Rexulti's Side Effects: What to Know

Medically Reviewed By Alex Brewer, PharmD, MBA
This drug has a boxed warning about an increased risk of death when used in older adults with dementia-related psychosis. It also has a boxed warning about an increased risk of suicidal thoughts and behaviors in people ages 24 years or younger. These are serious warnings from the Food and Drug Administration (FDA). For details, see the “ Rexulti: Side effects explained” section below.

Rexulti: Introduction

Rexulti is a brand-name prescription drug. It’s a type of drug called an atypical antipsychotic and contains the active drug brexpiprazole. It comes as a tablet and is taken by mouth. Rexulti is typically taken long-term.

Rexulti is approved by the Food and Drug Administration (FDA) to treat:

Similar to other drugs, Rexulti may cause side effects. Read below for information about possible side effects, including common, mild, and serious ones.


For a general overview of Rexulti, including details about its uses, see this article.

If you’d like to take Rexulti, search here to find a healthcare professional who might prescribe it.

Rexulti: More common side effects

Some of Rexulti’s side effects may be more common than others. These side effects may last only a few days to weeks. However, some side effects may last longer or become severe or bothersome. Tell your doctor or pharmacist if you have concerns about any side effects with Rexulti.

Some of the more common side effects of Rexulti that occurred during clinical studies are listed below. These side effects can vary depending on the condition Rexulti is being used to treat.

More common side effects of Rexulti in people with depression include:

  • inability to sit still
  • akathisia (feelings of restlessness)
  • tremors
  • headache
  • sleepiness
  • weight gain*

More common side effects of Rexulti in people with schizophrenia include:

  • inability to sit still
  • akathisia (feelings of restlessness)
  • tremors
  • upset stomach
  • diarrhea
  • weight gain*

* For more information about this side effect, see “Rexulti: Side effects explained” below.

Rexulti: Mild side effects

Rexulti can cause mild side effects, which are listed below. However, this list doesn’t include all possible mild side effects. To learn more about Rexulti’s side effects, view the drug’s prescribing information.

Rexulti’s mild side effects include:

  • headache
  • inability to sit still
  • akathisia (feelings of restlessness)
  • increased appetite
  • diarrhea
  • tremors
  • upset stomach
  • sleepiness, insomnia, or strange dreams
  • the common cold
  • restlessness
  • feeling dizzy
  • fatigue
  • constipation
  • weight gain*

The side effects listed above may last only a few days to weeks. However, some side effects may last longer or become severe or bothersome. Tell your doctor or pharmacist if you have concerns about side effects with Rexulti.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you develop a side effect while taking Rexulti and want to tell the FDA about it, visit MedWatch.

* For more information about this side effect, see “Rexulti: Side effects explained” below.

Rexulti: Serious side effects

It’s possible to have serious side effects with Rexulti. Serious side effects are listed below, but this list may not include all possibilities. To learn more about Rexulti’s side effects, view the drug’s prescribing information.

Call your doctor right away if you have serious side effects with Rexulti. However, if you think you’re having a medical emergency or have life threatening side effects, call 911 or your local emergency number.

Serious side effects of Rexulti and their possible symptoms include:

  • Tardive dyskinesia. Symptoms can include uncontrolled, repetitive movements of the:
    • face
    • mouth
    • arms, legs, fingers, or toes
  • Neuroleptic malignant syndrome. Symptoms can include:
    • high fever
    • rigid muscles
    • confusion
    • sweating
    • fast heartbeat
    • changes in blood pressure
  • Problems with metabolism. Symptoms can include:
  • Anxiety. Symptoms can include:
    • feeling tense or irritable
    • restlessness or excessive worrying
    • difficulty concentrating
  • Low white blood cell count. This usually won’t cause symptoms, but your doctor may notice it on a blood test. Having a low white blood cell count can raise your risk of infection.
  • Low blood pressure when changing positions. Symptoms can include:
    • falls
    • fainting
  • Seizures. Symptoms can include:
    • uncontrollable jerking movements of your arms or legs
    • loss of consciousness
  • Problems swallowing. Symptoms can include:
    • having food get caught in your throat
    • difficulty breathing
  • Problems regulating body temperature. Symptoms can include difficulty cooling down after exercise or being in the sun.
  • Problems with concentration or decision making.
  • Sexual side effects.*
  • Risk of death in certain people.**
  • Risk of suicidal thoughts and behaviors.**
  • Allergic reaction.†

