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Seroquel vs Rexulti
Introduction
For patients with schizophrenia, bipolar disorder or major depressive disorder (MDD), certain drugs that alter the neurotransmitters in the brain can help manage symptoms and stabilize mood swings. Seroquel and Rexulti are two such medications prescribed for these conditions. Both of them affect various neurotransmitters in the brain, contributing to their therapeutic effects.
Seroquel is classified as an atypical antipsychotic medication affecting levels of serotonin and dopamine by blocking their respective receptors. This helps reduce psychotic symptoms including hallucinations, delusions, and disorganized thinking.
Rexulti on the other hand is also an atypical antipsychotic drug but it operates a bit differently by acting as a partial agonist at serotonin 5-HT1A and dopamine D2 receptors, and antagonist at serotonin 5-HT2A receptor. This combination contributes to its efficacy in managing MDD when used along with antidepressants.
What is Seroquel?
Quetiapine (the generic name for Seroquel) was a significant advancement in the atypical class of antipsychotics, designed to treat mental/mood conditions such as schizophrenia, bipolar disorder, and sudden episodes of mania or depression associated with bipolar disorder. Quetiapine was first approved by the FDA in 1997. Seroquel works by helping to restore the balance of certain natural substances (neurotransmitters) in the brain.
On the other hand, Brexpiprazole (the generic name for Rexulti), also an atypical antipsychotic drug but newer than Seroquel, was approved by the FDA in 2015. Like Seroquel, it is used to treat schizophrenia and as an add-on treatment for major depressive disorder but it differs slightly on its mechanism—it targets serotonin receptors more selectively than dopamine receptors.
Both these drugs have their side effects and benefits; however, Rexulti's selective action on serotonin receptors results in fewer extrapyramidal symptoms compared with those seen with older typical antipsychotic drugs and even some of the atypical ones like Seroquel.
What conditions is Seroquel approved to treat?
Seroquel is approved for the treatment of several mental health disorders, including:
- Schizophrenia
- Acute manic episodes associated with Bipolar I Disorder (both as a monotherapy and in combination with lithium or divalproex)
- Acute depressive episodes in Bipolar disorder
- Maintenance treatment of Bipolar I Disorder (as an adjunct to lithium or divalproex)
How does Seroquel help with these illnesses?
Seroquel works to manage conditions like schizophrenia and bipolar disorder by adjusting the levels of dopamine and serotonin in the brain. It does this by blocking their respective receptors, thereby altering the chemical messages being sent between nerve cells. Both dopamine and serotonin are neurotransmitters that play key roles in mood regulation, cognition, memory, sleep patterns, appetite among other things. People with mental health disorders such as schizophrenia or bipolar disorder often have imbalanced levels of these chemicals. By modulating these neurotransmitters' activities, Seroquel can help mitigate symptoms associated with these disorders and contribute towards stabilizing a patient's mood.
What is Rexulti?
Rexulti is the brand name for brexpiprazole, which acts as a serotonin-dopamine activity modulator (SDAM), implying that it increases dopamine and serotonin levels in the brain by reducing their reabsorption. It also acts to balance out certain neurotransmitters, having a partial agonist effect on both serotonin 5-HT1A and dopamine D2 receptors, and antagonist effects on serotonin 5-HT2A receptors. Brexpiprazole was approved by the FDA in 2015. While not an SSRI antidepressant like Prozac, Rexulti doesn't inhibit the reuptake of these neurotransmitters either. Instead, its balanced action on particular receptors means that its side-effect profile differs from SSRIs - it's less likely to cause weight gain or sexual dysfunction, common side effects with drugs such as Seroquel. The balancing effect on dopamine can be beneficial for treating conditions like schizophrenia and depression especially in patients who may not respond well to “typical” antipsychotic drugs such as Seroquel.
What conditions is Rexulti approved to treat?
Rexulti is approved by the FDA for the treatment of certain mental/mood disorders:
- Adjunctive therapy to antidepressants for major depressive disorder (MDD)
- Schizophrenia, where it helps manage symptoms such as hallucinations, delusions, and disorganized thinking.
How does Rexulti help with these illnesses?
Rexulti (brexpiprazole) is an atypical antipsychotic that acts on multiple neurotransmission systems in the brain, specifically dopamine and serotonin. It works by balancing these two key neurotransmitters to alleviate symptoms of schizophrenia and major depressive disorder. Similar to norepinephrine's role in affecting wakefulness, memory recall, focus and attention, both dopamine and serotonin play crucial roles in mood regulation, cognition, reward system among other functions. Rexulti partially activates dopamine D2 receptors while simultaneously blocking serotonergic 5-HT2A receptors which may contribute to its therapeutic effects. Unlike Seroquel (quetiapine), which has a higher incidence of sedation due to its antagonistic effect on histamine H1 receptor as well as potential metabolic side effects such as weight gain or increased blood sugar levels; Rexulti demonstrates a more favorable side effect profile with less sedation reported commonly. Therefore it might be preferred when patients do not respond well or tolerate other antipsychotics like Seroquel.
How effective are both Seroquel and Rexulti?
