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Latuda vs Rexulti
Introduction
For patients with schizophrenia or bipolar disorder, certain medications that modify the levels of neurotransmitters in the brain associated with mood can aid in stabilizing manic highs and depressive lows. Latuda and Rexulti are two such drugs that are commonly prescribed for these conditions. Both influence different neurotransmitters in the brain but have similar effects on mood stabilization. Latuda (lurasidone) is an atypical antipsychotic which acts as a dopamine D2 and serotonin 5-HT2A receptors antagonist, while also having high affinity for serotonin 5-HT7 receptors. On the other hand, Rexulti (brexpiprazole), another atypical antipsychotic, works primarily by partly stimulating serotonin 5-HT1A and dopamine D2 receptors while blocking serotonin 5-HT2A receptors.
Latuda vs Rexulti Side By Side
| Attribute | Latuda | Rexulti |
|---|---|---|
| Brand Name | Latuda | Rexulti |
| Contraindications | Should not be taken with MAO inhibitors within the past 2 weeks | Should not be taken with MAO inhibitors within the past 2 weeks |
| Cost | Approximately $1,400 for 30 tablets of 40 mg | Approximately $1,100 for 28 tablets of 2 mg |
| Generic Name | Lurasidone | Brexpiprazole |
| Most Serious Side Effect | Increased thoughts about suicide or self-harm, signs of an allergic reaction, symptoms related to disturbances in vision, rapid heart rate, low sodium levels | Signs of allergic reactions, uncontrolled muscle movements, high blood sugar, low white blood cell counts, symptoms associated with serotonin syndrome |
| Severe Drug Interactions | MAO inhibitors | MAO inhibitors |
| Typical Dose | 20-120 mg/day, up to a maximum of 160 mg/day | Starts at 1 mg/day, up to a maximum of 4 mg/day |
What is Latuda?
Lurasidone (the generic name for Latuda) and Brexpiprazole (the generic name for Rexulti) are both atypical antipsychotic medications that have changed the way mental health conditions such as schizophrenia and bipolar disorder are treated. Both were approved by the FDA in recent years, with Lurasidone getting approval in 2010 and Brexpiprazole following later in 2015. These drugs work primarily by helping to balance dopamine levels within the brain, which can help mitigate symptoms of these disorders. They also interact with serotonin receptors, although they each do so differently: while Latuda acts more selectively on certain serotonin receptor subtypes without affecting others significantly, Rexulti influences a broader range of these receptors. This results in some differing side effects between the two medications - while both may cause weight gain and drowsiness among other things, Latuda is less likely than Rexulti to lead to restlessness or akathisia due to its selective activity.
What conditions is Latuda approved to treat?
Latuda is approved for the treatment of several mental health disorders, including:
- Schizophrenia in adults and adolescents aged 13-17 years
- Bipolar depression in adults and children aged 10–17 years when used alone
- Bipolar depression in adults when used as part of a combination therapy with lithium or valproate.
How does Latuda help with these illnesses?
Latuda helps to manage symptoms of schizophrenia and bipolar depression by affecting the balance of certain natural substances in the brain--specifically, dopamine and serotonin. It does this by acting as an antagonist at these neurotransmitters' receptors, meaning it binds to these receptors but blocks their activation rather than stimulating them. Dopamine and serotonin are chemicals that act as messengers throughout the brain and body, playing crucial roles in mood regulation, cognition, memory, sleep patterns among others. Imbalances in these chemicals are thought to contribute to conditions like schizophrenia or bipolar disorder. Therefore, by influencing dopamine and serotonin levels through receptor antagonism, Latuda can help moderate the negative effects of such disorders and aid patients with symptom management.
What is Rexulti?
Rexulti, also known by its generic name brexpiprazole, is an atypical antipsychotic that acts as a serotonin-dopamine activity modulator (SDAM). By adjusting the levels of serotonin and dopamine in the brain through partial agonism, Rexulti helps to alleviate symptoms of mental health disorders. Approved by the FDA in 2015, it differs from other antipsychotics because it doesn't entirely block dopamine or serotonin receptors. This results in a side-effect profile different from typical antipsychotics like Latuda; for instance, it's less likely to cause extrapyramidal symptoms such as restlessness or involuntary movements. The modulation effects on serotonin and dopamine can be beneficial for treating schizophrenia and assisting with major depressive disorder treatment when responses to typical antidepressants are inadequate.
