While a person is suffering severe mental health symptoms, tapering from an atypical antipsychotic drug like Rexulti may or may not be the right next step. At Alternative to Meds Center, clients receive a comprehensive consultation to help discover what the best way forward would be for that individual. If Rexulti did not garner the results you were seeking, there may be drug-free strategies to help reduce symptoms and a program that includes preparations to plan a well-managed Rexulti taper. This may be a workable plan.
Do Your Symptoms Require Rexulti?
For some, a prescription of Rexulti clearly may have been an imperfect choice. Nevertheless, the situation you may now be struggling with is how to make the changes you would like to make, safely and successfully. It is possible that a lifetime on heavy drug treatment is not always warranted. In many cases, a safe and well-designed Rexulti tapering program could be the better answer, and may be recommended. This is our specialty at Alternative to Meds and we have helped thousands of clients reach their individual goals with proven success.
Alternative to Meds Center has provided nearly 2 decades of effective non-toxic mental health treatments with a documented history of success. Over 40 professionals are on hand to assist our clients to reach their unique health goals. Successfully tapering off Rexulti takes a well-informed team of medication experts, nutrition experts, licensed practitioners and caregivers. Our team is dedicated to providing the experience and compassion needed to guide our clients every step of the way.
15 Years Experience by Professionals Who Understand Your Journey.
Rexulti was developed and approved in 2015, and is marketed as a second-generation or atypical antipsychotic medication. The FDA approved a daily dose of 4mg Rexulti to treat schizophrenia and 3mg daily as an add-on medication if your antidepressant (or other medication) didn’t resolve your symptoms of major depression.
FDA Warning: Please remember you should not abruptly discontinue taking Rexulti, even if you feel it is, or is not working well for you.
Rexulti may not have proved as effective as hoped. For example, if your doctor prescribed it to treat major depression, you might have found that it did not provide the desired lift in mood for you.
Important to understand, antipsychotic medications have been used “off-label” for everything from Autism to eating disorders, anxiety, insomnia, substance use disorders, and even to treat ADHD. Some researchers feel this practice leaves the patient at great risk as the mechanics for how these drugs work in each of these and other scenarios are incompletely known.6
You may have experienced undesirable side effects such as akathisia (2X placebo in trials) or weight gain (also 2X placebo). According to the drug manufacturer, elderly people have experienced stroke or death. Some persons report blood sugar spikes that can lead to coma or death. In others, Rexulti caused seizures, suicidal thoughts and behaviors or other adverse events after taking Rexulti.
Some patients taking Rexulti have developed pathological gambling or other compulsive behaviors, muscle movement disorders, blood disorders, and other major consequences. Perhaps there is concern that these types of reactions could develop in the future, so you are hoping to transition to non-drug treatments before that happens.9
Perhaps you wish to reduce your dosage to the barest minimum possible, while still managing your original symptoms.
Psychosis or other schizophrenia symptoms may have stabilized, and you might feel the drug has done its job, but you want to regain a more natural sense of reward and joy in life. Antipsychotic medications block dopaminergic transmission which dampens those sensations. But remember, the tapering process must be done very very gradually for safety and stability.6
Each individual will have personal reasons to consider whether Rexulti tapering is right for them. In each case, one should always consult with a trusted prescriber or caregiver who can help guide you to the best decision for your health needs and goals.
Notes on Sugar Metabolism and Antipsychotic Medications
Recent research indicates that virtually all antipsychotic medications, including Rexulti, can alter sugar metabolism in the brain and body. As a result, metabolic diseases such as diabetes, hyperglycemia, dyslipidemia (elevated lipids or fats in the blood that can lead to cardiovascular disease), and obesity have been linked to the use of antipsychotics.
Glucose (sugar) is the main energy source for brain function, and its disruption, in turn, is directly associated with the physiology behind disordered brain function. Healthy cell reproduction, maintenance of living brain cells, regulating blood flow in the brain, the production of neurotransmitters and many other vital functions all depend on proper glucose metabolism.14,15
Why is Gradually Stopping Antipsychotics Safer than Quitting Cold Turkey?
Not everything is known about antipsychotic medications. But medical consensus agrees that antipsychotics dampen the distribution of dopamine. Antipsychotics may also affect other types of neurotransmitters such as serotonin, to varying degrees. This is largely considered why they are effective at reducing mania or psychotic symptoms. And these drug responses, especially over long-term use, also explain what occurs when antipsychotics such as Rexulti are reduced or stopped.
For example, in response to taking Rexulti, the number of dopamine receptors built by the body itself will tend to increase. So any dopamine that does get transmitted will have a greatly enhanced effect. This condition is called dopamine supersensitivity or supersensitivity psychosis. Abruptly stopping antipsychotic medication “cold turkey” can produce unmanageable effects including tardive dyskinesia, psychosis, mania, and others.7,8,13
How Long Does it Take to Taper Off Rexulti?
Each person will have a unique health history, and a unique set of treatment needs and preferences. But a fairly reliable gauge for estimating a timeline is to allow some weeks to months or more for each one year of taking antipsychotic medications. Research shows that cuts should decrease very gradually over time, sometimes to 1/40th of the therapeutic dose, allowing for a gradual normalization after the severe dopamine blockage that is linked to antipsychotic medication.
