Rexulti (brexpiprazole) has potential interactions with alcohol and other medications. For example, Rexulti can interact with other antipsychotics, such as risperidone (Risperdal).
Rexulti is prescribed to treat:
- schizophrenia in adults and certain children
- depression in adults (when taken with antidepressants)
- dementia-related agitation due to Alzheimer’s disease
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Rexulti’s possible interactions. For more information about this drug, including details about its uses, see this in-depth Rexulti article.
Boxed warnings
This drug has boxed warnings about the risks of suicidal thoughts or behaviors and death in certain older adults. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.
Risk of suicidal thoughts or behaviors. Drugs used to treat depression, such as Rexulti, may increase the risk of suicidal thoughts or behaviors. This risk affects children and young adults (ages 18 to 24 years). But it’s important to note that Rexulti is prescribed for depression in adults only. It’s not approved for this use in children. Rexulti may be prescribed for schizophrenia in adults and certain children ages 13 years and older.
While you’re taking Rexulti, your doctor will watch for behavior or mood changes. Examples include agitation, anger, irritability, and thoughts of harming yourself. They’ll monitor you more closely right after you start taking the drug or after they change your Rexulti dosage.
Tell your doctor right away if you have behavior or mood or behavior changes while taking Rexulti. They can help decide whether the drug is right for you.
If you have thoughts of suicide, call 911 or your local emergency number. In the United States, you can also call the Suicide and Crisis Lifeline at 988 or text HOME to the Crisis Textline at 741741.
Risk of death in certain older adults. Antipsychotic drugs such as Rexulti may increase the risk of death in certain older adults. This risk affects adults ages 65 years and older with psychosis related to dementia.
Psychosis is a mental health condition that can cause a loss of touch with reality. Dementia is a condition that causes problems with thinking, memory, and communication.
Due to the risk of death, doctors will not prescribe Rexulti for older adults with psychosis related to dementia without agitation due to Alzheimer’s disease.
Antipsychotic drugs can also increase the risk of stroke in older adults with psychosis related to dementia. Stroke can be fatal in some cases. Symptoms of stroke include confusion, headache, and facial, arm, or leg weakness on one side of the body.
If you have symptoms of a stroke while taking Rexulti, call 911 or your local emergency number right away.
Certain health conditions or other factors could raise your risk of harm if you take Rexulti. In such cases, your doctor may not prescribe Rexulti for you. Rexulti has one contraindication, described below.
If you’ve had an allergic reaction. If you have had an allergic reaction to Rexulti or any of its ingredients, your doctor likely won’t prescribe Rexulti. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.
It may not be safe to drink alcohol with Rexulti. This is because drinking alcohol while taking Rexulti may increase your risk of certain Rexulti side effects. These include tiredness and slowed thinking, movements, or reactions.
If you drink alcohol, talk with your doctor before taking Rexulti. They can recommend whether there’s a safe amount of alcohol to consume during Rexulti treatment.
Before you start taking Rexulti, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Rexulti interacts with herbs, vitamins, or supplements, see the “Are there other interactions with Rexulti?” section below.)
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The table below lists drugs that may interact with Rexulti. Keep in mind that this table does not include all drugs that may interact with Rexulti. For more information about some of these interactions, see the “Drug interactions explained” section below.
