Home Drug Guide Brexpiprazole

Drug Guide

Generic Name

Brexpiprazole

Brand Names Rexulti

Classification

Therapeutic: Antipsychotic

Pharmacological: Serotonin-Dopamine Activity Modulator

FDA Approved Indications

  • Schizophrenia in adults
  • Major depressive disorder (adjunctive treatment)

Mechanism of Action

Brexpiprazole is a partial agonist at serotonin 5-HT1A and dopamine D2 receptors and an antagonist at serotonin 5-HT2A receptors. Its activity modulates neurotransmission, which helps in alleviating symptoms of schizophrenia and depression.

Dosage and Administration

Adult: For schizophrenia: 1 mg once daily, may be increased to 2-4 mg/day based on response. For adjunctive treatment of depression: 0.5-1 mg/day, may titrate up to 3 mg/day.

Pediatric: Not indicated for pediatric use.

Geriatric: Starting dose typically lower (e.g., 0.5 mg), with careful titration.

Renal Impairment: Use with caution; no specific dose adjustment established.

Hepatic Impairment: Use with caution; lower initial doses recommended.

Pharmacokinetics

Absorption: Well-absorbed orally with approximately 95% bioavailability.

Distribution: Highly protein-bound (~99%).

Metabolism: Extensively metabolized in the liver primarily via CYP3A4 and CYP2D6 enzymes.

Excretion: Eliminated mainly via feces (~73%) and urine (~23%).

Half Life: Approximately 91 hours (range 75-112 hours).

Contraindications

  • Hypersensitivity to brexpiprazole or any component of the formulation.

Precautions

  • Risk of metabolic syndrome, including weight gain, hyperglycemia, and lipid abnormalities.
  • Potential for increased mortality in elderly patients with dementia-related psychosis.
  • Monitor for suicidal thoughts or behaviors, especially in early treatment.

Adverse Reactions - Common

  • Akathisia (Common)
  • Headache (Common)
  • Somnolence (Common)
  • Extrapyramidal symptoms (Common)

Adverse Reactions - Serious

  • Suicidal thoughts and behaviors (Serious)
  • Neuroleptic malignant syndrome (Rare)
  • Orthostatic hypotension (Rare)
  • Hyperglycemia/diabetes (Serious)

Drug-Drug Interactions

  • CYP3A4 inhibitors or inducers (affect brexpiprazole levels)
  • Other CNS depressants (risk of sedation)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for improvements in psychotic symptoms, monitor metabolic parameters, assess for side effects.

Diagnoses:

  • Risk for weight gain related to metabolic side effects
  • Risk for extrapyramidal symptoms
  • Risk for falls due to orthostatic hypotension

Implementation: Administer once daily, preferably at the same time each day. Monitor metabolic parameters regularly.

Evaluation: Assess symptom control, weight, glucose levels, lipid profile, and side effects periodically.

Patient/Family Teaching

  • Take medication exactly as prescribed and do not discontinue abruptly.
  • Report any signs of side effects such as uncontrollable movements, fever, or unusual thoughts.
  • Maintain a healthy diet and exercise routine to help manage weight and metabolic side effects.
  • Avoid alcohol and CNS depressants unless approved by healthcare provider.

Special Considerations

Black Box Warnings:

  • Increased mortality in elderly patients with dementia-related psychosis.

Genetic Factors: Consider pharmacogenetic testing for CYP2D6 or CYP3A4 enzyme variants if inconsistency in response or side effects.

Lab Test Interference: May alter blood glucose, lipid levels, and weight.

Overdose Management

Signs/Symptoms: Drowsiness, sedation, agitation, tachycardia, hypotension, seizures.

Treatment: Supportive care, gastric lavage, activated charcoal. No specific antidote available.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F), away from moisture and light.

Stability: Stable for at least 24 months when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.