NYMC Faculty Publications

Brexpiprazole in the Management of Schizophrenia: A Consensus Report of Best Practices From Acute to Maintenance Treatment

Author Type(s)

Faculty

DOI

10.2147/NDT.S539306

Journal Title

Neuropsychiatric Disease and Treatment

First Page

1857

Last Page

1883

Document Type

Article

Publication Date

1-1-2025

Department

Psychiatry and Behavioral Sciences

Keywords

brexpiprazole, dopamine partial agonist, efficacy, schizophrenia, tolerability

Disciplines

Medicine and Health Sciences

Abstract

Brexpiprazole is a second-generation antipsychotic with multiple indications, including the treatment of schizophrenia. As a partial dopamine agonist, brexpiprazole differs from most other antipsychotics, yet uncertainties about its full mechanism of action have led to some ambiguity among prescribers. To address this gap, an international panel of psychiatric experts was organized and convened with funding from Otsuka Pharmaceutical Europe Ltd and H. Lundbeck A/S to discuss the safe and effective use of brexpiprazole across different stages of schizophrenia treatment. Brexpiprazole’s pharmacological profile—characterized by balanced binding affinities across norepinephrine, dopamine, and serotonin receptors—contributes to its efficacy in multiple symptom domains, including agitation and negative symptoms. Its tolerable safety profile, marked by minimal activation and minimal sedation and a relatively low risk of long-term cardiometabolic concerns, further supports its clinical utility. Brexpiprazole is a viable first-line therapy in both inpatient and outpatient settings when properly titrated and monitored. Brexpiprazole also serves as an option for different symptom domains in schizophrenia and for patients needing to switch antipsychotics due to inadequate symptom control or intolerable adverse events. Long-term maintenance therapy is essential for relapse prevention in schizophrenia, and when prescribed at appropriate doses for psychotic symptom control, brexpiprazole can provide sustained benefits with minimal long-term safety concerns. This report outlines the consensus panel’s recommendations on the optimal initiation and administration of brexpiprazole in management of schizophrenia treatment, including a treatment algorithm, which is supported by a literature review.

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