Brexpiprazole in the treatment of schizophrenia: pharmacology, efficacy, and side effects profile

Objectives.
The aim of this paper is to review clinically relevant aspects of the current knowledge of brexpiprazole in the treatment of schizophrenia, particularly its pharmacological properties, efficacy in the treatment of exacerbations and maintenance of remission as well as its side effects profile.

Literature review.
Brexpiprazole is an antipsychotic drug that exhibits its effects mainly through partial agonism of D₂ and D₃ dopamine receptors and 5-HT_1A serotonin receptors; it also has antagonistic effects against 5-HT_2A, 5-HT_2B, 5-HT₇, H₁ and M₁ receptors. It is metabolized mainly by CYP3A4 and CYP2D6 enzymes, excreted via the liver and the kidneys, and has a half-life of 96 hours. At doses of 2-4 mg/d, it is clinically effective in treating acute episodes of schizophrenia as it alleviates psychotic symptoms and improves psychosocial functioning. It also shows efficacy in maintenance treatment at doses of 1 to 4 mg/d, delaying relapse as compared to placebo. Brexpiprazole is well tolerated by patients in both acute and maintenance treatment. It is characterized by a lack of effect on metabolic profile, prolactin levels and QTc interval, as well as a small effect on body weight and a low risk of akathisia.

Conclusions.
Brexpiprazole is an effective medication in the treatment of schizophrenia. Among other drugs, it is distinguished by its favorable side effect profile, especially by a lack of metabolic side effects. With its set of features, it expands the range of therapeutic options in schizophrenia.