What conditions is Rexulti approved to treat?
Rexulti has been approved by the FDA for use in treating:
- Major depressive disorder (MDD) as an add-on treatment to antidepressants
- Schizophrenia, a chronic and severe mental health disorder that affects how a person thinks, feels, and behaves.
How does Rexulti help with these illnesses?
Dopamine, a neurotransmitter like norepinephrine, plays important roles in various bodily functions such as mood regulation, attention focus and the reward system. Similar to its function in depression where low levels are often observed, dopamine imbalance is also linked with other mental health conditions like schizophrenia and bipolar disorder. Rexulti operates by acting on the dopamine receptors in the brain, potentially increasing or decreasing their activity depending upon how it interacts individually. This can aid in relieving some symptoms associated with these conditions. Moreover, Rexulti has an impact on serotonin receptors as well which can further enhance its therapeutic effect. Given that it affects both dopamine and serotonin systems unlike Latuda that predominantly acts on dopamine receptors only; Rexulti might be chosen when patients do not respond optimally to typical antipsychotics (like Latuda) or may be used along side them for added benefit.
How effective are both Latuda and Rexulti?
Both lurasidone (Latuda) and brexpiprazole (Rexulti) are atypical antipsychotics with a demonstrated effectiveness in treating patients with schizophrenia and bipolar disorder. They were initially approved by the FDA within five years of each other, Latuda in 2010 and Rexulti in 2015. These medications operate on various neurotransmitters which makes them suitable for different circumstances.
Studies comparing Latuda to Rexulti directly are not available, but individual studies indicate that both drugs demonstrate efficacy in managing symptoms of schizophrenia and bipolar depression, as well as promising safety profiles. A clinical trial conducted between 2006-2007 showed that patients receiving Latuda experienced significant improvements compared to those receiving a placebo.
A review from 2013 confirmed that Latuda is effective against acute symptoms starting from the first week of treatment, its side effect profile is favorable over many other antipsychotics, particularly regarding weight gain and metabolic issues often associated with this class of drugs. It has quickly gained popularity due to its good tolerability profile.
Similarly, a meta-analysis review published in 2020 indicated Rexulti seems more effective than placebo for treating schizophrenia while demonstrating similar efficacy levels to other common atypical antipsychotics when used adjunctively for major depressive disorder treatment. However, like most second-generation or 'atypical' antipsychotics it can lead to side effects such as weight gain or dyslipidaemia but less likely extrapyramidal symptoms unlike typical ones.
While both seem useful treatments options for these conditions based on their unique pharmacological properties; further research may be needed before one could definitively state whether either drug might be considered optimal under specific circumstances or patient populations.
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At what dose is Latuda typically prescribed?
Oral dosages of Latuda range from 20-120 mg/day, but research suggests that 40 mg/day is sufficient for treating schizophrenia in most adults. Adolescents aged 13-17 years may be started on 20 mg/day. In either population, the dosage can be increased after a few weeks if there is no response. The maximum dosage that should not be exceeded in any case is 160 mg/day.
On the other hand, Rexulti typically starts at an oral dose of 1mg/day and then gradually increases to a target dose of between 2mg -4mg /day for major depressive disorder (MDD) or up to a maximum dose of up to 4mg daily for schizophrenia treatment depending on individual patient's response and tolerance levels. Always follow your healthcare provider's instructions when taking these medications.
At what dose is Rexulti typically prescribed?
Rexulti treatment typically begins at a dosage of 1 mg/day. After a week, the dose can be increased to 2 mg/day and further adjusted with increments of up to 4 mg/week. The maximum dose is generally 4 mg per day which may be tested if there's no response to treatment at lower doses after several weeks. Rexulti should ideally be administered once daily, without regard to meals but regular monitoring by your healthcare provider is necessary for any adjustment in dosage or frequency based on individual requirements and response.
What are the most common side effects for Latuda?
