Brexpiprazole/Rexulti is it The New Aripiprazole?
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- Опубліковано 15 січ 2022
- Brexpiprazole is an atypical dopamine blocking medication that acts as a partial agonist at the D2 dopamine receptors and a serotonin dopamine activity modulator. But is it really any better than aripiprazole?
Timestamps:
Introduction 00:32
Side Effects: 02:00
Drug interactions and MOA: 04:05
Receptor activity profiles: 09:18
Dosing: 10:33
Where this Medication fit into treatment: 11:15
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It's been a game changer for my Schizoaffective disorder. It's the first AP I've been on that doesn't make me extremely tired and gain weight, I love it! Great information friend, I subscribed to you!
Thanks, I appreciate the support
@@ShrinksInSneakers welcome Dr. Rossi!!
amazing video as always! Please keep making these videos!
Excellent advice
Rexulti is one of my favorite drugs to prescribe for bipolar, schizoaffective, but very rarely depression. Abilify/aripiprazole (invisible eye roll 🙄) almost always causes some side effect when it begins working well even at very low doses….I actually see less side effects with higher doses. Reasons I love Result 1. Very low doses 0.25 mg can be effective. 2. It works very very quickly…. 2-3 days. 3. My fav combo is with Vortioxetine-in outpatient this can have someone better in a week or two SN: I may have to coin this combo 4. Patients who are bipolar manic and like feeling the high of mania, don’t feel terribly depressed like with other dopamine blockers or mood stabilizers oftentimes they cannot tell it’s even doing anything (but I can!) (Abilify is like this too-I still have some love for it sometimes-esp with adolescents) 4. So far I’ve seen no side effects from Rexulti, no wt gain, no akathisia, zilch metabolic syndrome I mean c’mon that’s awesome. My only wishes is that I could use it (and vortioxetine) in the adolescent population, costs decrease bc fighting with insurance is burdensome, and there is one day a LAI (that would be magical). This was a good presentation. This is a great drug. I learned a little. No mention of the very quick response, but that is my experience- may not be yours. I also never start at 2 mg, but I steer more on the start low and go slow side. I start at 0.5mg, I’ve also started at 0.25 mg for special populations.
Keep it coming doc, good stuff!
**Excuse any misspellings and syntax errors**
The other place they are looking at using this medication is dementia related psychosis. If you ever worked consult service you know what a need there is for something like this. The two week mark for depression treatment is another important point you made. I think it's good to keep in mind that patients should see a reasonable amount of improvement say over 25% better at two weeks (objective measure like a screening scale). If not you it's a good idea to start making some changes. I appreciate the perspective on treatment love it
Great reply. Do you dose the rexulti with 20 mg Trintellix? Or do you prefer the lower dosages of Trintellix?
How common is Tardive Dyskenisia with abilify ??
Yes YES YES. Hoping HeWill comment on the dosing. As you mention less akathisia at higher doses w Abilify. I honestly didnt believe this when Abilify was new. Seemed like a good gimmick to keep prescriptions for Abilify coming. However did not take long to realize clinically that this was in fact correct. ABilify at 7.5 or even 10mg significantly less akathisia than 2.5.
Does Brexpiprazole have similar dose response of higher doses having less akathisia?
Just subscribed, I enjoy your channel. It’s very informative.
@12:47 Rexulti helps me to think more linearly. I work in IT so troubleshooting and logical thinking are necessary.
I recently watched a lecture by Andrew Cutler where he says, "some people think partial agonist means partial efficacy". Well, maybe they think it because it's true :)
I have not tried this med, I don’t think. Thank you for the information - Rom 8:22 For we know that all creation keeps on groaning together and being in pain together until now
great video; thanks again! Can akathisa caused by atypicals and even some SSRIs look like hyperactivity/ADHD and/or even hypomania? Akathisia sounds like an inner restlessness that can look like the hyperactivity of ADHD and/or the "wired" quality of hypomania. Do you agree? best.
If you think antipsychotic good for everything take them for a month doctor
Pharma scoop!! Good job, Dr. Rossi. Would you cover the stellate ganglion block? I've heard it's quite promising and that whole modality of site injections is one I have very little experience with.
This is usually used for management of pain and I think the data for use in PTSD at this point is not ready for prime time. It's an interesting concept there is one RCT in JAMA that I read and basically concluded that more research is needed. I can cover the RCT and the procedure as I'm always excited for new ideas. If you have not subscribed to the channel please do, and spread the word about what we are doing here.
I second this suggestion. I actually had a patient get one of these injections in C2 and C4 this past Monday, and saw her on Friday. She has CPTSD, and she states her hypervigilance and even dissociation s/s are gone! She has another one scheduled next month, only time will tell if it is long-lasting. Fingers crossed!
Pramipexole or rexulti which would free up more dopamine for depression? Thank you, Doctor
So what's the difference in the tiredness between the 2?
Great video. Thank you. I don't like what feels like a "sedating" quality to Rexulti. Makes me want to try Abilify again or give Vraylar a try. I wonder if Vraylar might have more Akathisia than the Abilify. Thoughts? I've also seen that there is a new medication, Capylta.
Akathesia is a high risk with all the partial agonist medications including abilify. I find with sedation dosing the medication at night can be very helpful (before bed). Just a little tip thats helped a lot of patients in the past
Would this help ocd? My dr is recomme ding it
I just got brexpiprazole prescribed, I've been taking it for three days now. Do you know if there is any sexual dysfunction related to brexpiprazole?
