Brexpiprazole

What is brexpiprazole?

Second generation antipsychotics (sometimes referred to as ‘atypical’ antipsychotics) such as brexpiprazole are a newer class of antipsychotic medication than first generation ‘typical’ antipsychotics. Second generation antipsychotics are effective for the positive symptoms of schizophrenia. It is sometimes claimed that they are more effective than first generation antipsychotics in treating the negative symptoms of schizophrenia. Negative symptoms include a lack of ordinary mental activities such as emotional expression, social engagement, thinking and motivation, whereas positive symptoms include the experiences of perceptual abnormalities (hallucinations) and fixed, false, irrational beliefs (delusions). Second generation antipsychotics may also cause less extrapyramidal side effects. These include dyskinesias such as repetitive, involuntary, and purposeless body or facial movements, Parkinsonism (cogwheel muscle rigidity, pill-rolling tremor and reduced or slowed movements), akathisia (motor restlessness, especially in the legs, and resembling agitation) and dystonias such as muscle contractions causing unusual twisting of parts of the body, most often in the neck. These effects are caused by the dopamine receptor antagonist action of these drugs.

What is the evidence for brexpiprazole?

Moderate to high quality evidence suggests brexpiprazole is more effective for symptoms than placebo, with no differences between 2mg/day and 4mg/day dose. However, there was a higher risk of weight gain with brexpiprazole, and 4mg/day resulted in more extrapyramidal symptoms than 2mg/day.

November 2019

Last updated at: 12:08 am, 21st November 2019
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