- Schizophrenia Slideshow Pictures
- Take the Schizophrenia Quiz
- Physical Symptoms of Depression Slideshow
- What is brexpiprazole, and how does it work (mechanism of action)?
- What are the side effects of brexpiprazole?
- What is the dosage for brexpiprazole?
- Which drugs or supplements interact with brexpiprazole?
- Is brexpiprazole safe to take if I'm pregnant or breastfeeding?
- What else should I know about brexpiprazole?
What is brexpiprazole, and how does it work (mechanism of action)?
Brexpiprazole is an oral atypical antipsychotic used to treat schizophrenia. Other atypical antipsychotic drugs include olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify).
Atypical antipsychotics differ from typical antipsychotics because they cause a lesser degree of movement (extrapyramidal) side effects and constipation.
The exact mechanism of action of brexpiprazole is not known, but, like other anti-psychotics, it is believed that brexpiprazole affects the way the brain works by interfering with communication among the brain's nerves. Nerves communicate with each other by making and releasing chemicals called neurotransmitters. The neurotransmitters travel to other nearby nerves where they attach to receptors on the nerves. The attachment of the neurotransmitters either stimulates or inhibits the function of the nearby nerves. Brexpiprazole blocks several of the receptors on nerves including dopamine type 2, serotonin type 2, and alpha 2 adrenergic receptors. It is believed that many psychotic illnesses are caused by abnormal communication among nerves in the brain and that by altering communication through neurotransmitters, brexpiprazole can alter the psychotic state. The FDA approved Rexulti in December, 2006.
What brand names are available for brexpiprazole?
Is brexpiprazole available as a generic drug?
Do I need a prescription for brexpiprazole?
What are the side effects of brexpiprazole?
The most common side effects include
- weight gain,
- upper respiratory tract infection,
- feeling restless or difficulty sitting still (akathisia), and
Brexpiprazole may increase blood levels of prolactin.
Less common but serious side effects include:
- Increased risk of stroke and death in elderly patients with dementia-related psychosis.
- Neuroleptic malignant syndrome (NMS). NMS is a rare but serious side effect associated with the use of antipsychotics. NMS may result in death and must be treated in the hospital. Signs and symptoms of NMS may include
Extrapyramidal side effects (EPS) including:
- Dystonia: painful spasms of the oral, throat, or neck muscles that may cause problems with speech, swallowing, and stiff neck.
- Pseudoparkinsonism: drug induced Parkinson's symptoms.
- Tardive dyskinesia (TD). Tardive dyskinesia usually occurs after long-term use of antipsychotics and usually presents with abnormal uncontrollable movement problems affecting the tongue, lips, jaw, face, and extremities.
- Metabolic changes including high blood sugar (hyperglycemia), diabetes, increase in blood cholesterol, and weight gain.
- High blood levels of prolactin. Prolactin is a hormone that allows the production of breast milk. High levels of prolactin may cause menstrual abnormalities, leakage of milk from the breast, development of breasts in males (gynecomastia), and erection problems in men.
- Brexpiprazole may increase risk of seizures.
What is the dosage for brexpiprazole?
- Brexpiprazole is administered once daily by mouth with or without food.
- The starting dose for schizophrenia is 1 mg once daily on days 1 to 4. Increase to 2 mg a day on day 5 through Day 7, then to 4 mg on Day 8 based on patient response.
- The maximum dose is 4 mg daily.
- The starting dose for treating depression is 0.5 mg or 1 mg once daily. The dose may be increased in weekly intervals up to a maximum dose of 3 mg daily.
Which drugs or supplements interact with brexpiprazole?
Brexpiprazole can cause low blood pressure especially when standing up from a sitting down or laying down position (orthostatic hypotension). Therefore, brexpiprazole should be used cautiously with other drugs also associated with causing orthostatic hypotension.
Brexpiprazole is metabolized or broken down by liver enzymes. Drugs that induce these enzymes will increase their activity and consequently decrease blood levels of brexpiprazole. The dose of brexpiprazole should be increased in people also taking carbamazepine (Tegretol), rifampin (Rifadin), St. John's Wort, and other drugs that may decrease its blood levels.
Drugs that block the action of enzymes that breakdown brexpiprazole will increase blood levels and side effects of brexpiprazole. The dose of brexpiprazole should be reduced in people who are also taking itraconazole (Sporanox), clarithromycin (Biaxin), ketoconazole, paroxetine (Paxil), fluoxetine (Prozac), quinidine, and other drugs that may increase its blood levels. The dose of brexpiprazole also should be reduced in people whose liver enzymes are less active than the general population.
Latest Mental Health News
Daily Health News
Is brexpiprazole safe to take if I'm pregnant or breastfeeding?
