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International consensus study of antipsychotic dosing
David M Gardner1, Andrea L Murphy, Heather O'Donnell
1Department of Psychiatry, Dalhousie University, Canada. david.gardner@dal.ca <david.gardner@dal.ca>
The American Journal of Psychiatry
|April 3, 2010
Summary
This study established expert consensus on antipsychotic drug potency equivalents for 61 medications. These findings provide crucial guidance for clinical dosing and research interpretation in psychiatric care.
Area of Science:
- Psychiatry and Pharmacology
- Clinical Neuroscience
Background:
- Accurate antipsychotic drug potency equivalents are essential for effective clinical dosing and robust research design.
- Existing dosing guidelines often lack comprehensive data and methodological rigor.
Framework:
- A two-step Delphi methodology engaged 43 international experts from 18 countries.
- Consensus was reached on median clinical dosing equivalents and dose recommendations for 61 antipsychotic agents.
Implementation:
- Recommendations cover 37 oral and 24 parenteral (short- and long-acting) antipsychotic formulations.
- Dosing adjustments were proposed for 17 patient and treatment characteristics, including age, organ function, and illness severity.
- Olanzapine 20 mg/day served as the reference, with equivalency ratios for oral agents ranging from 0.025 to 10.0.
Implications:
- Provides international, expert-derived recommendations for antipsychotic dosing in the absence of extensive comparative trials.
- Supports clinical practice by offering evidence-based dosing guidance.
- Facilitates the design and interpretation of future clinical trials involving antipsychotic medications.
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