AdultPediatricGeriatricDosage Forms & Strengths tablet 0.25mg 0.5mg 1mg 2mg 3mg 4mg Schizophrenia Indicated for treatment of schizophrenia Days 1-4: 1 mg PO qDay Day 5-7: Titrate to 2 mg qDay Day 8: Titrate to 4 mg/day based on the patient’s clinical response and tolerability Target dose: 2-4 mg PO qDay; not to exceed 4 mg/day Periodically reassess to determine the continued need and appropriate dose Depression Indicated an adjunctive therapy to antidepressants for major depressive disorder (MDD) 0.5 mg or 1 mg PO qDay initially Titrate according to clinical response and tolerability in weekly intervals to 1 mg/day and then up to 2 mg/day; not to exceed 3 mg/day Periodically reassess to determine the continued need and appropriate dose Agitation Associated With Alzheimer Dementia Indicated for agitation associated with dementia due to Alzheimer disease Days 1-7: 0.5 mg PO qDay Days 8-14: Increase to 1 mg PO qDay Days 15: Increase to 2 mg PO qDay Target dose: 2 mg PO qDay May increase to maximum recommended dosage of 3 mg qDay after at least 14 days, based on clinical response and tolerability Dosage Modifications Renal impairment Moderate, severe, or end-stage renal disease (ESRD) (CrCl <60 mL/min) MDD or agitation associated with Alzheimer dementia: Not to exceed 2 mg/day Schizophrenia: Not to exceed 3 mg/day Hepatic impairment Moderate-to-severe hepatic impairment (Child-Pugh ≥7) MDD or agitation associated with Alzheimer dementia: Not to exceed 2 mg/day Schizophrenia: Not to exceed 3 mg/day CYP2D6 poor metabolizers CYP2D6 poor metabolizers: Administer half of the usual brexpiprazole dose Known CYP2D6 poor metabolizers taking strong/moderate CYP3A4 inhibitors: Administer a quarter of the usual brexpiprazole dose CYP2D6 or CYP3A4 inhibitors Strong CYP2D6 inhibitors: Administer half of the usual brexpiprazole dose (see note below for MDD) Strong CYP3A4 inhibitors: Administer half of the usual brexpiprazole dose Strong/moderate CYP2D6 inhibitors plus strong/moderate CYP3A4 inhibitors: Administer a quarter of the usual brexpiprazole dose If the coadministered drug is discontinued, adjust the brexpiprazole dosage to its original level NOTE: In MDD clinical trials, brexpiprazole dosage was not adjusted for strong CYP2D6 inhibitors (eg, paroxetine, fluoxetine); thus, CYP considerations are already factored into general dosing recommendations and brexpiprazole may be administered without dosage adjustment in patients with MDD CYP3A4 inducers Strong CYP3A4 inducers: Double usual dose over 1 to 2 weeks If the coadministered CYP3A4 inducer is discontinued, reduce the brexpiprazole dosage to the original level over 1-2 weeks Geriatric Dosage & Uses Antipsychotic drugs increase the risk of death in elderly patients with dementia-related psychosis Brexpiprazole is not approved for the treatment of patients with dementia-related psychosis (see Black Box Warnings) Limitations of use: Not indicated as an as needed (PRN) treatment for agitation associated with dementia due to Alzheimer diseaseDosage Forms & Strengths tablet 0.25mg 0.5mg 1mg 2mg 3mg 4mg Schizophrenia Indicated for treatment of schizophrenia in adults and pediatric patients aged ≥13 years <13 years: Safety and efficacy not established 13-17 years Days 1-4: 0.5 mg PO qDay Days 5-7: Titrate to 1 mg PO qDay Day 8: 2 mg PO qDay based on clinical response and tolerability Target dose: 2-4 mg PO qDay; weekly 1-mg dose increments can be made, not to exceed 4 mg/day Periodically reassess to determine continued need and appropriate dose Dosage Modifications Renal impairment Moderate, severe, or end-stage renal disease (ESRD) (CrCl <60 mL/min) MDD: Not to exceed 2 mg/day Schizophrenia: Not to exceed 3 mg/day Hepatic impairment Moderate-to-severe hepatic impairment (Child-Pugh ≥7) H5 MDD: Not to exceed 2 mg/day Schizophrenia: Not to exceed 3 mg/day CYP2D6 poor metabolizers CYP2D6 poor metabolizers: Administer half of the usual brexpiprazole dose CYP2D6 poor metabolizers taking strong/moderate CYP3A4 inhibitors: Administer a quarter of the usual brexpiprazole dose CYP2D6 or CYP3A4 inhibitors Strong CYP2D6 inhibitors: Administer half of the usual brexpiprazole dose Strong CYP3A4 inhibitors: Administer half of the usual brexpiprazole dose Strong/moderate CYP2D6 inhibitors plus strong/moderate CYP3A4 inhibitors: Administer a quarter of the usual brexpiprazole dose If the coadministered drug is discontinued, adjust the brexpiprazole dosage to its original level NOTE: In MDD clinical trials, brexpiprazole dosage was not adjusted for strong CYP2D6 inhibitors (eg, paroxetine, fluoxetine); thus, CYP considerations are already factored into general dosing recommendations and brexpiprazole may be administered without dosage adjustment in patients with MDD CYP3A4 inducers Strong CYP3A4 inducers: Double usual dose over 1-2 weeks If coadministered CYP3A4 inducer is discontinued, reduce brexpiprazole dosage to the original level over 1-2 weeks Antipsychotic drugs increase the risk of death in elderly patients with dementia-related psychosisBrexpiprazole is not approved for the treatment of patients with dementia-related psychosis Interaction CheckerEnter a drug name and brexpiprazoleNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (2)amisulprideamisulpride, brexpiprazole. