From the Research
Brexpiprazole (Rexulti) for agitation associated with dementia is typically started at a dose of 0.5 mg once daily, with gradual titration based on response and tolerability, and the target dose range is usually 1-3 mg daily, as shown in a recent randomized clinical trial 1. The dosing should be conservative in elderly patients, with slower titration (increasing by 0.5 mg increments no more frequently than weekly) and careful monitoring for side effects. Treatment duration should be regularly reassessed, aiming for the shortest effective period. Rexulti works by modulating dopamine and serotonin receptors, which helps reduce agitation while having a more favorable side effect profile than older antipsychotics. However, it still carries a boxed warning for increased mortality in elderly patients with dementia-related psychosis. Common side effects include sedation, dizziness, weight gain, and akathisia. Before starting Rexulti, non-pharmacological approaches should be tried first, and medical causes of agitation should be ruled out. Regular monitoring for metabolic changes, extrapyramidal symptoms, and cardiovascular effects is essential during treatment, as recommended by recent studies 2, 1. Key considerations in the management of agitation in dementia include identifying and addressing underlying causes, using non-pharmacological interventions, and selecting pharmacological treatments with a favorable risk-benefit profile, as discussed in recent reviews 3, 4. The most recent and highest quality study 1 provides the best evidence for the dosing and efficacy of brexpiprazole in this population.