08 - Antipsychotics minimum effective doses

Antipsychotics – minimum effective doses

8 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Antipsychotics – minimum effective doses Table 1.1 suggests the minimum dose of individual antipsychotics likely to be effective in first-­ or multi-­episode schizophrenia. Most patients will respond to the dose suggested, although others may require higher doses. Given the variation in individual response, all doses should be considered approximate. Primary references are provided where available, but some consensus opinion has also been used. Only oral treatment with commonly used drugs is covered. Table 1.1  Minimum effective dose/day – antipsychotics Drug First episode Multi-­episode First-­generation Chlorpromazine1 200mg* 300mg Haloperidol2–6 2mg 4mg Sulpiride7 400mg* 800mg Trifluoperazine8,9 10mg* 15mg Second-­generation Amisulpride10,11 300mg* 400mg* Aripiprazole6,12–16 10mg 10mg Asenapine6,16,17 5mg* 10mg Blonanserin18 Not known 8mg Brexpiprazole19,20 2mg* 4mg Cariprazine21,22 1.5mg* 1.5mg Clotiapine23,24 Not known 120mg Iloperidone6,16,25 4mg* 8mg Lumateperone26 Not known 42mg* Lurasidone6,27 40mg HCl/37mg base* 40mg HCl/37mg base Olanzapine6,28–31 5mg 7.5mg Paliperidone16 3mg* 3mg Pimavanserin32–34 Not known 34mg** Quetiapine35,36 150mg* (but higher doses often used37) 300mg IR 500mg MR38 Risperidone3,6,39–42 2mg 4mg Xanomeline43,44 200mg* 200mg* Ziprasidone6,15,45–47 40mg* 80mg * Estimate – too few data available. ** US Food and Drug Administration-­approved for Parkinson’s disease psychosis; dose in schizophrenia not clear.