Can Rexulti Be Split in Half?
No, there is no specific guidance in the FDA labeling or available evidence that addresses whether Rexulti (brexpiprazole) tablets can be split in half, and the standard practice is to administer tablets whole as prescribed. 1
FDA Labeling Guidance
The FDA-approved prescribing information for brexpiprazole specifies that tablets should be "administered orally, once daily with or without food" but does not include any instructions regarding tablet splitting or scoring. 1 The absence of specific guidance on splitting, combined with the lack of mention of scored tablets in the formulation, suggests tablets should be taken whole.
Dosing Flexibility Built Into the Medication
Rather than splitting tablets, brexpiprazole is designed with multiple tablet strengths to allow precise dose titration:
For Major Depressive Disorder (adjunctive): Starting doses of 0.5 mg or 1 mg are available, with titration to a target of 2 mg daily (maximum 3 mg daily). 1
For Schizophrenia: Starting dose is 1 mg daily, titrating to 2-4 mg daily based on response. 1
Dose adjustments are specifically outlined for patients who are CYP2D6 poor metabolizers or taking interacting medications, where "half of the recommended dosage" is prescribed—this is achieved by using lower-strength tablets, not by splitting. 1
Clinical Considerations
The medication requires weekly titration intervals when adjusting doses, allowing clinicians to use commercially available tablet strengths rather than splitting. 1
If dose reduction is needed (for hepatic impairment, renal impairment, or drug interactions), the FDA label provides specific maximum doses that correspond to available tablet strengths. 1
Brexpiprazole demonstrates moderate weight gain and generally good tolerability in clinical trials, with discontinuation rates due to adverse events actually lower than placebo in schizophrenia trials. 2
Practical Recommendation
If a dose between available tablet strengths is clinically desired, contact the prescribing physician to determine if an alternative dosing strategy using whole tablets is appropriate, or consider whether the patient truly requires a dose not available in standard formulations. The medication's pharmacokinetic profile and clinical trial data support the use of standard tablet strengths without splitting. 1, 3