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndrome.thalidomidebrexpiprazole and thalidomide both increase sedation. Contraindicated.Serious - Use Alternative (35)abametapirabametapir will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.alfentanilbrexpiprazole and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateapalutamideapalutamide will decrease the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.benzhydrocodone/acetaminophenbenzhydrocodone/acetaminophen and brexpiprazole both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphinebrexpiprazole and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine buccalbrexpiprazole and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine subdermal implantbrexpiprazole and buprenorphine subdermal implant both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine subdermal implant and brexpiprazole both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine transdermalbrexpiprazole and buprenorphine transdermal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine, long-acting injectionbrexpiprazole and buprenorphine, long-acting injection both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebutalbitalbrexpiprazole and butalbital both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatechloramphenicolchloramphenicol will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.dacomitinibdacomitinib will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities. fentanylbrexpiprazole and fentanyl both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatefentanyl intranasalbrexpiprazole and fentanyl intranasal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatefentanyl iontophoretic transdermal systembrexpiprazole and fentanyl iontophoretic transdermal system both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatefentanyl transdermalbrexpiprazole and fentanyl transdermal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatefentanyl transmucosalbrexpiprazole and fentanyl transmucosal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatefexinidazolefexinidazole will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.givosirangivosiran will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.hydrocodonebrexpiprazole and hydrocodone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatehydromorphonebrexpiprazole and hydromorphone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateivosidenibivosidenib will decrease the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.lonafarniblonafarnib will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.methadonebrexpiprazole and methadone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatemetoclopramide intranasalbrexpiprazole, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.morphinebrexpiprazole and morphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatenelfinavirnelfinavir will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Administer half of the usual brexpiprazole dose when coadministered with strong CYP3A4 inhibitors. If also administered with a strong/moderate CYP2D6 inhibitor, administer a quarter of brexpiprazole dose.olopatadine intranasalbrexpiprazole and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. oxycodonebrexpiprazole and oxycodone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateoxymorphonebrexpiprazole and oxymorphone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateremifentanilbrexpiprazole and remifentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatesecobarbitalsecobarbital will decrease the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.selinexorselinexor, brexpiprazole. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.tucatinibtucatinib will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.voxelotorvoxelotor will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.Monitor Closely (271)acetaminophen/phenyltoloxaminebrexpiprazole and acetaminophen/phenyltoloxamine both increase sedation. Use Caution/Monitor.acrivastineacrivastine and brexpiprazole both increase sedation. Use Caution/Monitor.alprazolambrexpiprazole and alprazolam both increase sedation. Use Caution/Monitor.amifostineamifostine, brexpiprazole. Either increases effects of the other by anti-hypertensive channel blocking. Use Caution/Monitor. Monitor blood pressure and adjust dose accordingly.amiodaroneamiodarone will increase the level or effect of brexpiprazole by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP2D6 inhibitor PLUS a strong/moderate CYP3A4 inhibitor. amiodarone will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP3A4 inhibitor PLUS a strong/moderate CYP2D6 inhibitor.amisulprideamisulpride and brexpiprazole both increase sedation. Use Caution/Monitor.amitriptylinebrexpiprazole and amitriptyline both increase sedation. Use Caution/Monitor.amobarbitalamobarbital will decrease the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.brexpiprazole and amobarbital both increase sedation. Use Caution/Monitor.amoxapinebrexpiprazole and amoxapine both increase sedation. Use Caution/Monitor.aprepitantaprepitant will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP3A4 inhibitor