* For more information about this side effect, see “Rexulti: Side effects explained” below.
** Rexulti has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Rexulti: Side effects explained” section below.
† An allergic reaction is possible after taking Rexulti. However, it’s not clear whether this side effect occurred in clinical studies.

Rexulti: Side effects explained

Here’s detailed information about some of Rexulti’s side effects.

Risk of death in certain people

Rexulti carries a boxed warning regarding the risk of death in older adults with psychosis that’s related to dementia. A boxed warning is the strongest warning required by the Food and Drug Administration (FDA). These warnings alert doctors and patients about drug effects that may be dangerous.

Antipsychotic drugs such as Rexulti can increase the risk of death in adults ages 65 years or older with dementia-related psychosis. (With psychosis, you may hear and see things that aren’t real.) Due to the risk of death, Rexulti is not approved for use in this group.

What to do

Doctors typically won’t prescribe Rexulti to people who are ages 65 years or older and have a diagnosis of dementia-related psychosis.

Risk of suicidal thoughts and behaviors

Rexulti has a boxed warning regarding an increased risk of suicidal thoughts and behaviors in people ages 24 years and younger. A boxed warning is the strongest warning required by the FDA. These warnings alert doctors and patients about drug effects that may be dangerous.

This risk applies to drugs used for depression, and Rexulti is approved to treat depression.

Keep in mind that Rexulti is approved to treat depression in people ages 18 years and older. It’s approved to treat schizophrenia in adults and children ages 13 years and older. Having either of these conditions also increases the risk of suicidal thoughts or behaviors.

These thoughts and behaviors are more likely to occur during the first couple of months when you begin taking Rexulti, or anytime your doctor changes your dose. However, they can occur at any time during treatment.

What to do

While you’re taking Rexulti, keep track of any new thoughts or behaviors that you notice. Tell your doctor if you have any of the following symptoms. However, if you have thoughts of harming yourself or someone else, call your doctor right away. Symptoms include:

  • depression that is new or gets worse
  • feeling restless, agitated, or irritable
  • having trouble sleeping
  • new feelings of anger, aggression, or violence
  • talking too much or talking very fast
  • panic attacks
  • anxious feelings that are new or getting worse
  • feeling the urge to engage in dangerous behaviors
  • any unusual mood changes

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide

Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 800-273-8255.

Click here for more links and local resources.

Weight gain

In clinical studies, weight gain was a common side effect of Rexulti. This side effect happened in people taking Rexulti for depression as well as in people taking it to treat schizophrenia. The amount of weight people gained in clinical studies ranged from about 1 kilogram (kg) to 3 kg (about 2.2 pounds [lb] to about 6.5 lb).

What to do

Your doctor will check your weight before you start taking Rexulti. They’ll also monitor it while you are taking the medication. You can also keep track of your weight at home and let your doctor know if it changes over time. If you’re concerned about weight changes with Rexulti, talk with your doctor.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Rexulti. A more severe allergic reaction is rare but possible.

Possible symptoms of mild and serious allergic reactions are listed in the table below.

Mild allergic reaction symptoms Serious allergic reaction symptoms
• itching trouble breathing
rash • swelling in your throat or mouth
flushing • swelling under your skin, possibly in your hands, feet, lips, or eyelids

If you have an allergic reaction to Rexulti, call your doctor right away. This is important to do because the reaction could become severe.

However, if you’re having a medical emergency or your symptoms feel life threatening, call 911 or a local emergency number.

Rexulti: Common questions about side effects

Here are some common questions about the drug’s side effects and answers to them. Talk with your doctor if you have other questions about this drug.

