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Dose Equivalents for Second-Generation Antipsychotic Drugs: The Classical Mean Dose Method
Stefan Leucht1, Myrto Samara2, Stephan Heres2
1Department of Psychiatry and Psychotherapy, Technische Universität München Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Germany; Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychosis Studies, London, UK; Stefan.Leucht@lrz.tum.de.
Schizophrenia Bulletin
|April 5, 2015
Summary
This study calculated olanzapine equivalents for second-generation antipsychotics using a classical mean dose method. It provides crucial dose equivalence data for amisulpride, aripiprazole, and other antipsychotics in schizophrenia treatment.
Area of Science:
- Pharmacology
- Psychiatry
- Clinical Trials
Background:
- Dose equivalence is critical in pharmacotherapy, particularly for antipsychotics.
- The classical Davis (1974) method, based on mean flexible doses, has been widely adopted.
- This is the first study to apply this method to second-generation antipsychotics (SGAs).
Purpose of the Study:
- To determine the dose equivalence of various oral second-generation antipsychotics relative to olanzapine.
- To apply the classical mean dose method to a comprehensive list of SGAs.
Main Methods:
- A systematic search for randomized, double-blind, flexible-dose trials in acute schizophrenia.
- Inclusion of 13 oral SGAs, haloperidol, and chlorpromazine.
- Calculation of weighted mean doses for each drug and normalization to the weighted mean olanzapine dose.
Main Results:
- 75 studies with 16,555 participants were analyzed.
- Olanzapine equivalents (mg/d) were determined for several SGAs, e.g., amisulpride (38.3), aripiprazole (1.4), clozapine (30.6), quetiapine (32.3), risperidone (0.4).
- Data for iloperidone, lurasidone, and paliperidone were unavailable.
Conclusions:
- The mean dose method avoids limitations of fixed-dose and dose-response curve methods regarding data availability.
- The calculated dose equivalents may be influenced by the dose ranges utilized in the original trials.
- Comprehensive assessment of antipsychotic dose equivalence requires evaluating multiple methodologies.
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