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Psychosis: Antipsychotics

Table 7.1: First- and second-generation antipsychotic medications 

 

medication

starting dose (mg/day)

usual target dose (mg/day)

maximal dosage (mg/day)2

frequency

Second-generation antipsychotics — oral — generic name (brand name)

Risperidone

(Risperdal)

0.5 – 2

2 – 6

8

od or bid

Olanzapine

(Zyprexa)

5 – 10

10 – 20

20

od

Quetiapine

(Seroquel)

50 – 100

300 – 800

800

od or bid

Quetiapine  XR (Seroquel XR)

300

400 – 800

800

od

Ziprasidone

(Zeldox)3

80

120 – 160

200

bid with meals

Aripiprazole

(Abilify)

10 – 15

10 – 30

30

od

Clozapine

(Clozaril)

12.5 – 25

300 – 600

900

od to tid

Second-generation antipsychotics — depot — generic name (brand name)

Risperidone long- acting injectable (Risperdal Consta)

12.5 – 25 (oral supple- mentation required

for the first

3 weeks)

25 – 37.5

50

q2weeks

 

 

 

First-generation antipsychotics — oral— generic name (brand name)

Haloperidol

(Haldol)

1 – 3

4 – 12

20

bid or tid

Fluphenazine

(Moditen)

2.5 – 10

1 – 5

20

od to tid

Flupenthixol

(Fluanxol)

1 – 3

3 – 6

12

tid

Perphenazine

(Trilafon)

8 – 16

16 – 64

64

bid to qid

Loxapine (Loxapac)

10 – 50

60 – 100

250

bid to qid

Zuclopenthixol

(Clopixol)

10 – 50

20 – 60

100

bid or tid

First-generation antipsychotics — depot— generic name (brand name)

Haloperidol dec- anoate (Haldol LA)

25

50 – 200

300

q4 weeks

Fluphenazine dec- anoate (Modecate)

2.5 – 12.5

12.5 – 50

100

q2 – 4 weeks

Flupenthixol dec- anoate (Fluanxol Depot)

5 – 20

20 – 80

80

q2 – 3 weeks

Zuclopenthixol acetate (Clopixol Acuphase)

25 – 50

50 – 150

400 (cumulative dose)

q2 – 3 days

Zuclopenthixol decanoate (Clopixol Depot)

100 – 200

150 – 300

400 q2weeks

q2 – 4 weeks

 

1     Not an exhaustive list of all FGA or FGA-depot antipsychotics  available. Dosages are for adult patients. In the elderly, appropriate dosage adjustments may be necessary.

2   Based on Compendium  of Pharmaceuticals and Specialties (Canadian Pharmacists Association,

2009) values, or when not available, Clinical Handbook of Psychotropic Drugs, 18th edition

(Virani, et al., 2009).

3    Ziprasidone  must be taken with meals to ensure adequate medication absorption.