| Hallucinations and delusions associated with Parkinson’s disease psychosis (label). View labelExact | Recommended dose is 34 mg once daily without titration (label). | Selective serotonin 5-HT2A inverse agonist/antagonist with minimal dopamine receptor activity. Approved for hallucinations and delusions associated with Parkinson’s disease psychosis (label). | CYP3A4, CYP3A5, CYP2J2 (minor), CYP2D6 (minor) | Single-dose mean 57 h | No | | - Review baseline QT risk (history of arrhythmia/syncope, electrolyte abnormalities) and other QT-prolonging drugs; consider an ECG when risk is elevated (label/clinical).
- Monitor for confusional state/delirium, peripheral edema, and falls, especially in older adults with baseline cognitive impairment (label/clinical).
- Reassess hallucinations/delusions and caregiver distress after initiation (often within the first month) and after major medication changes (clinical).
- Medication reconciliation: avoid strong CYP3A4 inducers, reduce dose with strong CYP3A4 inhibitors, and re-check interactions when new medicines are started (label).
- If switching from another antipsychotic, use a structured cross-taper plan and monitor for rebound psychosis or withdrawal effects (consensus/clinical).
| No | 2026-02-22 |
|---|
| 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 |
|---|
| Treatment-resistant schizophrenia
Reduction of recurrent suicidal behavior in schizophrenia or schizoaffective disorder View labelExact | Initiate 12.5 mg once or twice on day 1; increase by 25–50 mg/day in divided doses as tolerated. | Mechanism not fully known. Proposed efficacy via antagonism at dopamine D2 and serotonin 5‑HT2A receptors; also antagonizes adrenergic, cholinergic, and histaminergic receptors. | CYP1A2, CYP3A4, CYP2D6 | Single-dose mean 8 h; Single-dose range 4–12 h; Steady-state mean 12 h; Steady-state range 4–66 h | 350–600 ng/mL | | - ANC monitoring: Weekly for first 6 months, every 2 weeks for months 6–12, then monthly thereafter per label.
- Metabolic: Track weight/BMI and fasting lipids/glucose at baseline, 3 months, then periodically.
- Clinical: Monitor for infection; inflammation or smoking changes can alter serum levels.
- Early myocarditis vigilance: Follow local guidance (some protocols include troponin/CRP during initial weeks).
| No | 2026-02-23 |
|---|
| Schizophrenia; acute treatment of manic or mixed episodes (bipolar I) and maintenance; in combination with fluoxetine for bipolar depression. View labelExact | Schizophrenia (adults): initiate 5–10 mg once daily; titrate by 5 mg increments at ≥24-hour intervals to 10–20 mg/day (max 20 mg). | Antagonist at serotonin 5‑HT2A and dopamine D2 receptors; strong H1 and muscarinic activity. | CYP1A2, CYP2D6 (minor) | Steady-state mean 30 h | No | | - Metabolic monitoring (weight/BMI, waist circumference, blood pressure, fasting glucose/A1c, lipids) at baseline and periodically (early and then ongoing) because weight and glycemic changes can occur quickly.
- Appetite changes, sedation, and falls risk—reassess driving and occupational safety after dose changes and when other CNS depressants are added.
- Smoking status and CYP1A2 modulators; reduce dose when smoking stops and reassess if smoking restarts or if CYP1A2 inhibitors are introduced.
- AIMS/EPS monitoring at routine intervals, especially in older adults and at higher doses (EPS risk is lower than FGAs but not zero).
- For depot olanzapine pamoate, adhere to REMS observation and PDSS counseling requirements, including post-injection monitoring and “no driving” instructions on injection day.
| q2–4wk | 2025-12-28 |
|---|