Neuroleptics dosages

Flemenbaum A. Pavor nocturnus a complication of single daily tricyclic or neuroleptic dosage. Am J Psychiatry 1976 133(5) 570-2. 

Moritz S, Woodward TS, Krausz M, Naber D. PERSIST Study Group. Relationship between neuroleptic dosage and subjective cognitive dysfunction in schizophrenic patients treated with either conventional or atypical neuroleptic medication. Int Clin Psychopharmacol 2002 17(1) 41 1. 

Do not abruptly discontinue use of the antiparkinsonism drugs Neuroleptic malignant-like syndrome may occur when the antiparkinsonism drugs are discontinued or the dosage of levodopa is reduced abruptly. The nurse carefully observes the patient and reports the following symptoms muscular rigidity, elevated body temperature, and mental changes... 

Functional activity (clinical effect, catalepsy in animals, etc.) is invariably correlated with plasma concentrations whereas the brain levels of many neuroleptics, which are very lipophilic compounds, could be much higher. Some clinicians also believe that many newer compounds achieve atypical status compared with older ones because they are used at minimal dosage while older ones are prescribed at established levels which may be unnecessarily high. 

HALOPERIDOL Individualize dosage. Children, debilitated, or geriatric patients and those with a history of adverse reactions to neuroleptic drugs may require less haloperidol. 

Extrapyramidal disorders which develop soon after initiating treatment with neuroleptic drugs are likely to be transient. A dosage of 1 to 2 mg orally 2 or 3 times a day usually provides relief within 1 or 2 days. After 1 or 2 weeks, withdraw drug to determine its continued need. If such disorders recur, reinstitute benztropine. 

Neuroleptic malignant syndrome (NMS) Sporadic cases of possible NMS have been reported in association with dose reduction or withdrawal of amantadine therapy. Observe patients carefully when the dosage of amantadine is reduced abruptly or discontinued, especially if the patient is receiving neuroleptics. 

Haloperidol is less likely to cause hypotension than chlorpromazine, which has a-adrenoceptor antagonist effects. Both can cause cardiac arrhythmias if used in high dosage or in patients with pre-existing heart disease, or as an idiosyncratic reaction. There have been numerous reports of sudden and unexplained deaths, probably due to cardiac arrhythmia, in patients given chlorpromazine and other neuroleptics. The risk of serious arrhythmia is higher in the obese, and possibly in those of African ancestry. 

Fentanyl is 80 to 100 times as potent as morphine. Sufentanil (Sufenta) is 500- to 1,000-fold more potent than morphine, while alfentanil (Alfenta) is approximately 20 times more potent than morphine. Their onset of action is usually less than 20 minutes after administration. Dosage is determined by the lean body mass of the patient, since the drugs are lipophilic and tend to get trapped in body fat, which acts as a reservoir, prolonging their half-life. In addition, redistribution of the drugs from the brain to fat stores leads to a rapid offset of action. Droperidol, a neuroleptic agent, is generally administered in combination with fentanyl for IV anesthesia. 

Tardive dyskinesia is a potentially irreversible movement disorder characterized by choreoathetoid movements. The possibility of a primary neurological disorder should be considered when a patient being treated with an antipsychotic develops involuntary movements. It should also be noted that patients might develop transient withdrawal dyskinesias as the dosage of neuroleptics is lowered or discontinued (Campbell et ah, 1999). It appears that withdrawal dyskinesias are more common in children than adults. 

The same general principles apply to adjusting the dosages of the typical and atypical neuroleptics (see above). 

Extrapyramidal Anticholinergic Neuroleptic Usual Oral Dosage ition Symptoms Reactions Potency (Usual Depot Dose IM)... 

Brand Names (Where Effects on Positive Effects on Negative Extrapyramidal Anticholinergic Neuroleptic Usual Oral Dosage... 

Using meta-analytic techniques based on the means and the standard errors presented graphically in the poster, we estimated pooled data of the four effective dosages of quetiapine both for the BPRS and the CGI severity of illness change scores from baseline to endpoint. Quetiapine produced an improvement of 0.43 effect-size units in comparison with placebo, a difference that was highly statistically significant and about the same improvement as haloperidol. Thus, based on the BPRS or PANSS, quetiapine was similar to neuroleptics in efficacy (i.e., differences were nonsignificant). Based on our meta-analysis, quetiapine is clearly superior to... 

Deberdt R, Elens P, Berghmans W, et al. Intramuscular haloperidol decanoate for neuroleptic maintenance therapy. Efficacy, dosage schedule and plasma levels. An open multicenter study. 

Kane JM. Dosage strategies with long-acting injectable neuroleptics, including haloperidol decanoate. J Clin Psychopharmacol 1986 6(suppl) 20S-23S. 

The management of a psychotic reaction in an Addisonian patient taking a glucocorticoid needs special care (SED-8, 820). Psychotic reactions that do not abate promptly when the glucocorticoid dosage is reduced to the lowest effective value (or withdrawn) may need to be treated with neuroleptic drugs occasionally these fail and antidepressants are needed (SEDA-18,387). However, in other cases, antidepressants appear to aggravate the symptoms. 

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