| Drug group or drug name | Drug examples | What can happen |
| other antipsychotics | • risperidone (Risperdal) • haloperidol (Haldol) • quetiapine (Seroquel, Seroquel XR) • ziprasidone (Geodon) • lurasidone (Latuda) | can increase the risk of side effects from Rexulti and the other antipsychotic |
| blood pressure drugs | • lisinopril (Qbrelis, Zestril) • losartan (Cozaar) • propranolol (Inderal, Innopran XL, others) • carvedilol (Coreg, Coreg CR) • clonidine (Catapres-TTS, Kapvay, Nexiclon XR) | can increase the effects of blood pressure drugs |
| monoamine oxidase inhibitors (MAOIs) | • isocarboxazid (Marplan) • selegiline (Emsam, Zelepar) • phenelzine (Nardil) | can increase the risk of side effects from Rexulti and the MAOI |
| tricyclic antidepressants (TCAs) | • imipramine (Tofranil) • amitriptyline • clomipramine (Anafranil) | can increase the risk of side effects from Rexulti and the TCA |
| certain selective serotonin reuptake inhibitors | • fluoxetine (Prozac) • paroxetine (Brisdelle, Paxil, others) • sertraline (Zoloft) • fluvoxamine (Luvox) | can increase the risk of side effects from Rexulti |
| certain antifungals | • ketoconazole • itraconazole (Sporanox, Tolsura) • voriconazole (Vfend) | can increase the risk of side effects from Rexulti |
| certain antibiotics | • clarithromycin • rifampin (Rifadin, Rimactane) | can increase the risk of side effects from Rexulti or make Rexulti less effective |
| certain antiarrhythmics | • quinidine • amiodarone (Nexterone, Pacerone) | can increase the risk of side effects from Rexulti |
| certain seizure drugs | • carbamazepine (Carbatrol, Tegretol, others) • phenytoin (Dilantin, Phenytek) • phenobarbital (Sezaby) | can make Rexulti less effective |
| certain HIV medications | • cobicistat (Tybost) • nelfinavir (Viracept) • ritonavir (Norvir) | can increase the risk of side effects from Rexulti |
| opioids | • morphine (MS Contin, others) • hydrocodone (Hysingla ER, others) • oxycodone (OxyContin, others) • tramadol (ConZip) | can increase the risk of sleepiness |
| duloxetine (Cymbalta) | – | can increase the risk of side effects from Rexulti |
| bupropion (Aplenzin, Wellbutrin SR, Wellbutrin XL, others) | – | can increase the risk of side effects from Rexulti and bupropion |
Learn more about certain drug interactions that can occur with Rexulti.
Interaction with other antipsychotics
Rexulti is an antipsychotic drug, and it can interact with other antipsychotics. Taking these drugs together can raise your risk of side effects from Rexulti and from the other antipsychotic.
Antipsychotics are used to treat certain mental health conditions, such as schizophrenia. Rexulti is an atypical antipsychotic, which is a newer kind of antipsychotic drug.
Examples of other antipsychotic medications include:
- risperidone (Risperdal)
- haloperidol (Haldol)
- quetiapine (Seroquel, Seroquel XR)
- ziprasidone (Geodon)
- lurasidone (Latuda)
What could happen
Rexulti and other antipsychotics may cause similar side effects. A few examples include tiredness, seizures, and neuroleptic malignant syndrome (a rare but severe reaction that causes high fever, fast heart rate, and muscle rigidity). Taking these drugs together can increase your risk of side effects even more.
What you can do
Before taking Rexulti, be sure your doctor knows about any other antipsychotics you take. They’ll tell you whether it’s safe to take Rexulti with these drugs.
If you do take Rexulti with another antipsychotic, your doctor may prescribe a lower dosage of Rexulti than usual.
If you have questions about taking Rexulti with other antipsychotics, talk with your doctor or pharmacist.
Interaction with blood pressure drugs
Rexulti can interact with blood pressure drugs. Taking these drugs together could cause your blood pressure to drop too low.
Examples of blood pressure drugs include:
- angiotensin-converting enzyme inhibitors, such as lisinopril (Qbrelis, Zestril)
- angiotensin II receptor blockers, such as losartan (Cozaar)
- beta-blockers, such as propranolol (Inderal, Innopran XL, others) and carvedilol (Coreg, Coreg CR)
- central agonists, such as clonidine (Catapres-TTS, Kapvay, Nexiclon XR)
What could happen
Because of the way Rexulti works, it may cause a temporary drop in blood pressure when you sit or stand up quickly. This effect is called orthostatic hypotension.
Blood pressure drugs are used to lower blood pressure, so taking them with Rexulti could lower your blood pressure too much.
What you can do
Before starting Rexulti treatment, tell your doctor if you take a blood pressure drug. They can determine whether it’s safe to take it with Rexulti. If you take these drugs together, your doctor may have you check your blood pressure often using a home monitor.
If you have questions about taking Rexulti with a blood pressure drug, talk with your doctor or pharmacist.
Interaction with certain antibiotics
Rexulti may interact with certain antibiotics (drugs used to treat bacterial infections).
How Rexulti interacts with an antibiotic may vary depending on the specific antibiotic. See below for details.
What could happen
Taking Rexulti with clarithromycin may prevent your body from breaking down Rexulti properly. This can increase the level of Rexulti in your body, which can raise your risk of side effects from Rexulti.
