Rexulti Interactions: Other medications, alcohol, and more

Rexulti (brexpiprazole) is a prescription medication that plays a key role in the management of several mental health conditions. As a second-generation antipsychotic, it’s often prescribed for major depressive disorder, schizophrenia, and agitation associated with Alzheimer’s-related dementia. Available in an oral tablet form, Rexulti Interactions is usually well-tolerated. However, understanding potential interactions—especially with other medications, alcohol, and supplements—is critical for ensuring safe and effective treatment.

In this guide, we’ll explore in detail how Rexulti interacts with various substances, including medications, herbs, foods, and health conditions, along with precautions to take to avoid harmful effects.

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What Is Rexulti Used For?

Rexulti has received approval from the FDA to treat specific mental health disorders, including:

• Major Depressive Disorder (MDD): As an add-on therapy for adults who don’t respond well to antidepressants alone.
• Schizophrenia: For adults and children aged 13 and older.
• Agitation in Alzheimer’s Disease: Used to manage behavioral symptoms in adults with dementia related to Alzheimer’s.

These indications make Rexulti a vital tool in psychiatric care. However, its effectiveness can be significantly altered when taken alongside certain drugs, herbal remedies, or even specific foods.

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Understanding Drug Interactions

A drug interaction happens when another substance—whether a medication, food, or supplement—affects how a drug works. These interactions may increase the drug’s effects, reduce its efficacy, or heighten the risk of side effects.

Some interactions can be mild and manageable, while others may be dangerous or even life-threatening. Understanding these risks helps you make informed choices and avoid complications while on Rexulti.

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Medications That Interact With Rexulti

Before starting Rexulti, it’s crucial to provide your healthcare provider with a comprehensive list of everything you’re taking—including prescriptions, over-the-counter medications, and dietary supplements. Below are common drug classes and examples that are known to interact with Rexulti:

Drug Class	Examples	Potential Interaction
Antibiotics	Ciprofloxacin, Clarithromycin, Erythromycin	May increase Rexulti levels, heightening side effects
Antifungals	Itraconazole, Ketoconazole, Voriconazole	Similar effect as antibiotics—greater risk of side effects
HIV Medications	Ritonavir, Cobicistat, Nelfinavir	Amplifies Rexulti’s effects, possibly dangerously
Antidepressants	Fluoxetine, Duloxetine, Bupropion, Paroxetine	May intensify Rexulti’s side effects like drowsiness
Antiarrhythmics	Dronedarone, Quinidine	Can increase side effect risks
Opioids	Morphine, Oxycodone, Hydrocodone, Tramadol	May cause extreme drowsiness or impaired cognition
Seizure Medications	Phenytoin, Carbamazepine, Phenobarbital	Can lower Rexulti’s effectiveness
Blood Pressure Medications	Prazosin, Ramipril, Furosemide	Increases the risk of low blood pressure
Anticholinergics	Oxybutynin, Glycopyrrolate	May increase risk of overheating or heatstroke
Rifampicin	Rifampin	Reduces effectiveness of Rexulti

This list isn’t exhaustive. Always consult your healthcare provider if you’re unsure about any medication you’re currently taking.

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When You Should Avoid Rexulti Altogether

Not everyone is a suitable candidate for Rexulti. In certain scenarios, the medication should be completely avoided due to the risk of severe adverse effects. One such contraindication includes:

• Allergic Reaction to Rexulti or Its Ingredients: If you’ve ever experienced a reaction like rash, swelling, or difficulty breathing after taking Rexulti, you should not take it again. The risk of another, possibly worse, allergic reaction is too high.

Before beginning Rexulti, make sure your doctor is aware of any allergies or sensitivities to medications. They can offer safer alternatives tailored to your medical history.

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Rexulti and Alcohol: A Risky Mix

While there’s no officially documented interaction between Rexulti and alcohol, that doesn’t mean it’s safe to mix the two. Most doctors advise patients to either avoid or significantly limit alcohol intake while on Rexulti.