Both quetiapine (Seroquel) and brexpiprazole (Rexulti) are atypical antipsychotics with a proven track record in managing symptoms of bipolar disorder and schizophrenia, as well as serving as adjunctive treatment for major depressive disorder. Quetiapine was initially approved by the FDA in 1997 while brexpiprazole received approval much later, in 2015. Both drugs work on an array of neurotransmitters but primarily act on dopamine and serotonin receptors.
Quetiapine's effectiveness has been demonstrated via multiple double-blind clinical trials since its introduction to the market. It is known not only for its efficacy but also for its rapid onset of action compared to other similar medications. A meta-analysis conducted in 2004 showed that Seroquel can start alleviating symptoms within the first week of treatment when used for acute mania or mixed episodes associated with bipolar disorder.
Brexpiprazole's relatively new status means there are fewer studies available than those for quetiapine, but initial research shows promising results regarding this medication’s effectiveness and safety profile. In a review published in 2016, it was found that Rexulti reduced scores on depression rating scales significantly more than placebo over six weeks when used alongside antidepressants among patients with major depressive disorder who had shown inadequate response to prior treatments.
While both medications have their place, they may suit different individuals based upon specific needs - such as tolerability concerns or potential drug interactions due to co-morbid conditions or concurrent medications.
At what dose is Seroquel typically prescribed?
Oral dosages of Seroquel for treating schizophrenia range from 150-750 mg/day, but studies have indicated that a starting dose of 25mg/day, increased daily in increments of 25-50mg divided two or three times on the second and third day, as tolerated, may be effective. For bipolar disorder initially 100mg/day in two doses; increase by up to 100mg/day at intervals greater than or equal to two days. The usual target dosage is around 400 mg per day taken in two doses. In either case, the maximum dosage should not exceed 800 mg/day under any circumstances.
Conversely Rexulti has an oral dosage range for treating schizophrenia from1–4 mg/day with a recommended starting dose of 1 mg once daily on Days 1 to four then increasing to reach a target dose within one week. For major depressive disorder adjunctive treatment with antidepressants typically starts at .5 or l mg/daily and can be titrated upwards if there is inadequate response after one week based upon clinical judgement up to a maximum daily dose of no more than3mg.
Always consult your doctor before changing medication levels, this information is meant as general advice only.
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At what dose is Rexulti typically prescribed?
Rexulti treatment typically begins at a dosage of 1 mg/day. After assessing the patient's response, this can then be increased to 2 mg/day after one week. The dose can further be escalated to a maximum of 4 mg/day if necessary based on individual clinical judgement and patient response. Each increase should have an interval of no less than one week as Rexulti has a long half-life and it will take several days for the medication level in your body to stabilize after each dose adjustment. Its effect is generally evaluated over several weeks, so if there isn't any marked improvement with the current prescribed dosage, speak with your healthcare provider about possibly adjusting it.
What are the most common side effects for Seroquel?
Common side effects of Seroquel include:
- Sleepiness/drowsiness
- Dizziness and lightheadedness
- Increased heartbeat
- Dry mouth
- Stomach upset, nausea, vomiting
- Constipation
- Weight gain
- Blurred vision or difficulty seeing at night
- Unusual tiredness or weakness (asthenia)
On the other hand, some of the common side effects reported with Rexulti are:
- Weight gain
- Tiredness (fatigue), sleepiness/drowsiness (somnolence)
- Inner sense of restlessness/need to move (akathisia)
- Nausea, constipation,
- Increase in blood sugar levels
Remember that everyone reacts differently to drugs and may not experience all or any side effects. Always follow your healthcare provider's instructions when taking medications.
Are there any potential serious side effects for Seroquel?
While Seroquel and Rexulti are both antipsychotic medications, they can cause different side effects. Here's what to watch for with Seroquel:
- Increased suicidal thoughts or self-harm tendencies.
- Any signs of an allergic reaction: hives; difficulty breathing; swelling in your face, lips, tongue, or throat.
- Vision problems such as blurred vision, tunnel vision, eye pain or swelling around the eyes.
- Cardiovascular issues like rapid heartbeats that you can feel pounding in your chest (palpitations), shortness of breath and sudden dizziness - these could be symptoms of a potentially serious heart condition known as Torsades de Pointes.
- Low sodium levels in the body which can lead to headache, confusion slurred speech severe weakness vomiting loss of coordination feeling unsteady
- Severe nervous system reactions like very stiff muscles high fever sweating confusion fast uneven heartbeat tremor feeling faint – this could be a sign of neuroleptic malignant syndrome which is rare but serious
- Symptoms suggestive serotonin syndrome: agitation hallucinations fever sweating shivering fast heart rate muscle stiffness twitching loss coordination nausea vomiting diarrhea.
Always seek immediate medical help if you experience any unusual or severe symptoms while taking Seroquel.
What are the most common side effects for Rexulti?
