Indications
Brexpiprazole is an atypical (second-generation) antipsychotic medicine. It is used to treat schizophrenia in adults (and in some countries in teenagers), as an add-on treatment with an antidepressant for major depression in adults when the antidepressant alone has not worked well enough, and in some countries for agitation linked to dementia due to Alzheimer’s disease.
How It Works
Brexpiprazole partly activates dopamine D2 and serotonin 5-HT1A receptors and blocks serotonin 5-HT2A receptors in the brain. This helps rebalance these chemical messengers, which can reduce hallucinations, delusions and disorganised thinking and improve mood.
Dosage and Administration
Take exactly as prescribed. The doctor starts with a low dose and increases it gradually over 1 to 2 weeks to the right amount for you. It is taken once a day, with or without food. Lower doses may be needed in liver or kidney disease or with certain other medicines. Do not stop it suddenly without talking to your doctor. It may take a few weeks to see the full benefit.
Interactions
- Strong CYP2D6 inhibitors (such as Fluoxetine, Paroxetine, Quinidine) and CYP3A4 inhibitors (such as Ketoconazole, Clarithromycin, Itraconazole): raise brexpiprazole levels; the dose usually needs reducing.
- CYP3A4 inducers (such as Rifampicin, Carbamazepine, Phenytoin): lower brexpiprazole levels.
- Alcohol, sedatives and opioids: more drowsiness.
- Medicines for high blood pressure: greater fall in blood pressure on standing.
Contraindications
Do not take if you are allergic to brexpiprazole or any ingredient.
Side Effects
- Weight gain and increased appetite.
- Restlessness or an urge to keep moving (akathisia).
- Drowsiness, headache, dizziness, tiredness.
- Tremor or other movement problems.
- Raised blood sugar and cholesterol.
- Uncontrollable urges such as gambling, binge eating or shopping (rare).
Get urgent medical help for high fever with stiff muscles, confusion and sweating (neuroleptic malignant syndrome), uncontrolled movements of the face, tongue or body, thoughts of suicide or self-harm, fainting, seizures, signs of high blood sugar (extreme thirst, passing a lot of urine), signs of infection with a low white blood cell count, or a severe allergic reaction.
Pregnancy and Lactation
Use in pregnancy only if the doctor decides the benefit outweighs the risk. Newborns exposed in the last 3 months of pregnancy may have movement or withdrawal symptoms such as agitation, stiffness, tremor, sleepiness or feeding problems. Do not stop treatment on your own if you become pregnant; talk to your doctor. Breastfeeding is generally not recommended; ask your doctor.
Precautions and Warnings
Elderly people with dementia-related psychosis treated with antipsychotics have a higher risk of death and stroke. Children, teenagers and young adults taking antidepressant treatment may have more suicidal thoughts, so close monitoring is needed. Your doctor may check weight, blood sugar, cholesterol and blood counts. Use with care if you have heart disease, low blood pressure, seizures, diabetes or swallowing difficulties. Avoid overheating and dehydration. It may affect judgement and reactions; take care when driving.
Overdose
Overdose may cause severe sleepiness, low blood pressure, fast heartbeat, movement problems and seizures. Seek emergency medical help.
Therapeutic Class
Atypical antipsychotic (serotonin-dopamine activity modulator).
Storage
Store below 30°C in a dry place, away from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.