophrenia, bipolar I disorder (acute manic or mixed episodes or maintenance), and, in combination with an antidepressant, treatment-resistant depression. Zyprexa, unlike Rexulti, is available as a lower-cost generic. Available dosage forms include oral tablets, orally disintegrating tablets, and an injectable. It is given once daily, with or without regard to meals.

Some of the most common side effects of Zyprexa are orthostatic hypotension (a drop in blood pressure when standing up), constipation, weight gain, restlessness, weakness, dry mouth, increased appetite, excess sleepiness, dizziness, and tremor. Like Rexulti, Zyprexa has a boxed warning to avoid use in older adults with dementia-related psychosis. When used for treatment-resistant depression along with fluoxetine, the warning for suicidal thoughts and behaviors also applies.

5. Seroquel (quetiapine)

Seroquel is approved to treat schizophrenia, bipolar I disorder (acute treatment of manic episodes), and bipolar depression. Seroquel is available as a lower-cost generic medicine, an immediate-release oral tablet given once or twice daily, and an extended-release oral tablet given once daily. 

The most common side effects of Seroquel are excess sleepiness, dry mouth, dizziness, constipation, weakness, stomach pain, weight gain, indigestion, and orthostatic hypotension. 

Seroquel shares the same boxed warning as Rexulti regarding older adults with dementia-related psychosis and suicidal ideation in younger patients. 

Natural alternatives to Rexulti

Natural remedies cannot replace the need for prescription antipsychotic medicine for patients with mental health conditions such as schizophrenia and MDD. However, natural products and lifestyle changes may help improve symptoms when used alongside prescribed treatments.

Although prescription drugs are a vital part of the treatment plan, non-drug aspects of a treatment plan may help with symptoms of schizophrenia or MDD as well. For example, cognitive behavioral therapy, or CBT, a type of talk therapy, can be beneficial. Some people find other activities, such as exercise, meditation, yoga, and prayer, to help manage symptoms. It is important to note that these are not substitutes for medication but rather a complement to it. Talk to your healthcare provider about various natural methods you can try with your medications. Always check with your healthcare provider for medical advice before trying an herbal supplement, as some may have drug interactions or dangerous adverse effects. 

RELATED: 5 ways to boost your mental health

How to switch to a Rexulti alternative

Switching from Rexulti to another atypical antipsychotic may be necessary due to a poor response, serious side effects, allergic reactions, or the cost of therapy. A healthcare professional must manage any discontinuation or change in medicines because stopping and switching antipsychotics may result in serious adverse events, including a worsening of the condition being treated. Withdrawal symptoms may also occur, depending on the characteristics of the antipsychotics involved.

If cost is a primary concern when seeking alternative treatment options, SingleCare can help. Suppose a medication is not covered by your insurance plan or is covered but remains expensive. In that case, you can use SingleCare coupons at your local pharmacy, which are available for Rexulti and its alternatives.

Expert takeaway  

“Even though second-generation antipsychotics are known for having fewer side effects than first-generation antipsychotics, there are still side effects and precautions to be aware of,” says Karen Berger, Pharm.D., member of the SingleCare Medical Board. “Before switching, be sure to review your full medical history with your healthcare provider and talk about what kind of side effects to expect and what to do if you experience them.”