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Dose equivalents for second generation long-acting injectable antipsychotics: The minimum effective dose method.

Philipp H Rothe1, Stephan Heres2, Stefan Leucht2

  • 1kbo-Klinik Taufkirchen (Vils), Departement of Forensic Psychiatry, Taufkirchen (Vils), Germany; Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany.

Schizophrenia Research
|July 25, 2017
PubMed
Summary

Determining antipsychotic dose equivalence is crucial. The minimum effective dose method offers an evidence-based approach for long-acting injectables, though further comparisons are needed.

Keywords:
AntipsychoticAripiprazoleAripiprazolemaintenaEquivalentdoseHaloperidolHaloperidoledecanoateLongactinginjectableMeandoseMinimumeffectivedoseOlanzapineOlanzapinepamoatePaliperidonePaliperidonepalmitateRisperidoneRisperidonemicrospheresSchizophrenia

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Area of Science:

  • Pharmacology
  • Psychiatry
  • Clinical Pharmacy

Background:

  • Dose equivalence of depot medications is vital for scientific and clinical applications.
  • Long-acting injectable (LAI) antipsychotics require standardized dosing for effective treatment.
  • Understanding dose equivalence aids in medication selection and management.

Purpose of the Study:

  • To determine the dose equivalence of second-generation antipsychotics available as long-acting injectables.
  • To apply the minimum effective dose (MED) method to establish these equivalents.
  • To compare MEDs across different antipsychotic formulations and treatment phases.

Main Methods:

  • A systematic literature search was performed for four second-generation antipsychotics and haloperidol.
  • The minimum effective dose (MED) method was employed, identifying the smallest effective dose from randomized fixed-dose studies.
  • Equivalent doses were calculated from acute phase studies, with MEDs from relapse prevention studies also reported.

Main Results:

  • Acute phase minimum effective doses (olanzapine equivalents) were calculated for various LAI antipsychotics.
  • Examples include aripiprazole lauroxil (441mg/4wks/0.71) and paliperidone palmitate (25mg/4wks/0.06).
  • Specific MEDs and relative potencies were provided for aripiprazole, paliperidone palmitate, risperidone, and RBP-7000.

Conclusions:

  • The MED method provides an operationalized, evidence-based approach for antipsychotic dose equivalence, applicable to LAI formulations.
  • The study suggests that minimum effective doses might not have been sufficiently low in all cases.
  • Further comparative studies with other methods are necessary to finalize conclusions on antipsychotic dose equivalence.