Rexulti interactions: Alcohol, medications, and other factors

Before you start treatment with Rexulti, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Rexulti interacts with supplements, herbs, or vitamins, see the “Rexulti and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Rexulti. Keep in mind that this table doesn’t include all drugs that may interact with Rexulti. Some of these interactions are described in detail just below in “Drug interactions in depth.”

In some cases, factors or conditions could prevent your doctor from prescribing Rexulti due to the risk of harm. These are known as contraindications. One contraindication of Rexulti is:

Having had an allergic reaction to Rexulti or any of its ingredients

If you have had an allergic reaction to Rexulti or any of its ingredients, your doctor will likely not prescribe Rexulti. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Rexulti, it’s important to tell your doctor if this contraindication applies to you. They can determine whether to prescribe Rexulti.

There aren’t any known interactions between Rexulti and alcohol. However, your doctor may advise you to avoid or limit alcohol consumption during Rexulti treatment.

This is because drinking alcohol while taking the drug may worsen some of Rexulti’s side effects. For example, you may experience increased:

• sleepiness
• dizziness (which may raise your risk of falls)
• difficulty with thinking or judgment
• slowed reactions
• headache
• diarrhea

Alcohol may also worsen the condition you’re taking Rexulti to treat. For example, if you have depression, drinking alcohol may worsen your symptoms.

If you have questions about drinking alcohol while taking Rexulti, talk with your doctor.

Here’s a closer look at certain drug interactions of Rexulti.

Certain antibiotics

Rexulti can interact with certain antibiotics, which are prescribed to treat bacterial infections.

Interaction result: Taking Rexulti with certain antibiotics can raise your risk of Rexulti’s side effects.

Interaction explained: Rexulti is broken down by an enzyme (type of protein) in your liver called cytochrome p450 3A4 (CYP3A4). Certain antibiotics can stop this enzyme from working as well. Taking one of these antibiotics with Rexulti can make Rexulti build up in your body.

Examples of antibiotic drugs: Here are some antibiotic drugs that may interact with Rexulti:

• ciprofloxacin (Cipro)
• clarithromycin
• erythromycin (Ery-Tab, others)

Steps you or your doctor may take: If you take certain antibiotics with Rexulti, your doctor may prescribe a lower dosage of Rexulti. Do not take a higher dosage of either medication your doctor prescribes.

While taking Rexulti with an antibiotic, talk with your doctor if you have new or increased Rexulti side effects. Examples can include sleepiness, dizziness, restlessness, or uncontrollable body movements.

After you finish taking the course of antibiotics, your doctor may increase your dosage of Rexulti.

If you have questions about taking Rexulti with an antibiotic, talk with your doctor.

Certain seizure medications

Rexulti can interact with certain seizure medications, which are prescribed to treat seizure disorders such as epilepsy.

Interaction result: Taking Rexulti with certain seizure medications can make Rexulti less effective.

Interaction explained: Rexulti is broken down by an enzyme in your liver called CYP3A4. Certain seizure medications can increase the action of this enzyme. Taking Rexulti with one of these seizure medications can make your liver break down Rexulti faster than it should.

Examples of seizure medications: Here are some seizure medications that may interact with Rexulti:

• carbamazepine (Tegretol, others)
• phenobarbital
• phenytoin (Dilantin)

Steps you or your doctor may take: If you take Rexulti with a seizure medication, your doctor may prescribe a Rexulti dosage that’s higher than is typical.

If you have questions about taking Rexulti with a seizure medication, talk with your doctor.

Opioids

Rexulti can interact with opioids, which are strong pain relievers prescribed to help relieve severe pain. Some opioids may also be prescribed for treating cough.

Interaction result: Taking Rexulti with opioids can raise your risk of sleepiness, difficulty with thinking or judgment, and slowed reactions.

Interaction explained: Rexulti and opioids both slow activity in your brain and nervous system.

Examples of opioid drugs: Here are some opioids that may interact with Rexulti:

• hydrocodone (Hysingla ER, others)
• morphine (MS Contin, others)
• oxycodone (OxyContin, others)
• tramadol (ConZip)

Steps you or your doctor may take: Your doctor will typically avoid prescribing opioid-containing cough medications with Rexulti. If you take Rexulti with an opioid pain reliever, your doctor will prescribe the lowest possible dose of the opioid for the shortest possible time. Do not take a higher dosage of either medication than your doctor prescribes.

If you feel very sleepy or confused while taking Rexulti with an opioid, call your doctor right away.

If you have questions about taking Rexulti with an opioid, talk with your doctor.

Rexulti may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Rexulti.

Rexulti interactions with supplements

Before you start treatment with Rexulti, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Rexulti interactions with herbs

Doctors will typically recommend you avoid taking St. John’s wort with Rexulti. St. John’s wort is an herbal supplement that may be taken to treat depression and other conditions.

St. John’s wort may speed up the activity of an enzyme in your body called CYP3A4. This enzyme helps break down Rexulti.

By speeding up this enzyme, St. John’s wort can cause Rexulti to break down more quickly. And this may lead to a low level of Rexulti in your system. If the level of Rexulti in your system is too low, the drug may not work to treat your condition.

