Medication

Forms

Dose for Psychosis (Start, Initial Target, Max)

Comments

• Aripiprazole (Abilify)

Tab: 2,5,10,15,20,30

Child: Start 2.5 mg daily, up to 15 mg daily

Adol/adult: Start 5 mg daily, initial target 5-15 mg daily, max 30 mg daily

Theoretically less metabolic side effects

• Lurasidone (Latuda)

Tab: 20,40, 60, 80, 120 mg

Adol/adult: Start 20-40 mg daily, increase by 20 mg daily every 2-7 days up to 80-120 mg daily

Bipolar depression, Schizophrenia

• Ziprasidone (Zeldox)

Adol/adult: Start 20 mg daily, initial target 20-40 mg daily, max 160-180 mg in adults

Bipolar,

Tourette Disorder

• Asenapine (Saphris)

Usual dose range: 2.5-10 mg bid

Max 10 mg bid (i.e. 20 mg daily total)

Adult: Start 5-10 mg twice daily; max dosage 10 mg twice daily.

• Risperidone (Risperdal)

Tab: 0.25,0.5, 1,2,3,4 mg

M-Tab: 0.5,1,2,3,4 mg

Child:

15-20 kg: Start 0.25 mg od up 0.5-3 mg daily

> 20 kg: Start 0.5 mg od, up to 1-3 mg daily

Adol/adult: Start 1-2 mg daily, up to 6-8 mg daily

Agitation / Aggression

Alzheimer;

Anxiety

Bipolar, Major depression, Schizophrenia, Tourette

Doses of < 3 mg daily are best for first episode psychosis

Dosing bid or tid

• Paliperidone (Invega)

Tabs: 3,6,9 mg

Susp: Sustenna, Trinza

Adol/adult: Start 3 mg daily, up to 12 mg daily

• Olanzapine (Zyprexa)

Tab: 2.5,5,7.5,10,15,20 mg

Rapid dissolve Zydis: 5,10,15,20

IM solution 10 mg

Child: Start 2.5 mg daily, up to 5 mg initial target; max 10 mg daily

Adol/adult: Start 2.5-5 mg daily, up to 10 mg daily initial target, max 20-30 mg daily

Rapid dissolve (Zydis) helpful as PRN for agitated patients

Compared to Risperidone:

• Lower risk of motor side effects and elevated prolactin
• Higher risk of sedation, weight gain

• Quetiapine (Seroquel) IR

Tab: 25,50,100,150,200,300 mg

Child: Start 12.5 mg, titrate up to 150 mg daily initial target; max 300 mg daily

Adol/adult: Start 25 mg qhs, titrate up to 400-800 mg daily, max 600-800 mg daily

Sample titration for Immediate-release tablet (IR):

Day 1: 25 mg twice daily

Day 2: 50 mg twice daily

Day 3: 100 mg twice daily

Day 4: 150 mg twice daily

Day 5: 200 mg twice daily target dosage

Usual dosage range: 200 to 400 mg twice daily

Maximum daily dose: 800 mg/day.

Bipolar disorder, mania, mixed episodes; Schizophrenia;

Depression

Adults: Studies show no additional benefit was seen with 400 mg twice daily vs 200 mg twice daily.

• Quetiapine XL (Seroquel XL)

Tab XR: 50,150,200,300,400 mg

Child: Start 12.5 mg, titrate up to 150 mg daily initial target; max 300 mg daily

Adol/adult: Start 25 mg qhs, titrate up to 400-800 mg daily, max 600-800 mg daily

Day 1: 50 mg qhs

Day 2: 100 mg qhs

Day 3: 200 mg qhs

Day 4: 300 mg qhs

Day 5: 400 mg qhs

Usual dosage range: 400-800 mg once daily

Max daily dose: 800 mg/day.

Bipolar disorder, mania, mixed episodes; Schizophrenia;

Depression

Treatment resistant

• Clozapine (Clozaril)

Child: Start 6.25-25 mg, titrate up to 150-300 mg daily, max 300 mg daily

Adol/adult: Start 6.25-25 mg daily, titrate up to 200-300 mg daily, max 600 mg daily

Indicated for treatment resistant psychosis

Regular bloodwork required

Medication

Forms

Dose for Psychosis (Start, Initial Target, Max)

Comments

Indication / Comments

Chlorpromazine (Largactil®)

Adult:

Less acutely disturbed:

25mg tid
 

Outpatient:

10mg, tid-qid or

25mg, bid-tid
 

Severe cases:

25mg tid

Initial target: 400-600 mg daily

Max dosages:

Less acutely disturbed:

400mg / daily
 

Outpatient:

200–800 mg daily

Inpatient:

500–1000 mg daily

Low doses (<400 mg daily) preferable due to less side effects

Loxapine HCl (Loxitane®)

10 mg PO tid

12.5-50 mg IM q4-6h

Titrate up to 60-100 mg daily

Max 250 mg daily

Fluphenazine enanthate (Moditen®,

Modecate® for IM formulation)

Start 2.5-10 mg/d

Titrate up to

1-5 mg qhs

25 mg IM/SC q1-3wk

Max 20 mg daily

Perphenazine (Trilafon®)

Outpatient with schizophrenia:

4-8 mg tid initially; reduce as soon as possible to minimum effective dosage.

Inpatient with schizophrenia: 8-6 mg bid to qid

Max 64 mg daily

Haloperidol (Haldol®)

Starting dose:

2-5 mg IM q4-8h

0.5-5 mg po tid

0.2 mg/kg/d po

Max 20-30 mg daily

Start low, go slow

Watch for EPS