Other Brands/Names

Rexulti.

How It Works

Brexpiprazole is an atypical antipsychotic. It helps balance certain natural brain chemicals by modifying their activity, which can ease symptoms linked to conditions such as schizophrenia and depression when used with an antidepressant.

Indications

Used to manage symptoms of schizophrenia. It is also prescribed together with an antidepressant for major depressive disorder when the antidepressant alone does not adequately control symptoms.

Contraindication

History of hypersensitivity or allergy to brexpiprazole.

Side Effects

• Drowsiness, dizziness, lightheadedness, tremors, increased appetite, weight gain, restlessness, and difficulty remaining still may occur. If these effects persist or get worse, inform your doctor promptly.
• This medicine can cause a significant drop in blood pressure, particularly when starting treatment or after dose increases.
• Seek medical advice right away if you experience serious effects, including trouble swallowing, fainting, or breathing problems during sleep.
• Brexpiprazole may lead to tardive dyskinesia, a movement disorder that can sometimes be permanent. Contact your doctor immediately if you notice unusual or uncontrolled movements of the face, lips, mouth, tongue, arms, or legs.

Types

Film-coated tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg.

Dosage

• Schizophrenia

Adults: Initial 1 mg once daily on days 1–4; may increase to 2 mg once daily on days 5–7, then 4 mg on day 8, adjusted based on response and tolerability. Recommended target dose: 2–4 mg once daily. Maximum dose: 4 mg daily.

• Major Depressive Disorder

Adults (adjunct to antidepressant): Start with 0.5 mg or 1 mg once daily. Increase by weekly steps to a target of 2 mg once daily according to response and tolerance. Maximum dose: 3 mg daily.

Safety

• This medicine can cause dizziness or drowsiness. Do not drive, operate machinery, or perform tasks requiring alertness until you know how it affects you.
• It may also reduce sweating, raising the risk of heat stroke. Avoid overheating from strenuous activity or hot environments, and choose light clothing and adequate fluids. If you overheat, move to a cool place and rest. Get medical help right away for persistent fever, mood or mental changes, headache, or dizziness.
• Studies show that older adults with dementia who use antipsychotics such as brexpiprazole have an increased risk of death during treatment and a higher risk of stroke or transient ischemic attack; the use of this medicine for elderly with dementia requires close supervision from healthcare practitioners.
• During pregnancy, use only if clearly needed. Newborns exposed during the last trimester may show muscle stiffness, tremors, drowsiness, feeding or breathing difficulties, or persistent crying; seek medical attention if these occur, especially in the first month of life.
• It is not known whether this drug passes into breast milk; consult your doctor before breastfeeding.

Drug Interactions

• Brexpiprazole blood levels may rise with moderate to strong CYP3A4 inhibitors (e.g., itraconazole, ritonavir, clarithromycin, ketoconazole) or moderate to strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine, quinidine).
• Blood levels may decrease with strong CYP3A4 inducers (e.g., rifampin).

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