Antipsychotics/mood stabilizers

Question 1

trifluoperazine/Stelazine

Answer 1

psychosis: starting dose- 2-5mg BID, increase gradually over 2-3 weeks
anxiety- 1-2 mg/day
max 6mg/day
dosing can be QD

Question 2

aripiprazole/abilify

Answer 2

Dosing- start at 5-10mg a day (usually start at 10mg/day)
start 10-20mg qhs
usually max out at 20mg/day, but in practice, can go up to 20mg BID or 30mg qhs if no ADRs
As adjunct- 2-10mg/day

see conversion chart for Aristada and Mantenna
Aristada- loading dose of Aristada initio, plus 30mg PO within 10 days of the first Aristada dose
May take 6 weeks to work

Mantenna- give 2 weeks of PO after the first shot

Question 3

olanzapine/Zyprexa

Answer 3

start 10-20mg qhs
usually max out at 20mg/day, but in practice, can go up to 20mg BID or 30mg qhs if no ADRs (not recommended for long term)
Anything above 20mg per day is heroic dosing

if it works and the pt gains weight or has metabolic ADRs- change to Lybalvi at same or lower dose

TAPER OFF slowly to avoid rebound psychosis- drop by 5 mg at a time (per visit)

Question 4

Brexipiprazole/Rexulti

Answer 4

depression- 2mg/day
schizophrenia- 2-4mg/day

Question 5

Lurasidone/Latuda

Answer 5

Schizophrenia- start at 40-80mg with dinner, max 160mg/day
Bipolar disorder- start at 20mg with dinner, max 120mg/day

Question 6

Quetiapine/Seroquel

Answer 6

Schizophrenia at 200mg
Bipolar I or II
Augment for depression
Sleep aid for psychotic people at 25 to 50mg

Question 7

Risperdal/Risperidone

Answer 7

start at 1 mg qhs or 0.5mg BID (safer）
Can increase by 1mg per day
usually 2-8mg per day, max 16mg/day
elderly and kids- max out at 2 mg
titrate down 1 mg every 2 weeks if elevated prolactin
once discontinued, recheck prolactin in 2 months

Question 8

Fluphenazine/Prolixin

Answer 8

Initially 10mg/day in divided doses
Max 40mg/day PO
IM- max 10mg/day
Titrate down slowly to avoid rebound symptoms
After fluphenazine is discontinued, continue the antiparkinsonian agents for a few weeks

Question 9

Trileptal/oxcarbazepine

Answer 9

Start at 600mg qhs
Then- above 600mg/day, go to BID dosing
usual dose- 1200-2400mg /day

Question 10

Lumateperone/Caplyta

Answer 10

42mg cap QHS

Question 11

Depakote/valproate

Answer 11

Check labs 1 week after dose increase
Do not take Depakote the morning of labs, take after
Usual dose for mania- 1200- 1500mg per day
In acute mania start at 1000mg per day
In less acute mania start at 250 to 500mg per day then titration up as needed