REXULTI® (brexpiprazole) | MDD | Clinical Pharmacology Skip to main content This site is intended for u.s. healthcare professionals U.S. full prescribing information MAJOR DEPRESSIVE DISORDER (ADJUNCTIVE) select the Indication Major Depressive Disorder (Adjunctive) AGITATION ASSOCIATED WITH DEMENTIA DUE TO ALZHEIMER’S DISEASE MAJOR DEPRESSIVE DISORDER (ADJUNCTIVE) SCHIZOPHRENIA (SZ) Partial Response Is Partial Response Good Enough? Patient Profiles Efficacy Data Primary Endpoint Study Design Summary Non-Pivotal Study Data Additional Analysis Post hoc Analysis Safety Profile Adverse Reactions Discontinuations Metabolic Profile Clinical Pharmacology Clinical Pharmacology Pharmacodynamic Profile Pharmacodynamics Video Dosing & Titration Dosing & Titration Schedule Dosing Adjustments Sample Starter Packs Savings & Coverage Savings Offer Coverage Formulary Lookup Coverage Support Resources For Your Patients For Your Practice Efficacy Data Short-term Efficacy PANSS Total Score: Disease Severity Maintenance Efficacy Data Safety Profile Adverse Reactions Additional Safety Metabolic Profile Patient Profile Clinical Pharmacology Dosing & Titration Dosing & Titration Schedule Dosing Adjustments Sample Starter Packs Savings & Coverage Savings Offer Coverage Formulary Lookup Coverage Support Resources For Your Patients For Your Practice Symptoms Symptoms Disease Burden Efficacy Data Primary Endpoint Full Study Design Secondary Endpoint CMAI Scale Safety Profile Adverse Reactions Discontinuations Extension Dosing & Titration Dosing & Titration Schedule Dose Adjustments Patient/Caregiver Profiles Clinical Pharmacology Savings & Coverage Coverage Formulary Lookup Coverage Support Savings Offer Resources For Your Patients and Caregivers For Your Practice Request a Rep Find Speaker Programs For Patients AND & Caregivers select the Indication Major Depressive Disorder (Adjunctive) AGITATION ASSOCIATED WITH DEMENTIA DUE TO ALZHEIMER’S DISEASE MAJOR DEPRESSIVE DISORDER (ADJUNCTIVE) SCHIZOPHRENIA (SZ) Partial Response Is Partial Response Good Enough? Patient Profiles Efficacy Data Primary Endpoint Study Design Summary Non-Pivotal Study Data Additional Analysis Post hoc Analysis Safety Profile Adverse Reactions Discontinuations Metabolic Profile Clinical Pharmacology Clinical Pharmacology Pharmacodynamic Profile Pharmacodynamics Video Dosing & Titration Dosing & Titration Schedule Dosing Adjustments Sample Starter Packs Savings & Coverage Savings Offer Coverage Formulary Lookup Coverage Support Resources For Your Patients For Your Practice Efficacy Data Short-term Efficacy PANSS Total Score: Disease Severity Maintenance Efficacy Data Safety Profile Adverse Reactions Additional Safety Metabolic Profile Patient Profile Clinical Pharmacology Dosing & Titration Dosing & Titration Schedule Dosing Adjustments Sample Starter Packs Savings & Coverage Savings Offer Coverage Formulary Lookup Coverage Support Resources For Your Patients For Your Practice Symptoms Symptoms Disease Burden Efficacy Data Primary Endpoint Full Study Design Secondary Endpoint CMAI Scale Safety Profile Adverse Reactions Discontinuations Extension Dosing & Titration Dosing & Titration Schedule Dose Adjustments Patient/Caregiver Profiles Clinical Pharmacology Savings & Coverage Coverage Formulary Lookup Coverage Support Savings Offer Resources For Your Patients and Caregivers For Your Practice Skip to Important Safety Information Clinical Pharmacology Clinical Pharmacology Pharmacodynamic Profile Pharmacodynamics Video REXULTI® (brexpiprazole) targets 3 neurotransmitter systems The only atypical antipsychotic indicated as an adjunctive therapy to antidepressants for the treatment of MDD with high binding affinity to norepinephrine, serotonin, and dopamine receptors. 1-4 The mechanism of action of REXULTI is unknown. The activity of these compounds is based on in vitro data. The clinical significance of the in vitro data is unknown. Reuptake inhibitors modulate neurotransmitter activity through different processes than partial agonists and antagonists. 