From the FDA Drug Label
The incidence of reported extrapyramidal symptoms (EPS)-related adverse reactions, excluding akathisia, was 6% for brexpiprazole plus ADT-treated patients versus 3% for placebo plus ADT-treated patients The incidence of akathisia events for brexpiprazole plus ADT-treated patients was 9% versus 2% for placebo plus ADT-treated patients. The incidence of reported EPS-related adverse reactions, excluding akathisia, was 5% for brexpiprazole-treated patients versus 4% for placebo-treated patients. The incidence of akathisia events for brexpiprazole-treated patients was 6% versus 5% for placebo-treated patients Dystonic symptoms include spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue
The extrapyramidal symptoms (EPS) associated with brexpiprazole (Rexulti) include:
- Akathisia
- Dystonia (characterized by spasm of the neck muscles, tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue) Other EPS-related adverse reactions (excluding akathisia) may also occur, with an incidence of 6% in adjunctive MDD studies and 5% in schizophrenia studies 1.
From the Research
Brexpiprazole is associated with a low risk of extrapyramidal symptoms (EPS), with a significant decrease in EPS observed in patients switched to brexpiprazole from other antipsychotics, as demonstrated by a decrease in the Drug-Induced Extrapyramidal Symptoms Scale total score 2. The risk of EPS with brexpiprazole is dose-dependent, with higher doses carrying greater risk than lower doses. Some key points to consider when evaluating the risk of EPS with brexpiprazole include:
- The medication's pharmacological profile, which includes partial agonism at D2 receptors rather than full blockade, allowing for adequate antipsychotic efficacy while minimizing movement disorders 3
- The results of studies demonstrating the efficacy and safety of brexpiprazole in patients with schizophrenia, including those with severe symptoms 4
- The importance of monitoring patients for EPS symptoms, including akathisia, parkinsonism, and dystonia, during treatment initiation and dose adjustments
- The potential management options for EPS, including dose reduction, switching to an antipsychotic with even lower EPS risk, or adding an anticholinergic medication [@Example@] Overall, brexpiprazole appears to be a useful treatment option for patients with schizophrenia, with a relatively low risk of EPS compared to other antipsychotics.