An antipsychotic for schizophrenia and add-on in depression
Brexpiprazole
A newer antipsychotic used for schizophrenia and as an add-on in depression that has not responded enough.
What is Brexpiprazole?
Brexpiprazole is a second-generation (atypical) antipsychotic used to treat schizophrenia and, in some settings, added to an antidepressant when depression has not responded well enough on its own. It works by adjusting the activity of brain chemicals, mainly dopamine and serotonin. A serious class warning applies: when antipsychotics are used in elderly people with dementia-related psychosis, there is an increased risk of death, so it is not licensed for that use. Other effects to be aware of include weight gain and other metabolic changes, restlessness (akathisia), and, rarely, compulsive behaviours such as gambling. It is taken by mouth, usually started low and built up, under specialist guidance.
Education and reference only. This is a plain-language guide to Brexpiprazole — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Brexpiprazole is a newer, second-generation antipsychotic. It is used to treat schizophrenia, a serious mental-health condition affecting thoughts and perception, and in some settings it is added to an antidepressant when depression has not improved enough on the antidepressant alone. It is taken by mouth as a tablet, usually started at a low amount and gradually increased. Like other antipsychotics, it is prescribed and reviewed by, or with the advice of, a specialist mental-health team, who weigh its benefits against its possible effects.
How it works
Brexpiprazole acts on chemical messengers in the brain, mainly dopamine and serotonin. Rather than simply blocking dopamine, it has a balancing (partial) effect at some dopamine receptors, which can help symptoms while aiming to reduce some movement side effects. By adjusting these signals, it can ease the symptoms of schizophrenia, such as hearing voices and disordered thinking, and can boost the effect of an antidepressant in depression. Because it changes brain-chemical activity, it is usually started low and built up slowly, and it can also bring metabolic effects such as weight gain and restlessness.
Company & origin
Originated / developed by: Specialist manufacturer.
A newer antipsychotic used for schizophrenia and, in some settings, added to an antidepressant when depression has not responded well enough.
What it treats
Conditions Brexpiprazole is used for
Practical use
How to take Brexpiprazole
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it by mouth once a day as prescribed, usually starting low and building up gradually.
- Do not stop it suddenly; speak to your team first, as stopping abruptly can cause problems.
- Tell your team about restlessness or an inability to sit still, as this can be a side effect that needs addressing.
- Report any new compulsive urges, such as gambling, binge eating or unusual sexual urges, which can rarely occur.
- Attend appointments for weight, blood sugar and cholesterol checks while taking it.
Weighing it up
Advantages & disadvantages of Brexpiprazole
Advantages
- Can ease the symptoms of schizophrenia, such as hearing voices and disordered thinking.
- Can boost the effect of an antidepressant when depression has not responded enough.
- Taken once a day by mouth, with the aim of fewer movement side effects than some older antipsychotics.
Disadvantages
- Carries the antipsychotic class warning of increased risk of death in elderly people with dementia.
- Can cause weight gain and other metabolic changes, and restlessness (akathisia).
- Rarely linked with compulsive behaviours such as gambling or binge eating.
Practical use
Good to know
The most important safety point with brexpiprazole, as with all antipsychotics, is the class warning about elderly people with dementia: when antipsychotics are used to treat psychosis in people with dementia, there is an increased risk of death, so brexpiprazole is not licensed for that purpose. Beyond this, several effects are worth knowing about. It can cause weight gain and other metabolic changes, such as effects on blood sugar and cholesterol, so weight and blood tests are usually monitored. It can cause akathisia, a distressing feeling of restlessness and inability to keep still, which should be reported. Rarely, antipsychotics of this type have been linked with compulsive behaviours such as gambling, binge eating or hypersexuality, which can start without the person realising the link. It is usually started low and increased slowly, and should not be stopped suddenly without advice.
Who should not take it / use with caution
- People who have had a serious allergic reaction to brexpiprazole should not take it.
- It is not licensed to treat psychosis in elderly people with dementia, where antipsychotics increase the risk of death.
- It is used with caution in people with heart problems, diabetes or risk factors for diabetes, or a history of movement disorders, under specialist guidance.
Monitoring
- Reviewing mental-health symptoms and how well the medicine is working.
- Checking weight, blood sugar and cholesterol over time.
- Watching for restlessness, movement problems and any new compulsive behaviours.
Side effects
- Weight gain and other metabolic changes, such as effects on blood sugar and cholesterol.
- Restlessness and an inability to sit still (akathisia).
- Drowsiness, dizziness or headache.
- Rarely, compulsive behaviours such as gambling, binge eating or hypersexuality, which should be reported.
Key interactions
- Some medicines change how brexpiprazole is broken down, so the amount may need adjusting; give your full medicines list.
- Alcohol and other medicines that cause drowsiness can add to its sedating effect.
- Medicines that affect the heart's rhythm should be reviewed alongside it.
Available as: Tablets taken by mouth.
Answers
Brexpiprazole: frequently asked questions
What is brexpiprazole used for?
It is used to treat schizophrenia and, in some settings, added to an antidepressant when depression has not responded well enough on its own.
Is it safe in elderly people with dementia?
No. Like other antipsychotics, it carries a class warning of increased risk of death when used for psychosis in people with dementia, and it is not licensed for that use.
Will it cause weight gain?
It can cause weight gain and other metabolic changes, so your team will usually monitor your weight, blood sugar and cholesterol.
What is akathisia?
Akathisia is a distressing feeling of restlessness and an inability to keep still that can occur with this medicine; tell your team if you notice it.
Can it cause gambling or other urges?
Rarely, this type of medicine has been linked with compulsive behaviours such as gambling or binge eating, so report any new urges to your team.
The wider class
About Second-generation (atypical) antipsychotic
Brexpiprazole belongs to the second-generation (atypical) antipsychotic class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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