Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-25T19:05:47.289Z Has data issue: false hasContentIssue false
  • English
  • Français

Effective Dosing and Dose Equivalency of Second-Generation Antipsychotic Medications

Published online by Cambridge University Press:  07 November 2014

Peter F. Buckley
Get access Rights & Permissions [Opens in a new window]

Abstract

Dosing patterns with second-generation antipsychotic medications (SGAs) are dynamic, with some SGAs surpassing current recommendations while others are declining in dose since their initial regulatory guidelines. Pertinent recent studies and available pharmacoepidemiologic reports, information, and expert consenses are reviewed herein to illuminate current thinking on the topic of dosing with SGAs. There is a need for fixed-dose studies of each SGA. Additionally, dosing should be a primary consideration when designing and subsequently interpreting comparative studies between SGAs.

Type
Academic Supplement
Information
CNS Spectrums , Volume 9 , Issue S9 , September 2004 , pp. 24 - 31
Copyright
Copyright © Cambridge University Press 2004

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.)

References

REFERENCES

1.Van Putten, T, Marder, SR, Wishing, W et al. , Neuroleptic plasma levels in treatment resistant schizophrenic patients. In: The Neuroleptic Nonresponsive Patients: Characterization and Treatment. Schulz, SC, Angist, B, eds. Washington, DC: American Psychiatric Press; 1990.Google Scholar
2.Van Putten, T, Marder, SR, Mintz, J. A controlled dose comparison of haloperidol in newly admitted schizophrenic patients. Arch Gen Psychiatry. 1990;47:754–753.CrossRefGoogle ScholarPubMed
3.Schulz, SC, McGorry, P. Conventional antipsychotics: contemporary clinical experience. In: Schizophrenia and Mood Disorders: The New Clinical Therapies. Buckley, PF, Waddington, JC, eds. London, Egland: Arnold Publications; 2001.Google Scholar
4.Citrome, L, Volavka, J. Optimal dosing or atypical antipsychotics in adults: a review of the current evidence. Harv Rev Psychiatry. 2002;10:280–291.CrossRefGoogle ScholarPubMed
5.Essock, SM. Editor's introduction: antipsychotic prescribing practices. Schizophr Bull. 2002;28(1):1–4.CrossRefGoogle ScholarPubMed
6.Geddes, J, Preemantle, N, Harrison, P et al. , Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. BMJ. 2000;231:1371–1376.CrossRefGoogle Scholar
7.Davis, JM, Chen, N, Glick, ID. A meta-analysis of the efficacy of second-generation antipsychotics. Arch Gen Psychiatry. 2003;60(6):553–564.CrossRefGoogle ScholarPubMed
8.Kane, JM, Leucht, S, Carpenter, D et al. , The expert consensus guideline series: optimizing pharmacologie treatment of psychotic disorders. J Clin Psychiatry. 2003;64(suppl 12):1–100.Google Scholar
9.Kinon, BJ, Ahl, J, Stauffer, VL, Hill, AL, Buckley, PF. Dose reponse and atypical antipsychotics in schizophrenia. CNS Drugs. 2004. In press.CrossRefGoogle Scholar
10.Tray, PV, Hamilton, SH, Kuntz, AJ, Potvin, JH, Andersen, SW, Berasley, C Jr.Double-blind comparison of olananpine versus risperidone in the treatment of schizophrenia and other psychotic disorders. J clin Psychopharmacol. 1997;17:407–418.Google Scholar
11.Conley, RR, Mahmoud, R. A randomized double-blind study of risperidone and olanzapine in the treatment of schizophrenia or schizoaffective disorder. Am J Psychiatry. 2001;158:765–774.CrossRefGoogle ScholarPubMed
12.Essock, SM, Drake, RE, Frank, RG, McGuire, TG. Controlling trials of evidence-based mental health care: getting the right answer to the right question. Schizophr Bull. 2003;29(1):115–123.CrossRefGoogle Scholar
