Abilify and Rexulti are cousins in the antipsychotic family—Rexulti is a newer medication designed to build on Abilify's success with improvements in tolerability and efficacy for certain presentations. If you've heard of Rexulti but aren't sure how it compares to Abilify, here's what you need to know.
The Relationship Between Them
Rexulti (brexpiprazole) was developed by the same pharmaceutical company that created Abilify (aripiprazole). It's a newer agent designed as an improvement—similar mechanism (partial dopamine agonist), but with some pharmacological refinements that may enhance tolerability. Rexulti is FDA-approved for schizophrenia, bipolar disorder, and major depressive disorder (as an add-on to antidepressants). Abilify has broader indications and longer clinical experience.
Efficacy: Abilify vs. Rexulti
Both are effective for psychotic disorders, mood disorders, and bipolar mania. Research suggests comparable efficacy, with some data suggesting Rexulti may be slightly more tolerable. However, individual response varies—some patients respond better to Abilify, others to Rexulti. There's no universal "better" option; it depends on your specific brain chemistry and symptom presentation.
Dosing Differences
Abilify is dosed at 10–30 mg daily for most indications. Rexulti is dosed lower—typically 1–4 mg daily. Rexulti's lower dose requirements reflect its higher potency at the dopamine D2 receptor. This lower dosing may contribute to Rexulti's perceived tolerability advantages, though this is still being studied.
Side Effects and Weight Gain
Both are weight-neutral to weight-favorable antipsychotics—far better than medications like Seroquel or Olanzapine. Research on Rexulti suggests it may cause slightly less akathisia (restlessness) than Abilify, potentially improving tolerability. However, both carry the full range of antipsychotic side effects: movement disorders, metabolic changes (though minimal), sexual dysfunction, and sedation/activation depending on the individual.
Activation Profile
Abilify is known for being activating—some patients report increased energy and alertness, which can help with depression and apathy but may worsen insomnia or agitation. Rexulti may have a more neutral profile, potentially suiting patients who can't tolerate Abilify's activation. However, this difference is subtle and varies by individual.
Cost and Insurance Coverage
Abilify is available as a generic (aripiprazole), making it inexpensive and widely covered. Rexulti is newer, still patent-protected, and significantly more expensive. Insurance often requires trying Abilify first before approving Rexulti. Cost may be a practical barrier for some patients.
Clinical Experience
Abilify has decades of clinical experience and extensive research. Rexulti is newer, with growing but shorter-term data. For some patients and psychiatrists, Abilify's longer track record is reassuring. For others, Rexulti's newer formulation and potential tolerability advantages make it worth the cost.
Which Should You Choose?
Start with Abilify if cost is a concern, you need established treatment, or you respond well to activating medications. Try Rexulti if Abilify causes bothersome akathisia or activation, you have insurance coverage, or your psychiatrist recommends it based on your presentation. If one doesn't work, switching to the other is straightforward.
Frequently Asked Questions
Is Rexulti better than Abilify?
Not universally—they're comparable in efficacy with slightly different tolerability profiles. Some patients prefer Rexulti's potentially smoother side effect profile. Others do fine with Abilify. The "better" medication is the one that works for your individual brain chemistry.
Can I switch from Abilify to Rexulti?
Yes, switching is straightforward. Your psychiatrist will typically overlap the medications briefly (Abilify decreasing while Rexulti increases) to avoid relapse. Since Rexulti is dosed lower, the transition requires careful dose adjustment.
Why is Rexulti so expensive?
Rexulti is still under patent protection, whereas Abilify has generic equivalents. Once Rexulti's patent expires, prices will drop significantly. For now, cost is a genuine barrier—talk to your psychiatrist about insurance coverage or assistance programs.
When to See a Psychiatrist
If you're on Abilify and experiencing side effects, or if you've been diagnosed with bipolar disorder and want to explore medication options, a psychiatric evaluation can help determine if Rexulti or another medication might work better for you.
Talk to Next Step Psychiatry
At Next Step Psychiatry in Lilburn, GA, Dr. Aneel Ursani and Fathima Chowdhury, PA-C stay current with newer medications like Rexulti while maintaining expertise with established treatments like Abilify. We'll help you navigate the options and find the medication that works best for your situation.
4145 Lawrenceville Hwy STE 100, Lilburn, GA 30047 • 678-437-1659 • Schedule an appointment
This article is for informational purposes only and should not replace a consultation with a licensed mental health professional. Always consult with your psychiatrist before starting, stopping, or switching medications.