Common side effects of Latuda and Rexulti are:
- Anxiety, agitation
- Insomnia, restlessness
- Somnolence (sleepiness/drowsiness)
- Extrapyramidal symptoms such as tremor (unintentional trembling or shaking), akathisia (a feeling of inner restlessness), dystonia (involuntary muscle contractions)
- Nausea, vomiting
- Dyspepsia (burning discomfort or pain in the digestive tract)
- Diarrhea or constipation
- Dry mouth Decreased libido (sex drive) is also a potential side effect. For men, issues like abnormal ejaculation and impotence can be experienced. Other possible side effects include sweating excessively, rash, weight gain and experiencing unusual dreams. Respiratory infections leading to symptoms similar to flu syndrome may occur alongside pharyngitis and sinusitis. In some rare cases extreme drowsiness might lead to excessive yawning.
Are there any potential serious side effects for Latuda?
In the context of comparing Latuda to Rexulti, it's important to be aware that both medications come with their own potential side effects. With respect to Latuda, a few rare but serious side effects may include:
- Increased thoughts about suicide or self-harm
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Symptoms related to disturbances in vision such as blurred vision and eye pain or swelling
- Rapid heart rate (tachycardia), palpitations or irregular heartbeat
- Low sodium levels - symptoms can include headache, confusion, slurred speech, severe weakness and unsteadiness.
On the other hand for Rexulti,
- Serious nervous system reaction - very rigid muscles leading high fever accompanied by sweating and tremors. Confusion along with fast or uneven heartbeats might also occur which could lead users feeling like they might pass out.
For both medications,
The occurrence of any symptoms associated with serotonin syndrome is required immediate medical attention: agitation/hallucinations/fever/sweating/shivering/fast heart rate/muscle stiffness/twitching/loss of coordination/nausea/vomiting/diarrhea.
If you experience any these symptoms while taking either medication immediately contact your healthcare provider.
What are the most common side effects for Rexulti?
Rexulti, like any other medication, comes with a set of potential side effects. These can include:
- Dry mouth and throat discomfort
- Blurred vision as well as possible ringing in the ears
- Digestive problems such as nausea, vomiting or stomach pain; it may also lead to loss of appetite or constipation
- Sleep disturbances including insomnia
- Physical symptoms such as tremors and sweating along with feelings of anxiety or nervousness
- Increased heart rate might be noticed by some patients
- Mental changes could manifest in confusion, agitation or potentially hostility
- Skin reactions leading to rashes are not uncommon
- Some people experience weight fluctuations while on Rexulti -Increased urination has been reported in few cases. -Potential for headaches, dizziness and muscle or joint pain is present.
It's important to remember that everyone reacts differently to medications and these side effects may not occur at all. Should you experience any unusual symptoms while taking Rexulti, consult your healthcare provider promptly.
Are there any potential serious side effects for Rexulti?
Rexulti, while generally well-tolerated, can potentially cause serious side effects in some cases. Here are symptoms that could denote a more severe adverse reaction:
- Signs of allergic reactions such as hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Uncontrolled muscle movements in the face (like chewing motions and frowning), which may be signs of tardive dyskinesia
- High blood sugar--increased thirst, increased urination, dry mouth or fruity breath odor
- Low white blood cell counts--sudden weakness or ill feeling, fever, chills or sore throat
- Symptoms associated with serotonin syndrome: agitation hallucinations fever sweating shivering fast heart rate stiffness twitching loss of coordination nausea vomiting diarrhea.
If you observe any such symptoms after starting Rexulti therapy stop taking the medication and reach out to your healthcare provider right away.
Contraindications for Latuda and Rexulti?
Both Latuda and Rexulti, along with most other antipsychotic medications, may cause a worsening of depressive symptoms in some individuals. If you notice your depression escalating or an increase in suicidal thoughts or behaviors while taking either medication, it is critical to seek immediate medical attention.
Neither Latuda nor Rexulti should be taken if you are currently using, or have recently used within the past 2 weeks, any monoamine oxidase (MAO) inhibitors. Always inform your healthcare provider about all medications you are currently taking; MAO inhibitors will require roughly two weeks to clear from the system to prevent dangerous interactions with both Latuda and Rexulti.
How much do Latuda and Rexulti cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Latuda (40 mg) averages around $1,400, which works out to approximately $46–92/day depending on your dose.
