Dosing of Antipsychotic Agents

A. Initial treatment should begin with divided doses, such as two to four times per day. Olanzapine (Zyprexa) can be initiated with once-a-day dosing.

B. Once steady state levels have been achieved (after about 5 days), the long half-life of neuroleptics may be given once a day; however, low- potency agents such as chlorpromazine should be given in divided doses to reduce side effects.

C. The dose of neuroleptic in acute psychosis, such as in schizophrenia, should be approximately 500 to 600 mg of chlorpromazine equivalents. Higher doses are generally not needed for most patients and usually result in more side effects and noncompliance.

D. Rapid tranquilization with large amounts of neuroleptic in the first few days of treatment has not been shown to be effective. The use of neuroleptics on an "as needed" basis is ineffective.

E. In the initial phase of treatment, agitated psychotic patients are best treated with sedating agents such as benzodiazepines combined with an adequate dose of neuroleptic.

Classification of Antipsychotic Drugs

Name

Trade name

Class

Average Dose (mg)

Chlorpromazine Equivalents (mg)

Dopaminergic

Effect (D2)

Muscarinic Effect

Alpha-1 Adrenergic Blocking Effect

Antihistamine Effect

Serotonergic Effect

Chlorpromazine

Thorazine

Phenothia-zine/Alipha-tic

600-800

100

++++

+ + + +

++++

++++

++++

Fluphenazine

zine/Pipera-

zine

10-20

2

++++

+

+

+ +

++

Perphenazine

zine/Pipera-

zine

60-80

10

++++

+

++

+++

++++

Trifluoperazine

zine/Pipera-

zine

30-40

5

++++

+

+ +

+ +

+++

Thioridazine

Mellaril

Phenothia-zine/Piperi-dine

600-800

100

++++

+ + + +

++++

++++

++++

Mesoridazine

Serentil

Phenothia-zine/Piperi-dine

300-400

50

++++

+ + +

++++

++++

++++

Haloperidol

Haldol

Butyrophe-none

10-20

2

++++

+

+

+

++

Clozapine

Clozaril

Dibenzo-diazepi-ne/Atypical Agents

300-600

60

++

+ + + +

++++

++++

++++

Name

Trade name

Class

Average Dose (mg)

Chlorpro-mazine Equivalents (mg)

Dopaminer-gic

Effect (D2)

Muscarinic Effect

Alpha-1 Adrenergic Blocking Effect

Antihistamine Effect

Serotonergic Effect

Loxapine

Loxitane

Dibenzodia-zepine

75-100

12.5

+++

+ +

+++

++++

++++

Pimozide

Orap

Diphenylbu-ylpiperidine

2-15

1

++++

+

+

+

Molindone

Moban

Dihydroindo-lone

50-100

10

+++

+ +

+

+

+

Thiothixene

Navane

Thioxanth-ene

30-40

5

++++

+

++

+++

+

Risperidone

Risperdal

Benzisox-azole

2-8

1-2

++

+

+++

++

+++

Olanzapine

Zyprexa

Thienoben-zodiazepine

5-20

3

+++

++

++

++

+++

Quetiapine

Seroquel

Dibenzothi-azepine

300-400

50

+

0

++

++

++

Ziprasidone

Zeldox

Benzisothi-azolyl pip-erzine

80-160

5-10

+++

+

+

+

+++

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