Download Dosing Guidelines for Antipsychotics Drug Starting dose Average

Dosing Guidelines for Antipsychotics
Drug
Starting dose
Average Daily
Doses1
Available Dosage Forms
PO
PO
tablet
IV / IM injection 2
0.5 – 1 mg PO q2-4h prn
2 mg / day
Use the lowest possible effective
dose
Haloperidol
(Haldol®)
(IV route 2x more potent than PO)
(higher risk of EPS with PO
route)
IV (Used in ICU settings or
IV
after consultation with C-L
Psychiatry)
10 mg / day
Patient specific, max daily
dose determined with C-L
Psychiatry consultation
Mild / Moderate*
1 – 2 mg IV q2h prn
Moderate/Severe
2.5-5 mg PO q2h prn
Olanzapine
(Zyprexa®)
tablet
oral dissolving wafer (Zydis®)
IM injection2
12.5 – 25 mg PO q4h prn 100-200 mg / day tablet
extended release tablet
2.5 - 5 mg PO q4h prn
5-10 mg / day
Quetiapine
(Seroquel®)
Risperidone 0.25 - 0.5 mg PO q4h prn 1-2 mg / day
(Risperdal®)
tablet
oral dissolving wafer (M tab®)
oral liquid
1Higher
2Do
doses may be required and should be prescribed in consultation with CL Psychiatry
not use IM dosage in the presence of blood thinners
NOTE:
Reduce above doses by 50% for elderly or frail
For severe delirium, consult CL Psychiatry as higher doses may be required.
Drug
Extrapyramidal
Symptoms (EPS)
Hyperglycemia
Adverse Effects of Common Antipsychotics
Haloperidol
Olanzapine Quetiapine
(Haldol®)
(Zyprexa®)
(Seroquel®)
+++
++
+
Risperidone
(Risperdal®)
++
(less risk with IV route)
+
+++
++
++
Orthostatic
Hypotension
Sedation
+
+
++
+
+
+++
+++
++
QTc Prolongation
++
+
+
+
higher risk with doses
> 5 mg and IV route
Medications that may cause or worsen DELIRIUM
Narcotics
Benzodiazepines *
Antihistamines
Codeine
Fentanyl
Hydrocodone
Meperidine
Morphine
Oxycodone
Alprazolam
Clonazepam
Diazepam
Lorazepam
Brompheniramine
Chlorpheniramine
Cyproheptadine
Dimenhydrinate (Gravol)
Diphenhydramine (Benadryl)
Doxylamine
Hydroxyzine
Scopolamine
Antidepressants *
Anticonvulsants
Antiparkinsonian
Amiptriptyline
Bupropion
Desipramine
Doxepin
Imipramine
Mirtazapine
Nortriptyline
Paroxetine
Phenelzine
Trazodone
Carbamazepine
Gabapentin
Levetiracetam
Phenytoin
Topiramate
Valproic Acid
Amantadine
Benztropine
Bromocriptine
Levodopa
Pramipexole
Rasagiline
Selegiline
Gastrointestinal
Genitourinary
Sedatives
Chlorpromazine
Diphenoxylate
Prochlorperazine
Ranitidine
Dicyclomine
Hyoscamine
Oxybutynin
Tolterodine
Barbiturates
Chloral Hydrate
Miscellaneous
Amoxicillin
Amiodarone
Cephalexin
Ciprofloxacin
Clozapine
Corticosteroids
Digoxin
Furosemide
Levofloxacin
Lithium
Nicotine (and withdrawal states)
Zopiclone (and in withdrawal
states)
Zolpidem (and in withdrawal states)
High risk, Moderate risk, Risk at high doses
* Consult C-L Psychiatry before discontinuing pre-existing antidepressants or benzodiazepine treatment
in the context of delirium
Clearing Up the Confusion: Delirium Workshop Prepared and Reviewed by: Pharmacy Department,
Toronto General Site and Medical Psychiatry Department, University Health Network. June, 2012.
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