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Medication Table: Antipsychotic Medications

Summary: This medication table is for informational purposes only and is not a replacement for clinical judgment and consulting a drug reference (such as PDR or Lexi-Comp).
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Antipsychotic Medications

Second General Antipsychotics (SGA) (aka “Atypicals”) 

Medication

Forms

Dose for Psychosis (Start, Initial Target, Max)

Comments

Less metabolic effects       
  • Aripiprazole (Abilify)

Tab: 2,5,10,15,20,30
May cut or crush.

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

May cut or crush.

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)
 
Capsule: 20,40,60,80 mg
Label states capsule should be swallowed whole.
However, not on ISMP’s “Do Not Crush List”.
Child: Unknown

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

Schizophrenia, Autistic disorder (irritability),

Bipolar,

Tourette Disorder

  • Asenapine (Saphris)
Tab: 5,10 mg
May cut or crush.
Child: Start 2.5 mg bid x 3-5 days, then 10 mg bid

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.

Agitation/aggression, bipolar disorder, schizophrenia, psychosis with dementia
More metabolic effects       
  • Risperidone (Risperdal)

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

May cut or crush.

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

Label states do not cut or crush M-Tabs. 

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

Don't cut or crush.

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

May be cut or crushed. 

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

May not be cut or crushed; doing so would eliminate the XL features and make it immediate release. 

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 rapid titration

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)
Tab: 25, 50, 100, 200
May be cut or crushed. 

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

 

* Monitor side effects as per CAMESA Guidelines.

* Dosage information from manufacturer.

First-Generation Antipsychotics (FGA) (aka “Typicals”) 

Medication

Forms

Dose for Psychosis (Start, Initial Target, Max)

Comments

Indication / Comments

Chlorpromazine (Largactil®)

Tab: 25,50,100 mg

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®, Loxapac®, Xylac®) 

Tab: 5,10,25,50 mg

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)

Tab 1,2,5 mg 

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®)

Tab: 2,4,8,16 mg 

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®)

Tab: 0.5,1,5,10 mg 

Liquid 5 mg/mL

Long acting (LA) 100 mg/mL 

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

 

Date Posted: Oct 20, 2020
Date of Last Revision: Sep 17, 2022

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