Formulation | Route | Initial dose (mg) | Frequency (hours) | Maximum initial dose per 24 hours (mg) | Time to peak plasma concentration (hours) | Notes | |
Second-generation agents | |||||||
Olanzapine | Injection (short-acting) | IM, IV* | 5 to 10¶ | 2 to 4Δ | 30 (including oral doses) | 0.25 to 0.75 |
|
Disintegrating tablet | Oral, SL | 5 to 10 | 2 | 20 (including IM/IV doses) | 5 | ||
Risperidone | Disintegrating tablet, oral solution | Oral | 1 to 2 | 0.5 to 2 | 6 | 1.5 |
|
Ziprasidone | Short-acting mesylate injection | IM | 10 to 20 | 2 to 4 | 40 | 0.5 to 1 |
|
Aripiprazole | Disintegrating tablet, oral solution | Oral | 10 to 15 | 2 | 30 | 3 to 5 |
|
First-generation agents | |||||||
Haloperidol | Short-acting lactate injection | IM, IV | 2 to 10 | 0.5 to 2Δ | 20◊ | 0.5 to 1 |
|
Oral solution | Oral | 2 to 10 | 6 | 30 | 2 | ||
Droperidol | Injection (short-acting) | IM, IV | 2.5 to 10 | 2 to 4Δ | 40 | 0.5 |
|
IM: intramuscular; IV: intravenous; SL: sublingual.
* IV administration of olanzapine should be limited to settings where patient can be closely monitored for respiratory depression and excessive sedation.
¶ If olanzapine is administered IV, limit total dose to 10 mg per episode (ie, if initial dose was <10 mg, may repeat with additional dose after ≥10 minutes up to 10 mg total).
Δ It may be necessary to repeat initial dose or fraction thereof after 15 to 20 minutes in patients with severe agitation until desired level of sedation attained.
◊ Selected patients without schizophrenia may need a higher cumulative haloperidol dose (eg, up to 30 mg) during the first 24 hours of treatment to achieve and maintain adequate sedation.
§ Treatment of acute dystonic reactions is diphenhydramine 25 to 50 mg IM/IV or benztropine 1 to 2 mg IM/IV, which is discussed in detail separately.Do you want to add Medilib to your home screen?