Hostname: page-component-74656f9884-c52kr Total loading time: 0 Render date: 2026-11-08T15:48:03.654Z Has data issue: false hasContentIssue false
  • English
  • Français

Dosing Atypical Antipsychotics

Published online by Cambridge University Press:  07 November 2014

Andrew Cutler ,
Sara Ball  and
Stephen M. Stahl
Get access Rights & Permissions [Opens in a new window]

Extract

The task of prescribing, dosing, and switching antipsychotics is generally characterized by a process of trial and error, often resulting in suffering from side effects and/or lack of response while searching for the optimum treatment. Clinical trials often inaccurately predict optimum doses and titration schedules, leaving prescribers without precise guidance for how to use newer therapies in clinical practice. A tremendous amount of individual response variability further complicates the task of effectively dosing antipsychotics.

Information

Type
Expert Review Supplement
Information
CNS Spectrums , Volume 13 , Issue S9: Dosing Atypical Antipsychotics , May 2008 , pp. 3 - 14
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Karow, A, Schimmelmann, BG, Naber, D, et al. Early and delayed onset of antipsychotic response and early prediction of outcome in 528 severely impaired patients with schizophrenia treated with amisulpride. Schizophr Res. 2008;98(s1):12.CrossRefGoogle Scholar
2.Chang, YC, Lane, HY, Yang, KH, Huang, CL.Optimizing early prediction for antipsychotic response in schizophrenia. J Clin Psychopharmacol. 2660;26(6):554–559.CrossRefGoogle Scholar
3.Correll, CU, Malhotra, AK, Kaushik, S, et al. Early prediction of antipsychotic response in schizophrenia. Am J Psychiatry. 2003;160:2063–2065.CrossRefGoogle ScholarPubMed
4.Leucht, S, Shamsi, SA, Busch, R, Kissling, W, Kane, JM.Predicting antipsychotic drug response - Replication and extension to six weeks in an international olanzapine study. Schizophr Res. 2008;epub ahead of print.Google Scholar
5.Kane, JM, Leucht, S, Carpenter, D, et al. The expert consensus guideline series. Optimizing phar-macologic treatment of psychotic disorders. Introduction: methods, commentary, and summary. J Clin Psychiatry. 2003;64(suppl 12):5–19.Google Scholar
6.Lieberman, JA.Effectiveness of antipsychotic drugs in patients with chronic schizophrenia: efficacy, safety and cost outcomes of CATIE and other trials. J Clin Psychiatry. 2007:68(2):04.CrossRefGoogle ScholarPubMed
7.Arato, M, O'Connor, R, Meltzer, H.A 1-year, double-blind, placebo-controlled trial of ziprasidone 40, 80, and 160 mg/day in chronic schizophrenia: the Ziprasidone Extended Use in Schizophrenia (ZEUS) study. Int Clin Psychopharmacol. 2002;17(5):207–215.Google Scholar
8.Woods, S, Tully, E, Walsh, B, et al. Aripiprazole in the treatment of the psychosis prodrome: an open-label pilot study. Br J Psychiatry Suppl. 2007;51:96–101.CrossRefGoogle ScholarPubMed
9. Risperdal [package insert]. Titusville, New Jersey: Janssen Pharmaceuticals; 2007.Google Scholar
10.Citrome, L, Volavka, J.Optimal dosing of atypical antipsychotics in adults” a review of the current evidence. Harv Rev Psychiatry. 2002;10(5):280–291.Google Scholar
11.Bai, Y, Ting Chen, T, Chen, J, et al. Equivalent switching dose from oral risperidone to risperidone long-acting injection: a 48-week randomized, prospective, single-blind pharmacokinetic study. J Clin Psychiatry. 2007;68(8):1218–1225.CrossRefGoogle ScholarPubMed