13.Kane, JM. Pharmacologic treatment of schizophrenia. Biol Psychiatry. 1999;46:1396–1408.CrossRefGoogle ScholarPubMed
14.Herz, MI, Lieberman, RP, Licberman, JA et al. American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. 1997;154(4 Suppl):1–63.Google Scholar
15.Lehman, AF, Steinwachs, DM, PORT Co-Investigators. Translating research into practice: the schizophrenia patient outcome research team (PORT) treatmentment recommendations. Schizophrenia Bull. 1998;24(1):1–10.CrossRefGoogle Scholar
16.Gutierrez, MA. Dosing of antipsychotic medication. Presentation at: 156th Annual Meeting or the American Psychiatric Association; May 2003; San Francisco, California.Google Scholar
17.Covell, NH, Jackson, CT, Evans, AC, Essock, SM. Antipsychotic prescribing practices in Connecticut's public mental health system: rates of changing medications and prescribing styles. Schizophrenia Bull. 2002;28:17–29.CrossRefGoogle ScholarPubMed
18.Sohler, NL, Walkup, J, McAlpine, D et al. , Antipsychotic dosage at hospital discharge and outcomes among persons with schizophrenia. Psychiatr Serv. 2003;4(9):1258–1263.CrossRefGoogle Scholar
19.Citrome, L, Jaffe, A, Levine, D. Dosing of second generation antipsychotics in a large state hospital system. Int J Neuropsychopharmacol. 2004;7(51):437.Google Scholar
20.Seeman, P, Lee, T, Chau Wong, M et al. , Antipychotic drug doses and neuroleptic dopamine receptors. Nature. 1976;261:717–719.CrossRefGoogle Scholar
21.VanderZwaag, C, McGee, M, McEvoy, JP, Freudenreich, O, Wilson, WH, Cooper, TB. Response of patients with treatment-refractory schizophrenia to clozapine within three serum level ranges. Am J Psychiatry. 1996;153:1579–1584.Google ScholarPubMed
22.Perry, PJ, Sanger, T, Beasley, C. Olanzapine plasma concentrations and clinical response in acutely ill schizophrenic patients. J Clin Psychopharmacol. 1997;17:472–427.CrossRefGoogle ScholarPubMed
23.Chong, SA, Remington, G. Plasma olanzapine and clinicnl response. J Clin Psychopharmacol. 1999;19:192–194.CrossRefGoogle ScholarPubMed
24.Crismon, ML, Buckley, PF. Schizophrenia. In: Di Piro, JT, Talbert, RL, Yee, GC et al. , eds. Contributions to Pharmacotherapy; A Pathophysiologic Approach. New York, NY: McGraw Hill. In Press.Google Scholar
25.Kapur, S, Zipursky, RB, Remington, G. Clinical and theoretical implications of 5-HT2 and D: receptor occupancy of clocapine, risperidone, and olanzapine in schizophrenia. Am J Psychiatry. 1999;156:286–293.CrossRefGoogle Scholar
26.Kapur, SJ, Zipursky, R, Jones, C, Remington, G, Houle, S. Relationship between dopamine D2 occpancy, clinical response, and side effects: a double-blind PET study of first-episode schizophrenia. Am J Psychiatry. 2000;157:514–520.CrossRefGoogle Scholar
27.Kapur, S, Zipursky, R, Jones, C, Shammi, CS, Remington, G, Seeman, P. A positron emission tomography study of quetiapine in schizophrenia: a prelimary finding of an antipsychotic effect with only transiently high dopamine D: receptor occupancy. Arch Gen Psychiatry. 2000;57:553–559.CrossRefGoogle Scholar
28.Kapur, S, Remington, G. Dopamine D2 receprors and their role in atypical antipsychotic action: still necessary and may even be sufficient. Biol. Psychiatry. 2001;50:873–883.CrossRefGoogle ScholarPubMed
29.Mamo, D, Kapur, S, Shammi, CM et al. , A PET study of dopamine D2 and serotonin 5-HT2 receptor occupancy in patients with schizophrenia treated with therapeutic does of ziprasidone. Am J Psychiatry. 2004;161:818–825.CrossRefGoogle ScholarPubMed
30.Gunder, G, Carlsson, A, Wong, DF. Mechanism of new antipsychotic medication: occupancy is not just antagonism. Arch Gen Psychiatry. 2003;60:974–977.CrossRefGoogle Scholar