Are there reviews about Rexulti’s side effects?

Sometimes drug manufacturers post reviews on their website about side effects of the drug they produce. Rexulti’s manufacturer does not provide reviews. However, they do have informational videos available on their site. These videos discuss depression, doctor visits, and treatment options. Episode 5 discusses side effects and things to watch out for when taking Rexulti.

In addition, side effects of a particular drug may vary from person to person. If you have questions about side effects of Rexulti, talk with your doctor.

Do side effects of Rexulti 1-mg doses differ from side effects of other doses?

In clinical studies, similar side effects were seen with all three doses of Rexulti.

However, some side effects were more common in people who took 1-milligram (mg) doses of Rexulti. These included constipation, cold symptoms, headaches, and upset stomach.

If you have questions about how your side effects may vary with your dosage of Rexulti, talk with your doctor.

Will certain side effects go away as I keep taking Rexulti?

Yes, certain side effects of Rexulti may get better as time goes on with treatment. The side effects that eased over time in clinical studies include:

  • headaches
  • diarrhea
  • constipation
  • upset stomach

Other side effects, such as feeling restless and gaining weight, may continue as long as you take the drug. If you have questions about how long certain side effects of Rexulti may last, talk with your doctor.

Does stopping Rexulti cause withdrawal symptoms?

In clinical studies, Rexulti did not cause dependence in people taking the drug. (Dependence happens when your body needs a medication to function as usual.) Drugs that cause dependence may also cause withdrawal symptoms. Withdrawal symptoms weren’t reported in studies of Rexulti in people taking the drug.  

However, infants born to a parent taking antipsychotic drugs similar to Rexulti in the third trimester have experienced withdrawal symptoms. These symptoms include:

  • agitation
  • stiff muscles or muscles that are floppy
  • tremors
  • extreme sleepiness
  • breathing problems
  • feeding problems

If you are pregnant or planning to become pregnant, talk with your doctor about ways to safely treat your condition.

Will I have sexual side effects with Rexulti?

Some people have experienced uncontrollable sexual urges while taking Rexulti. Compulsive sexual urges were not a side effect seen in clinical studies. However, this side effect was reported after Rexulti was approved for use in the general population.

When it’s used to treat depression, Rexulti is prescribed in combination with antidepressant medications. Some of these medications can interfere with sexual function.

Tell your doctor if you experience new compulsive sexual urges or if you are having sexual side effects. Your doctor can recommend ways to help manage your side effects.

Rexulti: Precautions

Rexulti comes with two boxed warnings. A boxed warning is a serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous. For more information, see Rexulti’s drug label information. You can also talk with your doctor.

Boxed warnings

This drug has a boxed warning about an increased risk of death when used in older adults with dementia-related psychosis. It also has a boxed warning about an increased risk of suicidal thoughts and behaviors in people ages 24 years or younger. These are serious warnings from the FDA. For details, see the “Rexulti: Side effects explained” section below.

Other precautions

Be sure to talk with your doctor about your health history before you take Rexulti. This drug may not be the right treatment option for you if you have certain medical conditions or other factors that affect your health.

The conditions and factors to consider include those described below.

Older females.* Rexulti can cause a problem known as tardive dyskinesia. The risk of this problem is highest in females ages 65 years and older, but it can happen to anyone.

Diabetes. Rexulti can increase your blood sugar level. Tell your doctor if you have diabetes before taking Rexulti. They may suggest checking your blood sugar more often while you take Rexulti.

High cholesterol. Rexulti can increase your levels of cholesterol and triglycerides. Tell your doctor if you’ve had high cholesterol or triglycerides in the past. Also, let them know about any medications you may take for high cholesterol. They may monitor your cholesterol and triglyceride levels more often.

Low white blood cell count. Rexulti may decrease the amount of white blood cells in your body. This is more likely to happen if you already have a low white blood cell count or if other drugs have decreased your white blood cell count in the past. Your doctor will likely monitor this with frequent blood tests.