12.Sparshatt, A, Jones, S, Taylor, D.Quetiapine: dose-response relationship in schizophrenia. CNS Drugs. 2008;22(1):49–72.CrossRefGoogle ScholarPubMed
13.Khazaal, Y, Tapparel, S, Chatton, A, et al. Quetiapine dosage in bipolar disorder episodes and mixed states. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31(3):727–730.CrossRefGoogle ScholarPubMed
14.Sparshatt, A, Jones, S, Taylor, D.Quetiapine: dose-response relationship in schizophrenia. CNS Drugs. 2008;22(1):49–72.Google Scholar
15.Citrome, L, Jaffe, A, Levine, J.Dosing of second-generation antipsychotic medication in a state hospital system. J Clin Psychoparm. 2005;25,388–391.CrossRefGoogle Scholar
16.Papakostas, GI, Petersen, TJ, Nierenberg, AA, et al. Ziprasidone augmentation of selective serotonin reuptake inhibitors (SSRIs) for SSRI-resistant major depressive disorder. J Clin Psychiatry. 2004;65(2):217–221.CrossRefGoogle ScholarPubMed
17.Miceli, J, Glue, P, Alderman, J, and Wilner, K.The effect of food on the absorption of oral ziprasidone. Psychopharmacol Bull. 2007;40(3):58–68.Google Scholar
18. Zyprexa [package insert]. Indianapolis, Indiana: Eli Lilly; 2007.Google Scholar
19.Citrome, L, Volavka, J.Optimal dosing of atypical antipsychotics in adults: a review of the current evidence. Harv Rev Psychiatry. 2002;10(5):280–291.CrossRefGoogle ScholarPubMed
20.Volavka, J, Czobor, P, Sheitman, B, et al. Clozapine, olanzapine, risperidone, and haloperidol in the treatment of patients with chronic schizophrenia and schizoaffective disorder. Am J Psychiatry. 2002;159:255–262.CrossRefGoogle ScholarPubMed
21.Lieberman, JA, Stroup, TS, McEvoy, JP, et al. Clinical antipsychotic trials of intervention effectiveness (CATIE) Investigators Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353:1209–1223.Google Scholar
22.Lindenmayer, JP, Khan, A, Iskander, A, et al. A randomized controlled trial of olanzapine versus haloperidol in the treatment of primary negative symptoms and neurocognitive deficits in schizophrenia. J Clin Psychiatry. 2007;68(3):368–379.Google Scholar
23.Meltzer, H, Bobo, W, Roy, A, et al. A randomized, double-blind comparison of clozapine and high-dose olanzapine in treatment-resistant patients with schizophrenia. J Clin Psychiatry. 2008; epub ahead of print.Google Scholar
24.Kumra, S, Kranzler, H, Gerbino-Rosen, G, et al. Clozapine and “High-Dose” Olanzapine in Refractory Early-Onset Schizophrenia: A 12-Week Randomized and Double-Blind Comparison. Biol Psychiatry. 2008;63(5):524–529.Google Scholar
25.Kane, J, Honigfeld, G, Singer, J, Meltzer, H.Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chloropromazine. Arch Gen Psychiatry. 1988;45(9):789–796.Google Scholar
26.Cutler, AJ, Martin, RN, Hardy, SN, et al. The efficacy and safety of lower doses of aripipra-zole for the treatment of patients with acute exacerbation of schizophrenia. CNS Spectr. 2006;11(9):691–702.Google Scholar
27.Citrome, L.A review of aripiprazole in the treatment of patients with schizophrenia or bipolar I disorder. Neuropsychiatr Dis Treat. 2006;2:427–443.CrossRefGoogle ScholarPubMed
28.Chim, JC, Shin, JG, Kelly, DL, et al. Adjunctive treatment with dopamine partial agonist, aripiprazole, for antipsychotic-induced hyperprolactinemia: a placebo-controlled trial. Am J Psychiatry. 2007;164:1404–1410.Google Scholar
29.Chen, CH, Huang, MC, Lu, ML.Aripiprazole improves metabolic adversity in olanzapine-treated schizophrenic patients. J Clin Psychopharmacol. 2007;27:516–517.CrossRefGoogle ScholarPubMed
