Rexulti Dosage/Direction for Use

Treatment of Schizophrenia: The recommended starting dosage for REXULTI is 1 mg once daily on Days 1 to 4, taken orally with or without food [see Pharmacology: Pharmacokinetics under Actions].
The recommended target REXULTI dosage is 2 mg to 4 mg once daily. Titrate to 2 mg once daily on Day 5 through Day 7, then to 4 mg on Day 8 based on the patient's clinical response and tolerability. The maximum recommended daily dosage is 4 mg.
Switching from other antipsychotics to brexpiprazole: When switching from other antipsychotics to brexpiprazole gradual cross-titration should be considered, with gradual discontinuation of the previous treatment while brexpiprazole treatment is initiated.
Switching to other antipsychotics from brexpiprazole: When switching to other antipsychotics from brexpiprazole, no gradual cross-titration is needed, the new antipsychotics should be initiated in its lowest dose while brexpiprazole is discontinued. It should be considered that plasma concentration of brexpiprazole will decline gradually and will be completely washed out in 1 to 2 weeks.
Dosage Adjustments for Hepatic Impairment: For patients with moderate to severe hepatic impairment (Child-Pugh score ≥ 7), the maximum recommended dosage is 3 mg once daily for patients with schizophrenia [see Hepatic Impairment under Precautions, Pharmacology: Pharmacokinetics under Actions].
Dosage Adjustments for Renal Impairment: For patients with moderate, severe or end-stage renal impairment the maximum recommended dosage is 3 mg once daily for patients with schizophrenia [see Renal Impairment under Precautions, Pharmacology: Pharmacokinetics under Actions].
Dosage Modifications for CYP2D6 Poor Metabolizers and for Concomitant Use with CYP Inhibitors or Inducers: 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 (see Table 2). If the coadministered drug is discontinued, adjust the REXULTI dosage to its original level. If the coadministered CYP3A4 inducer is discontinued, reduce the REXULTI dosage to the original level over 1 to 2 weeks [see Drugs Having Clinically Important Interactions with REXULTI under Interactions, Pharmacology: Pharmacokinetics under Actions]. (See Table 2.)


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