| Tourette’s disorder — suppression of motor and phonic tics after inadequate response to standard treatment (label). View labelExact | The label emphasizes slow, gradual titration to balance tic suppression with adverse effects. Baseline and periodic ECG monitoring is described as essential, particularly during dose adjustment (label).
Adults: label describes starting 1–2 mg/day in divided doses and increasing every other day as needed. Most patients are maintained at <0.2 mg/kg/day or 10 mg/day (whichever is less); higher doses are not recommended (label). | Dopamine receptor antagonist used primarily for Tourette’s disorder (tic suppression). Carries QT prolongation risk and has extensive contraindicated drug interactions (label). | CYP2D6, CYP3A4 | No | | - Baseline ECG and periodic ECGs during dose adjustment (label).
- Electrolytes (hypokalemia/hypomagnesemia increases torsades risk; label).
- Medication list review after any new prescription (QT and CYP interactions).
- Movement symptoms and tardive dyskinesia screening.
- Sedation and functional impairment when combined with other sedatives.
| No | 2026-02-23 |
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| 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 |
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| Schizophrenia; acute mania or mixed episodes (bipolar I) as monotherapy or adjunct; irritability associated with autistic disorder. View labelExact | Schizophrenia (adults): start 1–2 mg/day; increase by 1–2 mg/day to 4–6 mg/day (doses >6 mg/day increase EPS). | Dopamine D2 and serotonin 5‑HT2A receptor antagonism; also alpha‑1 and H1 activity. | CYP2D6 | Single-dose mean 3 h; Steady-state mean 21 h | No | - Weight
- Sedation
- EPS
- Prolactin
| - Metabolic: weight/BMI, fasting glucose/HbA1c, and lipids (baseline and periodic).
- EPS: monitor akathisia/parkinsonism; periodic AIMS for tardive dyskinesia.
- Prolactin: monitor for symptoms (amenorrhea, galactorrhea, sexual dysfunction).
- Sedation: assess next-day impairment and fall risk, especially with other sedatives.
| q2wk; Monthly (q4wk); q4wk or q8wk (by dose) | 2025-12-28 |
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| Schizophrenia; acute manic or mixed episodes of bipolar I disorder (monotherapy or adjunct to lithium/valproate); maintenance therapy via LAI formulations; adjunctive treatment of major depressive disorder; irritability in autistic disorder; Tourette disorder. View labelExact | Schizophrenia (adults): start 10–15 mg once daily; therapeutic range 10–30 mg/day. Doses above 30 mg rarely add benefit. | Dopamine D2/D3 partial agonist with 5-HT1A partial agonism and 5-HT2A antagonism, stabilizing dopaminergic tone with comparatively low metabolic and EPS burden.
| CYP2D6, CYP3A4 | Steady-state mean 75 h; Steady-state range 75–146 h | 120–270 ng/mL | | - Metabolic: weight/BMI, fasting glucose/HbA1c, and lipids (baseline and periodic).
- EPS: monitor akathisia/parkinsonism; periodic AIMS for tardive dyskinesia.
| Monthly (q4wk); q4–8wk (varies by strength); Every 2 months (q8wk) | 2025-12-28 |
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