Appendix of Psychiatric Medications

Appendixof Psychiatric Medications

Robert H.

Chew

Robert B.

MacArthur

		Adult		Pediatric
Medication	Approved indications	Usual dosage	Maximum (mg/day)	Usual dosage	Maximum (mg/day)	Comments
ANTIDEPRESSANTS
Tricyclic and tetracyclic antidepressants
Secondary tricyclics
Desipramine (Norpramin)	MDD	100–200 mg/day (at bedtime or in divided doses)	300	Ages ≥ 13 years: 25–100 mg/day (at bedtime or in divided doses)	150
Nortriptyline (Pamelor)	MDD	75–100 mg/day (once daily or divided tid–qid)	150	Ages 6–12 years: 1–3 mg/kg/day (divided tid–qid	150
Nortriptyline (Pamelor)	MDD	75–100 mg/day (once daily or divided tid–qid)	150	Ages > 12 years: 30–50 mg/day (once daily or divided tid–qid	150
Protriptyline (Vivactil)	MDD	15–40 mg/day (divided tid–qid)	60	Ages ≥ 12 years: 15 mg/day (divided tid)	60
Tertiary tricyclics
Amitriptyline (Elavil)	MDD	50–150 mg/day (at bedtime or in divided doses)	300	Ages ≥ 12 years: 50–100 mg/day (once daily or in divided doses)	200
Amitriptyline (Elavil)	MDD, hospitalized patients	100–200 mg/day (at bedtime or in divided doses)	300
Clomipramine (Anafranil)	OCD	150–250 mg/day (at bedtime or in divided doses)	250	Ages ≥ 10 years: 100–200 mg/day (at bedtime or in divided doses)	3 mg/kg/day or 200 mg/day, whichever is less
Doxepin	Depression and/or anxiety
	Mild to moderate symptoms	75–150 mg/day (at bedtime or in divided doses)	150
	Severe symptoms	300 mg/day (at bedtime or in divided doses)	300
Doxepin (Silenor)	Insomnia (sleep maintenance)	3–6 mg at bedtime	6
Imipramine (Tofranil)	MDD	50–150 mg/day (at bedtime or in divided doses)	200	Ages ≥ 13 years: 30–40 mg/day (at bedtime or in divided doses)	100
	MDD, hospitalized patients	250–300 mg/day (in divided doses)	300
	Nocturnal enuresis			Ages 6–12 years: 10–50 mg at bedtime	50
				Ages > 12 years: 10–75 mg at bedtime	75
Trimipramine (Surmontil)	MDD	50–150 mg/day (at bedtime or in divided doses)	200	Ages ≥ 13 years: 50–100 mg/day (at bedtime or in divided doses)	100
	MDD, hospitalized patients	250–300 mg/day (at bedtime or in divided doses)	300
Tetracyclics
Amoxapine	MDD	200–300 mg/day (at bedtime or in divided doses)	400
	MDD, hospitalized patients	200–300 mg/day (at bedtime or in divided doses)	600
Maprotiline	MDD	75–150 mg/day (at bedtime or in divided doses)	150
	MDD, hospitalized patients	150–225 mg/day (at bedtime or in divided doses)	225
Selective serotonin reuptake inhibitor (SSRI) antidepressants
Citalopram (Celexa)	MDD	20–40 mg/day	40
Escitalopram (Lexapro)	MDD	10–20 mg/day	20	Ages 12–17 years: 10–20 mg/day	20
	GAD	10–20 mg/day	20
Fluoxetine (Prozac)	MDD	20–80 mg/day in morning or divided bid; or 90 mg weekly^†	80	Ages ≥ 8 years: 10–20 mg/day in morning	20	^†Fluoxetine 90-mg delayed-release capsule
	OCD	20–60 mg/day in morning or divided bid	80	Ages ≥ 7 years: 20–60 mg/day in morning or divided bid	60
	Panic disorder	20–60 mg/day	60
	Bulimia nervosa	20–60 mg/day	60
Fluoxetine (Sarafem)	PMDD	20–60 mg/day^†	80			^†Administered throughout menstrual cycle or during luteal phase of menstrual cycle.
Fluvoxamine	OCD	100–300 mg/day (divided bid)	300	Ages 8–17 years: 50–200 mg/day (divided bid)	200
				Ages > 17 years: 100–300 mg/day (divided bid)	300
Fluvoxamine extended-release (Luvox CR)	OCD	100–300 mg/day at bedtime	300
Paroxetine (Paxil)	MDD	20–50 mg/day in morning	50
Paroxetine extended-release (Paxil CR)		CR: 25–62.5 mg/day	62.5
	GAD	20–50 mg/day	50
	Social anxiety disorder	20–60 mg/day	60	Ages 8–17 years:* 10–60 mg/day in morning	60	*Off-label use.
		CR: 12.5–37.5 mg/day	37.5
	Panic disorder	40 mg/day in morning CR: 12.5–75 mg/day in morning	60 75
	OCD	20–60 mg/day in morning	60	Ages 7–17 years:* 10–60 mg/day in morning	60	*Off-label use.
	PTSD	20–50 mg/day in morning	50
	PMDD	CR: 12.5–25 mg/ day in morning^†	25			^†Administered throughout menstrual cycle or during luteal phase of menstrual cycle.
Paroxetine mesylate (Brisdelle)^†	Moderate to severe vasomotor symptoms associated with menopause	7.5 mg/day at bedtime	—			^†Limitations of Use: Not indicated for treatment of any psychiatric condition; contains a lower dosage than that used to treat psychiatric disorders.
Sertraline (Zoloft)	MDD	50–200 mg/day in morning	200	Ages ≥ 6 years:* 25–200 mg/day in morning	200	*Off-label use.
	Social anxiety disorder	50–200 mg/day	200
	Panic disorder	50–200 mg/day in morning	200
	OCD	50–200 mg/day in morning	200	Ages 6–12 years: 25–200 mg/day	200
				Ages 13–17 years: 50–200 mg/day	200
	PTSD	50–200 mg/day in morning	200
	PMDD	50–200 mg/day in morning^†	150			^†Administered throughout menstrual cycle or during luteal phase of menstrual cycle.
Serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants
Desvenlafaxine (Pristiq)	MDD	50 mg/day	50
Duloxetine delayed-release (Cymbalta;^† Drizalma Sprinkle^††)	MDD	40–60 mg/day (once daily or divided bid)	120			^†Cymbalta must be swallowed whole; do not crush, chew, or open capsule.
	GAD	60 mg/day	120	Ages 7–17 years: 30–60 mg/day	120	^††Drizalma may be swallowed whole (do not crush or chew capsule); opened and sprinkled over applesauce; or administered via nasogastric tube.
	Diabetic neuropathic pain	60 mg/day	60
	Musculoskeletal pain	60 mg/day	60
	Fibromyalgia	60 mg/day	60	Ages 13–17 years:^† 60 mg/day	60	^†Cymbalta only; Drizalma is approved only in adults
Levomilnacipran (Fetzima)	MDD	40–120 mg/day	120
Milnacipran (Savella)	Fibromyalgia	100 mg/day (divided bid)	200
Venlafaxine	MDD	75–225 mg/day	225
Venlafaxine extended-release (Effexor ER)	MDD	75–225 mg/day	225
	GAD	75–225 mg/day	225
	Social anxiety disorder	75 mg/day	75
	Panic disorder	75–225 mg/day	225
Venlafaxine besylate extended-release tablets (112.5 mg)^†	MDD GAD	112.5 mg once daily with food	225			^†Do not initiate treatment with venlafaxine extended-release tablets. Use another venlafaxine extended-release product for initial dosage, titration, and dosages below 112.5 mg once daily.

