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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®) 50mg 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)
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
6mg strength tablets NOT APPROVED as significantly more expensive than using 2 x 3mg tablets
Orodispersible tablets restricted to those unable to swallow solid dose forms or problems with concordance.
Oral liquid should only be used when orodispersible tablets are not suitable.
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

Continue to Drugs for acute behavioural disturbance and rapid tranquilisation (RT) HPFT only

 

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