5 The pharmacology data of REXULTI do not provide further insights on the mechanism of action. REXULTI has high binding affinity to 3 neurotransmitter systems: norepinephrine, serotonin, and dopamine 6 Pharmacodynamic profile—binding affinities across neurotransmitter systems 7,a Norepinephrine, serotonin, and dopamine modulate each other's activity 8 Pharmacodynamic chart Pharmacodynamic chart Close INDICATIONS and IMPORTANT SAFETY INFORMATION for REXULTI® (brexpiprazole) INDICATION REXULTI is indicated for use as an adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD) in adults. IMPORTANT SAFETY INFORMATION WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at increased risk of death. REXULTI is not approved for the treatment of patients with dementia-related psychosis without agitation associated with dementia due to Alzheimer’s disease. WARNING: SUICIDAL THOUGHTS AND BEHAVIORS Antidepressants increased the risk of suicidal thoughts and behaviors in patients aged 24 years and younger. Monitor for clinical worsening and emergence of suicidal thoughts and behaviors. The safety and effectiveness of REXULTI have not been established in pediatric patients with MDD. Please continue watching for additional Important Safety Information including the BOXED WARNING and please see Full Prescribing Information at www.REXULTIhcp.com. For your awareness, the activity of these compounds is based on in vitro data. The clinical significance of the in vitro data is unknown. The mechanism of action of REXULTI is unknown. My name is Dr. Rakesh Jain and today we're going to discuss how REXULTI is thought to work. REXULTI and antidepressants both interact with some of the same neurotransmitter systems implicated in depression, but in different ways. Some antidepressants, such as SSRIs, SNRIs, and NDRIs, are reuptake inhibitors that are thought to work on one or two types of neurotransmitter receptors. SSRIs inhibit the reuptake of serotonin, SNRIs inhibit the reuptake of both serotonin and norepinephrine, while NDRIs inhibit the reuptake of norepinephrine and dopamine. Reuptake inhibitors, such as SSRIs, work by blocking the presynaptic reabsorption of serotonin. SNRIs and NDRIs function in similar ways for other neurotransmitter transporters. REXULTI is thought to work differently than reuptake inhibitors, as a partial agonist and antagonist. REXULTI has high binding affinity to three types of neurotransmitter receptors—norepinephrine, serotonin, and dopamine. REXULTI binds directly to the receptor, and acts as a partial agonist across some dopamine and serotonin receptors and as an antagonist across some norepinephrine and serotonin receptors. REXULTI acts as an antagonist at norepinephrine α1 B , α2 C , α1 D , and α1 A receptors. REXULTI acts as a partial agonist at serotonin 5-HT 1A receptors, but also as an antagonist at serotonin 5-HT 2A , 5-HT 2B , and 5-HT 7 receptors. REXULTI acts as a partial agonist at both dopamine D 2 and D 3 receptors. These neurotransmitters exert their effects not only individually, but also by modulating each other's activity. REXULTI and antidepressants may work together, but in different ways, on some of the same neurotransmitter receptors implicated in depression. Most antidepressants work through reuptake inhibition while REXULTI is both a direct partial agonist and antagonist of these systems. Please continue listening for additional Important Safety Information. INDICATION and IMPORTANT SAFETY INFORMATION for REXULTI (brexpiprazole) INDICATION REXULTI is indicated for use as an adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD) in adults. IMPORTANT SAFETY INFORMATION WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at increased risk of death. REXULTI is not approved for the treatment of patients with dementia-related psychosis without agitation associated with dementia due to Alzheimer’s disease. WARNING: SUICIDAL THOUGHTS AND BEHAVIORS Antidepressants increased the risk of suicidal thoughts and behaviors in patients aged 24 years and younger. Monitor for clinical worsening and emergence of suicidal thoughts and behaviors. The safety and effectiveness of REXULTI have not been established in pediatric patients with MDD. Contraindication: In patients with known hypersensitivity to brexpiprazole or any of its components. Reactions have included: rash, facial swelling, urticaria and anaphylaxis. Cerebrovascular Adverse Events, Including Stroke: In clinical trials, elderly patients with dementia randomized to risperidone, aripiprazole, and olanzapine had a higher incidence of stroke and transient ischemic attack, including fatal stroke.  