4.2.1 Antipsychotics drugs

Antipsychotics (first-generation)

Chlorpromazine
  • Tablets 25mg, 50mg, 100mg (£1.78 = 100mg x 28 tablets)
  • Oral solution 25mg in 5ml, 100mg in 5ml (£5.50 = 150ml x 100mg/5ml)

Indications

  • Schizophrenia and other psychoses, mania, short-term adjunctive management of severe anxiety, psychomotor agitation, excitement, and violent or dangerously impulsive behaviour
Haloperidol
  • Capsules 500 micrograms (£1.18 = 30 capsules)
  • Tablets 1.5mg, 5mg, 10mg (£12.95 = 28 x 10mg)
  • Oral liquidSF 1mg in 1ml (5mg/5ml), 2mg in 1ml (10mg/5ml) (£6.47 = 100ml x 5mg/5ml)
  • Injection 5mg/ml (£0.87 = ampoule)

Indications

  • Schizophrenia and other psychoses
  • Agitation and restlessness in the elderly
  • Short-term adjunctive management of severe anxiety
  • Motor tics, adjunctive treatment in choreas and Tourette syndrome
  • Nausea and vomiting, see Prescribing in Palliative Care, I/M injection, 1–2mg
  • Haldol®, maintenance in schizophrenia and other psychoses

Notes

  1. Baseline ECG is recommended prior to treatment with haloperidol in all patients, especially in the elderly and patients with a positive personal or family history of cardiac disease or abnormal findings on cardiac clinical examination.
Levomepromazine
  • Tablet 25mg (£20.26 = 84 tablets)
  • Injection 25mg in 1ml (£2.01 per ampoule)
  • Tablets 6mg (unlicensed preparation)

Indications

Sulpiride
  • Tablets 200mg, 400 mg (£18.80 = 30 x 400mg)
  • Oral solutionSF 200mg in 5ml (£27.00 = 150ml)

Indications

  • Schizophrenia
Trifluoperazine
  • Tablets 1mg, 5mg (£54.00 = 112 x 1mg)
  • Oral solutionSF 1mg in 5ml, 5mg in 5ml (£25.50 = 150ml x 5mg/5ml)

Indications

  • Schizophrenia and other psychoses, short-term adjunctive management of psychomotor agitation, excitement, and violent or dangerously impulsive behaviour

Notes

  1. Trifluoperazine is included in the formulary for currently treated patients, there should be no new initiations
Zuclopenthixol dihydrochloride
  • Tablets 2mg, 10mg, 25mg (£8.06 = 10mg x 100 tablets)

Indications

  • Schizophrenia and other psychoses

Antipsychotics (second-generation)

Amisulpride
  • Tablets 50mg, 100mg, 200mg, 400mg (£16.43 = 400mg daily)
  • Solution 100mg/ml (£36.00 = 60ml)

Indications

Aripiprazole
  • Tablets 5mg, 10mg, 15mg, 30mg (£1.86 = 15mg daily)
  • Orodispersible tablet 10mg, 15mg (£79.57 = 15mg daily)
  • Oral solution 1mg/ml (£288.12 = 15mg daily)
  • Injection 7.5mg/ml, 1.3ml = 9.75mg vial

Indications

Notes

  1. NICE TA213 Aripiprazole for schizophrenia in people aged 15 to 17 years (Jan 2011)
  2. NICE TA292 Aripiprazole for moderate to severe manic episodes in adolescents with bipolar I disorder (July 2013)
  3. Short acting injection should be used only in secondary care in accordance with Trust's rapid tranquillisation policy
Olanzapine
  • Tablets 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg (£1.05 = 10mg daily)
  • Orodispersible tablet 5mg, 10mg, 15mg, 20mg (£2.26 = 10mg daily)
  • Injection 10mg/2ml

Indications

Notes

  1. Olanzapine has been associated with an increased risk of hyperglycaemia, diabetes mellitus and exacerbations of diabetes. In diabetes and in patients with risk factors for diabetes mellitus, appropriate clinical and blood glucose monitoring is conducted.
  2. See NICE CG178 Psychosis and schizophrenia in adults.
  3. Short acting injection should be used only in secondary care in accordance with Trust's rapid tranquillisation policy
  4. Olanzapine long-acting injection is associated with post-injection syndrome. Olanzapine should only be given in health-care facilities where administration of the injection and observation of patients post-injection can be undertaken safely and for at least three hours. The three-hour observation period should be extended as clinically appropriate for patients who exhibit any signs or symptoms consistent with olanzapine overdose. Olanzapine should only be administered by healthcare professionals trained in the appropriate injection technique. Training materials are available at: https://www.zypadhera.co.uk/SignIn.aspx
Quetiapine
  • Tablets 25mg, 100mg, 150mg, 200mg, 300mg (£2.20 = 400mg daily)
  • Zaluron® XL modified release tablets 50mg, 150mg, 200mg, 300mg, 400mg (£43.87 = 400mg daily)

Indications

Notes

  1. Modified release quetiapine is only recommended for use when individuals cannot tolerate immediate-release quetiapine or if concordance with a twice daily regimen is difficult.
Risperidone
  • Tablets 500 micrograms, 1mg, 2mg, 3mg, 4mg, 6mg (£1.47 = 2 x 3mg daily) (£3.34 = 1 x 6mg daily)
  • Orodispersible tablet 500 micrograms, 1mg, 2mg, 3mg, 4mg (£67.00 = 2 x 3mg daily)
  • Liquid 1mg in 1ml (£6.99 = 6mg daily)

Indications

Notes

  1. Due to the cost, orodispersible tablets are included for use in patients where there is suspected non-compliance when compliance can be checked
  2. No new patients will receive risperidone long-acting injection. There is an existing cohort of patients who will continue to receive risperidone.
Clozapine
  • Clozaril® Tablets 25mg 100mg
  • Denzapine® suspension 50mg/ml

Indications

  • Schizophrenia in patients unresponsive to, or intolerant of, conventional antipsychotic drugs

Notes

  1. Prescribers, pharmacies and patients must be registered with either the Clozaril® Patient Monitoring Service (CPMS) for those taking tablets or the Denzapine® Monitoring Service (DMS) for those taking suspension. Make sure patients are registered in the correct service; they cannot be registered for both. Refer to hospital Pharmacy Department and the:
    1. PCH policy Clozaril® policy for mental health and GP staff
    2. DPT policy Pharmacological Treatment of Schizophrenia and Related Psychoses
    3. DPT Clinical Protocol for Clozapine CP19
  2. Treatment needs to re-titrated if there has been more than 48 hours between doses. Patient needs to be urgently reviewed by their specialist.
  3. MHRA Drug Safety Update (October 2017): Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus
    1. the antipsychotic drug clozapine has been associated with varying degrees of impairment of intestinal peristalsis; this effect can range from constipation, which is very common, to very rare intestinal obstruction, faecal impaction, and paralytic ileus
    2. exercise particular care in patients receiving other drugs known to cause constipation (especially those with anticholinergic properties), patients with a history of colonic disease or lower abdominal surgery, and in patients aged 60 years and older
    3. advise patients to report constipation immediately and actively treat any constipation that occurs, with an osmotic and/or stimulant laxative.
Lurasidone

The routine commissioning of lurasidone is not accepted in Devon for patients with schizophrenia (see Commissioning Policy for more details).

 

Home > Formulary > Chapters > 4. Central Nervous System > 4.2 Drugs used in psychoses and related disorders > 4.2.1 Antipsychotics drugs

 

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