Taking Rexulti with rifampin (Rifadin, Rimactane) may cause your body to break down Rexulti faster than it should. This can lower the level of Rexulti in your system, which could make Rexulti less effective.
What you can do
Before taking Rexulti, tell your doctor about any antibiotics you take. They can determine whether it’s safe to take Rexulti with these drugs.
If you need to take an antibiotic during your Rexulti treatment, be sure the doctor who’s treating the infection knows you’re taking Rexulti. They can determine which antibiotic may be safe to take with Rexulti.
If you take Rexulti with clarithromycin or rifampin, your doctor may temporarily adjust your Rexulti dosage while you’re taking the antibiotic. With clarithromycin, they may lower your Rexulti dosage to help reduce your risk of side effects. With rifampin, they may increase your Rexulti dosage to make sure the drug’s level is high enough in your body to treat your condition.
If you have questions about taking Rexulti with antibiotics, talk with your doctor or pharmacist.
Rexulti may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Rexulti.
Does Rexulti interact with supplements?
Before you start taking Rexulti, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Rexulti interactions with herbs
Rexulti may interact with an herbal supplement called St. John’s wort. This supplement can be used to help ease symptoms of depression and other conditions.
Taking Rexulti with St. John’s wort can make Rexulti less effective.
Before starting Rexulti treatment, tell your doctor if you take St. John’s wort. They can tell you whether it’s safe to take Rexulti with this supplement.
If you take Rexulti with St. John’s wort, your doctor may increase your Rexulti dosage to help the drug be more effective.
Rexulti and vitamins
There are currently no reports of Rexulti interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.
For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Rexulti.
Does Rexulti interact with food?
Rexulti may interact with grapefruit or grapefruit juice.
Taking Rexulti with grapefruit or grapefruit juice may prevent your body from breaking down Rexulti properly. This may increase the amount of the drug in your body, which could raise your risk of side effects from Rexulti.
If you eat grapefruit or drink grapefruit juice, talk with your doctor before starting Rexulti treatment. They’ll advise whether you should limit the amount you consume during Rexulti treatment.
If you take Rexulti with grapefruit or grapefruit juice, your doctor may prescribe a lower dosage of Rexulti. They’ll do this to lower your risk of side effects from the drug.
If you have questions about taking Rexulti with certain foods or drinks, talk with your doctor or pharmacist.
Does Rexulti interact with vaccines?
There are currently no reports of Rexulti interacting with vaccines. If you have questions about getting certain vaccines while taking Rexulti, talk with your doctor.
Does Rexulti interact with lab tests?
There are currently no reports of Rexulti interacting with lab tests. If you have questions about having certain lab tests done while taking Rexulti, talk with your doctor.
Does Rexulti interact with cannabis or CBD?Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Rexulti.
Using cannabis or cannabis products with Rexulti may increase your risk of certain side effects with Rexulti. These include tiredness and slowed movements, thinking, or reactions.
Before you start treatment with Rexulti, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with Rexulti. Before taking Rexulti, talk with your doctor about your health history. They’ll determine whether Rexulti is right for you.
Health conditions or other factors that might interact with Rexulti include:
Being age 24 years or younger: Rexulti may increase the risk of suicidal thoughts or behaviors in people ages 24 years and younger. In fact, the drug has a boxed warning about this risk. For more information, see the “Boxed warnings” section at the beginning of this article.
Being age 65 years or older and having psychosis related to dementia: Rexulti may increase the risk of death in certain adults ages 65 years or older. This risk affects older adults with psychosis related to dementia (problems with thinking, memory, and communication). In fact, the drug has a boxed warning about this risk. For more information, see the “Boxed warnings” section at the beginning of this article.
Kidney or liver problems: Before taking Rexulti, tell your doctor if you have a kidney or liver problem. Examples include kidney failure and liver failure. Your doctor may prescribe a lower dosage of Rexulti than usual.
Seizures: Rexulti may cause seizures in some people. Before taking the drug, tell your doctor if you have seizures or have had them before. They can tell you whether Rexulti is a safe treatment option.
Diabetes: Taking Rexulti may lead to high blood sugar. If you have diabetes, this could worsen your condition. Your doctor may have you check your blood sugar more often than usual while you’re taking Rexulti.
Heart problems: Before taking Rexulti, tell your doctor if you have a heart problem. Examples include heart failure or having had a heart attack.
