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UNIT 3 ■ Care of Patients With Psychiatric Disorders
TABLE 15–3 Antipsychotic Agents CATEGORY
GENERIC (TRADE NAME)
DAILY DOSAGE RANGE (MG)
40–400 2.5–10 1–100 20–250 12–64 1–10 15–150 150–800
Typical antipsychotic agents (first generation; conventional)
Chlorpromazine Fluphenazine Haloperidol (Haldol) Loxapine Perphenazine Pimozide (Orap) Prochlorperazine Thioridazine Thiothixene (Navane) Trifluoperazine
6–30 4–40
10–30 2–30
Atypical antipsychotic agents (second generation; novel)
Aripiprazole (Abilify) (Abilify MyCite; with tracking sensor) Aripiprazole lauroxil (Aristada)
441–662 monthly, 882 every 6 weeks, 1064 every 2 months (IM injection) 10–20 3.8–7.6 every 24 hr 2–4 42 daily 1.5–6 300–900
Asenapine (Saphris) (SL) (Secuado) (transdermal) Brexpiprazole (Rexulti) Lumateperone (Caplyta)
Cariprazine (Vraylor) Clozapine (Clozaril) Iloperidone (Fanapt) Lurasidone (Latuda) Olanzapine (Zyprexa) Paliperidone (Invega) (Invega Sustenna—once a month) (Invega Trinza—once every 3 months) Quetiapine (Seroquel) Risperidone (Risperdal) Long-acting risperidone (Perseris)
12–24 40–80
5–20 6–12
39–234 (IM injection) 273–819 (IM injection) 300–400 4–8 90 or 120 subcutaneously (once a month) 40–160
Ziprasidone (Geodon)
novel treatment is valbenazine (Ingrezza), a drug for the treatment of tardive dyskinesia. Tardive dyskine- sia, a movement disturbance that is more prevalent with typical antipsychotics, is particularly troubling because it has been a permanent, incurable side effect. Valbenazine works by reducing dopamine release at the synaptic cleft and has demonstrated effectiveness in reducing abnormal involuntary movements such as tardive dyskinesia. Future research will determine its long-term effectiveness. Currently, the cost for this treatment is over $125,000 annually, which may limit its accessibility for many with chronic, serious mental illness. Patient and Family Education Related to Antipsychotics The patent receiving antipsychotic medication should: ■■ Use caution when driving or operating dangerous machinery. Drowsiness and dizziness can occur.
■■ Not stop taking the drug abruptly after long-term use. To do so might produce withdrawal symp- toms, such as nausea, vomiting, dizziness, gastritis, headache, tachycardia, insomnia, tremulousness. ■■ Use sunblock lotion and wear protective clothing when spending time outdoors. Skin is more sus- ceptible to sunburn, which can occur after only 30 minutes. ■■ Report weekly (if receiving clozapine therapy) to have blood levels drawn and to obtain a weekly supply of the drug. ■■ Immediately report to the physician the occur- rence of any of the following symptoms: sore throat, fever, malaise, unusual bleeding, easy bruis- ing, persistent nausea and vomiting, severe head- ache, rapid heart rate, difficulty urinating, muscle twitching, tremors, darkly colored urine, excessive urination, excessive thirst, excessive hunger, weak- ness, pale stools, yellow skin or eyes, muscular incoordination, or skin rash.
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