30.Worthington, JJ III, Kinrys, G, Sygant, LE, Pollack, MH.Aripiprazole as an augmentor of selective serotonin reuptake inhibitors in depression and anxiety disorder patients. Int Clin Psychopharmacol. 2005;20(1):9–11.Google Scholar
31.Spina, E, Cavallaro, R.The pharmacology and safety of paliperidone extended-release in the treatment of schizophrenia. Expert Opin Drug Saf. 2007;6(6):651–662.CrossRefGoogle ScholarPubMed
32.Dlugosz, H, Nasrallah, HA.Paliperidone: A new extended-release oral atypical antipsychotic. Expert Opin Pharmacother. 2007;8:2307–2313.Google Scholar
33.Potkin, S, Cohen, M, and Panagides, J.Efficacy and tolerability of asenapine in acute schizophrenia: a placebo- and risperidone-controlled trial. J Clin Psychiatry. 2007;68(10):1492–1500.CrossRefGoogle ScholarPubMed
34.McIntyre, R, Panagides, J, Alphs, L et al. , Treatment of mania in bipolar I disorder: a placebo and olanzapine-controlled trial of asenapine. Poster presented at: Congress of the European College of Neuropsychopharmacology; October 16, 2007; Vienna. p.2.e.012.Google Scholar
35.Jain, K.An assessment of iloperidone for the treatment of schizophrenia. Expert Opin Investig Drugs. 2000;9(12):2935–2943.Google Scholar
36.Wolfgang, CD, Polymeropoulos, MH. Single-nucleotide polymorphisms in the CYP2D6 gene are correlated with iloperidone drug exposure levels, impacting the degree of QTc prolongation associated with iloperidone treatment. Poster presented at: Annual Meeting of the American Society of Human Genetics; October 23–27, 2007; San Diego, CA.Google Scholar
37.Keating, G, Robinson, D.Quetiapine: a review of its use in the treatment of bipolar depression. Drugs. 2007;67(7):1077–1095.CrossRefGoogle ScholarPubMed
38.Ketter, T, Jones, M, Paulsson, B.Rates of remission/euthymia with quetiapine monotherapy compared with placebo in patients with acute mania. J Affect Disord. 2007;100(Suppl 1):45–53.Google Scholar
39.Shelton, RC, Stahl, SM.Risperidone and paroxetine given singly and in combination for bipolar depression. J Clin Psychiatry. 2004;65(12):1715–1719.Google Scholar
40.Keck, PE Jr, Marcus, R, Tourkodimitris, S, et al. A placebo-controlled, double-blind study of the efficacy and safety of aripiprazole in patients with acute bipolar mania. Am J Psychiatry. 2003;160(9):1651–1658.CrossRefGoogle ScholarPubMed
41.Arato, M, O'Connor, R, Meltzer, H.A 1-year, double-blind, placebo-controlled trial of zipra-sidone 40, 80, and 160 mg/day in chronic schizophrenia: the Ziprasidone Extended Use in Schizophrenia (ZEUS) study. Int Clin Psychopharmacology. 2002;17(5):207–215.CrossRefGoogle ScholarPubMed
42.Manschreck, T, Boshes, R.The CATIE schizophrenia trial: results, impact, controversy. Harv Rev Psychiatry. 2007;15(5):245–258.Google Scholar
43.Lesser, I, Castro, D, Gaynes, B et al. Ethicity/race and outcome in the treatment of depression: results from STAR*D. Med Care. 2007;45(11):1043–1051.Google Scholar
44.Perlis, R, Ostacher, M, Patel, J, et al. Predictors of recurrentce in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry. 2006;163(2):217–224.Google Scholar
45.Keck, PE Jr, McElrowy, SL, Strakowski, SM, et al. 12-Month Outcome of Patients With Bipolar Disorder Following Hospitalization for a Manic or Mixed Episode. Am J Psychiatry. 1998;155:646–652.CrossRefGoogle ScholarPubMed