Here’s why:

• Alcohol can amplify Rexulti’s sedative effects, leading to excessive drowsiness, dizziness, or slowed reflexes.
• It can impair cognitive functions such as decision-making and concentration.
• Mixing alcohol and Rexulti may worsen psychiatric symptoms, especially in those being treated for depression.

Common side effects that may become more intense when alcohol is involved include:

• Sleepiness or fatigue
• Dizziness and lightheadedness
• Slower reaction times
• Impaired thinking or judgment
• Headaches or gastrointestinal issues

If you’re unsure whether occasional drinking is safe while on Rexulti, consult your physician for personalized guidance.

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Deep Dive: How Certain Medications Affect Rexulti

Now, let’s take a closer look at how specific medications interact with Rexulti and what you should do if you’re prescribed them.

Antibiotics

Some antibiotics, particularly macrolides like erythromycin and fluoroquinolones like ciprofloxacin, inhibit the enzyme CYP3A4. This enzyme is responsible for metabolizing Rexulti in your liver. When blocked, Rexulti accumulates in the body, increasing the risk of side effects such as:

• Fatigue
• Restlessness
• Dizziness
• Uncontrolled body movements

What You Should Do: If you need antibiotics while on Rexulti, your doctor may adjust your dosage temporarily and closely monitor your symptoms.

Seizure Medications

Drugs like carbamazepine and phenytoin speed up the activity of CYP3A4, which can cause your body to metabolize Rexulti too quickly—reducing its therapeutic effect.

What You Should Do: Your doctor may increase your Rexulti dosage if you’re also on seizure meds to ensure the drug remains effective.

Opioids

Combining opioids with Rexulti can be particularly dangerous due to their mutual sedative properties. Together, they may lead to:

• Profound drowsiness
• Cognitive dysfunction
• Respiratory issues in severe cases

What You Should Do: Avoid using opioid-based cough or pain medications unless explicitly approved by your healthcare provider. If prescribed, take the lowest effective dose for the shortest time possible.

Supplements and Herb Interactions with Rexulti

Not all drug interactions come from prescription medications. Supplements, vitamins, and herbal remedies can also impact how Rexulti works in your body—sometimes in unpredictable or dangerous ways. Here’s what you need to know:

St. John’s Wort: A Common Herbal Red Flag

St. John’s wort is a widely used herbal supplement, often taken for depression or mood disorders. But combining it with Rexulti is strongly discouraged. Why?

This herb speeds up the activity of CYP3A4, the same liver enzyme that metabolizes Rexulti. As a result, the medication is broken down too quickly, reducing its concentration in the bloodstream.

This can lead to lower effectiveness, meaning Rexulti may not work as intended. If you’re managing schizophrenia or severe depression, this can be especially problematic.

Tip: Always tell your doctor if you’re considering any herbal treatments. They might suggest safer alternatives that won’t interfere with your prescription drugs.

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Vitamins and Rexulti: What’s Safe?

Currently, no specific vitamins have been flagged for harmful interactions with Rexulti. However, that doesn’t mean you’re in the clear.

Some vitamin supplements can contain additional ingredients or interact with other drugs you might be taking concurrently. That’s why it’s still a good idea to check with your doctor or pharmacist before adding any new vitamin regimen.

Pro Tip: Bring a list of all your supplements, including multivitamins and single nutrients like B12 or magnesium, to your next medical appointment.

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Rexulti and Food Interactions

What you eat can also influence how medications work. When it comes to Rexulti, grapefruit and grapefruit juice are the biggest dietary concerns.

Why Grapefruit Is a Problem

Grapefruit inhibits CYP3A4, the enzyme responsible for processing Rexulti in the liver. This means your body won’t break the drug down efficiently, causing higher-than-normal levels to remain in your system.

Potential consequences include:

• More intense side effects
• Prolonged sedation
• Greater risk of dizziness or fainting

Simple Fix: Avoid grapefruit products altogether while on Rexulti. Check juice labels and flavored supplements to be sure you’re not consuming it unknowingly.

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Do Vaccines or Lab Tests Interact With Rexulti?

You might be relieved to know that Rexulti does not interfere with vaccines or common lab tests.

