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International Consensus Study of Antipsychotic Dosing

Author(s) :

David M. Gardner, Pharm.D., M.Sc. Andrea L. Murphy, Pharm.D. Heather O’Donnell, B.Sc. Pharm. Franca Centorrino, M.D. Ross J. Baldessarini, M.D.

Abstract :

Objective: Potency equivalents for anti- psychotic drugs are required to guide clinical dosing and for designing and inter- preting research studies. Available dosing guidelines are limited by the methods and data from which they were generated.

Method: With a two-step Delphi method, the authors surveyed a diverse group of international clinical and research experts, seeking consensus regarding antipsychotic dosing. The authors deter- mined median clinical dosing equivalents and recommended starting, target range, and maximum doses for 61 drugs, adjust- ed for selected clinical circumstances.

Results: Participants (N=43) from 18 countries provided dosing recommenda- tions regarding treatment of psychotic disorders for 37 oral agents and 14 short-acting and 10 long-acting parenteral agents. With olanzapine 20 mg/day as reference, estimated clinical equivalency ratios of oral agents ranged from 0.025 for sulpiride to 10.0 for trifluperidol. Sev- enteen patient and treatment character- istics, including age, hepatic and renal function, illness stage and severity, sex, and diagnosis, were associated with dos- ing modifications.

Conclusion: In the absence of adequate prospective, randomized drug-drug com- parisons, the present findings provide broad, international, expert consensus- based recommendations for most clini- cally employed antipsychotic drugs. They can support clinical practice, trial design, and interpretation of comparative anti- psychotic trials.

Am J Psychiatry 2010; 167:686–693 - Source link

Collège Méditerranéen de Psychiatrie