Rexulti may cause orthostatic hypotension (a drop in blood pressure upon standing or sitting up). Having a heart problem could raise your risk of this side effect. If you have a heart problem, your doctor can determine whether it’s safe for you to take Rexulti.
High triglyceride or cholesterol levels: Rexulti may cause high triglyceride or cholesterol levels. If you already have high triglycerides or cholesterol, taking the drug could worsen your condition. Your doctor may check your triglyceride or cholesterol levels more often than usual while you’re taking Rexulti.
Low white blood cell levels: Rexulti may lower the levels of white blood cells in your body. Having low white blood cell levels could increase your risk of infection.
Your doctor may check your white blood cell levels before you start Rexulti treatment. If your levels are low, your doctor may suggest a treatment other than Rexulti.
Pregnancy: Taking Rexulti while pregnant may cause harm to a fetus. If you’re pregnant or planning to become pregnant, talk with your doctor before taking Rexulti.
If you do take Rexulti during pregnancy, your doctor may suggest joining the National Pregnancy Registry for Atypical Antipsychotics. This registry collects information about the safety of antipsychotic drugs, including Rexulti, when taken during pregnancy. To learn more, visit the registry’s website or call 866-961-2388. You can also talk with your doctor.
Breastfeeding: It’s not known whether Rexulti is safe to take while breastfeeding. If you’re breastfeeding or planning to do so, talk with your doctor before starting Rexulti treatment.
Allergic reaction: If you’ve had an allergic reaction to Rexulti or any of its ingredients, your doctor will likely not prescribe Rexulti for you. Ask them about other treatments that may be better choices for you.
Find answers to some frequently asked questions about Rexulti and possible interactions.
Are there any drug interactions that will affect the Rexulti dosage I’m prescribed?
Yes, certain drug interactions can affect the Rexulti dosage you’re prescribed.
For example, certain medications can prevent your body from breaking down Rexulti as it should. This could lead to a higher level of the drug in your system, which can raise your risk of Rexulti side effects. Examples of medications that can have this effect include the antifungal drugs ketoconazole and itraconazole (Sporanox, Tolsura).
If you’re prescribed Rexulti with these drugs, your doctor may prescribe a lower dosage of Rexulti than usual.
Other medications can cause your body to break down Rexulti too quickly. This could lead to a lower Rexulti level in your body, making the drug less effective. The seizure drugs phenobarbital (Sezaby) and carbamazepine (Carbatrol, Tegretol, others) are examples of medications that may have this effect.
If you’re prescribed Rexulti with these drugs, your doctor may prescribe a higher dosage of Rexulti than usual.
That said, interactions with Rexulti are not likely to affect the time of day you’ll take the drug. Rexulti is usually taken once a day. Your doctor can determine whether you should take Rexulti in the morning or at night, or at another time of day.
Talk with your doctor or pharmacist to learn more.
Can I take Rexulti with Lexapro?
If your doctor recommends it, you can take Rexulti with escitalopram (Lexapro). These medications aren’t known to interact with each other.
Lexapro is a kind of antidepressant called a selective serotonin reuptake inhibitor (SSRI). If you take Rexulti to treat depression, your doctor will likely also prescribe an antidepressant. This may include Lexapro.
It’s important to note that Rexulti can interact with antidepressants other than Lexapro. Your doctor can determine whether it’s safe to take Rexulti with any of the following antidepressants:
- certain other SSRIs, such as paroxetine (Brisdelle, Paxil, others) and sertraline (Zoloft)
- monoamine oxidase inhibitors, such as isocarboxazid (Marplan) and selegiline (Emsam, Zelepar)
- tricyclic antidepressants, such as imipramine (Tofranil) and amitriptyline
- duloxetine (Cymbalta)
- bupropion (Aplenzin, Wellbutrin SR, Wellbutrin XL, others)
If you have questions about taking Rexulti with Lexapro or another antidepressant, talk with your doctor or pharmacist.
Taking certain steps can help you avoid interactions with Rexulti. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- Whether you drink alcohol or use cannabis.
- Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a
medication list . - What to do if you start taking a new drug during your Rexulti treatment.
It’s also important to understand Rexulti’s
If you have difficulty reading or understanding this information, your doctor or pharmacist can help.
Taking Rexulti exactly as prescribed can also help prevent interactions.
Disclaimer: Healthline 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.