Rexulti's effect on my wife with aggression

Jeff H · January 15

I'm new to this website. My 66 year old wife was diagnosed with Alzheimer's. She seems to be in later stages though. My wife was experiencing severe sundowning in the late afternoon to early evening. She was aggressive towards me. She occasionally shoves and pushes me. She once tore the iPad out of my hands and ripped the charging cable out. My safety is fine but I would like the aggression to be limited.

Her doctor prescribed Rexulti. She was given a sample pack for a month. The sample pack of Rexulti started at 0.5mg per day for the first week and then 1mg per day for the remaining three weeks. After the sample pack she was then prescribed the full 2mg dose once a day. It costs over $600/month on our Medicare drug plan but will cap after we hit $2200 for the year.

At first, the 0.5mg to 1mg sample pack didn't seem to do much. My wife wasn't experiencing any drowsiness. On the 2mg dose she does get drowsy about 4 hours after taking it. I have to administer it around 4pm so it aligns with her general sleep pattern. The 2mg dose does reduce if not totally eliminate the sundowning aggression! She has been on the 2mg dose for less than 2 weeks. From my limited research it doesn't fully take effect until after 2 weeks on 2mg. It's expensive, but if it continues to reduce and or eliminate the sundowning aggression it will be completely worth it.

To my knowledge, there currently isn't any generic for Rexulti in the United States.

Although it does have the drowsy side effect, it does provide me with some reprieve and down-time as her caregiver.

harshedbuzz · January 15

@Jeff H

Behavior is communication. It is appropriate and kind to treat the feelings that are resulting in agitation and aggression.

That said, Rexulti is one of many atypical antipsychotics prescribed for dementia with agitation. The only different between it and some of the others is that the manufacturer did the studies to qualify for the specific indication while other similar medications are being used off-label. The risks are that same and they all carry the same Black Box Warning. But the others are available as generics at significantly lower costs.

If the cost is a hardship or if you'd rather put that $2K towards some in-home help or respite, ask your doctor if you could trial something different.

HB

blueheron · January 15

My DH takes risperidone for agitation and aggression. It works well and is a generic prescription.

arldaughter · January 15

My LO is in memory care and her health care is based with the medical staff at her residence. She just started on Rexulti after initially being on Seroquel. I'm not convinced she tolerated the Seroquel, as her sundowning accelerated and became more intense after she started on that. She seems to be responding much better to the Rexulti: more likely to accept re-direction and more agreeable in general. I live in a different part of the country, so I haven't seen her myself since she started Rexulti but I'm encouraged by the reports. I do think she may be a little drowsy on it but the schedule has her taking it closer to bedtime so hopefully that is helping her sleep through the night. I hope your wife continues to tolerate the Rexulti and that it continues to help with her sundowning.

fesk · January 16

I disagree with the above. If Rexulti is working for your wife and the cost is acceptable to you, I recommend not changing it. It is true there are many other antipsychotics that are cheaper, but they all work differently and may not be as effective for your wife. It's trial and error with these medications and there are many risks to all. Once you land on something that is helping without unacceptable side effects, I would think very carefully before making any changes.

I wish you continued success.

Rexulti's effect on my wife with aggression

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