I given clonazepam to deal with akithisia.will it go away on its own as time goes by
It’s been two weeks since I’ve been prescribed this and I haven’t started it yet because I’m so afraid of the potential akathesia and worsening anxiety. That is what I’m trying to avoid but haven’t had much luck with standard antidepressants. Do these side effects hit all of the sudden or would I notice before it gets too bad and unbearable?
Same here I’m nervous about the weight gain .
Update? :)
Same. Did u try it?
I read that rexulti was developed with the Intent of producing less akathisia
This is more of a question on ability, but I was under the impression that only low dose ability is good for depression. Lower dose increases dopamine transmission while higher doses decrease it.
I've looked online and it seems there is contradictory opinions on this. Have any insight ?
For depression my dosing is 5-10 mg daily. For bipolar mania and schizophrenia my dosing is 15 to 30 mg/day. This plays out well in the research literature. I think the effect on dopamine pathways is related more to the endogenous dopamine production of the individuals. In depression dopamine is though to be low in which case a partial agonist will act to stimulate the receptors providing a benefit for depression. If you haven’t subscribed already, please do, and spread the word about what we are doing here.
What’s causing the akathesia?
Thank you Dr. Rossi. I think my Effexor XR/ Wellbutrin combo is not working for me. The Effexor works for my general anxiety and helps my irritable bowels as well. I’m still feeling super depressed. I’m gonna ask my psychiatrist on my next visit about Rexulti replacing my Wellbutrin. I like the modulating effect you were talking about.
I am pretty sure that’s what I need 😂. Anyway thanks for the great content
Recently studies have shown that adjunctive treatment with medications like brexpiprazole is superior to bupropion. You may be onto something
I'm taking a combo of wellbutrin & zoloft and it's working. Ask your doctor about this too.
@@ShrinksInSneakers Atypical Antipsychotics mixed with SSRI are so frequently great choices. Its actually exciting to watch the marked improvement. Thank you so much for this excellent lecture/info. Great Job!
Question - I've been taking Rexulti for a week so far and I'm starting to get a twitch in my eye. Is there a chance it will go away or there's something I can take for it?
Latuda was causing hand shakes
I did the research for you and what I found is post marketing analysis shows 0.14% of people taking this medication have experienced what we call blepharospasm. This is a rare side effect, anything that occurs in < 10% of patients is not considered common. These are usually nothing to worry about but you should still talk to your doctor about it as this is not medical advice. Things to check into are mineral deficiencies, Medical, neurological causes. Making sure a person is not dehydrated is one common reason that’s easily correctable. The labs tests include magnesium, calcium, both of which would be low if they are the cause. Also be mindful of sleep, stress, and caffeine intake all of which could be a cause. Hypothyroidism should also be screened for. Benzodiazepine withdrawal can also be in the differential. There is no specific medication to treat this, the plan would be to look into potential cause listed above along with the lifestyle modification. Hope this helps if you haven’t subscribed to the channel please do, and spread the word about what we are doing here. Also check out Instagram as we now have daily content posted to help you on your mental health journey.
@@ShrinksInSneakers thank you so much for your channel and your help.
I do have hypothyroidism and take meds for it.
The twitch is inconsistent and the meds are working really well otherwise. I hope to be able to come off prozac soon.
Also - would you consider doing a series which talks to professionals about anti-psychotic medication and ADHD meds?
I'm on both and my psych dr explained that many drs won't prescribe both because they do opposite actions (anti-psych lowers dopamine - Vyvanse raises dopamine)
After an increase in Latuda I noticed my ADHD symptoms were disrupting my life.
Vyvanse has been a complete game changer and most of the cognitive symptoms I experienced from schizophrenia are virtually gone.
Just a topic suggestion for your great channel
@@HeatherLMorigeau Thank you I appreciate the support. Schizophrenia exists on a spectrum and some people have more severe forms of the disease and others have less severe forms. Some people may tolerate medications that increase dopamine like stimulants and bupropion. All of these decisions are on a case by case basis so it hards to generalize the answer here. In my assessments, first I try to determine if the cognitive problems are related o true comorbid ADHD or symptoms related to schizophrenia. Then I will look for potential medications causing a worsening of cognitive symptoms the biggest one I encounter is benztropine (cogentin) the other common one is diphenhydramine. I will stop those medications if possible, which usually improves cognition. I might start with non-stimulant options such as atomoxetine or guanfacine to see if that improves the cognitive function. If not there are other options like modafinil which could be tried as well. There are many roads and I can add this to the list of topics to discuss. Please spread the word about what we are doing here it helps me to keep bringing you good information
Has made my insomnia So. Much. Worse.
What is "achadezia"?
Restlesness
Can help to sleep
Gaming more than usual could be considered a side effect as well?
hedonistic homeostatic dysregulation is the technical term. I would say it wound need to be grossly out of proportion to normal gaming activity and cause dysfunction. Essentially this is an over involvement in pleasurable activities
@@ShrinksInSneakers understood, thanks!
Lol
aripriprazol was the worst drug I've ever taken for depression. and I've tried A LOT of drugs
It really depends on the patient, there were several recent studies that showed aripirazole was superior to bupropion as an augmentation strategy for depression. Like I've said previously this is a general statement. In average if you had to add an augmentation medication choosing abilify over bupropion proves to be better in RCTs. To be a good psychiatrist you need to apply this general information to the individual patient and it might turn out that abilify is the incorrect choice for a number of reasons. Hope this helps
@@ShrinksInSneakers the akathisia and the loss of control over my impulses made my life horrible and I had to stop it right away and wait for those side effects to disappear
@@3omar_a7maad Seems like that was the right decision based on the side effects described here
Theree are alternative to these disorder called Ketamine but big pharma could not sell there crappy antipsychotic good for everything. HAHAHAHA
Liver disease and parkisons disease is a cure