Switching from Latuda to Rexulti: Managing Side Effects in Schizophrenia Treatment

Q: Switching from Latuda to Rexulti: Managing Side Effects in Schizophrenia Treatment

Hello： If you are not the physician who issued this prescription, please consult the prescribing physician.

Switching from Lurasidone 40 mg to Risperidone 1 mg, what are the related side effects?

The patient started medication for schizophrenia on July 22, taking Lurasidone 40 mg for nearly a year.
They sleep approximately 9 hours a day but often feel fatigued and lack interest in activities, exhibiting clear negative symptoms of schizophrenia.
The doctor previously mentioned that Lurasidone is also a third-generation antipsychotic and asked if the patient would like to switch to "Risperidone 1 mg." After nearly 2 weeks on Risperidone, the patient noticed an improvement in their mental state, becoming more willing to talk and expressing their own emotions and thoughts.
However, they are struggling with side effects, the most common being dizziness.
The patient would like to ask the doctor a few questions.
Thank you for your assistance.

1.
Is Risperidone also classified as a third-generation antipsychotic?
2.
Are there any medications that can alleviate the dizziness caused by Risperidone?
3.
Are there any antipsychotic medications that have better efficacy and fewer side effects for treating schizophrenia?

Allen, 40~49 year old female. Ask Date: 2023/10/16

Dr. Huang Zhijia reply Psychiatry

Hello: If you are not the physician who issued this prescription, please consult the prescribing physician.

Reply Date: 2023/10/16

More Info

Switching from Latuda (lurasidone) to Rexulti (brexpiprazole) in the treatment of schizophrenia can be a significant decision, especially when managing side effects. Both medications belong to the class of atypical antipsychotics, but they have different mechanisms of action and side effect profiles.

1. Is Rexulti also a third-generation antipsychotic?
Yes, Rexulti is considered a third-generation atypical antipsychotic. It works primarily as a partial agonist at dopamine D2 receptors and serotonin 5-HT1A receptors while acting as an antagonist at serotonin 5-HT2A receptors. This unique action helps in managing both positive symptoms (like hallucinations and delusions) and negative symptoms (such as lack of motivation and social withdrawal) associated with schizophrenia.
2. Managing side effects like dizziness:
Dizziness is a common side effect when starting a new antipsychotic medication, including Rexulti. It may occur as your body adjusts to the medication. To manage dizziness, consider the following strategies:
- Hydration: Ensure you are well-hydrated, as dehydration can exacerbate dizziness.

- Gradual Position Changes: When moving from lying down to sitting or standing, do so slowly to minimize dizziness.

- Medication Review: Discuss with your doctor about the dizziness. Sometimes, adjusting the dose or timing of the medication can help. In some cases, your doctor may prescribe a medication to help alleviate dizziness, but this should be done under medical supervision.

- Monitoring: Keep track of when the dizziness occurs and any other symptoms. This information can help your healthcare provider tailor your treatment plan.

3. Are there antipsychotic medications with better efficacy and fewer side effects?
The efficacy and side effects of antipsychotic medications can vary significantly from person to person. While some patients may respond well to one medication, others may experience intolerable side effects. Here are a few options to discuss with your healthcare provider:
- Aripiprazole (Abilify): This is another atypical antipsychotic that is often well-tolerated and has a favorable side effect profile. It is also a partial agonist at dopamine receptors, similar to Rexulti.

- Quetiapine (Seroquel): This medication is known for its sedative properties and may be beneficial for patients experiencing insomnia or anxiety alongside schizophrenia.

- Olanzapine (Zyprexa): While effective for many, it can cause weight gain and metabolic issues, so it should be considered carefully.

- Paliperidone (Invega): This medication is a metabolite of risperidone and can be effective with a manageable side effect profile for some patients.

Ultimately, the choice of medication should be individualized based on your specific symptoms, side effects, and overall health. It is crucial to maintain open communication with your healthcare provider about your experiences with both Latuda and Rexulti. If you find that the side effects of Rexulti are intolerable, your doctor may consider other options or adjust the dosage to find a balance between efficacy and tolerability.

In conclusion, switching antipsychotic medications can be a complex process, and it is essential to work closely with your healthcare provider to monitor your symptoms and side effects. Regular follow-ups and open discussions about your treatment plan will help ensure that you receive the most effective care for your schizophrenia while minimizing adverse effects.

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