Any experience with Rexulti?

LaneyG

DH has been getting more delusional and agitated. Doc suggested a switch from olanzapine to rexulti. Wondered if there is any experience with rexulti out there. I know every PWD is different but would still like to hear about experiences with this med. Also what dose at what time of day? Doc suggested a cutback reducing the olanzapine by more than half while beginning with a small dose of the rexulti. I’m a bit apprehensive about the temporary cutback of the antipsychotic but maybe that is unavoidable? Also…I’ve noticed in within the forum that usually antipsychotics are taken at night with a reduced dose in the am. Doc has always recommended the reduced dose around lunchtime instead. Is this unusual? I wonder if he would do better taking it earlier in the day. Will appreciate any input.

harshedbuzz

@LaneyG

FYI, Rexulti is also an atypical antipsychotic. A big difference is that manufacturer got "dementia-related agitation" approved as an indication unlike the other antipsychotics (and their lower cost generics) which are prescribed "off label". It still carries the same "Black Box Warning" and risks as any other medication in this calls and the website specifically says that it isn't indicated for treatment of "older-adults with dementia-related psychosis".

I can't recall any member here reporting on a LO taking this medication. I suspect, in part, because it is very expensive. At my CVS it would run about $1500/month. If you have commercial insurance, there is a coupon program; this is not available for those on Medicare or Medicaid.

The strategy of weaning off one medication by reducing the dose while adding a second similar/same class medication at a starting dose is a fairly common one with psychoactive meds.

That said, if your DH's agitation and delusions are breaking through his current Zyprexa regimen after having worked well previously, the doctor could add a second dose. Dad was agitated, delusional and aggressive; he started with generic Seroquel (25mg) around dinnertime to improve his behavior late at night. When his daytime behavior tanked, the doctor added a second dose with breakfast which dial back his anxiety enough that validation and redirection were effective at managing behavior. Typically, this class of medication is started at a very low dose, so there is room to add additional doses (2 or 3 x daily) and/or increase the amount given a lot.

HB

M1

Agree with above. I would ask specifically why he wants Rexulti and i would bet he won't have an answer for you—except that he's seen the ads or received drug detailing about the FDA indication also. I personally would increase the olanzapine or use a different drug like Seroquel or Risperdal—unless he has prior experience with those? i don't think the increased cost of Rexulti is worth it….

LaneyG

THANK YOU THANK YOU THANK YOU! This makes so much more sense to me. I need to find a new geri psych. Done with this guy.

rushali

For what it's worth with this late reply, Rexulti has done wonders for my LO with mid-stage AD and is completely covered by her Medicaid/Medicare. She went from being psychotic, regularly severely agitated, and not eating or drinking, to - within ONE WEEK - becoming relaxed and happier than we'd seen her in years. She also regained her appetite and now we need to watch her weight. She takes it in combination with 30 mg of mirtazipine (Remeron). Alone, the Remeron did nothing or little for her that we could tell, but in combination with the recommended 2 mg of Rexulti, the combination has helped her tremendously. These are the only two meds she takes. It used to take us 1 - 2 hours to settle her into sleep with her tossing, turning, whimpering, and now she wants to go to her bed and falls asleep within minutes. She is also still connected and with us (not overly sedated, though sleepy after taking it in the eve). We first tried Seroquel but it immediately made her symptoms worse.

ronda b

Medicare will not cover it. Medicaid will.