Medically reviewed by, Russell Braun RPH
Rexulti and Abilify are both prescription medications that belong to a class of drugs called atypical antipsychotics. Also, both are approved by the Food and Drug Administration (FDA) to treat symptoms of schizophrenia or additive treatments in Major Depressive Disorder (MDD).
Rexulti also known by the generic name brexiprazole was first approved by the FDA n 2015. Abilify was first approved by the FDA in 2002. Consequently, the patent has since expired and it is sold generically as aripiprazole. Aripiprazole was the first drug of its kind used to treat schizophrenia.
What is an atypical antipsychotic?
Atypical antipsychotics are newer medications to treat psychosis which first started to appear in the 90’s. Second generation is the common name they are referred to by. First generation antipsychotics, which caused many side effects is what they were intended to replace.
Below is a list of atypical antipsychotics by brand name:
1. How do Rexulti and Abilify work?
Atypical antipsychotics as a class of drugs work by affecting levels of dopamine and serotonin in the brain. Furthermore, Rexulti and Abilify are even more closely related in how they work as Otsuka, the manufacturer of Abilify also produces Rexulti. Therefore, Rexulti is considered a newer version of Abilify that is still under patent protection. Hence Rexulti can still be sold as brand name only.
What does Rexulti do to the brain?
Based on a study published in the journal Therapeutic Advances in Psychopharmacology here are the key ways Rexulti works.
- Stimulates certain dopamine receptors (D2)
- Stimulates certain serotonin receptors (5-HT1A & 5-HT2A)
- Blocks some dopamine receptors (D3)
- Blocks some serotonin receptors (5-HT2B)
What does Abilify do to the brain?
Abilify stimulates dopamine (D2) receptors and partially block serotonin (5-HT1A & 5-HT2A).
These drugs may affect other receptors in the brain. As a result, impacted receptors may lead to benefits or side effects. However, these effects have not been as extensively studied.
2. Rexulti vs Abilify quick facts
|FDA approved use||Schizophrenia|
Add on treatment of Major Depressive Disorder (MDD)
Acute episode of Bipolar
Add on treatment of Major Depressive Disorder (MDD)
Irritability with autism
|Approved for under 18 years old?||Only >18 years old||Pediatric & adult|
|Available strengths||0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg tablets||2mg, 5mg, 10mg, 20mg, 30mg tablets|
|Generic available?||No||Yes, for immediate release|
Orally disintegrating tablet
|Starting dose||1mg once per day||2mg – 10mg once per day depending on age and use|
Key differences are that Abilify has been around much longer than Rexulti. This has allowed the manufacturer to gain FDA approval for more conditions. Younger patients have also been treated successfully. In addition, different dosage forms are available such as the long acting injection and orally disintegrating tablets.
Abilify’s maximum dose can go up to 30mg per day, however data is lacking to show any benefit for a dose higher than 15mg. Rexulti has a maximum dosage of 4mg per day. These drugs are taken one time per day.
3. How long does Rexulti take to work?
Based on the manufacturers information about how the drug works in the body, it appears that levels are highest in the bloodstream after four hours. Schizophrenia symptom improvement may be seen shortly after taking Rexulti. However, doses should not be changed for at least a week to allow for the blood levels to accumulate and give a real sense of how it is working. If using for add on treatment for depression, then adequate time to allow for receptor changes in the brain should be given. This is typically four to six weeks.
How long does Abiliy take to work?
Abilify oral tablets reach the highest concentration in the blood within three to five hours after ingestion. This is very similar to Rexulti tablets. The injection and orally disintegrating tablets will be faster acting. These dosage forms are reach peak levels somewhere between one to three hours.
4. How do the side effects compare?
Abilify side effects that appear more than 5% of the time or twice what was seen with placebo groups are shown below.
|Schizophrenia||Restlessness, tremor, nausea, drowsiness|
|Bipolar mania||Restlessness, sedation, tremor, nausea, fatigue, blurred vision, dizziness|
|Major depressive disorder||Restlessness, insomnia, constipation, fatigue, blurred vision|
|Autistic disorder||Sedation, fatigue, vomiting, somnolence, tremor, drooling, decreased appetite|
|Tourette’s disorder||Sedation, drowsiness, nausea, headache, fatigue, increased appetite|
Rexulti side effects have not had as long to be studied and reported as it is a much newer drug. However, the following side effects have been reported more than 5% of the time or at twice the rate of placebo.
|Major depressive disorder||Restlessness, weight gain|
Other reported side effects include: headache, fatigue, heartburn, constipation, dizziness, drowsiness.