REXULTI is not approved for the treatment of patients with dementia-related psychosis without agitation associated with dementia due to Alzheimer’s disease. Neuroleptic Malignant Syndrome (NMS): NMS is a potentially fatal symptom complex reported in association with administration of antipsychotic drugs, including REXULTI. Clinical signs of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmia). Additional signs may include elevated creatinine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. Manage NMS with immediate discontinuation of REXULTI, intensive symptomatic treatment, and monitoring. Tardive Dyskinesia (TD): Risk of TD, and the potential to become irreversible, appear to increase with duration of treatment and total cumulative dose of antipsychotic drugs. TD can develop after relatively brief treatment periods, at low doses, or after discontinuation of treatment. For chronic treatment, use the lowest dose and shortest duration of REXULTI needed to produce a clinical response. If signs and symptoms of TD appear, drug discontinuation should be considered. Metabolic Changes: Atypical antipsychotic drugs, including REXULTI, have caused metabolic changes including: Hyperglycemia/Diabetes Mellitus: Hyperglycemia and diabetes mellitus, in some cases extreme and associated with diabetic ketoacidosis, hyperosmolar coma or death, have been reported in patients treated with atypical antipsychotics. Assess fasting plasma glucose before or soon after initiation of antipsychotic medication and monitor periodically during long-term treatment. Dyslipidemia: Atypical antipsychotics cause adverse alterations in lipids. Before or soon after initiation of antipsychotic medication, obtain a fasting lipid profile at baseline and monitor periodically during treatment. Weight Gain: Weight gain has been observed in patients treated with REXULTI. Monitor weight at baseline and frequently thereafter. Pathological Gambling and Other Compulsive Behaviors: Intense urges, particularly for gambling, and the inability to control these urges have been reported while taking REXULTI. Other compulsive urges have been reported less frequently. Prescribers should ask patients or their caregivers about the development of new or intense compulsive urges. Consider dose reduction or stopping REXULTI if such urges develop. Leukopenia, Neutropenia, and Agranulocytosis: Leukopenia and neutropenia have been reported with antipsychotics. Agranulocytosis (including fatal cases) has been reported with other agents in this class. Monitor complete blood count in patients with pre-existing low white blood cell count (WBC)/absolute neutrophil count or history of drug-induced leukopenia/neutropenia. Discontinue REXULTI at the first sign of a clinically significant decline in WBC and in patients with severe neutropenia. Orthostatic Hypotension and Syncope: Atypical antipsychotics cause orthostatic hypotension and syncope. Generally, the risk is greatest during initial dose titration and when increasing the dose. Monitor in patients vulnerable to hypotension, and those with cardiovascular and cerebrovascular diseases. Falls: Antipsychotics may cause somnolence, postural hypotension, motor, and sensory instability, which may lead to falls causing fractures or other injuries. For patients with diseases, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating treatment and recurrently during therapy. Seizures: REXULTI may cause seizures and should be used with caution in patients with a history of seizures or with conditions that lower the seizure threshold. Body Temperature Dysregulation: Use REXULTI with caution in patients who may experience conditions that increase body temperature (e.g., strenuous exercise, extreme heat, dehydration, or concomitant use with anticholinergics). Dysphagia: Esophageal dysmotility and aspiration have been associated with antipsychotics, including REXULTI, and should be used with caution in patients at risk for aspiration. Potential for Cognitive and Motor Impairment: REXULTI has the potential to impair judgment, thinking, or motor skills. Patients should be cautioned about operating hazardous machinery, including operating motor vehicles, until they are reasonably certain REXULTI does not affect them adversely. Concomitant Medication: Dosage adjustments are recommended in patients who are known cytochrome P450 (CYP) 2D6 poor metabolizers and in patients taking concomitant CYP3A4 inhibitors or CYP2D6 inhibitors or strong CYP3A4 inducers. Most commonly observed adverse reactions: In clinical trials of adults, the most common adverse reactions were: Major Depressive Disorder (MDD) (adjunctive treatment to antidepressant therapy; ≥5% incidence and at least twice the rate of placebo for REXULTI vs. placebo): weight increased, somnolence, and akathisia. Dystonia: Symptoms of dystonia may occur in susceptible individuals during the first days of treatment and at low doses. Pregnancy: Adequate and well-controlled studies to assess the risks of REXULTI during pregnancy have not been conducted. REXULTI should be used during pregnancy only if the benefit justifies the risk to the fetus. Lactation: It is not known if REXULTI is excreted in human breast milk. