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. 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. |
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