| Seizure disorders; panic disorder. View labelExact | Panic disorder (label): start 0.25 mg twice daily; increase every 3 days to 1 mg twice daily; maximum 4 mg/day. | Benzodiazepine; enhances GABA‑A receptor activity. | Hepatic | Steady-state mean 35 h | No | | - Sedation, cognition, gait/ataxia, and fall risk at each visit; counseling commonly covers driving and occupational safety after dose changes.
- Respiratory risk (sleep apnea, COPD) and co-prescribed CNS depressants; overdose education is important, and some settings coordinate naloxone when opioids are unavoidable.
- Misuse/diversion risk: PDMP review, documentation of indication/duration, and periodic reassessment with a time-limited plan are common.
- Withdrawal risk: written taper schedules, tracking rebound anxiety/insomnia, and slower tapers for long-term users or higher doses are typical.
| No | 2026-02-20 |
|---|
| Schizophrenia; acute manic/mixed episodes; bipolar depression; adjunct for major depressive disorder. View labelExact | Schizophrenia (IR): day 1 25 mg BID, titrate to 300–400 mg/day by day 4; maintenance 300–800 mg/day divided BID. | Antagonist at 5‑HT2A and D2 (transient), strong H1 and alpha‑1 activity. | CYP3A4 | Steady-state mean 6 h | No | | - Metabolic: weight/BMI, fasting glucose/HbA1c, and lipids (baseline and periodic).
- Sedation: assess next-day impairment and fall risk, especially with other sedatives.
| No | 2025-09-23 |
|---|
| Schizophrenia; severe behavior disorders; Tourette's syndrome (tics/vocal utterances); adjunct in acute agitation. View labelExact | Schizophrenia (oral): initiate 1–5 mg two or three times daily; maintenance 5–20 mg/day divided; doses >30 mg/day increase EPS risk. | Potent dopamine D2 receptor antagonist; minimal anticholinergic. | CYP3A4, CYP2D6 | Steady-state mean 21 h | No | | - Extrapyramidal symptoms are monitored periodically; prophylaxis is generally reserved for clear need.
- QTc: ECG monitoring is often considered when risk factors or higher doses are present.
- LAI: Haloperidol decanoate every 4 weeks—product-specific conversion guidance is typically used.
- Regular AIMS screening for tardive dyskinesia (typically every 3–6 months; every 3 months in higher-risk groups or with dose increases).
- Prolactin-related symptoms (sexual dysfunction, amenorrhea, galactorrhea) and overall quality-of-life impact—consider switching if persistent.
- Orthostatic vitals and falls risk, especially in older adults and when combined with other CNS depressants or antihypertensives.
- Metabolic monitoring (weight/BMI, glucose, lipids) periodically as part of comprehensive schizophrenia care, even though metabolic risk is lower than many SGAs.
| q4wk | 2026-03-31 |
|---|
| Acute mania associated with bipolar disorder; seizures (various types). View labelExact | Acute mania: initiate 750–1,000 mg/day (divided TID for DR or once daily ER) and titrate to serum 50–125 µg/mL; loading up to 20–30 mg/kg/day can achieve rapid control. | Increases GABA; modulates voltage-gated sodium and calcium channels. | UGT, beta-oxidation | Steady-state mean 12 h | 50–125 µg/mL | | - Baseline: LFTs, CBC with platelets, pregnancy test if relevant, weight/BMI.
- Level timing: 12-hour trough (extended-release may differ); target 50–125 µg/mL based on clinical context.
- Ongoing: Periodic LFTs and CBC; monitor metabolic effects and sedation.
- Precautions: Reinforce teratogenicity counseling; review pancreatitis and hepatotoxicity warnings.
- Drug interactions: Adjust for enzyme induction (UGT), lamotrigine titration, and other interacting therapies.
| No | 2026-03-31 |
|---|