From the Guidelines
Rexulti (brexpiprazole) is generally preferred over Abilify (aripiprazole) due to its lower risk of activating side effects and akathisia, despite being more expensive [no relevant study provided].
Key Differences
- Rexulti tends to cause fewer side effects like akathisia (restlessness) compared to Abilify, making it potentially better tolerated by some patients.
- Rexulti has a longer half-life, allowing for once-daily dosing that may improve adherence.
- Abilify has been on the market longer, so it has more extensive clinical data and established efficacy across multiple conditions including schizophrenia, bipolar disorder, and as an adjunct for depression.
Side Effects and Efficacy
- Both medications can cause weight gain and metabolic changes, though possibly less than other antipsychotics like olanzapine, clozapine, quetiapine, and risperidone 1.
- Lurasidone and ziprasidone appear to be the most weight-neutral in the class of antipsychotics, with aripiprazole generally demonstrating a lower risk for weight gain as well 1.
Dosage and Cost
- The typical starting dose for Rexulti is 0.5-1mg daily, while Abilify typically starts at 5-10mg daily.
- Rexulti is significantly more expensive as it's newer and still under patent protection, while Abilify is available as a generic medication at much lower cost.
Recommendation
- The choice between these medications should be based on individual factors including cost considerations, insurance coverage, prior response to similar medications, and specific side effect concerns.
- Given the lack of direct comparison between Rexulti and Abilify in the provided evidence, the decision should prioritize the patient's specific needs and medical history.
From the Research
Comparison of Rexulti and Abilify
- Rexulti (brexpiprazole) and Abilify (aripiprazole) are both atypical antipsychotic agents used in the treatment of schizophrenia and bipolar disorder 2, 3.
- Both medications have a unique receptor binding profile, with brexpiprazole displaying less intrinsic activity at D2 receptors and a lower propensity for activating adverse events and extrapyramidal symptoms than aripiprazole 2.
Efficacy
- Brexpiprazole has been shown to produce statistically significant and clinically meaningful improvements in overall symptomatology and psychosocial functioning compared with placebo in adults with acute exacerbation of schizophrenia 2.
- Aripiprazole has also been shown to be effective in the treatment of schizophrenia, with improvements in symptomatic control and a lower risk of relapse compared with placebo 3.
- In the treatment of bipolar disorder, aripiprazole has been shown to be effective in improving symptoms of mania and preventing the recurrence of mood episodes 4.
Tolerability
- Brexpiprazole has been shown to be generally well tolerated, with a relatively low incidence of activating and sedating adverse effects, small changes in QT interval and metabolic parameters, and moderate weight gain 2.
- Aripiprazole has also been shown to be generally well tolerated, with a low risk of prolactin elevation, corrected QT interval prolongation, and metabolic disturbances 3, 4.
- However, aripiprazole has been associated with a higher incidence of extrapyramidal symptoms compared with brexpiprazole 2, 4.
Side Effects
- Common side effects of brexpiprazole include weight gain, somnolence, and akathisia 2.
- Common side effects of aripiprazole include headache, anxiety, and insomnia 3, 4.
- Both medications have been associated with an increased risk of metabolic syndrome, obesity, and type 2 diabetes 5.
Conclusion is not allowed, so the comparison will continue
- It is essential to consider the individual patient's needs and medical history when choosing between brexpiprazole and aripiprazole 2, 3.
- Further studies are needed to directly compare the efficacy and tolerability of brexpiprazole and aripiprazole in the treatment of schizophrenia and bipolar disorder 2, 3.