Your doctor may be able to suggest a treatment option other than St. John’s wort.

Rexulti and vitamins

There are no specific reports of vitamins interacting with Rexulti. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Rexulti.

Rexulti interactions with food

Grapefruit and grapefruit juice can interact with Rexulti. Specifically, grapefruit products can stop your body from breaking down Rexulti. This raises the level of Rexulti in your body, which increases your risk of side effects from Rexulti.* Due to this risk, your doctor may recommend not consuming grapefruit and grapefruit juice while taking the drug.

* For details about Rexulti’s side effects, see this article.

Rexulti and vaccines

There aren’t any known interactions between Rexulti and vaccines. Talk with your doctor or pharmacist to find out whether you’re due for any vaccines.

Rexulti and lab tests

Rexulti isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

REXULTI INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Rexulti. Taking cannabis and Rexulti can raise your risk of sleepiness, difficulty with thinking or judgment, and slowed reactions.

Before you start treatment with Rexulti, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Rexulti. Before you take this drug, be sure to talk with your doctor about your health history. Rexulti may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Rexulti include:

• Diabetes: Rexulti can increase your blood sugar level. If you have diabetes, this can make your blood sugar harder to manage. Talk with your doctor about whether Rexulti is right for you.
• High cholesterol or triglycerides: Rexulti can increase your cholesterol and triglyceride levels. Your doctor will likely monitor your levels of these fats while you’re taking Rexulti.
• Low white blood cell count: Rexulti can lower your white blood cell count. You may have a raised risk of this if you already have a low white blood cell count or you’ve had this side effect with another drug in the past. Your doctor will likely monitor your white blood cells while you take Rexulti.
• Low blood pressure: Rexulti may lower your blood pressure. This can make you feel dizzy or faint, especially when getting up from sitting or lying down. If you already have low blood pressure, you may have a raised risk of this side effect. Talk with your doctor about whether Rexulti is right for you.
• Dehydration: If you become dehydrated while taking Rexulti, you may have a raised risk of low blood pressure (see just above). You may also have a raised risk of heatstroke. While taking this medication, it’s important to drink plenty of nonalcoholic fluids to avoid becoming dehydrated. Talk with your doctor about how to reduce your risk of dehydration while taking Rexulti.
• Risk of falls: Rexulti can cause sleepiness, dizziness, and low blood pressure, which can all raise your risk of falls. If you have other health factors that raise your risk of falls, talk with your doctor about whether Rexulti is right for you.
• Heart disease or stroke: Rexulti can cause blood pressure changes that may be dangerous if you have heart disease. If you have heart disease or you’ve had a past heart attack or stroke, talk with your doctor about whether Rexulti is safe for you.
• Seizures: Rexulti can raise your risk of seizures. If you’ve had past seizures or you have a seizure disorder such as epilepsy, talk with your doctor about whether Rexulti is right for you.
• Kidney or liver problems: If you have kidney or liver problems, Rexulti can build up in your body. This can raise your risk of side effects. Due to this risk, your doctor will likely prescribe a lower dose of Rexulti.
• Allergic reaction: If you’ve had an allergic reaction to Rexulti or any of its ingredients, your doctor will likely not prescribe Rexulti. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
• Breastfeeding: It’s not known whether it’s safe to take Rexulti while breastfeeding. There isn’t enough information to determine whether the drug passes into breast milk or what effects Rexulti may have on a child who is breastfed. If you’re breastfeeding or planning to, talk with your doctor before taking Rexulti. They can talk with you about treatment options and ways to feed your child.
• Pregnancy: There haven’t been enough clinical trials to determine whether Rexulti is safe to take while pregnant. When taken in the last 3 months of pregnancy, antipsychotic medications similar to Rexulti can cause withdrawal symptoms in a newborn. (Withdrawal symptoms are side effects that can occur when you stop taking a drug your body has become dependent on.) If you’re pregnant or planning to become pregnant, tell your doctor before starting Rexulti. They can advise you on the right treatment plan for you.
• Risk of suicidal thoughts and behaviors: Rexulti has a boxed warning about the risk of suicidal thoughts and behaviors. This is a serious warning from the FDA. A boxed warning alerts doctors and patients about drug effects that may be dangerous. For details, see the boxed warning at the top of this article.

You can take certain steps to help prevent interactions with Rexulti. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Rexulti label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Rexulti doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Rexulti by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Rexulti. These resources might help:

• Overview of Rexulti: For a general overview of Rexulti, you can see this article.
• Side effects: If you’re interested in the side effects of Rexulti, see this article. Another option is to refer to the Rexulti prescribing information.
• Dosage specifics: To learn about the dosage of Rexulti, see this article.
• Drug comparison: For information about how Rexulti compares with Abilify, read this article.
• Cost: If you’d like to learn about Rexulti and cost, see this article.
• Facts about your condition: For details on mental health, visit our mental health hub. You can also see our lists of depression articles, schizophrenia articles, and Alzheimer’s and dementia articles.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.