High and very high dosage antipsychotics: a critical review

Since antipsychotic drugs were introduced over 25 years ago, controversy has continued concerning the relative effectivness of standard and high dosage. Uncontrolled studies suggested that some psychotic patients responded to high but not to low drug dosage. Extrapyramidal effects seemed the same as with standard dosage. Our review of 14 controlled trials suggests some superiority of the high dosage over standard antipsychotic drug dosage but that extrapyramidal effects are more common. It is concluded that a minority of pychotic patients may benefit from high doses of neuroleptic medication, pharmacokinetic factors possibly being important.