- The price for a similar quantity and strength (28 tablets, 2 mg each) of Rexulti is about $1,100. Based on a standard dose between 2mg to 4mg per day, this equates to roughly $39–78/day.
Thus, if you are in the higher dosage range for Latuda (i.e., 80 mg/day or higher), then brand-name Rexulti is less expensive on a per-day treatment basis. Please note that cost should not be your primary consideration in determining which medication will work best for you.
As it stands currently there are no generic options available for either drug as both are still under patent protection. This means costs can be significantly high when compared with other mental health medications that have generic alternatives available. Always talk with your healthcare provider about possible financial assistance programs or alternative treatments if cost becomes an issue.
Popularity of Latuda and Rexulti
Lurasidone, also known under the brand name Latuda, was estimated to have been prescribed to about 1.6 million people in the US in 2020. Lurasidone accounted for approximately 3% of atypical antipsychotic prescriptions in the US. As an atypical antipsychotic, it is often used as a treatment option for schizophrenia and bipolar depression. The prevalence of lurasidone has seen substantial growth since its FDA approval in 2010.
Brexpiprazole, trading under the brand name Rexulti, was prescribed to roughly half a million people in the USA during 2020. In terms of prescription volume among atypical antipsychotics within the United States market, brexpiprazole accounts for just over 1%. Primarily used as an adjunctive therapy for major depressive disorder and a treatment for schizophrenia like lurasidone, brexpiprazole has held relatively steady usage rates since its introduction onto the market back in 2015.
Conclusion
Both Latuda (lurasidone) and Rexulti (brexpiprazole) are newer antipsychotic medications, often utilized in the management of bipolar depression and schizophrenia. These drugs have been proven effective in clinical studies with results indicating that they're more efficient than placebo treatments. At times, these two may be used together depending on a thorough evaluation by a healthcare provider since there can be interactions between them.
Latuda acts primarily as an antagonist at D2 dopamine receptors and 5-HT7 serotonin receptors while also being a partial agonist at 5-HT1A receptors; Rexulti works mainly through its action as an antagonist at 5HT2A serotonin receptors and partial agonist activity at D2 dopamine and 5HT1A serotonin receptors.
The decision to use one over the other is usually down to the specific patient profile. Both are available in generic form which can offer considerable cost savings for patients paying out-of-pocket.
There's typically an adjustment period after starting either drug before significant effects become apparent. Side effect profiles for both medications are relatively similar but generally well-tolerated: common side effects include weight gain, restlessness, insomnia among others. However, it's worth noting that sexual dysfunction appears less commonly with these drugs when compared to traditional antidepressants or antipsychotics.
Patients must closely monitor changes in mood or behavior especially during initial treatment stages or if dosage adjustments occur - seeking immediate medical assistance if symptoms worsen or suicidal thoughts emerge is paramount.
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Refrences
- Pompili, M., Verzura, C., Trovini, G., Buscajoni, A., Falcone, G., Naim, S., … Girardi, P. (2017, September 26). Lurasidone: efficacy and safety in the treatment of psychotic and mood disorders. Expert Opinion on Drug Safety. Informa UK Limited.http://doi.org/10.1080/14740338.2017.1379989
- McKeage, K. (2016, February). Adjunctive Brexpiprazole: A Review in Major Depressive Disorder. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40263-016-0320-0
- Fukuyama, K., Motomura, E., Shiroyama, T., & Okada, M. (2022, April). Impact of 5-HT7 receptor inverse agonism of lurasidone on monoaminergic tripartite synaptic transmission and pathophysiology of lower risk of weight gain. Biomedicine & Pharmacotherapy. Elsevier BV.http://doi.org/10.1016/j.biopha.2022.112750
- Weiss, C., Weiller, E., Baker, R. A., Duffy, R. A., Gwin, K. K., Zhang, P., & McQuade, R. D. (2018, September). The effects of brexpiprazole and aripiprazole on body weight as monotherapy in patients with schizophrenia and as adjunctive treatment in patients with major depressive disorder. International Clinical Psychopharmacology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/yic.0000000000000226
- Garnock-Jones, K. P. (2016, March 29). Brexpiprazole: A Review in Schizophrenia. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40263-016-0325-8