When should the first follow-up visit be made after reducing the dose of Rexulti (brexpiprazole) in a previously unstable patient?

Follow-Up Schedule After Reducing Rexulti (Brexpiprazole) Dose in Previously Unstable Patients

The first follow-up visit after reducing the dose of Rexulti in a previously unstable patient should be scheduled within 1-2 weeks to ensure close monitoring of symptom stability and potential adverse effects.

Rationale for Early Follow-Up

• The first follow-up visit after dose reduction should occur within 1-2 weeks for higher-risk patients who were previously unstable, as this timeframe allows for early detection of symptom recurrence or adverse effects 1
• For psychiatric medications with faster onset of action changes (like Rexulti), an early follow-up within 4 weeks is recommended to assess medication effects and tolerability 1
• Previously unstable patients require closer monitoring as they are at higher risk for symptom exacerbation following dose adjustments 2

Assessment During Follow-Up Visit

• Evaluate for return or worsening of psychiatric symptoms using standardized rating scales to objectively measure symptom changes 1
• Assess for medication side effects, particularly activating adverse events which may be affected by dose changes 3, 4
• Monitor for changes in sleep patterns, as Rexulti affects sleep parameters which may change with dose adjustments 5
• Review medication adherence and any barriers to consistent use that may have developed 1

Subsequent Follow-Up Schedule

• If the patient remains stable at the first follow-up, schedule the next visit in 4-6 weeks 1
• Once stability is confirmed over 2-3 months, follow-up frequency can be extended to every 2-3 months 6
• More frequent monitoring may be needed if any concerning symptoms or side effects emerge 1

Special Considerations

• For patients with comorbid medical conditions, coordinate follow-up with other healthcare providers to ensure comprehensive care 1
• Consider more frequent follow-up for patients with a history of rapid decompensation or poor insight into their illness 2
• If the patient shows signs of clinical worsening at any point, immediate reassessment is warranted rather than waiting for the scheduled follow-up 1

Monitoring Parameters

• At each follow-up visit, assess:
  • Psychiatric symptom severity using validated rating scales 1
  • Treatment-emergent adverse events, particularly akathisia which is reported in 5.5% of patients taking Rexulti 4
  • Weight changes, as modest weight gain may occur with Rexulti 4
  • Changes in sleep quality and daytime functioning 5

Adjusting the Treatment Plan

• If symptoms worsen after dose reduction, consider returning to the previous effective dose 1
• If the reduced dose is well-tolerated with maintained symptom control after 3-6 months, the current regimen can be continued 6
• Document the patient's response to dose reduction to guide future treatment decisions 1