Brexiprazole for Agitation in Dementia

Non-Pharmacological Interventions

The American Academy of Family Physicians recommends assessing and treating reversible causes of agitation, including pain, infections, constipation, and environmental stressors, before considering brexiprazole or any antipsychotic medication 1, 2
Implementing structured routines with predictable schedules for meals, exercise, and bedtime can help reduce agitation in patients with dementia 3
Modifying the environment by reducing noise, optimizing lighting, removing clutter, and ensuring safety features like grab bars can also help reduce agitation in patients with dementia 3
Using behavioral techniques, including the "three R's" (repeat, reassure, redirect) and distraction strategies, can help manage agitation in patients with dementia 3

The American College of Clinical Pharmacology recommends brexiprazole as a treatment option for agitation in patients with Alzheimer's dementia, but only after non-pharmacological interventions have been exhausted 1, 2
Brexiprazole should only be initiated when symptoms are severe, dangerous, or cause significant distress to the patient, and non-pharmacological interventions have failed to adequately control agitation 1, 2
The potential benefits of brexiprazole must outweigh the substantial risks, including increased mortality, before initiating treatment 1, 2

The American Geriatrics Society recommends discussing the mortality risk associated with brexiprazole with the patient (if feasible) and surrogate decision-makers before initiating treatment 1, 2
Monitoring for extrapyramidal symptoms, orthostatic hypotension, and cognitive changes is crucial when using brexiprazole to treat agitation in patients with dementia 1

The American Academy of Neurology recommends implementing a structured monitoring protocol, including quantitative measures like the Cohen-Mansfield Agitation Inventory (CMAI), to assess treatment response to brexiprazole 1, 2
If no clinically significant response is observed after 4 weeks of adequate dosing, brexiprazole should be tapered and discontinued 1, 2
Regular reassessment of the need for continued treatment with brexiprazole is necessary, as antipsychotics should be used for the shortest duration necessary 1, 2