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Antipsychotics / Mood Stabilizers
aripiprazole
(Abilify ®):
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Dosing (Adults): Bipolar disorder (acute manic or mixed episodes): Stabilization: Oral: 30 mg once daily; may require a decrease to 15 mg based on tolerability (15% of patients had dose decreased); safety of doses >30 mg/day has not been evaluated. Maintenance: Continue stabilization dose for up to 6 weeks; efficacy of continued treatment >6 weeks has not been established. Schizophrenia: Oral: 10-15 mg once daily; may be increased to a maximum of 30 mg once daily (efficacy at dosages above 10-15 mg has not been shown to be increased). Dosage titration should not be more frequent than every 2 weeks. Supplied: 5 mg, 10 mg, 15 mg, 20 mg, 30 mg tab. 1 mg/ml (150 ml) oral soln. |
chlorpromazine
(Thorazine ®):
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Low Potency. Dosing (Adults): Schizophrenia/psychoses: Oral: Range: 30-800 mg/day in 1-4 divided doses, initiate at lower doses and titrate as needed. Usual dose: 200 mg/day. Some patients may require 1-2 g/day. IM, IV: Initial: 25 mg, may repeat (25-50 mg) in 1-4 hours - gradually increase to a maximum of 400 mg/dose every 4-6 hours until patient is controlled. Usual dose: 300-800 mg/day. (Note: Avoid skin contact with oral solution or injection solution; may cause contact dermatitis. IV: Direct or intermittent infusion: Infuse 1 mg or portion thereof over 1 minute.) Intractable hiccups: Oral, IM: 25-50 mg 3-4 times/day. N/V: Oral: 10-25 mg every 4-6 hours. IM, IV: 25-50 mg every 4-6 hours. Warnings: 1) Significant hypotension may occur, particularly with parenteral administration. 2) Phenothiazines may cause anticholinergic effects (confusion, agitation, constipation, xerostomia, blurred vision, urinary retention). Therefore, they should be used with caution in patients with decreased gastrointestinal motility, urinary retention, BPH, xerostomia, or visual problems. Supplied: Tablet: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg. Injection: 25 mg/ml (1, 2 ml). |
Clozapine
(Clozaril ®):
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DOSING: ADULTS - Schizophrenia: Initial: 12.5 mg once or twice daily;
increased, as tolerated, in increments of 25-50 mg/day to a target dose
of 300-450 mg/day after 2-4 weeks, may require doses as high as 600-900
mg/day Reduce risk of suicidal behavior: Initial: 12.5 mg once or twice daily; increased, as tolerated, in increments of 25-50 mg/day to a target dose of 300-450 mg/day after 2-4 weeks; median dose is ~300 mg/day (range: 12.5-900 mg) IMPORTANT Termination of therapy: If dosing is interrupted for >/=48 hours, therapy must be reinitiated at 12.5-25 mg/day; may be increased more rapidly than with initial titration, unless cardiopulmonary arrest occurred during initial titration. In the event of planned termination of clozapine, gradual reduction in dose over a 1- to 2-week period is recommended. If conditions warrant abrupt discontinuation (leukopenia), monitor patient for psychosis and cholinergic rebound (headache, nausea, vomiting, diarrhea). Patients discontinued on clozapine therapy due to WBC <2000/mm3 or ANC <1000/mm3 should not be restarted on clozapine. Dosage adjustment for toxicity: Moderate leukopenia or granulocytopenia (WBC <3000/mm3 and ANC <1500/mm3): Discontinue therapy; may rechallenge patient when WBC >3500/mm3 and/or ANC >2000/mm3. Note: Patient is at greater risk for developing agranulocytosis. Severe leukopenia or granulocytopenia (WBC <2000/mm3 and/or ANC <1000/mm3): Discontinue therapy and do not rechallenge patient. Supplied: Tablet: 12.5 mg, 25 mg, 100 mg |
fluphenazine
(Prolixin ®):
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High Potency. Dosing (Adults): Psychosis: Oral: 0.5-10 mg/day in divided doses at 6 to 8 hour intervals; some patients may require up to 40 mg/day. IM: 2.5-10 mg/day in divided doses at 6 to 8 hour intervals (parenteral dose is 1/3 to 1/2 the oral dose for the hydrochloride salts). Depot (Long-acting maintenance injections): IM, SQ (decanoate): 12.5 mg every 3 weeks. Conversion from hydrochloride to decanoate IM: 0.5 ml (12.5 mg) decanoate every 3 weeks is approximately equivalent to 10 mg hydrochloride/day. Supplied: 1 mg, 2.5 mg, 5 mg, 10 mg tab. Oral concentrate: 5 mg/ml (120 ml). Injection (decanoate): 25 mg/ml (5 ml) |
haloperidol
(Haldol ®):
