Antipsychotics Flashcards
Fluphenazine (Prolixin) Dosing
Tablet: 1,2.5,5,10mg Oral Elixir: 2.5mg/5ml Concentrate: 5mg/ml Injection (IR): 2.5mg/ml LA Depot: 25mg/ml Initiate 2.5-10mg/day Q6-8 hrs; dose range: 1-50mg/day; MAX: 100mg/day
Fluphenazine (Prolix) Clinical
2D6 substrate
Haloperidol (Haldol) Dosing
Tablet: 0.5,1,2,5,10,20mg Oral Soln: 2mg/ml Injection (IR): 5mg/ml LA Depot: 50mg/ml, 100mg/ml Initiate 1-15mg/day, divide doses if needed, MAX: 100mg/day
Haloperidol (Haldol) Clinical
2D6, 3A4 substrate
Loxapine (Loxitane, Adasuve) Dosing
Oral inhalation powder: 10mg/dose
10mg dose Q24 hrs
Loxapine (Loxitane, Adasuve) Clinical
“Atypical typical”
Adasuve oral inhalation power has REMS - must be in hospital setting w/ emergency service access, CI’d w/ hx of lung disease, monitor closely for bronchospasm
Perphenazine (Trilafon) Clinical
Increased use in recent years due to CATIE study
Pimozide (Orap) Clinical
3A4 substrate, QTc prolongation limits use, usual clinical use limited to Tourette’s disorder
Thioridazine (Mellaril) Clinical
Significant QTc prolongation limits use, not generally initiated as new therapy, informed consent necessary
Thiothixene (Navane) Clinical
1A2 substrate
Aripiprazole (Abilify and Abilify Maintena) Dosing
Tablet: 2,5,10,15,20,30mg
LA Depot: 300mg/vial, 400mg/vial
Liquid: 1mg/ml
Initiate 10-15mg QD, titrate Q2 weeks, MAX: 30mg/day
IR Injection: 9.75mg IM, 2 hrs between doses, MAX: 3 injections/day
LA Depot: 400mg IM once monthly, overlap w/ oral x2 weeks
Aripiprazole (Abilify and Abilify Maintena) Clinical
2D6, 3A4 substrate
Very long T1/2
FDA approved for MDD in combo with antidepressant (not LAI)
Aripiprazole lauroxil (Aristada) Dosing
LA Depot: 442mg/vial, 662mg/vial, 882mg/vial
Initiate based on oral dose:
10mg QD: 442mg
15mg QD: 662mg
20mg QD: 882 mg
Any dose can be given Q4 weeks, 882mg Q6 weeks if tolerated, MUST overlap oral aripiprazole x3 weeks
Aripiprazole lauroxil (Aristada) Clinical
2D6, 3A4 substrate
LAI dosage form only, dose adjustments for 2D6/3A4 inhibitors and/or 3A4 inducers
Asenapine (Saphris) Dosing
Sublingual tablet
Asenapine (Saphris) Clinical
1A2 substrate
Must be taken SL, bioavailability improved to 25-30%, must not eat, drink, smoke for 10 min after dose
Brexpiprazole (Rexulti) Clinical
2D6, 3A4 substrate
Lower risk of akathisia compared to aripiprazole, higher risk of weight gain, dose adjustments for severe hepatic impairments, D2/D3 partial agonist
Cariprazine (Vraylar) Clinical
3A4 substrate
Greater risk of akathisia vs aripiprazole or brexpiprazole, moderate weight gain, may have serotonin effects for better efficacy in negative symptoms, D2/D3 partial agonist
Clozapine (Clozaril, Fazaclo) Dosing
Initiate 12.5-25mg/day at bedtime, titrate in increments of 25-50mg/day wkly to target of 300-450mg/day, MAX: 900mg/day, can divide dose for tolerability
Clozapine (Clozaril, Fazaclo) Clinical
1A2 substrate
WBC/ANC must be monitored wkly x6 months, Q2 wks x6 months, then Q4 wks, maintain ANC above 1500, boxed warning for agranulocytosis, myocarditis, dose-related seizures, and orthostatic hypertension, constipation, weight gain, metabolic syndrome, hypersalivation, Pregnancy B
Iloperidone (Fanapt) Dosing
Initiate 1mg BID, increase by 2mg/day until target dose: 12-24mg/day, MAX: 24mg/day
Iloperidone (Fanapt) Clinical
2D6, 3A4 substrate
Titrate slowly due to significant orthostatic hypotension, QTc prolongation
Lurasidone (Latuda) Dosing
Initiate 40mg QD, MAX: 160mg/day
Lurasidone (Latuda) Clinical
3A4 substrate
Pregnancy B, must take with food to improve bioavailability and Cmax (400 calorie meal)
Olanzapine (Zyprexa) Dosing
Initiate 2.5-10mg QD, dose range: 5-20mg/day (may see clinically higher doses)
IR injection: 10mg, MAX: 3 injections Q24 hrs, given 2-4 hrs apart
LA Depot: 150-300mg IM Q2 wks or 405mg IM Q4 wks
Olanzapine (Zyprexa) Clinical
1A2 substrate
IR injection: Don’t give in same syringe as lorazepam injection: boxed warning for respiratory depression
LA Depot: REMS for PDSS
Paliperidone (Invega, Invega Sustenna, Invega Trinza) Dosing
ER tablet LA Depot (Q4 wks): 39,78,117,156,234mg LA Depot (Q12 wks): 273,410,546,819mg Initiate 6mg QD, MAX: 12mg/day LA Depot (Q4 wks): 234mg load, 117mg booster on day 8, maintenance Q5 wks after load, 39-234mg IM Q4 wks LA Depot (Q12 wks): based on stable 4 wks of Invega Sustenna: 78mg Invega: 273mg Trinza 117mg: 410mg 156mg: 546mg 234mg: 819mg
Paliperidone (Invega, Invega Sustenna, Invega Trinza) Clinical
Renal elimination, ER leaves ghost tabs, 9-OH metabolite of risperidone
Trinza: specific instructions for vigorous shaking to suspend, important to avoid incomplete suspension
Quetiapine (Seroquel) Clinical
3A4 substrate
25-50mg used for sleep (NOT RECOMMENDED)
Street use: $1/mg
Recent boxed warning for QTc prolongation
Risperidone (Risperdal) Dosing
LA depot injection doesn’t provide appreciable serum concentrations until between 2nd and 3rd dose, must overlap oral for efficacy, EPS prominent at doses beginning at 6mg/day
Ziprasidone (Geodon) Dosing
Initiate 20mg BID WITH FOOD, dose range: 80mg BID, min effective dose: 120mg/day, MAX recommended: 160mg/day, MAX clinically: 240mg/day
Ziprasidone (Geodon) Clincal
Must be given with food to improve bioavailability (400 calorie meals), clinically given QD with evening meal, QTc prolongation, DRESS
