Psychosis Treatments

Psychosis Treatments
Generic Brand Form Indication Adult Initial Dose Adult Dose Titration
First-Generation Antipsychotics
chlorpromazine HCl tabs Psychosis. Mania Less acutely disturbed: 25mg three times daily
Outpatient: 10mg 3–4 times daily or 25mg 2–3 times daily
Severe cases: 25mg three times daily
Inpatient: 500–1000mg/day
Less acutely disturbed: 400mg/day
Outpatient: 200–800mg/day
Increase dose gradually until symptoms are controlled. Continue optimum dosage for 2wks; then gradually reduce to lowest effective maintenance dose. See full labeling.
fluphenazine HCl tabs, elixir, oral conc Psychosis 2.5–10mg daily in 3–4 divided doses Maintenance:
1–5mg/day; max 40mg/day
Reduce gradually to 1–5mg/day when symptoms are controlled
haloperidol decanoate Haldol Decanoate inj Schizophrenia when prolonged parenteral therapy required 10–20 times previous daily dose of oral haloperidol; max initial dose: 100mg (if >100mg, give balance in 3–7 days) Maintenance: 10–15 times previous daily dose of oral haloperidol; max: 450mg/month.
haloperidol lactate Haldol inj Schizophrenia 2–5mg IM every 4–8hrs or up to hourly if needed; max: 20mg/day Switch to oral form 12–24hrs after last inj
loxapine caps Schizophrenia 10mg twice daily. Severe: up to 50mg/day in 2–4 divided doses Maintenance: 20–60mg/day in 2–4 divided doses May increase over first 7–10 days until effective response; usual range 60–100mg/day; max 250mg/day
Adasuve pwd for oral inh Agitation due to schizophrenia 10mg/24hrs
thioridazine HCl tabs Schizophrenia unresponsive to (preferably 2) other antipsychotics 50–100mg three times daily 200–800mg/day in 2–4 divided doses May increase gradually to max 800mg/day
thiothixene caps Schizophrenia Mild: 2mg three times daily; max 15mg/day. Severe: 5mg twice daily 20–30mg/day; max 60mg/day
trifluoperazine HCl tabs Psychosis 2–5mg twice daily 15–20mg/day
Second-Generation Antipsychotics
aripiprazole Abilify tabs Schizophrenia 10mg or 15mg once daily 10–15mg/day; max 30mg/day May increase at intervals of at least 2wks
Abilify Maintena ext-rel
Schizophrenia 400mg IM once monthly (no sooner than 26 days after the previous inj) 400mg IM once monthly (no sooner than 26 days after the previous inj) After first Maintena dose, continue with concurrent oral aripiprazole (10mg or 20mg) or other antipsychotic for 14 consecutive days. May reduce to 300mg IM once monthly if adverse reactions occur.
Abilify Mycite tabs with sensor Schizophrenia 10mg or 15mg once daily 10–15mg/day; max 30mg/day May increase at intervals of at least 2wks
aripiprazole lauroxil Aristada ext-rel
Schizophrenia 441mg, 662mg, or 882mg IM once monthly (no sooner than 14 days after the previous inj), or 882mg IM once every 6wks, or 1064mg IM every 2mos. 441mg, 662mg, or 882mg IM once monthly (no sooner than 14 days after the previous inj), or 882mg IM once every 6wks, or 1064mg IM every 2mos. Concurrently with first Aristada dose, administer oral aripiprazole for 21 consecutive days.
Aristada Initio ext-rel inj Schizophrenia when used for initiation (or reinitiation after a missed dose) of Aristada 675mg IM once Concurrently administer oral aripiprazole 30mg once. Administer first Aristada inj on same day as Aristada Initio or ≤10 days after.
asenapine Saphris SL tabs Schizophrenia Acute: 5mg twice daily; max 20mg/day Maintenance: 5mg twice daily; max 20mg/day May increase to 10mg twice daily after 1wk
Secuado transdermal system Schizophrenia One 3.8mg/24hrs patch once daily 3.8mg/24hrs, 5.7mg/24hrs, or 7.6mg/24hrs patch once daily May increase as needed after 1wk
brexpiprazole Rexulti tabs Schizophrenia 1mg once daily on days 1–4; increase to 2mg once daily on days 5–7, then 4mg once daily on day 8 2–4mg/day; max 4mg/day
cariprazine Vraylar caps Schizophrenia 1.5mg once daily 1.5–6mg once daily; max 6mg/day May increase to 3mg on Day 2. May further adjust by 1.5mg or 3mg increments based on response and tolerability