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High Potency. Butyrophenone antipsychotic. Dosing (Adults): Psychosis: Oral: 0.5-5 mg 2-3 times/day; usual maximum: 30 mg/day. IM (as lactate): 2-5 mg every 4-8 hours as needed. (decanoate): Initial: 10-20 times the daily oral dose administered at 4-week intervals. Maintenance dose: 10-15 times initial oral dose; used to stabilize psychiatric symptoms. ICU- Delirium: 2-10 mg IV - may repeat bolus doses every 20-30 minutes until calm then administer 25% of the maximum dose every 6 hours. Monitor ECG and QTc interval. Alternatively: Continuous I.V. infusion: 3 to 25 mg/hour. Rapid tranquilization: Oral: 5-10 mg or IM: 5 mg. Average total dose (oral or IM) for tranquilization: 10-20 mg. Supplied: Tablet: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg. Oral concentrate: 2 mg/ml (15 ml, 120 ml). Injection (decanoate): 50 mg/ml (1 ml, 5 ml); 100 mg/ml (1 ml, 5 ml). Injection (lactate): 5 mg/ml (1 ml, 10 ml). |
loxapine
(Loxitane ®):
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Mid Potency. Dibenzoxazepine antipsychotic. Dosing (Adults): Psychosis: Oral: 10 mg twice daily, increase dose until psychotic symptoms are controlled; usual dose range: 20-100 mg/day in divided doses 2-4 times/day. Dosages > 250 mg/day are not recommended. Supplied: 5 mg, 10 mg, 25 mg, 50 mg cap. |
molindone
(Moban ®):
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Dosing (Adults): Schizophrenia/psychoses: Oral: 50-75 mg/day
increase at 3- to 4-day intervals up to 225 mg/day. Supplied: 5 mg, 10 mg, 25 mg, 50 mg tab. |
olanzepine (Zyprexa ®):
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Atypical antipsychotic. Dosing (Adults): Schizophrenia: Oral: Usual starting dose: 5-10 mg once daily - increase to 10 mg once daily within 5-7 days, thereafter adjust by 5 mg/day at 1-week intervals, up to a maximum of 20 mg/day. Doses as high as 30-50 mg per day have been used. Acute mania associated with bipolar disorder: Oral: Mono- therapy: Usual starting dose: 10-15 mg once daily - increase by 5 mg/day at intervals of not less than 24 hours. Maintenance: 5-20 mg/day. Maximum dose: 20 mg/day. Combination therapy (with lithium or valproate): Initial: 10 mg once daily; dosing range: 5-20 mg/day. Agitation (acute, associated with bipolar disorder or schizophrenia): IM: Initial dose: 5-10 mg (a lower dose of 2.5 mg may be considered when clinical factors warrant); additional doses (2.5-10 mg) may be considered; however, 2-4 hours should be allowed between doses to evaluate response (maximum total daily dose: 30 mg, per manufacturer's recommendation). Supplied: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg tablet. Orally-disintegrating tab (Zydis®): 5, 10, 15, 20 mg. Injection: 10 mg (powder for reconstitution) Manufacturer: ZYPREXA® Zydis® (Olanzapine) Orally Disintegrating Tablets ZYPREXA Zydis, an alternative formulation that dissolves quickly in the mouth, is available in 5, 10, 15, and 20 mg tablets. * Rapidly dissolves in mouth * Can be taken with or without water * Same indications as ZYPREXA tablet * For use where clinically indicated (for example, patients who have difficulty swallowing pills, those who cheek or spit their medication) * Bioequivalent to ZYPREXA tablets ZYPREXA® IntraMuscular ZYPREXA IntraMuscular is approved for the treatment of agitation associated with schizophrenia and bipolar mania. Follow the steps below to reconstitute and use ZYPREXA IntraMuscular: 1. Inject 2.1 mL of Sterile Water for Injection into single-packaged vial for up to 10-mg dose. 2. Dissolve contents of vial completely; resulting solution should be clear and yellow. 3. Use solution within 1 hour; discard any unused portion. 4. Refer to table for injection volumes and corresponding doses of ZYPREXA IntraMuscular. 5. Immediately after use, dispose of syringe in approved sharps box. Recommended dose for agitation in schizophrenia or bipolar mania is 10 mg. If clinically warranted, subsequent doses up to 10 mg may be given to agitated patients with schizophrenia or bipolar mania. However, the efficacy of repeated doses has not been systematically evaluated in controlled clinical trials. The safety of total daily doses greater than 30 mg or of 10 mg injections given more frequently than 2 hours after the initial dose and 4 hours after the second dose has not been evaluated in clinical trials. Maximal dosing (three 10-mg doses administered 2-4 hours apart) may be associated with substantial occurrence of significant orthostatic hypotension; it is recommended that patients requiring subsequent intramuscular injections be assessed for orthostatic hypotension prior