• If you’re due for routine vaccinations, you can generally proceed without issues.
• Standard blood tests, including metabolic panels and complete blood counts, are also safe while taking Rexulti.

Still, if you’re undergoing a specialized test or procedure, it’s smart to mention all the medications you’re taking to the technician or doctor, just to be safe.

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Cannabis and CBD Use With Rexulti

With the increasing legalization of cannabis across many states, it’s essential to discuss how Rexulti interacts with THC and CBD-based products.

What Happens When Cannabis and Rexulti Mix

Both cannabis and Rexulti can affect your brain’s central nervous system, especially in ways that influence:

• Alertness
• Reaction time
• Coordination
• Mental clarity

Combining the two substances can amplify these effects, making it unsafe to drive, operate machinery, or even walk in high-traffic areas due to increased fall risk.

Additionally, cannabis may affect Rexulti’s therapeutic action and potentially blunt its effectiveness in treating mood or psychotic disorders.

Advice: Let your healthcare provider know if you use cannabis recreationally or medically. They can help you weigh the pros and cons and adjust your treatment plan accordingly.

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Health Conditions That May Interact With Rexulti

Rexulti isn’t suitable for everyone, especially individuals dealing with certain chronic or acute health issues. These conditions could either worsen side effects or reduce Rexulti’s effectiveness.

Here’s a breakdown of what to be cautious about:

1. Diabetes and Blood Sugar Issues

Rexulti can raise blood glucose levels, which can be problematic if you have:

• Type 1 or Type 2 diabetes
• Prediabetes
• Insulin resistance

If you’re diabetic, your doctor may need to monitor your blood sugar more frequently or adjust your diabetic medication while you’re on Rexulti.

2. High Cholesterol and Triglycerides

Rexulti can elevate levels of LDL (bad cholesterol) and triglycerides. If you already have high lipid levels or a history of cardiovascular disease, your doctor will likely monitor your cholesterol with routine lab tests.

Action Step: Maintain a heart-healthy diet and engage in regular physical activity to minimize this risk.

3. Low White Blood Cell Count

This medication may suppress your immune system by reducing white blood cell (WBC) levels. If you already have low WBC or have experienced this from another antipsychotic, you’re at a higher risk for infections.

Your doctor may recommend regular blood work to ensure your WBC count remains stable during treatment.

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4. Hypotension (Low Blood Pressure)

Since Rexulti can lower blood pressure, people who already experience hypotension might deal with:

• Lightheadedness
• Fainting spells
• Blurred vision

These symptoms can become more pronounced when standing up quickly, a condition known as orthostatic hypotension.

Tip: Rise slowly from sitting or lying positions, and drink plenty of fluids.

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5. Dehydration and Heat Risk

Due to its effect on body temperature regulation, Rexulti may put you at greater risk of dehydration or heatstroke, especially during warm weather or intense physical activity.

What to Do: Stay hydrated, avoid prolonged sun exposure, and wear light clothing when outdoors.

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6. Increased Fall Risk

Older adults or individuals with mobility challenges should be extra cautious. Dizziness, fatigue, and muscle stiffness can increase the likelihood of accidental falls, particularly in the elderly population.

Safety Tip: Make sure your living space is free of clutter, and consider using assistive devices like canes or walkers if needed.

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7. Cardiovascular Conditions

Rexulti’s effect on blood pressure and heart rhythm means it’s not always safe for people with:

• A history of heart attack
• Irregular heartbeat
• Previous stroke

Your doctor might conduct an ECG or other cardiac assessments before continuing Rexulti in such cases.

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8. Seizure Disorders

Rexulti may lower your seizure threshold, especially if you already have epilepsy or a history of seizures. It’s essential to monitor symptoms closely if you’re at risk.

Doctor’s Note: You may need a tailored dosing strategy or closer supervision.

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9. Kidney and Liver Impairment

If your kidneys or liver are not functioning at full capacity, Rexulti may accumulate in your system. This increases the risk of toxicity and prolonged side effects.

Adjustments: Your doctor will likely start you on a lower dose and monitor blood levels or symptoms more frequently.