5. How much weight do you gain on Rexulti?
Rexulti has lead to weight gain for some patients. This is a common side effect of atypical antipsychotics. Therefore, 6 week trials were done to compare rates of weight gain on patients taking Rexulti verses placebo. Weight gain was considered as a 7 percent or greater change in body weight.
- 5% of patients in the MDD trial saw weight gain (7% or more of body weight)
- 10% -11% of patients in the schizophrenia trial experienced weight gain (7% or more of body weight)
Weight gain was measured by long term studies as well.
- Rexulti was discontinued by 4% of patients due to weight gain.
- 30% of patients experience a 7% or more weight gain.
- Conversely, 4% of patients saw a 7% or more decrease in weight.
- Rexulti was discontinued by 0.6% of patients due to weight gain.
- 20% of patients experienced a 7% or more weight gain.
- 10% of patients saw a 7% or more decrease in weight.
6. Long term effects
All antipsychotic drugs have the potential for producing symptoms called Extrapyramidal Side Effects (EPS). EPS are a group of movement disorders directly caused by a drug. These movement changes can include restlessness, uncontrolled muscle contractions and Parkinson-like movement disorders. These side effects can be debilitating.
The good news is atypical antipsychotics like Rexulti and Abilify have a low risk of EPS. In addition, these symptoms tend to go away when the drug is discontinued.
Here are some other long term implications of atypicals.
- High cholesterol
- Low white blood cell counts
Talk to your doctor before you stop taking these meds!
Rexulti and Ability are not habit forming drugs like narcotics. However, a doctor should closely monitor patients taking them. There could be symptoms that may feel like withdrawal if stopped without tapering down slowly.
7. Black box warning.. what is that?
Certain medications that carry serious safety risks are required to have a black box warning by the Food and Drug Administration (FDA) Often these warnings are for rare side effects that do not happen frequently enough for the FDA to remove the drug from the market.
The black box refers to the way the warning must appear on the products packaging. The hope is to call attention to risks so doctors and pharmacists remember to think about these risks while prescribing the medication.
Black box warning for Abilify
This warning is to notify patients and prescribers that elderly patients with dementia-related psychosis and suicidal thoughts are at an increased risk of death.
- Abilify is not approved for the treatment of dementia-related psychosis.
- There is an increased risk of suicidal thinking in children and young adults taking antidepressants. Watching for worsening of suicidal thoughts and behaviors.
Black box warning Rexulti
This warning is to notify patients and prescribers that elderly patients with dementia-related psychosis and suicidal throughs and behaviors are at an increased risk of death.
- Antidepressants increase the risk of suicidal thoughts and behaviors in patients age 24 years and younger.
- The safety and effectiveness of Rexulti for pediatric patients has not been established.
8. Compulsive behavior
Rexulti and Abilify could be problematic for patients who have addictive personalities. They affect levels on dopamine in the brain. Dopamine has been proven to be part of the reward and pleasure centers in the brain. Therefore, patients using Rexulti or Abilify may be more prone to compulsive use of pleasure seeking activities. Those may include gambling, over eating, dangerous activities, or sexual promiscuity to name a few.
Talk to your doctor if once starting Rexulti or Abilfiy you notice an increase in any of these behaviors.
9. Drug interactions
Both Reltuxi and Abilify have potential for drug drug interactions. They are metabolized in the liver by the same enzymes that metabolize other drugs and this can cause problems if not monitored. The dose can be adjusted to account for the drug interaction most of the time.
Medications that treat the following conditions may interact (this is not a complete list of drugs that could interact):
- Antiseizure medication
- Blood pressure medication
Talk to your doctor and pharmacist to make sure that you get the right dose if you take a medication that may interact.
10. Can you take Rexulti and Abilify together?
Rexulti and Abilify are produced by the same manufacturer. In fact, Otsuka Pharmaceutical company came out with Rexulti as Abilify was losing its patent protection, meaning it would not longer be a brand only drug. That being said, these drug are very similar in the how they work. In most cases taking them together would not make sense.
There may be a situation that your doctor or psychiatrist may want you to be on both, but that would not be the norm.
11. Cost comparison
Below are the cash prices of the various forms of Abilify and Rexulti according to GoodRx.
|Abilify (brand)||30||All strengths||$891|
|Aripiprazole oral solution||30||1mg/1ml||$284|
|Aripiprazole oral disintegrating tablet||30||All strengths||$310|
|Abilify Mycite||30||All strengths||$1642|
Brand name products are significantly more expensive as is shown in the table. Therefore, you should ask your prescriber for generic whenever possible. Any of the tablets listed above can be split (besides the oral disintegrating tablets). Since all strengths cost the same amount tablet splitting could save a bundle. For more money saving ideas check out 5 Proven Methods to get Cheap Rx Drugs with Health Insurance.
