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A cocktail and a pill: Can you drink while taking Rexulti?
Drug Info

Can you drink while taking Rexulti?

Drinking alcohol can negatively interact with any medication, and Rexulti is no exception
Sarah Bradley writer headshot
By | Jul. 2, 2024 Medically reviewed by Samantha Marr, DNP, APN, AGPCNP-BC, CCRN

Key takeaways

  • Rexulti is an atypical antipsychotic prescribed for the treatment of major depressive disorder, schizophrenia, and agitation associated with Alzheimer’s disease.

  • Anyone taking any kind of antipsychotic medication should be careful to avoid alcohol as much as possible because it can worsen their symptoms and side effects, leading to central nervous system depression.

  • People taking Rexulti should be especially careful because the drug stays in the body for more than 12 days.

  • While some drugs have a shorter half-life than Rexulti and may offer some flexibility for people who wish to consume alcohol, most experts recommend avoiding alcohol completely in combination with any psychiatric medication.

In this article:

People with major depressive disorder (MDD) sometimes need to add an antipsychotic medication to their treatment plan. Rexulti (brexpiprazole) is commonly prescribed alongside other antidepressants to help people with MDD better manage symptoms of depression in adults. As an atypical antipsychotic, Rexulti is also approved by the Food and Drug Administration (FDA) to treat schizophrenia in people ages 13 and older, as well as agitation associated with Alzheimer’s disease.

If you’ve been prescribed Rexulti, your healthcare provider may have advised you not to drink alcohol while taking the drug. Many of us take that advice with a grain of salt, assuming that “not drinking” means not drinking excessively. But what about Rexulti: Should you literally not drink at all while taking it, or just moderate your intake? Here’s what you should know about mixing Rexulti with alcohol. 

Can you drink on Rexulti?

“Most people taking any type of psychiatric medication should try to avoid alcohol entirely, or at least greatly minimize their intake,” said Alex Dimitriu, MD, psychiatrist, sleep medicine specialist, and founder of Menlo Park Psychiatry & Sleep Medicine in California. 

“Psychiatric medications like Rexulti cause central nervous system (CNS) depression,” according to Dr. Dimitriu, which means your nervous system slows down to a potentially dangerous level. This effect can be magnified when you combine Rexulti with alcohol, which is also a central nervous system depressant. Additionally, mixing Rexulti with alcohol can not only increase adverse side effects but prevent it from working as intended to improve your symptoms, according to the National Alliance on Mental Illness.

Can this really happen with just one glass of wine or a couple of beers? Unfortunately, yes. Rexulti stays in your system for an unusually long time, and Erika Gray, Pharm.D., cofounder of Toolbox Genomics, says people should exercise extreme caution when combining it with alcohol because the combination could be more dangerous than when mixing alcohol with other similar drugs.

What happens if you drink alcohol with Rexulti?

When you mix Rexulti with alcohol, the chances of experiencing CNS depression are higher than when you take Rexulti by itself. According to Dr. Dimitriu, common symptoms of CNS depression include:

  • Sedation (i.e., sleepiness or drowsiness)
  • Dizziness
  • Increased risk of falling
  • Decreased rate of breathing

“These symptoms can occur fairly quickly,” Dr. Dimitriu said. “Someone taking this medication who drinks would immediately experience the effects of alcohol in addition to Rexulti, which is already in their system.” 

In general, these effects go away once the alcohol is metabolized in your body, but that timing depends on how much alcohol was consumed along with other factors such as your overall health, body weight, and gender. Meanwhile, serious side effects of CNS depression could occur, causing difficulty breathing, irregular heart rate, seizure, and loss of consciousness.

Are certain people at greater risk?

Dr. Gray says anyone taking Rexulti should make every attempt to avoid alcohol, but some groups of people should be even more cautious, including:

  • Anyone over the age of 65
  • Anyone with impaired kidney or liver function 
  • Anyone who is a poor metabolizer of CYP2D6, an enzyme that breaks down many pharmaceutical drugs
  • Anyone experiencing serious symptoms of the psychiatric illness being treated by Rexulti, since alcohol may make their symptoms worse  

How long after taking Rexulti can I drink alcohol?

According to Dr. Dimitriu, Rexulti reaches peak levels in your blood around four hours after you take it, but the drug has a very long half-life of 91 hours. The half-life of a drug is the amount of time it takes for your body to remove 50% of the dosage you last took. That means the half-life of Rexulti won’t be reached for almost four days, so you can’t just wait a day or two after taking it to start drinking alcohol. 

In fact, Dr. Gray says Rexulti isn’t considered clinically eliminated (i.e., at least 90% removed) from your system until 12.5 days after your last dose, regardless of how many milligrams you take per day. Until the drug is clinically eliminated from your system, you could experience serious side effects from drinking while taking Rexulti.

“Technically, larger doses could extend this timeline,” said Dr. Gray, although the dosing doesn’t play as big of a role as you might think. “Larger doses do increase the amount of Rexulti your body is exposed to and how much drug the body has to break down.” But, it ultimately depends on how much Rexulti your liver can metabolize at a time. 

Some of the other factors that affect how long a drug remains in your system include your body size, metabolic function, and liver function, according to Dr. Gray.

Which antipsychotic medications are not affected by alcohol?

“All medications prescribed for psychiatric conditions can interact with alcohol,” said Dr. Gray. This means mixing alcohol with one of these drugs increases your risk of CNS depression and can also counteract the effects of your medication, leading to worsening symptoms. Therefore, healthcare experts recommend avoiding alcohol when taking Rexulti or any of its alternatives, like Abilify (aripiprazole), Vraylar (cariprazine), Seroquel (quetiapine), or Risperdal (risperidone). 

Dr. Gray says Rexulti alternatives with a shorter half-life may give you some flexibility with timing when it comes to consuming alcohol. For example, Risperdal has a half-life of less than 24 hours, and Seroquel’s half-life is about six to seven hours, so they are eliminated from your system sooner.

That said, just because a Rexulti alternative has a shorter half-life doesn’t make it safe to combine with alcohol. Dr. Dimitriu says it’s important to remember that alcohol is a neurotoxin (especially in larger doses) that disrupts sleep and often leads to more drinking: “There is a slippery slope with alcohol, and when people are told they can drink lightly, it can easily become too much.” 

RELATED: Rexulti generic availability, cost & more

The bottom line

Rexulti and alcohol are both central nervous system depressants, so mixing them together increases your risk for serious side effects like sedation, injury, and decreased respiration. Rexulti also has a long half-life and stays in your system for several weeks, which makes it riskier than other drugs to combine with alcohol.

It’s possible that a small amount of alcohol wouldn’t harm you while taking Rexulti, but Dr. Dimitriu strongly suggests avoiding it entirely. 

If you don’t think you can completely abstain from alcohol while taking Rexulti, talk to a healthcare provider who knows your whole medical history and can make a more informed recommendation.

Sources