Mental health conditions, such as depression and schizophrenia, often require the use of medications to manage symptoms effectively. Among the drugs prescribed for these conditions is REXULTI (brexpiprazole), a relatively newer antipsychotic and antidepressant. Since its approval by the U.S. Food and Drug Administration (FDA) in 2015, REXULTI has gained traction for its effectiveness in treating major depressive disorder (MDD) as an adjunct to antidepressants and schizophrenia in adults. However, like all medications, it comes with potential side effects. Understanding these effects, particularly the most common ones, is essential for patients and caregivers.
This article delves into the most common side effect of REXULTI, focusing on weight gain, its implications, management strategies, and how it compares to other side effects. By the end, readers will have a thorough understanding of this medication and what to expect during its use.
What Is REXULTI?
REXULTI belongs to a class of drugs called atypical antipsychotics, which are known for balancing dopamine and serotonin levels in the brain. This mechanism helps regulate mood, thinking, and behavior. Unlike first-generation antipsychotics, atypical antipsychotics have a lower risk of severe side effects like extrapyramidal symptoms (movement disorders) but come with their unique challenges.
REXULTI is primarily used for:
- Major Depressive Disorder (MDD): When combined with standard antidepressants, it helps individuals who have not responded well to initial treatments.
- Schizophrenia: It alleviates symptoms such as hallucinations, delusions, and disorganized thinking.
Despite its benefits, patients should weigh the pros and cons, including potential side effects, before beginning treatment.
Weight Gain: The Most Common Side Effect
Among the side effects of REXULTI, weight gain is the most frequently reported. Clinical studies and patient experiences highlight this as a prominent concern, especially for individuals already struggling with weight management or metabolic issues.
Prevalence of Weight Gain
Research indicates that weight gain occurs in a significant percentage of patients taking REXULTI. In clinical trials:
- Patients with schizophrenia reported an average weight gain of approximately 1.5–2.1 kg (3.3–4.6 lbs) over a 6-week period.
- For those using REXULTI as an adjunct therapy for depression, the increase was slightly lower but still noticeable.
Weight gain is often gradual, becoming evident after several weeks of consistent use. While the extent varies among individuals, certain factors, such as dosage, duration, and baseline weight, can influence the degree of change.
Why Does REXULTI Cause Weight Gain?
The exact mechanism behind weight gain associated with REXULTI isn’t entirely understood, but several theories provide insight:
- Metabolic Changes: Atypical antipsychotics, including REXULTI, can affect the body’s metabolism, leading to increased fat storage and reduced calorie burning.
- Increased Appetite: Many patients report feeling hungrier while on the medication, resulting in higher calorie consumption.
- Altered Hormonal Levels: Changes in dopamine and serotonin can indirectly influence hunger and satiety signals.
- Reduced Physical Activity: Some patients experience fatigue or sedation, reducing their overall activity levels.
Implications of Weight Gain
Weight gain might seem like a minor inconvenience compared to the benefits of improved mental health. However, it can have significant physical and emotional repercussions, including:
- Physical Health Risks:
- Obesity
- Type 2 diabetes
- Hypertension
- Cardiovascular diseases
- Emotional and Psychological Impact:
- Lower self-esteem
- Body image concerns
- Potential worsening of depressive symptoms due to dissatisfaction with appearance
- Medication Adherence:
- Some patients may discontinue REXULTI due to frustration over weight changes, potentially risking a relapse in mental health symptoms.
How to Manage Weight Gain on REXULTI
Proactively addressing weight gain can help patients maintain their physical health and continue benefiting from REXULTI. Below are evidence-based strategies:
1. Lifestyle Modifications
- Diet: Adopt a balanced diet rich in whole foods, lean proteins, vegetables, and whole grains. Limit processed foods and sugary snacks.
- Exercise: Engage in regular physical activity, such as walking, swimming, or yoga. Aim for at least 150 minutes of moderate-intensity exercise per week.
2. Regular Monitoring
- Track weight changes weekly.
- Monitor blood sugar and cholesterol levels periodically.
3. Professional Support
- Work with a nutritionist or dietitian to create a personalized meal plan.
- Consult with a fitness trainer for tailored exercise programs.
4. Medication Adjustments
- Discuss concerns with a healthcare provider. In some cases, lowering the dose or switching to an alternative medication may help.
5. Behavioral Interventions
- Cognitive-behavioral therapy (CBT) can address emotional eating and promote healthier habits.
- Mindfulness techniques, such as meditation, can reduce stress-related eating.
Other Common Side Effects of REXULTI
While weight gain is the most prevalent, REXULTI may cause other side effects, including:
- Akathisia (Restlessness):
- A feeling of inner agitation that compels movement.
- Usually managed with dose adjustments or additional medications.
- Fatigue and Drowsiness:
- May improve as the body adjusts to the medication.
- Consider taking the dose at bedtime to minimize daytime drowsiness.
- Gastrointestinal Issues:
- Nausea, constipation, or diarrhea may occur but are generally mild and temporary.
- Headaches:
- Over-the-counter pain relievers can alleviate symptoms.
- Dizziness or Lightheadedness:
- Arising from changes in blood pressure, these symptoms often subside with time.
- Increased Risk of Hyperglycemia:
- Regular monitoring of blood sugar levels is crucial for individuals with diabetes or prediabetes.
Comparing REXULTI to Other Atypical Antipsychotics
REXULTI is often compared to other drugs in its class, such as aripiprazole (Abilify), olanzapine (Zyprexa), and risperidone (Risperdal). Each medication has a unique side effect profile:
- Aripiprazole: Lower risk of weight gain but higher incidence of akathisia.
- Olanzapine: Notorious for significant weight gain and metabolic issues.
- Risperidone: Moderate weight gain with a higher likelihood of prolactin elevation.
REXULTI’s side effect profile falls somewhere in the middle, with a manageable risk of weight gain compared to older medications.
The Importance of Patient Education
Understanding the potential side effects of REXULTI empowers patients to make informed decisions. Healthcare providers play a vital role in:
- Setting realistic expectations about weight changes.
- Offering support and resources for weight management.
- Monitoring progress and adjusting treatment plans as needed.
Conclusion
Weight gain is the most common side effect of REXULTI, presenting challenges for patients and clinicians alike. However, with proactive measures and open communication, it is possible to mitigate this side effect while reaping the mental health benefits of the medication. Patients are encouraged to prioritize their overall well-being, balancing mental and physical health to lead fulfilling lives.
