thoughtscape NP Psychiatry · Patient education
Brexpiprazole
Rexulti
A daily medicine with several uses. Your reason for taking it guides the dose and what you and your care team watch for.
Draft for review · Clinical content has not been revalidated for this website.
For patients and caregivers. Follow your own prescription, not someone else's dose.
What it is used for
Depression: added to an antidepressant when more help is needed. Also treats schizophrenia from age 13.
Alzheimer dementia: may reduce agitation. It is not an extra, as-needed calming dose, or a treatment that reverses dementia.
How it works
It changes signaling at dopamine and serotonin receptors. These are parts of the brain's communication system.
The diagram shows drug actions, not a promise of benefit or freedom from side effects. Your experience matters more than a receptor map.
What to expect over time
EARLY DAYS
Sleepiness, dizziness, or restlessness may appear before benefit.
OVER SEVERAL WEEKS
Track mood, thinking, or agitation with your care team. Improvement is gradual.
AFTER A CHANGE
The medicine stays in the body for days. Benefits and side effects can change slowly.
Taking your medication
Take the prescribed dose once daily, with or without food. Do not take extra for agitation.
If you miss a dose, take it when remembered unless it is nearly time for the next. Skip then; do not double. Ask about restarting after several missed days.
Do not change or stop it on your own. For depression, keep taking your antidepressant unless your prescriber changes the plan.
When to get help
Emergency: fever with stiff muscles/confusion, trouble breathing, face swelling, stroke symptoms, or a seizure. Call 911.
New suicidal thoughts or unsafe impulses: get help now. In the US, call/text 988; call 911 for immediate danger.
Call promptly: severe restlessness, new uncontrollable movements, or urges, fever/infection, or marked thirst and frequent urination.
Early side effects
Sleepiness, dizziness, nausea, headache, or an uncomfortable need to keep moving can occur. Report restlessness; it may be a side effect rather than worsening anxiety.
Other effects to discuss
Appetite, weight, blood sugar, and cholesterol can rise. Report new movements, breast changes, or sexual difficulties. Persistent movement problems are possible, even at low doses.
What to keep track of
Keep weight, blood pressure, and lab checks. Tell the team about falls, swallowing trouble, or changes in sleep, mood, and daily function. Caregiver observations can help.
Before you start
Share your full medicine list and any diabetes, seizures, heart/stroke history, low blood pressure, low white cells, or kidney/liver problems. Discuss pregnancy or breastfeeding. Older adults with dementia face increased risks of death and stroke with antipsychotics; the Alzheimer agitation approval does not erase those risks.
Medicines & interactions
Antidepressants
Fluoxetine, paroxetine, and other medicines can affect dosing. The adjustment depends on the reason for treatment; do not halve your dose yourself.
Antifungals & antibiotics
Some raise drug levels. Check every new prescription with your pharmacist, including medicines used for infections.
Seizure drugs & herbs
Carbamazepine and St. John's wort can lower levels. Starting or stopping interacting medicines needs a dosing review.
Alcohol & sedatives
Avoid alcohol. Sleep medicines, opioids, and other sedatives can worsen drowsiness; blood-pressure medicines can add dizziness.
Everyday tips
Rise slowly. Avoid driving until you know how alert and steady you feel.
Stay hydrated and avoid overheating. Ask about a fluid plan if you have restrictions.
Keep regular meals and manageable movement. Mention appetite or weight changes early.
For agitation, look for pain, illness, constipation, or stressful surroundings. Keep routines calm and familiar.
Your questions, answered
What about new urges?
Report hard-to-control gambling, spending, eating, or sexual urges promptly. These deserve a medicine review, not blame.
Will it change who I am?
The goal is better function, not feeling dulled. Tell your prescriber if you feel unlike yourself.
Pregnant or breastfeeding?
Contact your prescriber. Late-pregnancy exposure can affect the newborn; milk supply may fall. Plan treatment and infant monitoring together.
Can I stop once I feel better?
Make a plan first. Symptoms can return even though the medicine leaves your body slowly.
Storage & safety
Store at room temperature, out of reach of children. Never share it. For an extra dose or suspected overdose, call US Poison Control: 1-800-222-1222; call 911 for severe symptoms.
About this information
For general information only; not a substitute for individualized medical advice. This sheet does not cover every risk or interaction. Ask your prescriber or pharmacist before changing how you take this medication.
Sources
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.