What is the comparison between Brexpiprazole (Rexulti) and Quetiapine (Seroquel)?

From the Guidelines

Rexulti (brexpiprazole) is generally considered a better option than Seroquel (quetiapine) due to its more favorable side effect profile, particularly with regards to weight gain and metabolic changes, as suggested by studies such as 1. When comparing Brexpiprazole (Rexulti) and Quetiapine (Seroquel), it's essential to consider their differences in terms of efficacy, side effects, and indications.

• Rexulti is primarily used for major depressive disorder as an add-on treatment and for schizophrenia, while Seroquel treats schizophrenia, bipolar disorder, and sometimes depression or insomnia.
• These medications work differently: Rexulti is a partial dopamine agonist that modulates dopamine and serotonin systems, while Seroquel blocks multiple neurotransmitter receptors including dopamine, serotonin, and histamine.
• Taking both simultaneously could increase the risk of side effects like sedation, weight gain, metabolic changes, and movement disorders, as noted in studies such as 1 and 1. Some key points to consider when choosing between these medications include:
• The potential for weight gain and metabolic changes, with Quetiapine being more likely to cause these side effects, as mentioned in 1.
• The risk of sedation and movement disorders, which may be higher with Quetiapine, as suggested by 1 and 1.
• The specific indication being treated, as Rexulti may be more suitable for major depressive disorder and schizophrenia, while Quetiapine may be more suitable for bipolar disorder. If you're considering these medications, it's crucial to consult your healthcare provider who can determine the appropriate option based on your specific condition, medical history, and other medications you may be taking, as emphasized by 1 and 1. Never adjust your psychiatric medication regimen without professional guidance, as proper dosing and monitoring are essential for safety and effectiveness.

From the Research

Comparison of Brexpiprazole (Rexulti) and Quetiapine (Seroquel)

There are no direct comparisons between Brexpiprazole (Rexulti) and Quetiapine (Seroquel) in the provided studies. However, the following information is available about Brexpiprazole:

• Brexpiprazole is an antipsychotic medication that acts as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors, and as an antagonist at serotonin 5-HT2A and at adrenergic alpha1B and alpha2C receptors 2.
• The recommended dose range of brexpiprazole for the treatment of schizophrenia is 2-4 mg/day, and for major depressive disorder, it is 2 mg/day 3, 4.
• Brexpiprazole has been shown to be effective in treating psychosis and preventing relapse in patients with schizophrenia, and as an adjunct to antidepressants in treating major depressive disorder in individuals inadequately responsive to antidepressant treatment alone 2, 3, 4, 5.
• Common adverse effects of brexpiprazole include akathisia, gastrointestinal side effects, and moderate weight gain 2, 3, 4, 5.

Efficacy and Safety of Brexpiprazole

• Brexpiprazole has been shown to be effective in treating schizophrenia and major depressive disorder, with a number needed to treat (NNT) of 7 for schizophrenia and 12 for major depressive disorder 3.
• The most commonly encountered adverse event is increased weight, with a number needed to harm (NNH) of 17 for schizophrenia and 53 for major depressive disorder 3.
• Brexpiprazole has a relatively fair tolerability profile, with discontinuation rates due to adverse events being lower than those for placebo in some studies 3, 4.

Potential Place in Therapy

• Brexpiprazole appears to be a viable option for treating acute exacerbations of schizophrenia and adjunctive treatment of major depressive disorder in patients who have shown an inadequate response to antidepressants 5.
• Further clinical trials are needed to determine the long-term efficacy of brexpiprazole and to establish its place in therapy compared to other antipsychotic agents 4, 5.