to the administration of any subsequent doses. The administration of an additional dose to a patient with a clinically significant postural change in systolic blood pressure is not recommended. Patients should remain recumbent if drowsy or dizzy after injection until examination has indicated that they are not experiencing postural hypotension and/or bradycardia. Recommended dose for agitation in special populations is 2.5mg - 5mg. A dose of 5 mg per injection should be considered for geriatric patients or when other clinical factors warrant. A lower dose of 2.5mg per injection should be considered for patients who otherwise might be debilitated, be predisposed to hypotensive reactions, or be pharmacodynamically sensitive to olanzapine. |
perphenazine
(Trilafon ®):
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Piperazine phenothiazine. Dosing (Adults): Schizophrenia/psychoses: Oral: 4-16 mg 2-4 times/day not to exceed 64 mg/day. Nausea/vomiting: Oral: 8-16 mg/day in divided doses up to 24 mg/day. Supplied: 2 mg, 4 mg, 8 mg, 16 mg tab. |
pimozide
(Orap ®):
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INDICATIONS: ORAP (pimozide) is indicated for the
suppression of motor and phonic tics in patients with Tourette's
Disorder who have failed to respond satisfactorily to standard
treatment. ORAP is not intended as a treatment of first choice nor is it
intended for the treatment of tics that are merely annoying or
cosmetically troublesome. ORAP should be reserved for use in Tourette's
Disorder patients whose development and/or daily life function is
severely compromised by the presence of motor and phonic tics. Evidence supporting approval of pimozide for use in Tourette's Disorder was obtained in two controlled clinical investigations which enrolled patients between the ages of 8 and 53 years. Most subjects in the two trials were 12 or older. Dosing (Adults): Tourette's: In general, treatment with ORAP should be initiated with a dose of 1 to 2 mg a day in divided doses. The dose may be increased thereafter every other day. Most patients are maintained at less than 0.2 mg/kg per day, or 10 mg/day, whichever is less. Doses greater than 0.2 mg/kg/day or 10 mg/day are not recommended. Note: Sudden unexpected deaths have occurred in patients taking doses >10 mg. Note: An ECG should be performed baseline and periodically thereafter, especially during dosage adjustment. Supplied: 1 mg, 2 mg tab. |
quetiapine (Seroquel ®):
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Atypical antipsychotic. Dosing (Adults): Schizophrenia/psychosis: Oral: 25-100 mg 2-3 times/day. Usual starting dose 25 mg twice daily, increased in increments of 25-50 mg 2-3 times/day on the second or third day. By the fourth day, the dose should be in the range of 300-400 mg/day in 2-3 divided doses. Further adjustments may be made, as needed, at intervals of at least 2 days in adjustments of 25-50 mg twice daily. Usual maintenance range: 150-750 mg/day. Mania: Oral: Initial: 50 mg twice daily on day 1, increase dose in increments of 100 mg/day to 200 mg twice daily on day 4; may increase to a target dose of 800 mg/day by day 6 at increments of </= 200 mg/day. Usual dosage range: 400-800 mg/day. Supplied: 25 mg, 100 mg, 200 mg, 300 mg tab. |
risperidone (Risperdal ®):
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Atypical antipsychotic. Dosing (Adults): Bipolar mania: Oral: Recommended starting dose: 2-3 mg once daily; if needed, adjust dose by 1 mg/day in intervals of at least 24 hours. Dosing range: 1-6 mg/day. Schizophrenia: Oral: Recommended starting dose: 0.5-1 mg twice daily - slowly increase to the optimum range of 3-6 mg/day. May be given as a single daily dose once maintenance dose is achieved. Daily dosages >6 mg does not appear to confer any additional benefit, and the incidence of extrapyramidal symptoms is higher than with lower doses. IM (Risperdal ® Consta): 25 mg every 2 weeks. Some patients may benefit from larger doses. Maximum dose not to exceed 50 mg every 2 weeks. Dosage adjustments should not be made more frequently than every 4 weeks. Supplied: Tablet: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg. Oral solution: 1 mg/ml (30 ml). Oral disintegrating tablets (Risperdal M-Tabs): 0.5 mg, 1 mg , 2 mg. Injection (Risperdal® Consta): 25 mg, 37.5 mg, 50 mg. |
thioridazine
(Mellaril ®):
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Low Potency. Dosing (Adults): Schizophrenia/psychosis: Oral: Initial:
50-100 mg 3 times/day with gradual increments as needed and tolerated.