31.Buckley, PF, Kapur, S, Baldassano, CF, Miller, A, Chengappa, KNR. Choosing the right dose of an atypical antipsychotic: art or science? Presented at: 157th Annual Meeting of the American Psychiatric Association; May 1–6, 2004; New York, NY.Google Scholar
32.Marder, SR, Essock, SM, Miller, AL et al. , The Mount Sinai conference on the pharmacotherapy of schizophrenia. Schizophrenia Bull. 2002;28:5–16.CrossRefGoogle Scholar
33.Leucht, S, Barnes, T, Kissling, W et al. , Relapse prevention in schizophrenia with new-generation antipsychotics: a systematic review and exploratory meta-analysis of randomized, controlled trials. Am J Psychiatry. 2003;160:1209–1222.CrossRefGoogle ScholarPubMed
34.Lehman, AF, Lieberman, JA, Dixcon, LB et al. , Practice guideline for the treatment of patients with schizophrenia. 2nd ed. Am J Psychiatry. 2004;161(Suppl 2):S1–S56.Google ScholarPubMed
35.Miller, AL, Hall, CS, Buchanan, RW, Buckley, PF et al. , The Texas Medication Algorithm Project: antipsychotic algorithm for schizophrenia. Algorithm 2033 update. J Clin Psychiatry. 2004;65:500–508.CrossRefGoogle Scholar
36.Lehman, AF, Kreyenbuhl, J, Buchanan, RW et al. , The Schizophrenia Patients Outcomes Research Tream (PORT): Updated treatment recommendations 2003. Schizophrenia Bull. 2004. In Press.CrossRefGoogle Scholar
37.Stroup, TS, McEvoy, JP, Swartz, MS, Byerly, MJ et al. , The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: schizophrenia trial design and protocol development. Schizophr Bull. 2003;29(1):15–31.CrossRefGoogle ScholarPubMed
38.Rosenheck, R, Cramer, J, Xu, W et al. , Department of Veterans Affairs Cooperative Study Group of Clozapine in refractory schizophrenia. A comparison of clozapine and haloperidol in hospitalized patients with refractory schizophrenia. New Eng J Med. 1997;337:809–815.CrossRefGoogle Scholar
39.Meltzer, HY, Alphs, L, Green, AI et al. , International Suicide Prevention Trial Study Group. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry. 2003;60(1):82–91.CrossRefGoogle Scholar
40.Love, RC, Conley, RR, Kelly, DL, Bartko, JJ. A dose-outcome analysis of risperidone. J Clin Psychiatry. 1999;60:771–775.CrossRefGoogle ScholarPubMed
41.Csemansky, JG, Mahmoud, R et al. , A comparison of risperidone and haloperidol for the prevention of relapse in patients with schizophrenia. N Engl J Med. 2002;346(1):16–22.CrossRefGoogle Scholar
42.Marder, SR, Glynn, SM, Wirshing, WC et al. , Maintenance treatment of schizophrenia with risperidone or haloperidol: 2-year outcomes. Am J Psychiatry. 2003;160:1405–1412.CrossRefGoogle ScholarPubMed
43.Kane, JM, Eerdekens, M, Lindenmayer, JP, Keith, SJ, Lesem, M, Karcher, K. Long-acting injectable risperidone: efficacy and safety of the first long-acting atypical antipsychotic. Am J Psychiatry. 2003;160(6):1125–1132.CrossRefGoogle ScholarPubMed
44.Fleischhacker, WW, Eerdekens, M, Karcher, K et al. , Treatment of schizophrenia with long-acting injectable risperidone: a 12-month open-label trial of the first long-acting second-generation antipsychotic. J Clin Psychiatry. 2003;64(10):1250–1257.CrossRefGoogle ScholarPubMed
45.Beasley, CM Jr, Tollefson, G, Tran, P, Satterlee, W, Sanger, T, Hamilton, S. Olanzapine versus placebo and haloperidol: acute phase results of the North American double-blind olanzapine trial. Neuropsychopharmacology. 1996;14:111–123.CrossRefGoogle ScholarPubMed
46.Lindenmayer, JP, Volavka, J, Lieberman, J et al. , Olanzapine for schizophrenia refractory to typical and atypical antipsychotics: an open Libel, prospective trial. J Clin Psychopharmacol. 2001;21:448–453.CrossRefGoogle Scholar
