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Second International Consensus Study of Antipsychotic Dosing (ICSAD-2)
Matthew Kt McAdam1, Ross J Baldessarini2,3, Andrea L Murphy1,4
1Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
Journal of Psychopharmacology (Oxford, England)
|October 16, 2023
Summary
Expert consensus provides clinically equivalent dose estimates and dosing recommendations for antipsychotic drugs, aiding clinical practice and research for psychosis treatment. This study updated recommendations for 44 oral, 16 long-acting injectable, and 14 short-acting injectable formulations.
Area of Science:
- Psychopharmacology
- Clinical Psychiatry
- Drug Dosing
Background:
- Expert consensus on clinically equivalent doses supports the use of antipsychotic drugs in clinical practice and research.
- Antipsychotic dosing recommendations are crucial for effective treatment of psychosis.
Purpose of the Study:
- To provide updated dosing equivalencies and recommendations for newer antipsychotic drugs.
- To establish consensus on dosing for 44 oral, 16 long-acting injectable (LAI), and 14 short-acting injectable (SAI) formulations.
Main Methods:
- A two-step Delphi survey process involving 72 international experts from 24 countries.
- Establishment of consensus on dosing recommendations (start, target range, maximum) and equivalent doses for schizophrenia treatment.
- Utilized oral olanzapine and intramuscular haloperidol as reference agents for dose equivalency estimates.
Main Results:
- Consensus improved across survey stages, with the highest agreement for LAI formulations, followed by oral agents, and lowest for SAI formulations.
- Provided updated equivalency estimates and dosing recommendations for a comprehensive list of antipsychotic drugs.
- 72 experts provided data on oral, LAI, and SAI formulations.
Conclusions:
- Expert consensus serves as a valuable alternative for estimating clinical dosing equivalents due to the rarity of fixed-dose trials.
- The findings support clinical practice, guideline development, and research involving antipsychotic medications.
- Updated dosing information aids in optimizing the treatment of psychosis.
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