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. To report SUSPECTED ADVERSE REACTIONS, contact Otsuka America Pharmaceutical, Inc. at 1-800-438-9927 or FDA at 1-800-FDA-1088 ( www.fda.gov/medwatch ). Please see FULL PRESCRIBING INFORMATION, including BOXED WARNING , at REXULTIhcp.com. To learn more about REXULTI, visit REXULTIhcp.com/MDD. Close While the mechanism of action of REXULTI is unknown, the efficacy of REXULTI may be mediated through a combination of partial agonist activity at serotonin 5-HT 1A and dopamine D 2 receptors, and antagonist activity at serotonin 5-HT 2A receptors. a The binding affinity of brexpiprazole was determined in vitro in cells overexpressing human receptors and is expressed as an nM concentration with lower values representing higher affinity. High binding affinity Ki <1 nM. 7 5-HT, serotonin; D, dopamine; H, histamine; Ki, binding affinity; M, muscarinic; MDD, major depressive disorder; nM, nanomolar; NDRI, norepinephrine and dopamine reuptake inhibitor; NE, norepinephrine; SNRI, serotonin and norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor. Explore the pharmacodynamics of REXULTI with Dr. Jain Rakesh Jain, MD, MPH Clinical Professor Department of Psychiatry Texas Tech University School of Medicine Austin, Texas Read Transcript PHARMACOLOGY BROCHURE Access a digital brochure detailing the binding profile for REXULTI, including the pharmacodynamic profile. Download Brochure Continue exploring REXULTI Review results from pivotal clinical trials for REXULTI. VIEW MDD DATA Consider a patient with partial response. MEET REBECCA Full Prescribing Information Please see FULL PRESCRIBING INFORMATION , including BOXED WARNING . References: 1. Seroquel XR. Prescribing information. AstraZeneca Pharmaceuticals LP; 2022. 2. Abilify. Prescribing information. Otsuka Pharmaceutical Company; 2019. 3. Latuda. Prescribing information. Sunovision Pharmaceuticals Inc; 2022. 4. Vraylar. Prescribing information. Allergan Pharmaceuticals International Limited; 2024. 5. Ross EM, Kenakin TP. Pharmacodynamics: mechanisms of drug action and the relationship between drug concentration and effect. In: Hardman JG, Limbird LE, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill; 2001:31-43. 6. Stahl SM. Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 4th ed. Cambridge University Press; 2013. 7. Maeda K, Sugino H, Akazawa H, et al. Brexpiprazole I: in vitro and in vivo characterization of a novel serotonin-dopamine activity modulator. J Pharmacol Exp Ther . 2014;350(3):589-604. 8. Mansari M, Guiard BP, Chernoloz O, Ghanbari R, Katz N, Blier P. Relevance of norepinephrine-dopamine interactions in the treatment of major depressive disorder. CNS Neurosci Ther. 2010;16(3):e1-17. doi:10.1111/j.1755-5949.2010.00146.x Footer logos Otsuka Lundbeck © 2025 Otsuka America Pharmaceutical, Inc. All rights reserved. Footer menu Privacy Policy Terms of Use August 2025 11US25EBP0255 ISI Block Title INDICATIONS and IMPORTANT SAFETY INFORMATION for REXULTI® (brexpiprazole) INDICATIONS REXULTI is indicated for: Use as an adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD) in adults Treatment of schizophrenia in adults and pediatric patients ages 13 years and older Treatment of agitation associated with dementia due to Alzheimer’s disease Limitations of Use : REXULTI is not indicated as an as needed (“prn”) treatment for agitation associated with dementia due to Alzheimer’s disease. IMPORTANT SAFETY INFORMATION WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at increased risk of death. REXULTI is not approved for the treatment of patients with dementia-related psychosis without agitation associated with dementia due to Alzheimer’s disease. WARNING: SUICIDAL THOUGHTS AND BEHAVIORS Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric patients and young adult patients. