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Antipsychotic dosing in children and adolescents with schizophrenia*

Antipsychotic dosing in children and adolescents with schizophrenia*
Medication Initial dose Recommended dose increase Therapeutic range Max dose
Second-generation antipsychotics
Aripiprazole[1]
Preadolescent 2 mg 3 to 5 mg every three to five days (divided dose) 5 to 20 mg 20 mg
Adolescent 2 mg 3 to 5 mg every three to five days 10 to 30 mg 30 mg
Lurasidone[2]
Preadolescent 20 mg 20 mg after one to three days 20 to 40 mg 40 mg
Adolescent 40 mg 40 mg after one to three days 40 to 80 mg 80 mg
Olanzapine[3]
PreadolescentΔ 2.5 mg 2.5 mg every three to five days (divided dose) 5 to 20 mg 20 mg
AdolescentΔ 5 mg 5 mg every three to five days 10 to 30 mg 30 mg
Paliperidone[4]
Preadolescent 1.5 mg 1.5 mg every five to seven days 6 mg 6 mg
Adolescent 3 mg 3 mg every five to seven days 12 mg 12 mg
Quetiapine[5]
Preadolescent 25 mg 15 to 50 mg daily (divided twice daily or every eight hours) 100 to 400 mg 400 mg
Adolescent 25 mg twice daily 50 to 100 mg daily (divided twice daily or every eight hours) 400 to 800 mg 800 mg
Risperidone[6-8]
Preadolescent 0.25 mg 0.25 to 0.5 mg increase every three to five days (divided dose) 2 to 3 mg/day 3 mg/day
Adolescent 0.25 mg twice daily 0.5 mg to 1 mg increase every three to five days (divided dose) 3 to 6 mg/day 6 mg/day
Clozapine[9,10]
Preadolescent 12.5 mg 12.5 mg increase every three to five days (divided dose) 150 to 900 mg 900 mg
Adolescent 25 mg 25 mg increase every three to five days 150 to 900 mg 900 mg
First-generation antipsychotics
Chlorpromazine
Preadolescent 50 mg 50 mg every one to three days (divided twice daily or every eight hours) 50 to 400 mg 400 mg/day
Adolescent 100 mg 50 to 100 mg every one to three days (divided twice daily or every eight hours) 100 to 400 mg 600 mg/day
Haloperidol[11]
Preadolescent 1 mg 0.5 mg to 1 mg every three to five days 0.5 to 6 mg 10 mg
Adolescent 1 mg 1 mg every three to five days 3 to 24 mg 24 mg
Perphenazine[12]
Preadolescent 2 to 4 mg twice daily 4 to 8 mg every three to five days (divided twice daily or every eight hours) 16 to 36 mg/day 36 mg/day
Adolescent 4 to 8 mg three times daily 4 to 8 mg every two to three days (divided twice daily or every eight hours) 24 to 64 mg/day 64 mg/day

* Weight, age, and exposure to previous antipsychotic medications should be taken into account when deciding upon dosing recommendations.

¶ If uncertain, we suggest starting with the lower dose and slower titration schedule.

Δ Preadolescent is generally defined as school age up until age 12 and adolescent is age 13 to 17.
References:
  1. Findling RL, Robb A, Nyilas M, et al. A multiple-center, randomized, double-blind, placebo-controlled study of oral aripiprazole for treatment of adolescents with schizophrenia. Am J Psychiatry 2008; 165:1432.
  2. Goldman R, Loebel A, Cucchiaro J, et al. Efficacy and Safety of Lurasidone in Adolescents with Schizophrenia: A 6-Week, Randomized Placebo-Controlled Study. J Child Adolesc Psychopharmacol 2017; 27:516.
  3. Kryzhanovskaya L, Schulz C, McDougle CJ, et al. A double-blind, placebo-controlled study of olanzapine in adolescents with schizophrenia. Neuropsychopharmacology 2005; 30:S258.
  4. Savitz AJ, Lane R, Nuamah I, et al. Efficacy and safety of paliperidone extended release in adolescents with schizophrenia: A randomized, double-blind study. J Am Acad Child Adolesc Psychiatry 2015; 54:126.
  5. Shaw JA, Lewis JE, Pascal S, et al. A study of quetiapine: Efficacy and tolerability in psychotic adolescents. J Child Adolesc Psychopharmacol 2001; 11:415.
  6. McCracken JT, McGough J, Shah B, et al. Risperidone in children with autism and serious behavioral problems. N Engl J Med 2002; 347:314.
  7. Haas M, Delbello MP, Pandina G, et al. Risperidone for the treatment of acute mania in children and adolescents with bipolar disorder: A randomized, double-blind, placebo-controlled study. Bipolar Disord 2009; 11:687.
  8. Haas M, Eerdekens M, Kushner S, et al. Efficacy, safety and tolerability of two dosing regimens in adolescent schizophrenia: Double-blind study. Br J Psychiatry 2009; 194:158.
  9. Kumra S, Frazier JA, Jacobsen LK, et al. Childhood-onset schizophrenia: A double-blind clozapine-haloperidol comparison. Arch Gen Psychiatry 1996; 53:1090.
  10. Shaw P, Sporn A, Gogtay N, et al. Childhood-onset schizophrenia: A double-blind, randomized clozapine-olanzapine comparison. Arch Gen Psychiatry 2006; 63:721.
  11. Engelhardt DM, Polizos P, Waizer J, Hoffman SP. A double-blind comparison of fluphenazine and haloperidol in outpatient schizophrenic children . J Autism Dev Disord 1973; 3:128.
  12. John M. Eisenberg Center for Clinical Decisions and Communications Science. First- and Second-Generation Antipsychotics for Children: Comparative Effectiveness. In: Comparative Effectiveness Review Summary Guides for Clinicians. Agency for Healthcare Research and Quality, Rockville 2007. Available from: https://www.ncbi.nlm.nih.gov/books/NBK109555/.
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