Rexulti causing anxiety?

[Arj72]

Hi all, I had previously been on Rexulti but quit due to anxiety and insomnia.  After a few failures along the way, my pdoc suggested I try it again, and try to push through the anxiety/insomnia to see if it goes away on its own.  I'm 10 days on (standard titration pack, 1mg 4 days and 2mg since), and am really feeling the anxiety/insomnia at this point.  On the bright side, my mood is fine.

So for all that have tried or are currently taking Rexulti, have you had a similar experience?  Did it go away over time?

TIA.

[Arj72]

The anxiety is sort of letting up, but mornings are still kind of awful.  Any one know how long it might take to adjust?

[Iceberg]

Medscape says it can be 12 days, but going by the 5x the half-life rule it’s more like 2 1/2 weeks 

[Arj72]

2 hours ago, Iceberg said:

Medscape says it can be 12 days, but going by the 5x the half-life rule it’s more like 2 1/2 weeks 

Would you say 2.5 weeks from the start of the side effects or from the change in dose?  The anxiety didn’t start until about 4 days into the change to 2mg

[Iceberg]

Well that’s the time for a steady concentration, but a steady state doesn’t necessarily mean the side effects will go away right then 

[Arj72]

6 minutes ago, Iceberg said:

Well that’s the time for a steady concentration, but a steady state doesn’t necessarily mean the side effects will go away right then 

Gotcha.  So maybe even a week or 2 after that.  Holding my bottle of Valium tight

[Iceberg]

Could you change dose? Go down to 1 maybe? ... or up to 3 depending on what exactly you’re trying to treat?

[Arj72]

22 minutes ago, Iceberg said:

Could you change dose? Go down to 1 maybe? ... or up to 3 depending on what exactly you’re trying to treat?

Trying to treat bipolar depression, which it’s working for.  Just have this agitation/anxiety now.  If it weren’t for it working on the depression I wouldn’t even bother, but it is, and here I am.  My pdoc suggested a reduction might be a possibility but he was unsure if Rexulti acted like Abilify in that higher doses were more soothing.  He said up or down is a possibility.  Do you know if higher doses are less stimulating?

[Iceberg]

2 minutes ago, Arj72 said:

Trying to treat bipolar depression, which it’s working for.  Just have this agitation/anxiety now.  If it weren’t for it working on the depression I wouldn’t even bother, but it is, and here I am.  My pdoc suggested a reduction might be a possibility but he was unsure if Rexulti acted like Abilify in that higher doses were more soothing.  He said up or down is a possibility.  Do you know if higher doses are less stimulating?

I had better luck with 3 for BP depression, but even that didn’t solve insomnia issues. I would think since the higher doses are aimed at psychosis they would be generally more calming and less activating, which my doc thought too, but YMMV obviously 

[Arj72]

1 hour ago, Iceberg said:

I had better luck with 3 for BP depression, but even that didn’t solve insomnia issues. I would think since the higher doses are aimed at psychosis they would be generally more calming and less activating, which my doc thought too, but YMMV obviously 

I think that may be the direction I’ll ask to go at my next check in in about 10 days if it doesn’t resolve by then.  Thanks for the input.

[Iceberg]

17 minutes ago, Arj72 said:

I think that may be the direction I’ll ask to go at my next check in in about 10 days if it doesn’t resolve by then.  Thanks for the input.

Let us know how the appointment goes, good luck 

[browri]

On 12/29/2019 at 4:35 PM, Arj72 said:

My pdoc suggested a reduction might be a possibility but he was unsure if Rexulti acted like Abilify in that higher doses were more soothing.  He said up or down is a possibility.  Do you know if higher doses are less stimulating?

I can assure you lower doses of Rexulti are calming and higher are stimulating. Opposite of Abilify. And if you're having anxiety and insomnia on 2mg, it's probably because it's just too high. I did 0.25mg for several weeks before going to 0.5mg and then only more recently trying 1mg, but it gets more stimulating as you increase for sure.