Unborn babies exposed to antipsychotics during the third trimester of pregnancy are at risk for extrapyramidal and withdrawal symptoms after birth. Symptoms reported included agitation, hypertonia, hypotonia, tremor, somnolence, depressed breathing, and feeding disorder. Currently there is no data on the use of brexpiprazole during pregnancy. Brexpiprazole should only be used during pregnancy if the potential benefit to the mother outweighs the potential for side effects in the unborn baby.
A pregnancy exposure registry has been established to monitor the use of atypical antipsychotics, including brexpiprazole, during pregnancy. All pregnant women treated with atypical antipsychotics are advised to enroll in this pregnancy registry and report any side effects.
Brexpiprazole is known to enter human milk but its effects on the breastfeeding infant or milk production is not yet known.
What else should I know about brexpiprazole?
What preparations of brexpiprazole are available?
Tablets: 0.25, 0.5, 1, 2, 3, and 4 mg
How should I keep brexpiprazole stored?
Brexpiprazole should be stored at room temperature, between 15 C and 30 C (59 F and 86 F).
Multimedia: Slideshows, Images & Quizzes
What's Schizophrenia? Symptoms, Types, Causes, Treatment
What is the definition of schizophrenia? What is paranoid schizophrenia? Read about schizophrenia types and learn about...
What Is Bipolar Disorder? Symptoms, Manic Episodes, Testing
Bipolar disorder (formerly "manic depression") causes extreme mood shifts and manic episodes. Learn about bipolar 1, bipolar 2,...
Schizophrenia Quiz: What is Schizophrenia?
Schizophrenia is a complex psychiatric disorder. Learn more about the challenges of mental illness with the Schizophrenia Quiz.
Related Disease Conditions
Mental Illness in Children
About 5 million children and adolescents in the U.S. suffer from a serious mental illness such as eating disorders, anxiety disorders, disruptive behavior disorders, pervasive development disorders, elimination disorders, learning disorders, schizophrenia, tic disorders, and mood disorders. Symptoms of mental illness include frequent outbursts of anger, hyperactivity, fear of gaining weight, excessive worrying, frequent temper tantrums, and hearing voices that aren't there. Treatment may involve medication, psychotherapy, and creative therapies.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Schizophrenia is a disabling brain disorder that may cause hallucinations and delusions and affect a person's ability to communicate and pay attention. Symptoms of psychosis appear in men in their late teens and early 20s and in women in their mid-20s to early 30s. With treatment involving the use of antipsychotic medications and psychosocial treatment, schizophrenia patients can lead rewarding and meaningful lives.
Bipolar Disorder vs. Schizophrenia
Bipolar disorder and schizophrenia are mental illnesses that share some risk factors and treatments. Symptoms of bipolar disorder include mood changes and manic and depressive episodes. Symptoms of schizophrenia include unusual behavior, delusions, and hallucinations.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood-stabilizer medications, antidepressants, and psychotherapy.
What Is Schizotypal Personality Disorder?
Schizotypal personality disorder is characterized by odd behaviors, feelings, perceptions, and ways of relating to others that interfere with one's ability to function. Medication and psychotherapy can help the sufferer to manage their symptoms.
Brief Psychotic Disorder
Brief psychotic disorder is a short-term mental illness that features psychotic symptoms. There are three forms of brief psychotic disorder. The first occurs shortly after a major stress, the second has no apparent trauma that triggers the illness, and the third is associated with postpartum onset. Symptoms include hallucinations, delusions, unusual behavior, disorientation, changes in eating and sleeping, and speech that doesn't make sense. Treatment typically involves medication and psychotherapy.
Schizoaffective disorder is a mental illness that features schizophrenia and a mood disorder, either major depression or bipolar disorder. Symptoms include agitation, suicidal thoughts, little need for sleep, delusions, hallucinations, and poor motivation. Treatment may involve psychotherapy, medication, skills training, or hospitalization.
Mental health is an optimal way of thinking, relating to others, and feeling. All of the diagnosable mental disorders fall under the umbrella of mental illness. Depression, anxiety, and substance-abuse disorders are common types of mental illness. Symptoms and signs of mental illness include irritability, moodiness, insomnia, headaches, and sadness. Treatment may involve psychotherapy and medication.
Psychotic disorders are a group of serious illnesses that affect the mind. Different types of psychotic disorders include schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, shared psychotic disorder, delusional disorder, substance-induced psychotic disorder, paraphrenia, and psychotic disorders due to medical conditions.
Mental illness is any disease or condition affecting the brain that influence the way a person thinks, feels, behaves, and/or relates to others. Mental illness is caused by heredity, biology, psychological trauma and environmental stressors.
Depression in the Elderly
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants, psychotherapy, or electroconvulsive therapy.
Treatment & Diagnosis
Medications & Supplements
Subscribe to MedicineNet's General Health Newsletter
Health Solutions From Our Sponsors
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
FDA Prescribing Information