46.Robinson, DG, Woerner, MG, Delman, HM, Kane, JM.Pharmacological treatments for firstepisode schizophrenia. Schizophr Bull. 2005;31:705–722.Google Scholar
47.Nierenberg, AA, Ostacher, MJ, Borrelli, DJ, et al. The integration of measurement and management for the treatment of bipolar disorder: a STEP-BD model of collaborative care in psychiatry. J Clin Psychiatry. 2006;67(suppl 11):3–7.Google ScholarPubMed
48.Miklowitz, D, Otto, M, Frank, E, et al. Intesnsive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month randomized controlled trial. Am J Psychiatry. 2007;164(9):1340–1347.CrossRefGoogle Scholar
49.Otto, MW, Reilly-Harrington, N, Sachs, GS.Psychoeducational and cognitive-behavioral strategies in the management of bipolar disorder. J Affect Disord. 2003;73(1–2):171–181.Google Scholar
50.Milkowitz, DJ and Otto, MW.Psychosocial interventions for bipolar disorder: a review of literature and introduction of the systematic treatment enhancement program. Psychopharmacol Bull. 2008;40(4):116–131.Google Scholar
51.Keck, PE Jr, McElroy, SL, Strakowski, SM, et al. Factors associated with pharmacologic noncom-pliance in patients with mania. J Clin Psychiatry. 1996;57(7):292–297.Google Scholar
52.Otto, MW, Reilly-Harrington, N, Sachs, GS.Psychoeducational and cognitive-behavioral strategies in the management of bipolar disorder. J Affect Disord. 2003;73:171–181.CrossRefGoogle ScholarPubMed
53.Kane, JM, Leucht, S, Carpenter, D, et al. The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary. J Clin Psychiatry. 2003;64(s12):5–19.Google Scholar
54.Diaz, FJ, de Leon, J, Josiassen, RC, et al. Plasma clozapine concentration coefficients of variation in a long-term study. Schizophr Res. 2005;72(2–3):131–135.Google Scholar
55.Bigos, K, Pollock, B, Coley, K, et al. Sex, race, and smoking impact olanzapine exposure. J Clin Pharmacol. 2008;48(2):157–165.CrossRefGoogle ScholarPubMed
56.Kroon, L.Drug interactions with smoking. Am J Health Syst Pharm. 2007;64(18):1917–1921.Google Scholar
57.Nozawa, M, Ohnuma, T, Matsubara, Y, et al. The relationship between response of clinical symptoms and plasma olanzapine concentration, based on pharmacogenetics: Juntendo University Schizophrenia Projects (JUSP). Ther Drug Monit. 2008;30(1):35–40.CrossRefGoogle ScholarPubMed
58.Robinson, DG, Woerner, MG, Delman, HM, Kane, JM.Pharmacological treatments for firstepisode schizophrenia. Schizophr Bull. 2005;31:705–722.CrossRefGoogle ScholarPubMed
59.Cardno, AG, Rijsdijk, FV, Sham, PC, et al. A twin study of genetic relationships between psychotic symptoms. Am J Psychiatry. 2002;159(4):539–545.Google Scholar
60.Stahl, SM.Personalized medicine, pharmacogenomics, and the practice of psychiatry: on the threshold of predictive therapeutics in psychopharmacology? CNS Spectr. 2008;13(2):115–118.Google Scholar
61.Stahl, SM.Stahl's Essential Psychopharmacology. 3rd ed.New York, NY: Cambridge University Press; 2008.Google Scholar
62.Stahl, SM.The Prescriber's Guide. New York, NY: Cambridge University Press; 2005.Google Scholar
63.Jann, MW.Clozapine. Pharmacotherapy. 1991;11(3):179–195.CrossRefGoogle ScholarPubMed
64.Stahl, SM, Grady, MM.A critical review of atypical antipsychotic utilization: comparing monotherapy with polypharmacy and augmentation. Curr Med Chem. 2004;11(3):313–327.CrossRefGoogle ScholarPubMed
65.Roberts, C.ACP-103, a 5-HT2A receptor inverse agonist. Curr Opin Investig Drugs. 2006;7(7):653–660.Google Scholar