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors. The safety and effectiveness of REXULTI have not been established in pediatric patients with MDD. Contraindication: In patients with known hypersensitivity to brexpiprazole or any of its components. Reactions have included: rash, facial swelling, urticaria, and anaphylaxis. Cerebrovascular Adverse Events, Including Stroke: In clinical trials, elderly patients with dementia randomized to risperidone, aripiprazole, and olanzapine had a higher incidence of stroke and transient ischemic attack, including fatal stroke. REXULTI is not approved for the treatment of patients with dementia-related psychosis without agitation associated with dementia due to Alzheimer’s disease. Neuroleptic Malignant Syndrome (NMS): NMS is a potentially fatal symptom complex reported in association with administration of antipsychotic drugs, including REXULTI. Clinical signs of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatinine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. Manage NMS with immediate discontinuation of REXULTI, intensive symptomatic treatment, and monitoring. Tardive Dyskinesia (TD): Risk of TD, and the potential to become irreversible, appear to increase with duration of treatment and total cumulative dose of antipsychotic drugs. TD can develop after relatively brief treatment periods, at low doses, or after discontinuation of treatment. For chronic treatment, use the lowest dose and shortest duration of REXULTI needed to produce a clinical response. If signs and symptoms of TD appear, drug discontinuation should be considered. Metabolic Changes: Atypical antipsychotic drugs, including REXULTI, have caused metabolic changes including: Hyperglycemia/Diabetes Mellitus: Hyperglycemia and diabetes mellitus, in some cases extreme and associated with diabetic ketoacidosis, hyperosmolar coma, or death, have been reported in patients treated with atypical antipsychotics. Assess fasting plasma glucose before or soon after initiation of antipsychotic medication and monitor periodically during long-term treatment. Dyslipidemia: Atypical antipsychotics cause adverse alterations in lipids. Before or soon after initiation of antipsychotic medication, obtain a fasting lipid profile at baseline and monitor periodically during treatment. Weight Gain: Weight gain has been observed in patients treated with REXULTI. Monitor weight at baseline and frequently thereafter. Pathological Gambling and Other Compulsive Behaviors: Intense urges, particularly for gambling, and the inability to control these urges have been reported while taking REXULTI. Other compulsive urges have been reported less frequently. Prescribers should ask patients or their caregivers about the development of new or intense compulsive urges. Consider dose reduction or stopping REXULTI if such urges develop. Leukopenia, Neutropenia, and Agranulocytosis: Leukopenia and neutropenia have been reported with antipsychotics. Agranulocytosis (including fatal cases) has been reported with other agents in this class. Monitor complete blood count in patients with pre-existing low white blood cell count (WBC)/absolute neutrophil count or history of drug-induced leukopenia/neutropenia. Discontinue REXULTI at the first sign of a clinically significant decline in WBC and in patients with severe neutropenia. Orthostatic Hypotension and Syncope: Atypical antipsychotics cause orthostatic hypotension and syncope. Generally, the risk is greatest during initial dose titration and when increasing the dose. Monitor in patients vulnerable to hypotension and those with cardiovascular and cerebrovascular diseases. Falls: Antipsychotics may cause somnolence, postural hypotension, and motor and sensory instability, which may lead to falls causing fractures or other injuries. For patients with diseases, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating treatment and recurrently during treatment. Seizures: REXULTI may cause seizures and should be used with caution in patients with a history of seizures or with conditions that lower the seizure threshold. Body Temperature Dysregulation: Use REXULTI with caution in patients who may experience conditions that increase body temperature (eg, strenuous exercise, extreme heat, dehydration, or concomitant use with anticholinergics). Dysphagia: Esophageal dysmotility and aspiration have been associated with antipsychotics, including REXULTI, and should be used with caution in patients at risk for aspiration. Potential for Cognitive and Motor Impairment: REXULTI may cause somnolence and has the potential to impair judgment, thinking, or motor skills. Patients should be cautioned about operating hazardous machinery, including operating motor vehicles, until they are reasonably certain REXULTI does not affect them adversely. Concomitant Medication: Dosage adjustments are recommended in patients who are known cytochrome P450 (CYP) 2D6 poor metabolizers and in patients taking concomitant CYP3A4 inhibitors or CYP2D6 inhibitors or