Maximum: 800 mg/day in 2-4 divided doses. Depressive disorders,
dementia: Oral: Initial: 25 mg 3 times/day; maintenance dose: 20
to 200
mg/day. Supplied: 10 mg, 15 mg, 25 mg, 50 mg, 100 mg, 150 mg, 200 mg tablet. |
thiothixine
(Navane ®):
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High Potency. Dosing (Adults): Mild / moderate psychosis: Oral: 2 mg 3 times/day, up to 20-30 mg/day. Severe psychosis: Initial: 5 mg 2 times/day, may increase gradually, if necessary; maximum: 60 mg/day. Rapid tranquilization (administered every 30 to 60 minutes): Oral: 5-10 mg; average total dose for tranquilization: 15-30 mg Supplied: 1 mg, 2 mg, 5 mg, 10 mg cap. |
trifluoperazine
(Stelazine ®):
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Piperazine phenothiazine.
High Potency. Dosing (Adults): Schizophrenia/ psychoses: Oral: Outpatient: 1-2 mg twice daily. Hospitalized / well supervised patient: Initial: 2-5 mg twice daily with optimum response in the 15-20 mg/day range; do not exceed 40 mg/day. Supplied: 1 mg, 2 mg, 5 mg, 10 mg tab. |
ziprasidone (Geodon ®):
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Dosing (Adults): Bipolar mania: Oral:
Initial: 40 mg twice daily (with food). Adjustment: May increase to 60
or 80 mg twice daily on second day of treatment. Average dose 40-80 mg
twice daily. Schizophrenia: Oral: Initial: 20 mg twice daily (with food). Adjustment: Increases (if indicated) should be made no more frequently than every 2 days; ordinarily patients should be observed for improvement over several weeks before adjusting the dose. Maintenance: Range 20-100 mg twice daily; however, dosages >80 mg twice daily are generally not recommended. Acute agitation (schizophrenia): 10 mg IM every 2 hours or 20 mg every 4 hours (maximum: 40 mg/day). Oral therapy should replace IM administration as soon as possible. Supplied: 20 mg, 40 mg, 60 mg, 80 mg cap. 20 mg - injection (powder for reconstitution). |
Other |
Lithium (Eskalith CR ® Eskalith ® Lithobid ®)
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Indications: Management of acute manic episodes,
bipolar disorders, and depression Dosage forms: Lithium is a monovalent cation Lithium carbonate Tablet or capsule: 300 mg (8.12 mEq lithium) 600 mg (16.24 mEq lithium) Extended release capsule: 300 mg (8.12 mEq lithium) 450 mg (12.18 mEq lithium) Lithium citrate Oral solution: 8 mEq (of lithium) /5 mL Other: 1) No clinically significant differences exist between lithium-immediate-release capsules and tablets. 2) Both formulations are 95-100% absorbed. 3) Switching among the citrate, capsule, and tablet dosage forms should not result in significantly different 12-hr steady-state levels. 4) Sustained-release formulations were developed to decrease the adverse effects associated with peak and rapidly rising serum lithium concentrations. This difference is restricted to a minority of patients. 5) Switch patients between the immediate-release and sustained-release products on a mg-for-mg basis. Usual dosage: 900-2000 mg/day (acute mania) with normal renal function. 600 mg/day (prophylaxis). Literature-Based Dosing vs Kinetic-Based Dosing Based on kinetic population parameters and modified according to clinical experience -initial doses = 900-1200mg/day; increased by 300-600mg Q 2-3 days. if decreased renal function, use above guidelines. Test Dose Methods for Inital Dosage (Single Point Method) . Monitor serum lithium every 4 to 5 days during initial therapy. Drawing Levels: obtain trough level just before next dose (8-12 hours after previous dose). Levels should be obtained twice weekly until both patient's clinical status and levels are stable then levels may be obtained every 1-3 months. Target levels: Acute mania: 0.6-1.2 mEq/L (SI: 0.6-1.2 mmol/L) Protection against future episodes in most patients with bipolar disorder: 0.8-1 mEq/L (SI: 0.8-1.0 mmol/L); a higher rate of relapse is described in subjects who are maintained at <0.4 mEq/L (SI: 0.4 mmol/L). Elderly patients can usually be maintained at lower end of therapeutic range (0.6-0.8 mEq/L) Toxic concentration: >1.5 mEq/L (SI: >2 mmol/L). Adverse effect levels: GI complaints/tremor: 1.5-2 mEq/L. Confusion/somnolence: 2-2.5 mEq/L. Seizures/death: >2.5 mEq/L Renal Dosing: CrCl 10-50 mL/minute: Administer 50-75% of normal dose CrCl < 10 mL/minute: Administer 25-50% of normal dose Hemodialysis: 50-100% dialyzable - administer after each dialysis treatment. Most patients tolerate BID dosing. |
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