Brexpiprazole

How it works

It acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors and as an antagonist at 5-HT2A receptors, modulating dopaminergic and serotonergic signalling.

Prescribing in practice

• Like all antipsychotics, it should not be used to treat dementia-related psychosis in elderly patients because of an increased risk of stroke and death.
• Akathisia, weight gain and metabolic changes can occur, and impulse-control disorders such as pathological gambling have been reported with dopamine partial agonists.
• Dose adjustment is needed in significant hepatic or renal impairment and with strong CYP3A4 or CYP2D6 inhibitors.

Monitoring

Monitor weight, blood glucose, lipids, mental state and for akathisia and impulse-control problems.

Counselling the patient

• It may take several weeks to work fully; keep taking it as prescribed.
• Report restlessness, unusual urges such as gambling, or significant weight gain.
• Avoid alcohol and tell your prescriber about other medicines you take.

Evidence & guidelines

Efficacy in schizophrenia is supported by randomised controlled trials underpinning its licence.