47.Dursun, SM, Gardner, DM, Bird, DC, Flinn, J. Olanzapine for patients with treatment-resistant schizophrenia: a naturalistic case series outcome study. Can J Psychiatry. 1999;44:701–704.CrossRefGoogle ScholarPubMed
48.Volavka, J, Czobor, P, Shcitman, B et al. , Clozapine, olinzapine, risperidone, and haloperidol in the treatment of patients with chronic schizophrenia and schizoaffective disorder. Am J Psychiatry. 2002;159:255–262.CrossRefGoogle ScholarPubMed
49.Rosenheck, R, Perlick, D, Bingham, S et al. , Effectiveness and cost of olanzapine and haloperidol in the treatment of schizophrenia: a randomized controlled trial. JAMA. 2003;290(20):2693–2702.CrossRefGoogle ScholarPubMed
50.Czobor, P, Volavka, J, Shietman, B, et al Antipsychotic-induced weight gain and therapeutic response: a differential association. J Clin Psychopharmacol. 2002;22:244–251.CrossRefGoogle ScholarPubMed
51.Kinon, R. Study on olanzapine's impact on weight. Presentation at: 156th Annual Meeting of the American Psychiatric Association; May 2003; San Francisco, California.Google Scholar
52.Small, JG, Hirsch, SR, Arvanitis, LA, Miller, BG, Link, CG. Quetiapine in patients with schizophrenia: a high- and low-dose double-blind comparison with placebo. Arch Gen Psychiatry. 1997;54:549–557.CrossRefGoogle ScholarPubMed
53.Smith, MA. Optimal Titration for Quetiapine: Pilot Tria. Poster presented at: 42nd Annual Meeting of the New Clinical Drug Evaluation Unit; June 10–13, 2002; Boca Raton, Florida.Google Scholar
54.Buckley, PF. Broad therapeutic uses of atypical antipsychotic medications. Bid Psychiatry. 2001;50(11):912–924.CrossRefGoogle ScholarPubMed
55.Buckley, PF. Maintenance treatment with quetiapine. Hion Psychopharmacol. In Press.Google Scholar
56.Conley, RR et al. , High dose quetiapine in schizophrenia. Presentation at: the International Congress on Schizophrenia Research; April 2003; Colorado Springs, CO.Google Scholar
57.Pierre, JM, Wirshing, DA, Cannel, J et al. , High dose quetiapine in treatment refractory schizophrenia. Presentation at: International Congress on Schizophrenia Research; April 2003; Colorado Springs, CO.CrossRefGoogle Scholar
58.Mackell, JA, Ollendorf, DA, Loebel, AD, Russell, JM, Joyce, AJ. Effect of ziprasidone dosing on discontinuation in schizophrenia patients. Schizophr Res. 2004;67(1):178.Google Scholar
59.Micelli, JJ, Shiovitz, T, Swift, R, Tensfeldt, T. High-dose ziprasidone is associated with marginal additional Qtc increase. Schizophr Res. 2004;67(1):179.Google Scholar
60.Addington, D, Pantelis, C, Romano, SU, Murray, S. Ziprasidone vs risperidone in schizophrenia: 52-wcek randomized, double-blind comparison. Schizophr Res. 2004;67:177.Google Scholar
61.Buckley, PF. Aripiprazole: efficacy and tolerability profile of a novel-acting atypical antipsychotic. Drugs of Today. 2003;39(2):145–151.CrossRefGoogle ScholarPubMed
62.Pigott, TA, Carson, WH, Saha, AR, Torbeyns, AF, Stock, EG, Ingenito, GG; Aripiprazole Study Group. Aripiprazole for the prevention of relapse in stabilized patients with chronic schizophrenia: a placebo-controlled 26-week study. J Clin Psychiatry. 2003;64(9):1048–1056.CrossRefGoogle ScholarPubMed
63.Kasper, S, Lerman, MN, McQuade, RD et al. , Efficacy and safety of aripiprazole vs. haloperidol for long-term maintenance treatment following acute relapse of schizophrenia. Int J Neuropsychopharmacol. 2003;6(4):325–337.CrossRefGoogle ScholarPubMed
64.Riera, L, Hu, R, Stock, E et al. , Broad effectiveness trial with aripiprazole. Schizophr Res. 2004;67(1):157.Google Scholar