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Side Effects of Brexpiprazole (Rexulti)


Side Effects of Brexpiprazole (Rexulti)

Brexpiprazole, available under the name Rexulti, is a prescribed antipsychotic medication used to treat schizophrenia. It is also combined with antidepressants to treat major depressive disorder (MDD). Brexpiprazole works by changing how chemicals in the brain affect patients.

Serious Side Effects

Reuxlti can cause serious side effects, according to the FDA. Some of the serious side effects are cerebrovascular problems that can lead to death or stroke in elderly people with dementia (decline in mental ability which interrupts daily activities).


Rexulti can also increase suicide ideation or suicidal actions in some children, teenagers, and young adults within the first few months of Rexulti treatment. There is increased risk for those who have or with a family history of bipolar disorder (also called manic depression) or present suicidal thoughts or actions.


In addition, Rexulti use can cause metabolism related problems: increase in blood sugar, increased fat (cholesterol and triglycerides) levels in your blood, and weight gain. Extremely high blood sugar can lead to coma or death.


The FDA lists other serious side effects:

  • Leukopenia (low white blood cell count), which increases risks of infections
  • Problems controlling body temperature
  • Seizures or convulsions
  • Difficulty in swallowing

Rexulti may cause a rare and serious condition called Neuroleptic Malignant Syndrome (NMS), a disorder characterized by fever, altered mentalities, rigidness in the muscles, and autonomic dysfunction. Inform your healthcare provider if you have some or all of the following symptoms: high fever, stiff muscles, confusion, sweating, changes in pulse, heart rate, and blood pressure as they may be symptoms of NMS. Rexulti may also cause movements that you cannot control in your face, tongue or other body parts. These may be symptoms of Tardive dyskinesia (condition affecting the nervous system from long-term antipsychotic medication usage). Call your healthcare provider right away if you have any of these symptoms.

Common Side Effects

The common side effects of Rexulti are weight gain and feeling of restlessness such as having an urge to move (Rexulti label documented by the FDA).

When to Contact Your Doctor:

The FDA advises that before Rexulti treatment, to inform your doctor about current medications that you are taking or stopped taking, especially antibiotics, antifungal medicines (such as itraconazole, clarithromycin, ketoconazole, quinidine, rifampicin), or antidepressants like paroxetine, fluoxetine.


Immediately contact your healthcare provider if you or a family member experiences any of the following symptoms:

  • Suicidal attempts or thoughts
  • New or worsening depression and irritability
  • Very agitated or restless feelings Ppanic attacks
  • Extreme increase in activity or talking (mania)
  • Anxiety
  • Dangerous impulsive behavior
  • Insomnia or trouble sleeping
  • Aggressive, angry, or violent behavior
  • Other unusual changes in behavior or mood

Other Precautions When Taking Rexulti

If you are pregnant or plan to become pregnant, inform your healthcare provider, as it is not known if brexpiprazole may harm your unborn baby. Rexulti in the last trimester of pregnancy may cause muscle movement problems, medicine withdrawal symptoms, or both in your newborn.

Rexulti causes drowsiness, driving a car, operating machinery, or doing other dangerous activities should be avoided. Avoid getting over-heated or dehydrated, over-exercising, or wearing too much or heavy clothing in hot weather while Rexulti treatment (Rexulti label reported by the FDA).

About Pharmacogenetic Testing

Brexpiprazole is metabolized by CYP2D6 and its metabolism is significantly affected in individuals with varying CYP2D6 activity. Dosage adjustments are recommended in patients who are known CYP2D6 poor metabolizers, which can be identified by pharmacogenetic testing. Pharmacogenetic testing has a definitive role in enabling healthcare provider to deliver personalized brexpiprazole therapy.

Understand Your Risks with the Rxight® Genetic Test

The Rxight® pharmacogenetic test for antipsychotics side effects is based on the sequencing of 18 genes. The Rxight® test determines a patient’s response to over hundreds of prescription and over-the-counter (OTC) medications. With Rxight®, a pharmacist and doctor will be able to create a proper and effective treatment plan unique to a patient.


Get more information about Rxight® pharmacogenetic testing, at 1-888-888-1932 or email us at support@Rxight.com.


Contributors to this Article:
Michael Sapko, MD, PhD; Deborah Kallick, PhD, Medicinal Chemistry

Read more about Rxight® Genetic Health Testing