Rexulti has been known to cause an array of side effects that may include:
- Dry mouth and throat discomfort
- Nasal congestion
- Ringing sensations in the ears
- Visual disturbances or blurred vision
- Nausea, vomiting, stomach pain, loss of appetite, constipation
- Sleep disruptions such as insomnia
- Tremors, excessive sweating or feelings of anxiety or nervousness
- Increased heart rate
- Confusion, restlessness or aggressive behavior
- Skin reactions like rashes
-Unintended weight changes including both gain and loss
-Increased frequency of urination
-Recurring headaches and episodes of dizziness
-Painful muscle stiffness or joint pain
Are there any potential serious side effects for Rexulti?
Rexulti, much like other antipsychotic drugs, may have a range of side effects. Some of the more serious adverse reactions associated with Rexulti include:
- Signs of severe allergic reaction or skin issues: hives, itching, fever, swollen glands, difficulty breathing; swelling in your face or throat; sore throat and burning eyes; intense skin discomfort; red or purple skin rash that blisters and peels.
- Increased suicidal thoughts or tendencies to harm oneself
- A seizure (convulsions)
- Confusion or unusual changes in behavior or mood
- Blurred vision, tunnel vision, pain in the eye area accompanied by swelling; seeing halos around lights
- Rapid or irregular heart rhythms
- Indications of a manic episode: escalated thought tempo; heightened energy levels coupled with reckless actions; extreme happiness alternating with irritability episodes; talking excessively compared to one's usual speech patterns and severe sleep disorders.
In case any such symptoms are experienced following ingestion of Rexulti medication immediately seek medical assistance.
Contraindications for Seroquel and Rexulti?
Both Seroquel and Rexulti, along with most other antipsychotic medications, may worsen symptoms of depression in some people. If you notice your depression worsening or an increase in suicidal ideation, thoughts or behavior, please seek immediate medical attention.
Neither Seroquel nor Rexulti should be taken if you are taking, or have been taking drugs that inhibit the metabolism of these medications such as certain antibiotics and antifungal agents. Always tell your physician which medications you are taking; these inhibitors will require a period to clear from the system to prevent dangerous interactions with Seroquel and Rexulti. Keep in mind that both drugs can also lower seizure threshold so they should be used cautiously in individuals with conditions predisposing them to seizures.
How much do Seroquel and Rexulti cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Seroquel (100 mg) averages around $600, which works out to $10–20/day, depending on your dose.
- The price of 30 tablets of Rexulti (1 mg) averages is about $1100, working out to approximately $36.67/day.
Thus, if you are in the higher dosage range for Seroquel (i.e., 400 mg/day or higher), then brand-name Rexulti is less expensive on a per-day treatment basis only when considering extremely high doses. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
For the generic versions of Seroquel (quetiapine) and Rexulti (brexpiprazole), costs are significantly lower:
-
Quetiapine fumarate (100 mg tablets) is available in packs from 15 up to several hundred pills with approximate costs ranging from about $2 - $5 per day for dosages between 50 -200mg /day and can increase up to roughly between $8 -12 if you are taking more typical dosages closer to 300 –400mg/day.
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Brexpiprazole isn't as widely available as quetiapine due its relative newness; however where it's obtainable it comes at an average cost starting around roughly from just under a dollar per pill or up to around ~$3-$4 daily assuming standard dosages.
Popularity of Seroquel and Rexulti
Quetiapine, known by the brand name Seroquel, was estimated to have been prescribed to about 1.5 million people in the US in 2020. Quetiapine accounted for just over 2% of antipsychotic prescriptions in the US. Having been available since the mid-90s, quetiapine is a frequently-prescribed second-generation antipsychotic medication which has remained relatively consistent in its prevalence over recent years.
Brexpiprazole, sold under brand names such as Rexulti, was prescribed to approximately half a million people in America during the same year. With less than 1% of overall antipsychotic prescriptions attributed to it within America's borders, brexpiprazole is still building its footprint on pharmaceutical markets due to its more recent introduction into clinical use (approved by FDA in 2015). However, despite this disparity with older drugs like quetiapine, prescription rates for brexpiprazole have shown an uptick from previous years.
Conclusion
Both Seroquel (quetiapine) and Rexulti (brexpiprazole) have been used extensively in the management of several psychiatric conditions, including schizophrenia and bipolar disorder. They also serve as adjunctive treatments to antidepressants in cases of treatment-resistant depression. Both drugs function by modulating activity at serotonin and dopamine receptors, but they operate via slightly different mechanisms which makes them suitable for different clinical scenarios.
Seroquel is often chosen as a first-line treatment due to its extensive research backing and generic availability, resulting in cost savings for patients. It may take some time before the effects are noticeable as it requires an adjustment period.
Rexulti, on the other hand, is a newer medication that works well as an add-on therapy when first-line medications like SSRIs or SNRIs fail to achieve desired results. Its side effect profile has shown fewer metabolic disruptions compared to Seroquel - this makes it preferred among individuals concerned about weight gain or diabetes risk associated with antipsychotic use.
The side effect profiles of both these drugs include potential sedation, weight gain, movement disorders, and if discontinued suddenly after long-term use can lead to withdrawal symptoms. Therefore close monitoring is necessary while initiating these treatments; any worsening conditions should be immediately reported to healthcare providers.