📋 Indications & Clinical Dosage
*Acute and chronic psychosis:*
Adult: 2 mg daily in 1-2 divided doses for day 1, then 4 mg daily in 1-2 divided doses for day 2, slowertitration is appropriate in some patients, usual dose 4-6 mg daily, doses above 10 mg daily only if benefit considered to outweigh risk; max. 16 mg per day.
Elderly: Initially 500 mcg twice daily, then increased in steps of 500 mcg twice daily, increased to 1-2 mg twice daily.
*Mania:*
Adult: Initially 2 mg once daily, then increased in stepsof 1 mg daily if required; usual dose 1-6 mg daily.
Elderly: Initially 500 mcg twice daily, thenincreased in steps of 500 mcg twice daily, increased to 1-2 mg twice daily.
*Short-term treatment (up to 6 weeks) of persistent aggression in patients with moderate to severe Alzheimers dementia:*
Adult: Initially 250 mcg twice daily, then increased in steps of 250 mcg twice a day on alternate days, adjusted according to response; usual dose 500 mcg twice daily (max. per dose 1 mg twice daily).
*Short-term treatment (up to 6 weeks) of persistent aggression in conduct disorder:*
Children 5-18 yrs: (body-weight under 50 kg), initially 250 mcg once daily increased according to response in steps of 250 mcg on alternate days, usual dose 500 mcg daily (up to 750 mcg once daily has been required); 5-18 yrs: body-weight above 50 kg), initially 500 mcg once daily increased according to response in steps of 500 mcg on alternate days, usual dose 1 mg daily (up to 1.5 mg once daily has been required).
⚠️ Precautions & Warnings
Avoid in acute porphyrias, cataract surgery (risk of intra-operative floppy iris syndrome), dehydration, elderly, dementia with Lewy bodies, epilepsy, Parkinsonism, prolactin-dependent tumours, renal, hepatic and cardiovascular disease. Monitor for signs of tardive dyskinesia, withdraw if these occur.
🔄 Drug Interactions
Centrally acting drugs, levodopa, dopamine agonists.
⚠️ Adverse Reactions / Side Effects
Anxiety, alopecia, arthralgia, depression, epistaxis, hypertension, infection, malaise, myalgia, oedema, respiratory disorders, sleep disorders, toothache, urinary disorders, elevated plasma-cholesterol and plasma-triglyceride concentrations, hypoaesthesia, paraesthesia, taste disturbances, tinnitus, visual disorders. Rare Inappropriate antidiuretic hormone secretion, intestinal obstruction, intra-operative floppy iris syndrome, pancreatitis, pulmonary embolism, rhabdomyolysis
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Avoid unless potential benefit outweighs risk
Lactation / Breastfeeding:
Contraindicated, avoid