High or low blood pressure or heart disease. Rexulti can cause your blood pressure to become too low when you move from sitting to standing. This is most likely to happen when you first start taking Rexulti. It may also happen if your doctor increases your dosage. Tell your doctor if you take any medications to treat high blood pressure or if your blood pressure is usually low. You should also let your doctor know if you have heart disease, as this may increase your risk of blood pressure changes as a side effect. Your doctor can recommend if you should take Rexulti.

Fainting and falls. Rexulti can cause sleepiness and decreased blood pressure, which may lead to falls. If you are already at risk of falls or have a history of fainting, tell your doctor. They will decide if Rexulti is safe for you to take.

Seizures. Rexulti can cause seizures. Be sure to let your doctor know if you’ve had seizures in the past or if you take any medications to treat seizures. They’ll determine if Rexulti is safe for you to take.

Difficulty swallowing. Rexulti may increase the risk of aspiration. (With aspiration, food or drink ends up in the lungs rather than the stomach.) Let your doctor know if you have had problems with swallowing in the past.

Liver or kidney problems. If you have certain liver or kidney problems, your doctor may recommend a lower dosage of Rexulti. They’ll likely order lab tests to monitor your liver and kidney function while you’re taking Rexulti. Let your doctor know if you’ve had any problems in the past with your liver or kidneys.

Compulsive behaviors, including gambling. There have been reports of people taking Rexulti experiencing certain urges, including gambling, binge eating, and certain sexual behaviors. If you have a history of compulsive or addictive behavior, be sure to let your doctor know before you start taking Rexulti. Your doctor can help determine whether Rexulti is safe for you to take.

Allergic reaction. If you’ve had an allergic reaction to Rexulti or any of its ingredients, your doctor will likely not prescribe Rexulti. Ask your doctor what other medications may be better options for you.

* Sex and gender exist on spectrums. In this article, the term “female” refers to sex assigned at birth.

Consuming alcohol during Rexulti treatment

There are no known interactions between Rexulti and alcohol. However, Rexulti can increase your risk of falls. Drinking alcohol with Rexulti may further increase your risk of this side effect.

Talk with your doctor if you have questions about drinking alcohol while taking Rexulti.

Pregnancy and breastfeeding during Rexulti treatment

It’s not known whether Rexulti is safe to take while pregnant. Rexulti hasn’t been studied in pregnant people.

However, certain side effects have happened in infants when pregnant people took medications similar to Rexulti in the third trimester. Infants had withdrawal symptoms after they were born, including:

  • problems breathing and feeding
  • tremors
  • agitation
  • extreme sleepiness
  • very stiff or very floppy muscles

Talk with your doctor if you’re thinking about becoming pregnant while taking Rexulti. If you become pregnant during treatment, ask your healthcare professional about registering with the National Pregnancy Registry for Atypical Antipsychotics. You can register by calling 866-961-2388 or by visiting the registry’s website.

It’s not known whether Rexulti passes into breast milk. Talk with your doctor about safe ways to feed your child while taking Rexulti.

Rexulti: What to discuss with your doctor

Rexulti may cause some mild side effects, including some that are common. These usually go away over time and don’t need medical attention.

Sometimes, serious side effects can happen. Tell your doctor if you experience any serious side effects. For more information about these possible symptoms, see the “Rexulti: Serious side effects” section above.

Talk with your doctor or pharmacist to find out more information about Rexulti. If you have questions about the drug’s side effects, your pharmacist or healthcare professional can help answer them for you.

In addition to discussing Rexulti with your doctor, you may find the following articles helpful in learning more.

  • Overview of Rexulti. To read an overview of Rexulti, see this article.
  • Drug comparison. To learn how Rexulti compares with Abilify, read this article. And to see how Rexulti and Latuda compare, view this article.
  • Details about Rexulti’s uses. To learn more about the conditions Rexulti is approved to treat, see these articles about depression and schizophrenia.

Disclaimer: Healthgrades has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Medical Reviewer: Alex Brewer, PharmD, MBA
Last Review Date: 2022 Jun 21
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.