From the FDA Drug Label
- 2 Drugs Having No Clinically Important Interactions with Brexpiprazole Based on pharmacokinetic studies, no dosage adjustment of brexpiprazole is required when administered concomitantly with ... substrates of CYP2D6 (e.g., dextromethorphan)
Rexulti (brexpiprazole) can be given in conjunction with Adderall (a substrate of CYP2D6) without a dosage adjustment of brexpiprazole, as there are no clinically important interactions between the two drugs, according to the FDA drug label 1.
From the Research
Rexulti (brexpiprazole) can be given in conjunction with Adderall (amphetamine/dextroamphetamine) under proper medical supervision, but this combination requires careful monitoring. These medications work on different neurotransmitter systems - Rexulti primarily affects dopamine and serotonin receptors as an atypical antipsychotic, while Adderall increases dopamine and norepinephrine as a stimulant. The combination might be prescribed for conditions like treatment-resistant depression with ADHD, or bipolar disorder with ADHD. However, there are important considerations: this combination may increase the risk of side effects like elevated heart rate, blood pressure changes, or worsening of certain psychiatric symptoms. Potential drug interactions exist because both medications affect dopamine pathways, though in different ways.
Key Considerations
- Dosing should always be individualized and adjusted gradually under medical supervision.
- Patients taking both medications should report any unusual symptoms promptly, including changes in mood, energy levels, heart rhythm abnormalities, or worsening of the original condition being treated.
- The most recent study on brexpiprazole, 2, suggests that it may be effective in ADHD adults who are nonresponders to 2 or more stimulants, but the primary outcome measure showed no drug-placebo differences.
- Another study, 3, compares brexpiprazole with aripiprazole, suggesting that brexpiprazole may cause less akathisia, extrapyramidal side effects (EPS), and activation, but more clinical experience is needed.
Monitoring and Safety
- Careful monitoring is necessary due to the potential for increased side effects and drug interactions.
- Patients should be educated on the potential risks and benefits of the combination and the importance of reporting any unusual symptoms.
- Regular follow-up appointments should be scheduled to assess the effectiveness of the treatment and to monitor for any adverse effects, as suggested by the study 4, which highlights the importance of individualized dosing and monitoring.