Polypharmacy Management of Antipsychotics in Patients with Schizophrenia
Abstract
:1. Introduction
2. Proper Use of Antipsychotics
3. Polypharmacy
3.1. Factors for Polypharmacy
3.2. Merits of Polypharmacy
3.3. Matters to Be Considered with Polypharmacy
4. Strategies for Polypharmacy
4.1. Switching to APM
4.2. Practical Use of Dosage Forms
5. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Dose Range (mg/Day) | CPZeq (mg) | |
---|---|---|
Risperidone | 2–16 | 1 |
Paliperidone | 1.5–15 | 1.5 |
Aripiprazole | 2–30 | 4 |
Brexpiprazole | 1–4 a | - |
Asenapine | 0.4–20 | 2.5 |
Quetiapine | 75–800 | 66 |
Olanzapine | 1–20 b | 2.5 |
Clozapine | 100–600 | 50 |
Haloperidol (First-generation antipsychotic) | 4–20 | 2 |
Drug | Receptor Affinity | |||||||
---|---|---|---|---|---|---|---|---|
Dopamine | Serotonin | Adrenaline | Histamine | Muscarine | ||||
D2L | 5-HT1A | 5-HT2A | 5-HT2C | α1A | α2B | H1 | M1 | |
Risperidone | 6.17 | 178 | 0.204 | 6.76 | 5.13 | 9.55 | 81.3 | 26,900 |
Paliperidone | 6.60 | 1030 | 1.20 | 19.0 | 2.50 | 4.00 | 19.00 | >10.000 |
Aripiprazole | 1.15 | 2.69 | 9.55 | 28.2 | 324 | 191 | 20.4 | 3890 |
Brexpiprazole | 0.30 | 0.12 | 0.47 | 34.0 | 3.80 | 35.0 | 19.0 | >1.000 |
Asenapine | 1.26 | 2.51 | 0.0708 | 0.0347 | 1.17 | 0.324 | 1.00 | 8130 |
Quetiapine | 417 | 166 | 155 | 1050 | 64.6 | 83.2 | 11.0 | 282 |
Olanzapine | 21.4 | 1510 | 1.32 | 3.89 | 22.4 | 331 | 3.39 | 12.0 |
Clozapine | 135 | 87.1 | 4.07 | 2.75 | 12.6 | 28.2 | 1.74 | 5.13 |
Haloperidol (First-generation antipsychotic) | 1.45 | 513 | 52.5 | 1620 | 25.1 | 562 | 2090 | 5620 |
Drug | Sedation | Weight Gain | Diabetes Mellitus | Extrapyramidal Symptoms | Anticholinergic Effects | Increase in Prolactin Levels |
---|---|---|---|---|---|---|
Risperidone | + | ++ | ++ | + | + | +++ |
Paliperidone | +/− | +/− | − | + | + | +++ |
Aripiprazole | − | +/− | − | + | − | − |
Brexpiprazole | − | +/− | − | + | − | − |
Asenapine | + | +/− | − | + | − | +/− |
Quetiapine | ++ | ++ | ++ | − | − | − |
Olanzapine | ++ | +++ | +++ | +/− | + | + |
Clozapine | +++ | +++ | +++ | − | +++ | − |
Haloperidol (First-generation antipsychotic) | + | + | + | +++ | − | +++ |
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Kamei, H. Polypharmacy Management of Antipsychotics in Patients with Schizophrenia. Medicina 2022, 58, 1584. https://doi.org/10.3390/medicina58111584
Kamei H. Polypharmacy Management of Antipsychotics in Patients with Schizophrenia. Medicina. 2022; 58(11):1584. https://doi.org/10.3390/medicina58111584
Chicago/Turabian StyleKamei, Hiroyuki. 2022. "Polypharmacy Management of Antipsychotics in Patients with Schizophrenia" Medicina 58, no. 11: 1584. https://doi.org/10.3390/medicina58111584