Side Effects of Brexpiprazole (Rexulti)
Brexpiprazole (Rexulti) has several common side effects including weight gain, sleepiness, dizziness, common cold symptoms, and akathisia (restlessness or feeling like you need to move). 1
Common Side Effects
- Weight gain is one of the most common side effects, with moderate weight gain reported in clinical trials 1, 2
- Sleepiness, drowsiness, and fatigue that may interfere with daily activities 1
- Dizziness, which may increase the risk of falls, especially in elderly patients 1
- Akathisia (restlessness or inner feeling of needing to move) 1, 2
- Upper respiratory tract infections and common cold symptoms 1
Serious Side Effects
Metabolic Effects
- Hyperglycemia and diabetes - blood sugar increases that can be severe 1
- Elevated cholesterol and triglyceride levels 1
- Weight gain that may be clinically significant - monitoring is recommended 1, 2
Neurological Effects
- Tardive dyskinesia - uncontrollable movements of face, tongue, or other body parts that may not resolve even after stopping the medication 1
- Neuroleptic malignant syndrome - a rare but potentially fatal condition characterized by high fever, muscle stiffness, altered mental status, and autonomic instability 1
- Seizures 1
Cardiovascular Effects
- Orthostatic hypotension (decreased blood pressure when changing positions) 1
- QT interval prolongation, though clinical studies suggest minimal effects 2
Other Serious Concerns
- Cerebrovascular problems including stroke in elderly patients with dementia-related psychosis 1
- Low white blood cell count 1
- Unusual and uncontrollable (compulsive) urges such as gambling, sexual urges, shopping, and binge eating 1
- Difficulty swallowing that can lead to aspiration 1
Comparison to Other Antipsychotics
- Brexpiprazole has a lower incidence of akathisia, insomnia, and agitation compared to aripiprazole 3
- It demonstrates relatively low incidence of extrapyramidal symptoms compared to typical antipsychotics 4, 3
- The drug shows minimal effects on prolactin levels 2
- It has a relatively low incidence of both activating and sedating adverse effects 4
Special Populations
- In elderly patients with Alzheimer's dementia, common side effects include headache, insomnia, dizziness, and urinary tract infections 5
- Elderly patients with dementia-related psychosis treated with antipsychotics are at increased risk of death and cerebrovascular events 1
- Dose adjustments may be needed for elderly patients or those with hepatic or renal impairment 1
Monitoring Recommendations
- Regular monitoring of weight, especially during the first few months of treatment 1, 2
- Blood glucose, lipid profiles, and metabolic parameters should be checked before starting treatment and periodically thereafter 1
- Monitor for signs of tardive dyskinesia and neuroleptic malignant syndrome 1
- Watch for unusual changes in behavior or the development of compulsive urges 1
- Falls risk assessment, particularly in elderly patients 1
Practical Considerations
- Taking brexpiprazole with food may help reduce gastrointestinal side effects 1
- Patients should avoid activities requiring mental alertness until they know how the medication affects them 1
- Alcohol may worsen side effects and should be avoided 1
- Patients should be advised not to stop taking brexpiprazole abruptly without consulting their healthcare provider 1