clozapine Clozaril tabs Treatment-resistant schizophrenia. Reduce risk of recurrent suicidal behavior in schizophrenia or schizoaffective disorders. 12.5mg 1–2 times daily 300–450mg/day in divided doses May increase by increments of 25–50mg/day to 300–450mg/day in divided doses by the end of 2wks. Then may increase once or twice weekly in increments of up to 100mg; max 900mg/day. Reduce gradually over 1–2wks if discontinuing; may discontinue abruptly if necessary (eg, severe neutropenia, myocarditis; may cause relapse or cholinergic rebound). Retitrate if stopped for ≥2 days.
Versacloz oral susp
iloperidone Fanapt tabs Schizophrenia 1mg twice daily on day 1, 2mg twice daily on day 2, 4mg twice daily on day 3, 6mg twice daily on day 4, 8mg twice daily on day 5, 10mg twice daily on day 6, 12mg twice daily on day 7 12–24mg/day Retitrate if stopped for >3 days
lumateperone Caplyta caps Schizophrenia 42mg once daily
lurasidone HCl Latuda tabs Schizophrenia 40mg once daily 40–160mg once daily; max 160mg/day
olanzapine Zyprexa tabs Schizophrenia 5–10mg once daily, increase to 10mg once daily within several days 10–20mg/day; max 20mg/day May adjust by 5mg/day at intervals of 1wk
Zyprexa Zydis ODT
Zyprexa Intra-Muscular inj Agitation
due to schizophrenia
2.5–10mg/dose IM; up to max 3 doses/day (2–4hrs apart) Switch to oral form when appropriate
Zyprexa Relprevv ext-rel inj Schizophrenia Target oral dose 10mg/day: 210mg every 2wks or 405mg every 4wks for first 8wks. Target oral dose 15mg/day: 300mg every 2wks for first 8wks. Target oral dose 20mg/day: 300mg every 2wks for first 8wks. Maintenance: Target oral dose 10mg/day: 150mg every 2wks or 300mg every 4wks. Target oral dose 15mg/day: 210mg every 2wks or 405mg every 4wks. Target oral dose 20mg/day: 300mg every 2wks.
paliperidone Invega ext-rel tabs Schizophrenia. Schizoaffective disorder. 6mg once daily in AM 3–12mg once daily; max 12mg/day May increase in increments of 3mg/day at intervals of >5 days (for schizophrenia) or >4 days (for schizoaffective disorder)
Invega Sustenna ext-rel inj Schizophrenia. Schizoaffective disorder. 234mg IM on day 1, then 156mg IM one week later Maintenance: Schizophrenia: 117mg IM (39–234mg) once monthy; max 234mg/month
Schizoaffective: 78–234mg IM once monthly; max 234mg/month
Invega Trinza ext-rel inj Schizophrenia Give when next Invega Sustenna dose is scheduled using 3.5-fold higher dose equivalent (see full labeling) Give once every 3mos May adjust dose every 3mos in increments of 273–819mg based on tolerability and/or efficacy
pimavanserin Nuplazid tabs, caps Parkinson disease psychosis 34mg once daily
quetiapine fumarate Seroquel tabs Schizophrenia 25mg twice daily on day 1; increase by 25–50mg 2–3 times daily on days 2 and 3; target 300–400mg/day in 2–3 divided doses by day 4 150–750mg/day; max 800mg/day, all in divided doses May adjust at 2-day intervals by 25–50mg twice daily. Continue at lowest dose to maintain remission.
Seroquel XR ext-rel tabs Schizophrenia 300mg once daily in the PM 400–800mg/day; max 800mg/day May increase at 1-day intervals in increments of up to 300mg/day
risperidone Perseris ext-rel inj Schizophrenia 90mg or 120mg SC once monthly 90–120mg/month; max 1 dose/month
Risperdal tabs, soln Schizophrenia 2mg/day in 1–2 doses 4–16mg/day; max 16mg/day May increase by 1–2mg/day at intervals of at least 24hrs to target dose 4–8mg/day
Risperdal Consta long-
Schizophrenia Give with oral risperidone (or other antipsychotic) for 3wks, then stop oral form 25mg IM every 2wks; max 50mg every 2wks May adjust dose every 4wks
ziprasidone HCl Geodon caps Schizophrenia 20mg twice daily, max 80mg twice daily 20–80mg twice daily May increase at intervals of at least 2 days
ziprasidone mesylate Geodon for Injection inj Rapid control of acute agitation 10–20mg IM as needed Max 40mg/day (10mg every 2hrs; or 20mg IM every 4hrs); treat for max 3 days Switch to oral form as soon as possible

Key: ext-rel = extended-release; immediate-rel= immediate-release; ODT = orally-disintegrating tablets; SL = sublingual
Not an inclusive list of medications and/or official indications. Please see drug monograph at and/or contact company for full drug labeling.

(Rev. 5/2020)