66.Nasrallah, HA.Atypical antipsychotic-induced metabolic side effects: insights from receptorbinding profiles. Mol Psychiatry. 2008;13(1):27–35.Google Scholar
67. Data on file. Janssen; 2008.Google Scholar
68. Data on file. Johnson & Johnson Pharmaceutical Research & Development, LLC; Beerse, Belgium; Document ID No:EDMS-PSDB-5527989:2.0.Google Scholar
69.Kongsamut, S, Roehr, JE, Cai, J, et al. Iloperidone binding to human and rat dopamine and 5-HT receptors. Eur J Pharmacol. 1996:317(2–3):417–423.Google Scholar
70.Kalkman, HO, Subramanian, N, Hoyer, D.Extended radioligand binding profile of iloperidone: a broad spectrum dopamine/serotonin/norepinephrine receptor antagonist for the management of psychotic disorders. Neuropsychopharmacology. 2001;25(6):904–914.Google Scholar
71.Bondolfi, G, Morel, F, Crettol, S, et al. Increased clozapine plasma concentrations and side effects induced by smoking cessation in 2 CYP1A2 genotyped patients. Ther Drug Monit. 2005;27(4):539–543.Google Scholar
72.Miceli, J, Glue, P, Alderman, J, Wilner, K.The effect of food on the absorption of oral ziprasidone. Psychopharmacol Bull. 2007;40(3):58–68.Google Scholar
73.O'Malley, FP, Thomson, T, Julian, J, et al. HER2 testing in a population-based study of patients with metastatic breast cancer treated with trastuzumab. Arch Pathol Lab Med. 2008;132(1):61–65.CrossRefGoogle Scholar
74.Engel, RH, Kaklamani, VG.HER2-positive breast cancer: current and future treatment strategies. Drugs. 2007;67(9):1329–1341.CrossRefGoogle ScholarPubMed
75.Wu, AHB.Use of genetic and nongenetic factors in warfarin dosing algorithms. Pharmacogenomics. 2007;8(7):851–861.CrossRefGoogle ScholarPubMed
76.Perlis, RH.Cytochrome P450 genotyping and antidepressants. BMJ. 2007;334(7597):759Google Scholar
77.Schillevoort, I, de Boer, A, van der Weide, J, et al. Antipsychotic-induced extrapyramidal syndromes and cytochrome P450 2D6 genotype: a case-control study. Pharmacogenetics. 2002;12(3):235–240.CrossRefGoogle ScholarPubMed
78.Woodward, ND, Jayathilake, K, Meltzer, HY.COMT val108/158met genotype, cognitive function, and cognitive improvement with clozapine in schizophrenia. Schizophr Res. 2007; 90(1–3):86–96.Google Scholar
79.Bertolino, A, Carforio, G, Blasi, G, et al. Interaction of COMT (Val(108/158)Met) genotype and olanzapine treatment on prefrontal cortical function in patients with schizophrenia. Am J Psychiatry. 2004;161(10):1798–805.Google Scholar
80.Bertolino, A, Caforio, G, Blasi, G, et al. COMT Val158Met polymorphism predicts negative symptoms response to treatment with olanzapine in schizophrenia. Schizophr Res. 2007; 95(1–3):253–255.Google Scholar
81.Sachidanandam, R, Weissman, D, Schmidt, SC, et al. A map of human genome sequence variation containing 1.42 million single nucleotide polymorphisms. Nature. 2001;409(6822):928–933.Google ScholarPubMed
82.Altshuler, JS, Altshuler, D.Organizational challenges in clinical genomic research. Nature. 2004;429(6990):478–481.Google Scholar
83.Arranz, MJ, de Leon, J.Pharmacogenetics and pharmacogenomics of schizophrenia: a review of last decade of research. Mol Psychiatry. 2007;12(8):707–747.Google Scholar
84.Licamele, L, Volpi, S, Heaton, C, et al. Pharmacogenomic study of iloperidone treatment in patients with schizophrenia identifies markers associated with efficacy. Poster presented at: Annual Meeting of the American Society of Human Genetics; October 23–27, 2007; San Diego, CA.Google Scholar