Laboratory and Monitoring Requirements for Brexpiprazole in Elderly Patients

Baseline Laboratory Assessment

The European Society of Cardiology recommends measuring baseline blood pressure in both supine and standing positions to assess for orthostatic dysregulation in elderly patients 1
The European Society of Cardiology suggests calculating creatinine clearance using CKD-EPI Cr-cystatin C equation if available, as this is more accurate than creatinine-based equations alone in elderly patients 1
The American Heart Association recommends adjusting dosing based on renal function, as elderly patients exhibit delayed elimination of many psychotropic medications 2

The European Society of Cardiology recommends monitoring blood pressure (supine and standing) to detect orthostatic hypotension, which increases fall risk in elderly patients 1
The European Society of Cardiology suggests monitoring for cognitive changes, as some cardiovascular and psychotropic drugs can increase neurocognitive impairment in elderly patients 1
The American Society of Clinical Oncology recommends evaluating functional status and fall risk, as elderly patients are more susceptible to adverse effects including sedation and orthostatic hypotension 5

The European Society of Cardiology recommends starting at 0.5-1 mg daily rather than standard adult doses, as elderly patients require lower initial doses and more gradual titration due to altered pharmacokinetics and pharmacodynamics 5
The American Heart Association suggests reducing doses further in patients with renal or hepatic impairment, as these conditions are common in elderly populations 4
The European Society of Cardiology recommends reviewing all medications including over-the-counter drugs, vitamins, and herbal supplements, as polypharmacy is extremely common in elderly patients and increases risk of adverse drug reactions 1

The European Society of Cardiology warns against assuming normal renal function based on serum creatinine alone, as elderly patients may have reduced muscle mass masking renal impairment 1
The European Society of Cardiology advises against overlooking orthostatic vital signs, as standing blood pressure should always be measured to detect postural hypotension 6
The American Society of Clinical Oncology recommends against prescribing standard adult doses initially, as this substantially increases risk of adverse reactions in elderly patients 5