Adequate time must be given for the body to gently re-set without introducing changes that can overwhelm the natural healing process. Rexulti tapering done too fast will typically end up in chaos and relapse due to the returning surge of dopamine that results from too rapid discontinuation.1
Rexulti Tapering Guidelines to Discuss With Your Doctor
Before you begin the Rexulti taper:
Are you sleeping well, eating regularly? If not, seek guidance to improve these points stable before starting a Rexulti taper.
Have you arranged a trusted family member or friend to be your co-pilot? Have you considered a “Ulysses contract” — a voluntary agreement that you sign, so that if things become unmanageable, or an emergency occurs, you have someone to help you, and you agree to be hospitalized if necessary? 10
Have you found a doctor to work with who is familiar with antipsychotic tapering, and who is sympathetic to your goals? Ask questions so this point is well established for your own confidence.
Additional Strategies to discuss:
Nutritional support, including avoiding sugars or refined carbs that can spike blood sugar
Complete avoidance of caffeine in coffee or energy drinks, no marijuana, alcohol, stimulants or other recreational drugs
Calming environment, choose pleasant activities that do not overly stimulate
Aerobic exercises and other physical activities
A system to report changes or concerns in a time-sensitive manner
Help with cutting the pills, or a way to accurately reduce the dosage
How to manage other drugs if you are taking more than just Rexulti
Ask about bridge medications if an impasse is reached
Keeping a daily log may be useful for your doctor to determine when to reduce or hold dosages
Importance of Nutrition During Medication Cessation and Recovery
Nutritional support is effective, and is one of the most fundamental tools in recovery of health after medication use. It shouldn’t be neglected.
Over the course of a day, opt for 4-6 smaller meals consisting of healthy proteins, fats, and plant-based fiber. Start the day with eating a good breakfast. This will provide consistent slow-burning fuel for energy, as well as avoid blood sugar spikes that can occur with sugary high carb or junk foods. It’s all about keeping things even during the Rexulti taper process. A low-carb-based diet has been clinically proven to be helpful during medication withdrawal.11
Adequate fiber from fruits (in moderation) and vegetables will also help where the digestive tract has been compromised. However, best to avoid grapefruit juice as it may interact with some antipsychotic medications to raise blood sugar to dangerous levels, or cause other undesirable effects.
Other nutritional aids during Rexulti tapering can include:
Omega-3 fatty acids (healthy fats such as wild-caught salmon, flaxseed oil, chia seeds, etc.)
Daily portions of yogurt, kimchi, sauerkraut, probiotic supplements to help facilitate gut repair
Get lab testing to see if you have any vitamin or mineral deficiencies. This is important as clinical research shows that some diagnoses of mental illness could have actually been vitamin or mineral deficiencies in the first place.12
Neurotoxin Removal
An important facet of the Alternative to Meds Center treatment plans for Rexulti tapering and improving mental health naturally is the gentle removal of neurotoxicants from the body.
Neurotoxin overload is linked to many undesirable symptoms, and can be overcome in safe and effective removal methods. You can find out more by reviewing more detailed information on the importance of neurotoxin removal and how it is comfortably accomplished.19
Where to Find Help for Rexulti Tapering?
We understand that not everyone is in a position to enroll in inpatient treatment. A good resource to find a physician to help you is IMMH.org which offers listings for both the US and Europe for the type of integrative help you may be looking for. Do not try to taper Rexulti on your own. Get help to assist you.
Find Out More About Inpatient Rexulti Tapering at Alternative to Meds Center
At Alternative to Meds Center, our approach is to carefully design a program that is tailored to the uniqueness of each client. This can involve a vast number of variables which are determined by the person’s medical history, current symptoms, and personal goals. Some main pillars of treatment are supporting the client with diet and correct supplementation, repairing the neurochemistry, and removal of neurotoxic burden so the person can achieve a return to a state of balance. Lab testing is used extensively to guide the process.
The center offers an environment of comfort and calm, so the client can relax and focus on achieving their personal goals in a welcoming and supportive atmosphere. Our medical team include licensed and holistic-minded psychiatrists, therapeutic practitioners, nutritionists, counselors, and caregivers, all of whom are dedicated to you and your health.16-18
Please reach out to us for more detailed information on these protocols and how they may provide effective solutions. We are happy to help you with exploring insurance coverage and other logistics that can make enrollment smooth and stress-free. We look forward to hearing from you.
4. Aucoin M, LaChance L, Cooley K, Kidd S. Diet and Psychosis: A Scoping Review. Neuropsychobiology. 2020;79(1):20-42. doi: 10.1159/000493399. Epub 2018 Oct 25. PMID: 30359969. [cited 2023 Nov 14]
14. Kowalchuk C, Castellani LN, Chintoh A, Remington G, Giacca A, Hahn MK. Antipsychotics and glucose metabolism: how brain and body collide. Am J Physiol Endocrinol Metab. 2019 Jan 1;316(1):E1-E15. doi: 10.1152/ajpendo.00164.2018. Epub 2018 Jul 3. PMID: 29969315. [cited 2023 Nov 14]
19. Cardenas-Iniguez C, Burnor E, Herting MM. Neurotoxicants, the Developing Brain, and Mental Health. Biol Psychiatry Glob Open Sci. 2022 Jul;2(3):223-232. doi: 10.1016/j.bpsgos.2022.05.002. Epub 2022 May 23. PMID: 35911498; PMCID: PMC9337627. [cited 2023 Nov 14]
Originally Published November 14, 2023 by Diane Ridaeus
This content has been reviewed and approved by a licensed physician.
Dr. Samuel Lee
Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.
Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.
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