Second-Generation Antipsychotics*
Drug | Dose Range | Usual Adult Dose | Comment† |
|---|---|---|---|
10–30 mg orally | 15 mg orally | Dopamine-2 partial agonist Low risk of metabolic syndrome | |
5–10 mg sublingually twice a day | 10 mg sublingually twice a day | Given sublingually with no food to be consumed for 10 minutes afterward (tablet should not be swallowed) | |
2–4 mg orally | 2–4 mg orally | Dopamine-2 partial agonist Low risk of metabolic syndrome Helps with major depression Dose titrated with
| |
1.5–6 mg orally | 3–6 mg orally | Low risk of metabolic syndrome Most common adverse effects: Somnolence, upset stomach Dose titrated with
| |
150–450 mg orally twice a day | 400 mg orally at bedtime | First SGA Only one with demonstrated efficacy in patients unresponsive to other antipsychotics Frequent WBC counts required because agranulocytosis is a risk Increased risk of seizures and metabolic syndrome | |
1–12 mg orally twice a day | 12 mg orally once a day | Because of possible orthostatic hypotension, titrated over 4 days when initiated | |
40–60 mg a day | 42 mg orally once a day | Probable antagonist activity at central serotonin 5-HT2A receptors and postsynaptic antagonist activity at central dopamine D2 receptors Lower risk of motor and metabolic side effects Contraindicated in older patients with dementia-related psychosis | |
40–160 mg orally once a day | 80 mg orally once a day | Given once a day with food Lower doses used in patients with liver impairment | |
10–20 mg orally at bedtime | 15 mg orally at bedtime | Most common adverse effects: Somnolence, metabolic syndrome, and dizziness | |
3–12 mg orally at bedtime | 6 mg orally at bedtime | ||
34 mg a day | 34 mg orally at bedtime | A 5HT2a antagonist; it was tested in and approved for psychosis in Parkinson disease | |
150–375 mg orally twice a day Extended-release: 400–800 mg orally at bedtime | 200 mg orally twice a day | Low potency allowing a wide dosing range May cause metabolic syndrome No anticholinergic effect Dose titration required because of blocking of alpha-2 receptors Twice-daily dosing required for immediate-release formulation; extended release given once at bedtime | |
4–10 mg orally at bedtime | 4 mg orally at bedtime | May cause extrapyramidal symptoms at doses > 6 mg, dose-dependent prolactin elevation, or metabolic syndrome | |
40–80 mg orally twice a day | 80 mg orally twice a day | Shortest half-life of new drugs Requires twice-daily dosing with food IM form available for acute treatment Low risk of metabolic syndrome | |
* Monitoring for metabolic syndrome and type 2 diabetes is recommended for this class of antipsychotics. | |||
† All SGAs have been associated with increased mortality in older patients with dementia. | |||
SGA = second-generation antipsychotic; WBC = white blood cell. | |||