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Brexpiprazole Dosage

Applies to the following strength(s): 0.25 mg ; 0.5 mg ; 1 mg ; 2 mg ; 3 mg ; 4 mg

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Geriatric Dose for:

Additional dosage information:

Usual Adult Dose for Schizophrenia

Initial dose: 1 mg orally once a day on Days 1 through 4
Titration: Based on clinical response and tolerability, titrate to 2 mg once a day on Day 5 through Day 7, then to 4 mg once a day on Day 8
Target Dose: 2 to 4 mg orally once a day
Maximum dose: 4 mg per day

Use: Treatment of schizophrenia.

Usual Adult Dose for Depression

Initial dose: 0.5 mg or 1 mg orally once a day
Titration: Based on clinical response and tolerability, dose increases should be done at weekly intervals; titrate to 1 mg once a day, then up 2 mg once a day.
Target dose: 2 mg orally once a day
Maximum dose: 3 mg per day

Use: Adjunctive treatment of major depressive disorder.

Usual Geriatric Dose for Depression

Dose selection should be cautious, usually starting at the low end of the dosing range.

Usual Geriatric Dose for Schizophrenia

Dose selection should be cautious, usually starting at the low end of the dosing range.

Renal Dose Adjustments

Schizophrenia:
Moderate to Severe Renal Impairment (CrCl less than 60 mL/min): Maximum recommended dose is 3 mg orally once a day

Major Depressive Disorder:
Moderate to Severe Renal Impairment (CrCl less than 60 mL/min): Maximum recommended dose is 2 mg orally once a day

Liver Dose Adjustments

Schizophrenia:
Moderate to Severe Hepatic Impairment (Child-Pugh score 7 or higher): Maximum recommended dose is 3 mg orally once a day

Major Depressive Disorder:
Moderate to Severe Hepatic Impairment (Child-Pugh score 7 or higher): Maximum recommended dose is 2 mg orally once a day

Dose Adjustments

Known CYP450 2D6 Poor Metabolizers: Administer one-half of the usual dose
Known CYP450 2D6 Poor Metabolizers AND Concomitant use of Strong/Moderate CYP450 3A4 Inhibitors: Administer one-quarter of the usual dose

Concomitant use of CYP450 2D6 Inhibitors:
-Schizophrenia: Administer one-half usual dose
-Major Depressive Disorder: No adjustment necessary

Concomitant use of Strong CYP450 3A4 Inhibitors: Administer one-half of the usual dose

Concomitant use of Strong/Moderate CYP450 2D6 Inhibitors AND Strong/Moderate CYP450 3A4 Inhibitors: Administer one-quarter of the usual dose

Concomitant use of Strong CYP450 3A4 Inducers: Double usual dose over 1 to 2 weeks

Precautions

US BOXED WARNINGS: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS and SUICIDAL THOUGHTS AND BEHAVIORS
-Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. This drug is not approved for the treatment of patients with dementia-related psychosis.
-Antidepressants increased the risk of suicidal thoughts and behaviors in patients aged 24 years and younger in short-term studies. Monitor closely for clinical worsening and for the emergence of suicidal thoughts and behaviors. The safety and efficacy of this drug have not been established in pediatric patients.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-May be taken with or without food
-If a dose is missed, take the missed dose as soon as remembered, however, if close to next dose, skip missed dose; do not take 2 doses at the same time.

General:
-Patients should be reassessed periodically to determine continued need for treatment and appropriate dosage for treatment.

Monitoring:
-Cardiovascular: Monitor heart rate and blood pressure.
-Hematologic: CBC frequently during the first few months in patients with preexisting low WBC and/or a prior history of drug-induced leukopenia or neutropenia.
-Metabolic: Monitor for increases in blood sugar, weight, and lipids
-Psychiatric: Monitor for clinical worsening and suicidality.

Patient advice:
-Patients, families, and caregivers should report worsening of depression, suicidal ideation, or any unusual changes in behavior, especially during early antidepressant treatment and when doses are adjusted up or down.
-Patients should be advised to speak with health care providers if they plan to take any new medications including over the counter medications as there are potential drug interactions requiring dose adjustments.
-This drug may impair judgment, thinking, or motor skills; have patient avoid driving or operating machinery until adverse effects are determined.
-Advise patient to speak to physician or health care professional if pregnant, intend to become pregnant, or are breastfeeding.
-Advise patient that this drug may cause metabolic changes such as increases in blood sugar, body weight and lipids.
-Patients should avoid overheating and dehydration.

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