Selecting the Dose of Antipsychotic Drug - April 1, 2010
Gardner et al. report a consensus study
of antipsychotic dosing that used an international panel to recommend doses of a wide range of antipsychotic drugs, relative to a standard dose of olanzapine (20 mg/day) for an adult man with more than 2 years of illness who is not considered treatment resistant. Doses were similar for manic patients but reduced 25% for psychotically depressed patients. Doses were also reduced 25% for more responsive patients and increased 25% for more resistant patients. For children 6–12 years old a 60% reduction is recommended, for elderly persons more than 65 years old a 50% reduction is recommended, and for women a 10% reduction is recommended. Wang et al. found in a prospective comparative study
that continuing the optimal therapeutic dose of risperidone that produced resolution of the acute episode was more effective for preventing relapse than reducing the dose at 4 or 26 weeks after hospital discharge, without an increase in side effects. The 4.3-mg mean daily dose of risperidone was lower than the 6-mg dose recommended for most men by the consensus study, but it was consistent with the panel’s recommended 20% reduction for Asians.