Rexulti Is an Atypical Antipsychotic Used to Treat Depression, Schizophrenia, and Alzheimer's-Related Agitation

Rexulti (Brexpiprazole) is a prescription atypical antipsychotic medication that works by adjusting the balance of dopamine and serotonin in the brain. It is FDA-approved to treat major depressive disorder (as an add-on to antidepressants), schizophrenia, and agitation associated with dementia due to Alzheimer's disease.

What Is Rexulti?

Here are the essential facts:

• Brand name: Rexulti
• Generic name: Brexpiprazole
• Drug class: Atypical antipsychotic (serotonin-dopamine activity modulator)
• Manufacturer: Otsuka Pharmaceutical and Lundbeck
• FDA approval: July 2015 (MDD adjunct and schizophrenia); May 2023 (Alzheimer's agitation)
• Generic approved: August 2022
• Controlled substance: No — Rexulti is not a controlled substance. It is prescription-only (Rx) but has no DEA schedule.
• How supplied: Oral tablets in 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, and 4 mg strengths

Rexulti is considered a successor to Aripiprazole (Abilify), which was developed by the same manufacturer. Both are atypical antipsychotics, but Rexulti was designed to have a more balanced receptor profile.

What Is Rexulti Used For?

Rexulti has three FDA-approved uses:

1. Major Depressive Disorder (MDD) — As an Add-On Treatment

Rexulti is not used alone for depression. It's prescribed as an adjunct (add-on) to an antidepressant when the antidepressant alone isn't providing enough relief. If you've been taking an antidepressant like Sertraline (Zoloft), Escitalopram (Lexapro), or Venlafaxine (Effexor) and still have significant depression symptoms, your doctor may add Rexulti to your treatment plan.

2. Schizophrenia

Rexulti is approved as a standalone treatment for schizophrenia in adults. It can help manage symptoms like hallucinations, delusions, and disorganized thinking.

3. Agitation Associated with Alzheimer's Dementia

In May 2023, Rexulti became the first medication FDA-approved specifically for agitation associated with dementia due to Alzheimer's disease. This was a significant milestone, as agitation in Alzheimer's patients had no specifically approved treatment before.

How Is Rexulti Taken?

Rexulti is taken once daily by mouth, with or without food. The dosing depends on the condition being treated:

For Depression (Adjunct)

• Week 1: 0.5 mg or 1 mg once daily
• Week 2: 1 mg once daily
• Week 3 and beyond: Target dose of 2 mg once daily
• Maximum dose: 3 mg once daily

For Schizophrenia

• Days 1–4: 1 mg once daily
• Days 5–7: 2 mg once daily
• Day 8 and beyond: Target dose of 2–4 mg once daily
• Maximum dose: 4 mg once daily

For Alzheimer's-Related Agitation

• Days 1–7: 0.5 mg once daily
• Days 8–14: 1 mg once daily
• Day 15 and beyond: Target dose of 2 mg once daily
• Maximum dose: 3 mg once daily

Your doctor will start you at a low dose and gradually increase it. This is called titration, and it helps minimize side effects. Do not change your dose without talking to your doctor.

Important Dosing Notes

• If you take a strong CYP2D6 inhibitor (like Fluoxetine or Paroxetine) or a strong CYP3A4 inhibitor (like Ketoconazole), your doctor may prescribe a lower dose of Rexulti because these drugs slow how your body processes it.
• If you are a CYP2D6 poor metabolizer (your body processes certain drugs more slowly due to genetics), your doctor may also lower your dose.
• If you take a strong CYP3A4 inducer (like Rifampin), your doctor may need to increase your Rexulti dose.

For more details on how Rexulti interacts with other medications, see: Rexulti Drug Interactions: What to Avoid.

Who Should Not Take Rexulti?

Do not take Rexulti if you are allergic to Brexpiprazole or any ingredients in the medication.

Rexulti carries two FDA boxed warnings:

• Elderly patients with dementia-related psychosis (not Alzheimer's agitation) have an increased risk of death when taking antipsychotic medications.
• Children, adolescents, and young adults (under 25) may have increased suicidal thoughts and behaviors when starting antidepressant-type treatments.

Tell your doctor if you have:

• Diabetes or high blood sugar
• High cholesterol or triglycerides
• A history of seizures
• Low blood pressure or dizziness when standing
• Low white blood cell count
• Liver or kidney problems

For a full list of potential side effects, see our Rexulti side effects guide.

How Much Does Rexulti Cost?

Rexulti is expensive. Here's what you might pay:

• List price (WAC): About $1,516 per month
• With insurance: Copays vary but often range from $30 to $100+ depending on your plan and formulary tier.
• With the manufacturer savings card: Eligible commercially insured patients may pay as little as $0. Visit rexulti.com/savings-cost for details.
• With discount cards (GoodRx, SingleCare): Cash-pay prices may be reduced, but still typically $1,000+ per month without insurance.
• Generic Brexpiprazole: A generic was FDA-approved in August 2022 and may offer lower prices where available.

For a complete breakdown of savings options, see: How to Save Money on Rexulti.

If you need help affording Rexulti, Otsuka Patient Support can help. Call 1-833-468-7852 or visit otsukapatientsupport.com/rexulti.

Final Thoughts

Rexulti is a versatile atypical antipsychotic that has helped many people manage depression, schizophrenia, and Alzheimer's-related agitation. Understanding how it works, how to take it, and what it costs puts you in a better position to work with your doctor on the right treatment plan.

Ready to fill your prescription? Use Medfinder to find a pharmacy with Rexulti in stock near you. And if you're curious about how Rexulti works in your brain, check out our plain-English guide: How Does Rexulti Work?