Any experience with Rexulti?

LaneyG · May 21

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 · May 21

@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 · May 21

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 · May 21

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 · October 17

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 · October 17

Medicare will not cover it. Medicaid will.

FTDCaregiver1 · October 22

DW went on Rexulti about a year ago for severe agitation, she seems to peek in afternoons. After consulting w/our Geri psych we opted to dose 1 mg. each morning. DW responded positively, no side effects. She's on Medicare now, cost is covered through our local PACE program as I don't pay anything.

ronda b · October 22

What is a PACE program?

Despondent · October 22

My DH started on Rexulti about 3 mos. ago. His psych Doc has plenty of samples. Because I questioned the cost. He said he would never prescribe it for someone on Medicare because of the cost. When I questioned Dr further about its efficacy, he stated that he has found a smoother reaction compared to Seroquel. His dose was increased to 2 mg. in PM or dinnertime. DH becomes agitated with me if I say something he doesn't like. But he has been doing that for 40 yrs, so I wouldn't expect that to change. He has been manifesting sundowning since he started Rexulti. Is that the progression of the disease or a side effect of the Rexulti. Who knows. The only way to know is by titrating him off the Rexulti but I don't feel he has had a long enough trial. Someone said they had good results when Remeron was added. He sees the Dr on Thursday so I will ask his opinion.

Lkrielow99 · October 22

My DH was started on Rexulti by the PCP. We used samples for about two weeks and I saw an improvement with his agitation. The PCP gave us a 30 day prescription that had an out of pocket cost of $700. I was told it was a cleaner drug than Seroquel, meaning less side effects. Ok, the great improvement went south after one more week. I had to bring him to the ER. The ER doctor said a PCP or actually in our case a NP had no business prescribing this type of drug. He referred us to a Geriatric Psychiatrist who took him off the drug and prescribed new medications. I’m not familiar with the new drugs and failed to write them down as he was transferred to a MC Facility. He no longer is super agitated and seems to be adjusting to the MC facility. He is still declining but without the intense agitation. It could be the new drugs or the facility, or both. I hope posting my journey is helpful to someone. Much love to all that suffer from this disease.

FTDCaregiver1 · October 26

https://alzconnected.org/discussion/comment/226313#Comment_226313

Here's some info on PACE programs.

PACE | Medicare

Any experience with Rexulti?

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