strong CYP3A4 inducers. Most commonly observed adverse reactions: In clinical trials, the most common adverse reactions were: Major Depressive Disorder (MDD) in adults (adjunctive treatment to antidepressant therapy; ≥5% incidence and at least twice the rate of placebo for REXULTI vs placebo): weight increased, somnolence, and akathisia. Schizophrenia in adults (≥5% incidence): weight increased, akathisia, headache, somnolence, and insomnia. Schizophrenia in pediatric patients (≥5% incidence): weight increased, somnolence, headache, akathisia, and nasopharyngitis. Agitation associated with dementia due to Alzheimer’s disease in adults (≥4% incidence and at least twice the rate of placebo for REXULTI vs placebo): nasopharyngitis and dizziness. Dystonia: Symptoms of dystonia may occur in susceptible individuals during the first days of treatment and at low doses. Pregnancy: Adequate and well-controlled studies to assess the risks of REXULTI during pregnancy have not been conducted. REXULTI should be used during pregnancy only if the benefit justifies the risk to the fetus. Lactation: It is not known if REXULTI is excreted in human breast milk. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. To report SUSPECTED ADVERSE REACTIONS, contact Otsuka America Pharmaceutical, Inc. at 1-800-438-9927 or FDA at 1-800-FDA-1088 ( www.fda.gov/medwatch ). To report SUSPECTED ADVERSE REACTIONS, contact Otsuka America Pharmaceutical, Inc. at 1-800-438-9927 or FDA at 1-800-FDA-1088 ( www.fda.gov/medwatch ). Please see FULL PRESCRIBING INFORMATION , including BOXED WARNING . IMPORTANT SAFETY INFORMATION and INDICATIONS Use as an adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD) in adults Treatment of schizophrenia in adults and pediatric patients ages 13 years and older Treatment of agitation associated with Alzheimer’s dementia (AAD) ISI Block Title WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at increased risk of death. REXULTI is not approved for the treatment of patients with dementia-related psychosis without agitation associated with dementia due to Alzheimer’s disease. WARNING: SUICIDAL THOUGHTS AND BEHAVIORS Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric patients and young adult patients. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors. The safety and effectiveness of REXULTI have not been established in pediatric patients with MDD. Contraindication: In patients with known hypersensitivity to brexpiprazole or any of its components. Reactions have included: rash, facial swelling, urticaria, and anaphylaxis. Cerebrovascular Adverse Events, Including Stroke: In clinical trials, elderly patients with dementia randomized to risperidone, aripiprazole, and olanzapine had a higher incidence of stroke and transient ischemic attack, including fatal stroke. REXULTI is not approved for the treatment of patients with dementia-related psychosis without agitation associated with dementia due to Alzheimer’s disease. Neuroleptic Malignant Syndrome (NMS): NMS is a potentially fatal symptom complex reported in association with administration of antipsychotic drugs, including REXULTI. Clinical signs of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatinine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. Manage NMS with immediate discontinuation of REXULTI, intensive symptomatic treatment, and monitoring. Tardive Dyskinesia (TD): Risk of TD, and the potential to become irreversible, appear to increase with duration of treatment and total cumulative dose of antipsychotic drugs. TD can develop after relatively brief treatment periods, at low doses, or after discontinuation of treatment. For chronic treatment, use the lowest dose and shortest duration of REXULTI needed to produce a clinical response. If signs and symptoms of TD appear, drug discontinuation should be considered. Metabolic Changes: Atypical antipsychotic drugs, including REXULTI, have caused metabolic changes including: Hyperglycemia/Diabetes Mellitus: Hyperglycemia and diabetes mellitus, in some cases extreme and associated with diabetic ketoacidosis, hyperosmolar coma, or death, have been reported in patients treated with atypical antipsychotics. Assess fasting plasma glucose before or soon after initiation of antipsychotic medication and monitor periodically during long-term treatment. Dyslipidemia: Atypical antipsychotics cause adverse alterations in lipids. Before or soon after initiation of antipsychotic medication, obtain a fasting lipid profile at baseline and monitor periodically during treatment. Weight