Psychosis Treatments

PSYCHOSIS TREATMENTS
Brand
(Generic & Form)
Indication Adult
Initial Dose
Adult Dose Titration
FIRST-GENERATION ANTIPSYCHOTICS
(fluphenazine HCl; tabs, elixir, oral conc) Psychosis 2.5−10mg daily in 3−4 divided doses Maintenance:
5mg twice daily
Reduce gradually to 1−5mg/day when symptoms are controlled
Haldol
(haloperidol lactate; inj)
Schizophrenia 2−5mg IM every 4−8hrs or up to hourly if needed Switch to oral form 12−24hrs after last inj
(trifluoperazine HCl; tabs) Psychosis 2−5mg twice daily 15−20mg/day
(thioridazine HCl; tabs) Schizophrenia unresponsive to (preferably 2) other antipsychotics 50−100mg three times daily 200−800mg/day in 2−4 divided doses May increase gradually to max 800mg/day
(chlorpromazine HCl; tabs)

Psychosis

 

Mania

Less acutely disturbed:

25mg three times daily

 

Outpatient:

10mg 3−4 times daily or 25mg 2−3 times daily

 

Severe cases:

25mg three times daily

Inpatient:

500−1000mg/day

 

Less acutely disturbed:

400mg/day

 

Outpatient:

200−800mg/day

Increase dose gradually until symptoms are controlled. Continue optimum dosage for 2wks; then gradually reduce to lowest effective maintenance dose. See literature.
SECOND-GENERATION ANTIPSYCHOTICS
Abilify
(aripiprazole; tabs, soln)
Abilify Discmelt
(aripiprazole; ODT)
Schizophrenia 10mg or 15mg once daily 15mg/day; max 30mg/day May increase at intervals of at least 2wks
Abilify Maintena
(aripiprazole; ext‑rel inj)
Schizophrenia 400mg IM once monthly (no sooner than 26 days after the previous inj) 400mg IM once monthly (no sooner than 26 days after the previous inj) After first Maintena dose, continue with concurrent oral aripiprazole (10mg or 20mg) or other antipsychotic for 14 consecutive days. May reduce to 300mg IM once monthly if adverse reactions occur.
Clozaril
(clozapine; tabs)

Refractory severe schizophrenia

 

Reduce risk of recurrent suicidal behavior in schizoaffective disorders

Schizophrenia:

12.5mg 1−2 times daily

 

Recurrent suicidal behavior:

300mg/day

Schizophrenia:

300−450mg/day in divided doses

 

Recurrent suicidal behavior:

300mg/day (12.5−900mg daily; treat for at least 2yrs)

May increase by increments of 25−50mg/day to 300−450mg/day in divided doses by the end of 2wks. Then may increase once or twice weekly in increments of up to 100mg; max 900mg/day. Reduce gradually over 1−2wks if discontinuing; may discontinue abruptly if necessary (eg, leukopenia, myocarditis; may cause relapse or cholinergic rebound). Retitrate if stopped for ≥2 days.
Fanapt
(iloperidone; tabs)
Acute treatment of schizophrenia 1mg twice daily on day 1,
2mg twice daily on day 2,
4mg twice daily on day 3,
6mg twice daily on day 4,
8mg twice daily on day 5,
10mg twice daily on day 6,
12mg twice daily on day 7
6−12mg twice daily; max 24mg/day Retitrate if stopped for >3 days
FazaClo
(clozapine; ODT)

Refractory severe schizophrenia

 

Reduce risk of recurrent suicidal behavior in schizoaffective disorders

Schizophrenia:
12.5mg 1−2 times daily

 

Recurrent suicidal behavior:
300mg/day

Schizophrenia:
300−450mg/day in divided doses

 

Recurrent suicidal behavior:
300mg/day (12.5−900mg daily; treat for at least 2yrs)