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10. Pregnancy and Breastfeeding

There isn’t enough solid research to confirm whether Rexulti is entirely safe during pregnancy or breastfeeding. Potential risks include:

• Withdrawal symptoms in newborns if taken late in pregnancy
• Unknown effects on breastfed infants

Always consult your OB-GYN and psychiatrist before taking Rexulti during these life stages.

Boxed Warning: Suicidal Thoughts and Behaviors

One of the most serious concerns with Rexulti is its FDA-issued boxed warning—the strictest kind of warning a medication can carry.

What the Warning Means

Rexulti may increase the risk of suicidal thoughts or behaviors, especially in:

• Children
• Teenagers
• Young adults under 25

Although Rexulti is not approved for depression in children or teens, off-label use can occur. Patients and caregivers should be on high alert for:

• Sudden mood changes
• Irritability or agitation
• Expressions of hopelessness
• Withdrawal from family or friends

If any of these symptoms occur, medical help should be sought immediately.

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Help Is Available

If you or someone you know is experiencing suicidal thoughts or behaviors, support is just a call or text away:

• Call or text the 988 Lifeline at 988
• Chat online at 988lifeline.org
• Text HOME to 741741 to reach the Crisis Text Line

For emergencies, dial 911 or visit the nearest emergency room.

If you’re supporting someone else, stay with them if safe, and remove any items that could cause harm.

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How to Prevent Interactions with Rexulti

Taking Rexulti safely isn’t just about avoiding the wrong drugs or foods—it also involves daily mindfulness and communication with your healthcare providers. Here are actionable steps to reduce the risk of interactions:

1. Be Transparent with Your Medical Team

Always provide a complete list of:

• Prescription medications
• Over-the-counter drugs
• Supplements and herbs
• Alcohol or cannabis use

Update your doctor anytime you start or stop a medication, even if it seems minor.

2. Read the Medication Guide

Each Rexulti prescription should come with a patient medication guide. This document often includes vital safety information, including:

• Dosage instructions
• Side effect warnings
• Potential interactions

If you didn’t receive one, your pharmacist can print a copy for you.

3. Stick to the Prescribed Dosage

Never alter your dosage without first speaking with your doctor. Doubling up on missed doses or self-adjusting your schedule can lead to side effects or loss of effectiveness.

4. Avoid Self-Medicating

Don’t start new supplements, herbal remedies, or OTC medications without checking first with your provider.

5. Carry a Medication List

Keep a digital or paper record of all your medications. This is especially useful during:

• Emergency room visits
• Pharmacy pickups
• New doctor consultations

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Conclusion

Rexulti can be a life-changing medication for individuals dealing with serious mental health conditions, but it doesn’t come without risks. Understanding how this drug interacts with other medications, supplements, and lifestyle factors is critical for safety and success in treatment.

By staying informed, openly communicating with your healthcare team, and adhering to prescribed guidelines, you can greatly minimize the risk of harmful interactions. As always, your doctor is your best resource for navigating Rexulti use effectively.

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Frequently Asked Questions (FAQs)

1. Can I take Tylenol or ibuprofen with Rexulti?

Yes, occasional use of over-the-counter pain relievers like Tylenol (acetaminophen) or ibuprofen is generally safe. However, always consult your doctor if you plan to use these regularly.

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2. How long do interactions with Rexulti last after stopping the medication?

Interactions typically subside as Rexulti clears from your system, which can take several days due to its long half-life. However, effects can linger based on your metabolism, liver function, and the interacting substance.

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3. What should I do if I accidentally take Rexulti with grapefruit juice?

Don’t panic. One-time consumption may not cause serious harm, but avoid grapefruit moving forward and notify your doctor, especially if you notice unusual side effects.

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4. Is it safe to stop Rexulti suddenly if I notice a bad interaction?

No. Abruptly stopping Rexulti can worsen symptoms or lead to withdrawal effects. Always consult your doctor before making any changes to your treatment.

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5. Can I use CBD oil while on Rexulti?

CBD can intensify Rexulti’s sedative effects and affect how it’s metabolized. Always talk to your doctor before combining the two to avoid impaired cognition or increased side effects.