Newer Abilify products
Abilify Maintena is an extended release intramuscular injection. The key benefit is it only needs to be injected once monthly. This product is quite expensive, but cuts down on patients forgetting to take the medication.
Abilify Mycite is a high tech form of aripiprazole tablets. The tablets actually have an embedded sensor that allows them to report back to a patch worn on the skin. The patch detects the tablet has been ingested and sends a reading back to an application that can track doses and activity levels. It is a high tech way to make sure medication was taken and look for more systems like this with medication in the future.
12. Formulary status
You need to confirm with your insurer if Rexulti or Abilify is on formulary. If so, is one more preferred than the other? The more preferred the lower your copay will be.
Most insurers do cover aripiprazole (generic Abilify). However, for brands Rexulti or Abilify some may want you to have tried another atypical antipsychotic first, that is lower cost.
Regardless of the formulary status your doctor may still have to complete a Prior Authorization (PA). A PA is a requirement for approval to pay for a medication by many health insurers. Your doctor will be required to complete paperwork to ensure proper medication use. Without the PA your insurance will not pay for the medication.
Step therapy is the first part of many PA requests. Older antipsychotics are effective and are much lower cost than Rexulti. Insurance companies may put a step therapy policy in place. They would want to know per your doctor if you had tried and failed some older less expensive medications. Your doctor will need to document this as part of the prior authorization process.
Are Rexulti and Abilify covered by Medicare?
Most Medicare plans do provide some form of coverage for generic aripiprazole. Medicare Advantage plans will vary on their coverage for Rexulti or brand Abilify. Prior authorization or step therapy may also be required.
13. Always request samples
What do you do if you discuss therapeutic alternatives to Rexalti or brand Abilify, but your doctor still wants you to try it?
The next step should be to ask for samples. Ask for samples anytime you are prescribed a brand name drug! The reason is that the sample will give you a chance to determine if you can tolerate this drug before you actually have to pay for it. Aripiprzaole is not likely to have samples as they vary rarely exist for generic medications.
Most doctors who would be treating you for schizophrenia or bipolar disorder should have samples of these brands available as the manufacturer is more than willing to provide doctors with them.
Bullet journaling medication effects is vital while you have samples available. This will help you determine if you should continue taking Rexulti or Abilify or ask your doctor for another treatment.
14. Patient Assistance Programs (PAP’s)
Patient assistance programs are your next step if you are prescribed Rexulti or Abilify Maintena. Otsuka Patient Assistance Foundation the manufacturer of these drugs and provides medication at low or no cost. The Healthwell Foundation has a PAP program for Abilify Mycite.
To qualify for these program(s) you must meet the following criteria:
- Based on income and must contact program for details
- Income levels and house size based on Federal Poverty Level (FPL)
- Must have an FDA approved diagnosis
- Prescriber (or assistant) must submit application
NeedyMeds.org website is where details on these programs can be found. Search under patient savings, and then Rexulti, Abilify Maintena or Abilify Mycite and look for PAP programs. A decision may take several weeks to be processed.
Otsuka doesn’t give income limits so it never hurts to apply!
Enrollment if for a year if you qualify. After the year is up you have to reapply and provide updated income information.
15. Copay coupon card
Copay coupon cards are provided by pharmaceutical manufacturers to assist patients with insurance to be able to afford their out of pocket expenses. That could be a copay, coinsurance or deductible.
The Rexulti savings card allows you to pay $0 on your first prescription and then as low as $15 on each refills.
Abilify Maintena also has a savings card offering to make the copay as little as $10 per month. The savings card is good for up to 12 fills. You must have commercial insurance and be over 18 years of age to be eligible.
Abilify Mycite does not have a manufacturer copay coupon at this time. However, many pharmacies may offer a savings card. A search of google for Abilify Mycite savings will find deals available in your area.
If you have a high deductible health plan (HDHP) you may have a copay accumulator. What is that you ask?
Copay accumulators are when your insurance tracks how much money you receive from drug manufacturers in the form of copay coupon cards. Your deductible will NOT have that amount applied. Meaning you would still have to pay the amount the copay card pays in order to meet your deductible.
This can be a rude awakening if you fill Rexulti or Abilify several times with a copay coupon card paying nearly full price each time. Many people have sticker shock at the pharmacy as they think they have reached their deductible amount and insurance will pay the rest of the year. Only to find out that none of the money spent on these medications using a copay card applies toward the deductible amount!
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Share your story!
Have you used Rexulti or Abilify? How well did it they work for you? Please chime in below with your comments and thoughts below.