From the Guidelines
Rexulti (brexpiprazole) should be used with caution in patients with Parkinson's disease due to its potential to worsen parkinsonian symptoms, as it blocks dopamine receptors which can exacerbate the dopamine deficiency that characterizes Parkinson's disease. As an atypical antipsychotic, Rexulti carries a significant risk of causing or worsening movement disorders, including tremors, rigidity, and bradykinesia in Parkinson's patients 1.
Key Considerations
- The risk of extrapyramidal side effects, including drug-induced Parkinsonism, is a concern with antipsychotic medications, and early diagnosis and rapid withdrawal of the offending agent may improve the possibility of complete recovery 1.
- Medications with lower risk of extrapyramidal side effects, such as quetiapine, should be considered first for psychiatric treatment in Parkinson's patients.
- Pimavanserin (Nuplazid) is specifically approved for Parkinson's disease psychosis and does not worsen motor symptoms, making it a preferable option for these patients.
Monitoring and Management
- Any antipsychotic use in Parkinson's patients should involve careful monitoring for worsening motor function.
- The lowest effective dose should be used for the shortest necessary duration.
- The risk-benefit ratio must be carefully evaluated by both neurologists and psychiatrists when considering Rexulti in these patients. Some antipsychotics have a lower risk of QT prolongation, as shown in the table from the study 1, which may be relevant when choosing an antipsychotic for patients with Parkinson's disease. However, the primary concern with Rexulti in Parkinson's patients is its potential to worsen parkinsonian symptoms, rather than QT prolongation.
From the Research
Rexulti and Parkinson's
- There is no direct evidence in the provided studies that links Rexulti (brexpiprazole) to the treatment of Parkinson's disease.
- The studies focus on the efficacy and safety of brexpiprazole in the treatment of schizophrenia and major depressive disorder 2, 3, 4, 5, 6.
- Brexpiprazole is a dopamine D2 receptor partial agonist, which may have implications for its use in patients with Parkinson's disease, but this is not explored in the provided studies.
- The most common adverse events associated with brexpiprazole include akathisia, weight gain, and nausea/vomiting, but extrapyramidal side effects are reported to be lower compared to other antipsychotics 4, 5.
- Further research is needed to determine the potential benefits and risks of using brexpiprazole in patients with Parkinson's disease.