May increase by increments of 25−50mg/day to 300−450mg/day in divided doses by the end of 2wks. Then may increase once or twice weekly in increments of up to 100mg; max 900mg/day. Reduce gradually over 1−2wks if discontinuing; may discontinue abruptly if necessary (eg, leukopenia, myocarditis; may cause relapse or cholinergic rebound). Retitrate if stopped for ≥2 days.
Geodon
(ziprasidone HCl; caps)
Schizophrenia 20mg twice daily, max 80mg twice daily 20−80mg twice daily May increase at intervals of at least 2 days
Geodon for Injection
(ziprasidone mesylate; for inj)
Rapid control of acute agitation 10−20mg IM as needed Max 40mg/day (10mg every 2hrs; or 20mg every 4hrs); treat for max 3 days Switch to oral form as soon as possible
Invega
(paliperidone; ext‑rel tabs)

Schizophrenia

 

Acute treatment of schizoaffective disorder

6mg once daily in AM 3−12mg once daily; max 12mg/day May increase in increments of 3mg/day at intervals of >5 days (for schizophrenia) or >4 days (for schizoaffective disorder)
Invega Sustenna
(paliperidone; ext‑rel inj)
Schizophrenia 234mg IM on day 1, then 156mg IM one week later 117mg IM (39−234mg) monthly
Invega Trinza
(paliperidone; ext‑rel inj)
Schizophrenia Give when next Invega Sustenna dose is scheduled using 3.5‑fold higher dose equivalent (see full labeling) Give once every 3mos May adjust dose every 3mos in increments of 273−819mg based on tolerability and/or efficacy
Latuda
(lurasidone HCl; tabs)
Schizophrenia 40mg once daily 40−160mg once daily; max 160mg/day
Risperdal
(risperidone; tabs, soln)
Risperdal M-Tabs
(risperidone; ODT)
Schizophrenia 2mg/day in 1−2 doses 4−16mg/day; max 16mg/day May increase by 1−2mg/day at intervals of at least 24hrs to target dose 4−8mg/day
Risperdal Consta
(risperidone; long-acting inj)
Schizophrenia Give with oral risperidone (or other antipsychotic) for 3wks, then stop oral form 25mg IM every 2wks; max 50mg every 2wks May adjust dose every 4wks
Saphris
(asenapine SL; tabs)
Schizophrenia Acute:
5mg twice daily; max 20mg/day
Maintenance:
5mg twice daily; max 20mg/day
May increase to 10mg twice daily after 1wk
Seroquel
(quetiapine fumarate; tabs)
Schizophrenia 25mg twice daily on day 1; increase by 25−50mg 2−3 times daily on days 2 and 3; target 300−400mg/day in 2−3 divided doses by day 4 150−750mg/day; max 800mg/day, all in divided doses May adjust at 2-day intervals by 25−50mg twice daily. Continue at lowest dose to maintain remission.
Seroquel XR
(quetiapine fumarate; ext‑rel tabs)
Schizophrenia 300mg once daily in the PM 400−800mg/day; max 800mg/day May increase at 1-day intervals in increments of up to 300mg/day
Versacloz
(clozapine; oral susp)

Treatment-resistant schizophrenia

 

Reduce risk of recurrent suicidal behavior in schizoaffective disorders

12.5mg 1−2 times daily May increase by 25−50mg/day to 300−450mg/day by the end of 2wks. Then may increase once or twice weekly in increments of up to 100mg; max 900mg/day.
Zyprexa
(olanzapine; tabs)
Zyprexa Zydis
(olanzapine; ODT)
Schizophrenia 5−10mg once daily, increase to 10mg once daily within several days 10−20mg/day; max 20mg/day May adjust by 5mg/day at intervals of 1wk
Zyprexa IntraMuscular
(olanzapine; inj)
Agitation due to schizophrenia 2.5−10mg/dose IM; up to 3 doses (2−4hrs apart) Switch to oral form when appropriate
NOTES

Key: ext-rel = extended-release; ODT = orally-disintegrating tablets; SL = sublingual

Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.

(Rev. 7/2015)

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