Brexpa

Brexi is an atypical antipsychotic indicated for:
Use as an adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD)
Treatment of schizophrenia.

Adjunctive Treatment of Major Depressive Disorder
: The recommended starting dosage for Brexpiprazole as adjunctive treatment is 0.5 mg or 1 mg once daily, taken orally with or without food. Titrate to 1 mg once daily, then up to the target dosage of 2 mg once daily. Dosage increases should occur at weekly intervals based on the patient's clinical response and tolerability. The maximum recommended daily dosage is 3 mg. Periodically reassess to determine the continued need and appropriate dosage for treatment.
Treatment of Schizophrenia
: The recommended starting dosage for Brexpiprazole is 1 mg once daily on Days 1 to 4, taken orally with or without food. The recommended target Brexpiprazole dosage is 2 mg to 4 mg once daily. Titrate to 2 mg once daily on Day 5 through Day 7, then to 4 mg on Day 8 based on the patient’s clinical response and tolerability. The maximum recommended daily dosage is 4 mg.

Extrapyramidal Symptoms
Akathisia
Suicidality
QT prolongation
Weight gain
Neuroleptic malignant syndrome
Nausea

Cerebrovascular Adverse Reactions in Elderly Patients with Dementia-
Related Psychosis: Increased incidence of cerebrovascular adverse reactions (e.g. stroke, transient ischemic attack)
Neuroleptic Malignant Syndrome: Manage with immediate discontinuation and close monitoring
Tardive Dyskinesia: Discontinue if clinically appropriate
Metabolic Changes: Monitor for hyperglycemia/diabetes mellitus, dyslipidemia and weight gain
Pathological Gambling and Other Compulsive Behaviors: Consider dose reduction or discontinuation
Leukopenia, Neutropenia, and Agranulocytosis: Perform complete blood counts (CBC) in patients with pre-existing low white blood cell count (WBC) or history of leukopenia or neutropenia. Consider discontinuing Brexi if a clinically significant decline in WBC occurs in absence of other causative factors
Orthostatic Hypotension and Syncope: Monitor heart rate and blood pressure and warn patients with known cardiovascular or cerebrovascular disease, and risk of dehydration or syncope
Seizures: Use cautiously in patients with a history of seizures or with conditions that lower the seizure threshold

Brexpiprazole is an atypical antipsychotic agent. The pharmacology of Brexpiprazole is believed to be mediated by a modulatory activity at the serotonin and dopamine systems that combines partial agonist activity at serotonergic 5-HT
1A
and at dopaminergic D
2
receptors with antagonist activity at serotonergic 5-HT
2A
receptors. It shows similar high affinities at all of these receptors. Brexpiprazole also shows antagonist activity at noradrenergic a
1B/2c
receptors.