[Arj72]

45 minutes ago, browri said:

I can assure you lower doses of Rexulti are calming and higher are stimulating. Opposite of Abilify. And if you're having anxiety and insomnia on 2mg, it's probably because it's just too high. I did 0.25mg for several weeks before going to 0.5mg and then only more recently trying 1mg, but it gets more stimulating as you increase for sure.

Do you think you can do every other day dosing of the 2mg pills to get 1mg, or do you think it'd be better to do half each day.

I'm giving it till end of this week to settle down, but may have to lower my dose as you suggested.  I'm just worried that I won't have as much antidepressant oomph at 1mg.

[browri]

Actually the real calming and antidepressant oomph is at the lower doses. You go to the higher doses just to get more stimulation if the lower doses aren't enough.

I personally find 1mg to be enough. Keeping my dose low, that's the highest I've ever had to go.

Edited December 30, 2019 by browri

[Iceberg]

6 minutes ago, browri said:

Actually the real calming and antidepressant oomph is at the lower doses. You go to the higher doses just to get more stimulation if the lower doses aren't enough.

I personally find 1mg to be enough. Keeping my dose low, that's the highest I've ever had to go.

Does that hold for schizophrenia dosage too? Because going above 2 isn’t shown to be more beneficial to MDD, so I assumed that would indicate that activating at least leveled off 

[Arj72]

10 minutes ago, browri said:

Actually the real calming and antidepressant oomph is at the lower doses. You go to the higher doses just to get more stimulation if the lower doses aren't enough.

I personally find 1mg to be enough. Keeping my dose low, that's the highest I've ever had to go.

Did you feel more anxious when you went up too fast?

[browri]

6 minutes ago, Iceberg said:

Does that hold for schizophrenia dosage too? Because going above 2 isn’t shown to be more beneficial to MDD, so I assumed that would indicate that activating at least leveled off 

Actually the schizophrenia target dose is 3mg with a max of 4mg as opposed to MDD at a target of 2mg and max of 3mg. Going to 3mg in MDD may be beneficial for some but not for most. 3mg and 4mg are generally the schizophrenia doses.

5 minutes ago, Arj72 said:

Did you feel more anxious when you went up too fast?

Actually I just felt all around incapacitated starting on 0.5mg. I had to decrease after 2 weeks to 0.25mg, do that for 4 weeks, then increase again to 0.5mg. do that for 4-6 weeks then increase to 1mg.

[Arj72]

On ‎12‎/‎29‎/‎2019 at 3:25 PM, Iceberg said:

Let us know how the appointment goes, good luck 

I think I have to hang up the towel.  There's no sign that the agitation is going away.  Honestly, it feels like I'm mildly mixed, though I can't be so sure it's not the side effects of the med itself.  I had a couple days of improvement, but it came back just as bad as before.  I have some emergency Zyprexa that I think I'm going to take tonight and I emailed my pdoc about next steps (reduction?).  I know the half life is long so I'm not worried about missing a couple days over the weekend until the pdoc likely will get back to me.

Another one bites the dust?

Edited January 4, 2020 by Arj72

[browri]

11 hours ago, Arj72 said:

I think I have to hang up the towel.  There's no sign that the agitation is going away.  Honestly, it feels like I'm mildly mixed, though I can't be so sure it's not the side effects of the med itself.  I had a couple days of improvement, but it came back just as bad as before.  I have some emergency Zyprexa that I think I'm going to take tonight and I emailed my pdoc about next steps (reduction?).  I know the half life is long so I'm not worried about missing a couple days over the weekend until the pdoc likely will get back to me.

Another one bites the dust?

Sorry it didn't work out for you. If you decide to try it again, start at 0.25mg for a few weeks before increasing.

[Arj72]

On 1/4/2020 at 4:55 AM, browri said:

Sorry it didn't work out for you. If you decide to try it again, start at 0.25mg for a few weeks before increasing.

I’m disappointed too.  Now just waiting it out for the med to get out of my system.  Been taking the Zyprexa and off the Rexulti for 6 days now.  Feel better but still agitated.  I imagine I have some time to wait until it’s all out.