Gain: Weight gain has been observed in patients treated with REXULTI. Monitor weight at baseline and frequently thereafter. Pathological Gambling and Other Compulsive Behaviors: Intense urges, particularly for gambling, and the inability to control these urges have been reported while taking REXULTI. Other compulsive urges have been reported less frequently. Prescribers should ask patients or their caregivers about the development of new or intense compulsive urges. Consider dose reduction or stopping REXULTI if such urges develop. Leukopenia, Neutropenia, and Agranulocytosis: Leukopenia and neutropenia have been reported with antipsychotics. Agranulocytosis (including fatal cases) has been reported with other agents in this class. Monitor complete blood count in patients with pre-existing low white blood cell count (WBC)/absolute neutrophil count or history of drug-induced leukopenia/neutropenia. Discontinue REXULTI at the first sign of a clinically significant decline in WBC and in patients with severe neutropenia. Orthostatic Hypotension and Syncope: Atypical antipsychotics cause orthostatic hypotension and syncope. Generally, the risk is greatest during initial dose titration and when increasing the dose. Monitor in patients vulnerable to hypotension and those with cardiovascular and cerebrovascular diseases. Falls: Antipsychotics may cause somnolence, postural hypotension, and motor and sensory instability, which may lead to falls causing fractures or other injuries. For patients with diseases, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating treatment and recurrently during treatment. Seizures: REXULTI may cause seizures and should be used with caution in patients with a history of seizures or with conditions that lower the seizure threshold. Body Temperature Dysregulation: Use REXULTI with caution in patients who may experience conditions that increase body temperature (eg, strenuous exercise, extreme heat, dehydration, or concomitant use with anticholinergics). Dysphagia: Esophageal dysmotility and aspiration have been associated with antipsychotics, including REXULTI, and should be used with caution in patients at risk for aspiration. Potential for Cognitive and Motor Impairment: REXULTI may cause somnolence and has the potential to impair judgment, thinking, or motor skills. Patients should be cautioned about operating hazardous machinery, including operating motor vehicles, until they are reasonably certain REXULTI does not affect them adversely. Concomitant Medication: Dosage adjustments are recommended in patients who are known cytochrome P450 (CYP) 2D6 poor metabolizers and in patients taking concomitant CYP3A4 inhibitors or CYP2D6 inhibitors or strong CYP3A4 inducers. Most commonly observed adverse reactions: In clinical trials, the most common adverse reactions were: Major Depressive Disorder (MDD) in adults (adjunctive treatment to antidepressant therapy; ≥5% incidence and at least twice the rate of placebo for REXULTI vs placebo): weight increased, somnolence, and akathisia. Schizophrenia in adults (≥5% incidence): weight increased, akathisia, headache, somnolence, and insomnia. Schizophrenia in pediatric patients (≥5% incidence): weight increased, somnolence, headache, akathisia, and nasopharyngitis. Agitation associated with dementia due to Alzheimer’s disease in adults (≥4% incidence and at least twice the rate of placebo for REXULTI vs placebo): nasopharyngitis and dizziness. Dystonia: Symptoms of dystonia may occur in susceptible individuals during the first days of treatment and at low doses. Pregnancy: Adequate and well-controlled studies to assess the risks of REXULTI during pregnancy have not been conducted. REXULTI should be used during pregnancy only if the benefit justifies the risk to the fetus. Lactation: It is not known if REXULTI is excreted in human breast milk. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. To report SUSPECTED ADVERSE REACTIONS, contact Otsuka America Pharmaceutical, Inc. at 1-800-438-9927 or FDA at 1-800-FDA-1088 ( www.fda.gov/medwatch ). INDICATIONS REXULTI is indicated for: Use as an adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD) in adults Treatment of schizophrenia in adults and pediatric patients ages 13 years and older Treatment of agitation associated with dementia due to Alzheimer’s disease Limitations of Use : REXULTI is not indicated as an as needed (“prn”) treatment for agitation associated with dementia due to Alzheimer’s disease. Please see FULL PRESCRIBING INFORMATION , including BOXED WARNING . ↑