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Antipsychotic drugs


Antipsychotic drugs Preparations Comments 
Amisulpride 50mg, 100mg, 200mg tablets  100mg/ml oral solution (sugar free) 400mg tablets are significantly more expensive than 200mg tablets.
Aripiprazole 5mg, 10mg, 15mg and 30mg tablets 10mg and 15mg orodispersible tablets 1mg/1ml oral solution     7.5mg/ml injection

To be initiated by HPFT and then continued in primary care. Rationale for choice over other antipsychotics to be provided to GP.
Orodispersible tablets are bioequivalent to plain tablets, with a similar rate and extent of absorption. They are restricted for use in those with swallowing difficulties or problems with concordance.
Oral solution very expensive - only to be used when titrating doses after which transfer to plain or orodispersible tablets should be considered.

Injection - for HPFT prescribing only

NICE TA213  Aripiprazole is recommended as an option for the treatment of schizophrenia in people aged 15 to 17 years who are intolerant of risperidone, or for whom risperidone is contraindicated, or whose schizophrenia has not been adequately controlled with risperidone.

NICE TA292 Aripiprazole is recommended as an option for treatment of moderate to severe manic episodes in adolescents with bipolar 1 disorder, within it's marketing authorisation (that is upto 12 weeks of treatment for moderate to severe manic episodes in biploar 1 disorder in adolescents aged 13 and older). Prescribing responsibility to remain with HPFT CAMHS for this indication.

Benperidol 250microgram tablets  For use in management of inappropriate sexual behaviour.
Chlorpromazine hydrochloride 25mg, 50mg and 100mg tablets
25mg/5ml and 100mg/5ml oral solution
Can cause skin photosensitivity.
Oral solution to be handled with care - risk of contact sensitisation.
Clozapine (Denzapine®) 25mg and 100mg tablets only
50mg/ml oral suspension
Prescribing to remain within HPFT.
See Clozapine Policy and Clozapine - Key points for GPs. Suspension can settle on standing - risk of uneven distribution of clozapine and inaccurate dosing if bottle is not shaken thoroughly before dispensing/administration. Only to be used in those with swallowing difficulties or when there is poor compliance with tablets. Once service user is stabilised then consider switching to tablets.
Flupentixol dihydrochloride 3mg tablets See section 4.2.2 for use in depression.
Haloperidol 500microgram capsules/tablets
1.5mg, 5mg, 10mg, tablets
1mg/ml and 2mg/ml oral liquid
5mg/ml injection
Baseline ECG is recommended.
See DTC recommendation on haloperidol and ECG monitoring
The maximum recommended daily dose for IM and oral administration is different, because parenteral doses generally have a greater bioavailability than oral doses. See Haloperidol IM and oral equivalent doses.
Injection for HPFT prescribing only.
Levomepromazine 25mg tablets Use cautiously - titrate dose extremely slowly. Risk of postural hypotension in elderly, not recommended for ambulant patients over 50 years unless risk of hypotensive reaction assessed.
See Prescribing Guidelines for Acute behavioural disturbance and rapid tranquilisation (RT)
Lurasidone 18.5mg, 37mg and 74mg tablets

For use within its licensed indication (i.e. for schizophrenia) for adult patients (aged 18 years and over) once aripiprazole has either failed to manage the service user’s condition or is not suitable due to a contraindication or intolerance.

Initiation, clinical (and dose) stabilisation (assessment of efficacy and side effects) to be carried out by specialist (usually at least 3 months), with continuation in primary care.

Olanzapine 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg tablets
5mg, 10mg, 15mg, 20mg orodispersible tablets
5mg/ml (10mg vial) injection
Orodispersible tablets are bioequivalent to plain tablets with a similar rate and extent of absorption. They are restricted for use in those unable to swallow solid dose forms or problems with concordance.
There are slight variations in the speed at which generic orodispersible tablets dissolve in the mouth. It may be necessary to prescribe Velotab brand if there is a problem with a service user removing tablet from mouth. Velotabs are difficult to remove once placed inside the mouth but are significantly more costly than generic tablets or orodispersible tablets.
Injection for HPFT prescribing only.
Promazine hydrochloride 25mg and 50mg tablets
25mg/5ml and 50mg/5ml oral solution

Considered less suitable for prescribing by BNF

Quetiapine 25mg, 100mg,150mg, 200mg, 300mg tablets
50mg, 150mg, 200mg, 300mg, 400mg modified release tablets

Modified release (MR/XL) tablets are significantly more expensive than immediate release (IR) tablets.
The use of IR tablets should be considered in all new patients. MR tablets should only be used in those who cannot tolerate IR tablets or if concordance with a twice daily regimen is difficult.
Existing patients on MR tablets must not be switched to IR tablets without agreement or involvement of a psychiatrist. See Briefing note on switching from quetiapine MR to IR.

Risperidone 500micrograms, 1mg, 2mg, 3mg, 4mg tablets
500micrograms, 1mg, 2mg, 3mg, 4mg orodispersible tablets
1mg/ml oral liquid

Orodispersible tablets and oral liquid restricted to those unable to swallow solid dose forms or have problems with concordance.

Sulpiride 200mg and 400mg tablets
200mg/5ml oral solution
Trifluoperazine 1mg and 5mg tablets
1mg/5ml and 5mg/5ml oral solution
Note - two different strengths of liquid available - prescribe correct strength.
Zuclopenthixol acetate (Clopixol Acuphase®) 50mg/ml injection and 100mg/2ml injection Only for HPFT. NOT for primary care prescribing.
Not suitable for use in rapid tranquillisation.
DO NOT confuse with zuclopenthixol decanoate (Clopixol®) depot injection. 
Zuclopenthixol dihydrochloride 2mg and 10mg and 25mg tablets  


Continue to Antipsychotic depot injections

Rapid Tranquillisation (RT) Policy


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