Norepinephrine-dopamine reuptake inhibitor (NDRI) antidepressant (putative§)
Bupropion immediate-release	MDD	300 mg/day (divided tid)	150 mg/dose; 450 mg/day			§Bupropion’s precise mechanism of action is not known.
	ADHD*	300 mg/day (divided tid)	^†	Ages ≥ 6 years: 1.4–6.0 mg/kg/day (divided bid)	^†	*Off-label use.
		300 mg/day (divided tid)		Ages ≥ 6 years: 1.4–6.0 mg/kg/day (divided bid)	^†	^†Maximum dosing (adult and pediatric) for bupropion IR: 150 mg/dose; 450 mg/day
Bupropion sustained-release (Wellbutrin SR)	MDD	SR: 300 mg/day (divided bid)	400
	ADHD*	SR: 300 mg/day (divided bid)	400	Ages ≥ 12 years: 3–6 mg/kg/day (divided bid)	400	*Off-label use.
Bupropion extended-release
Bupropion XL	MDD, seasonal affective disorder	300 mg/day in morning	450
	ADHD*	300 mg/day in morning	300	Ages ≥ 12 years: 3–6 mg/kg/day in morning	400	*Off-label use.
Aplenzin	MDD, seasonal affective disorder	348 mg/day in morning	522

Multimodal serotonin antagonist antidepressants
Nefazodone‡	MDD	300–600 mg/day (divided bid)	600			‡Risk of hepatic failure associated with nefazodone hydrochloride treatment.
	Depression	Refer to manufacturer’s full prescribing information for dosing guidelines and titration schedule.	600
Trazodone	MDD	150–300 mg/day (divided bid–tid)	400
	Insomnia*	25–100 mg/day at bedtime	200			*Off-label use.
Trazodone extended-release^†	MDD	150–375 mg/day at bedtime	375			^†The Oleptro brand name has been discontinued in the United States.
Serotonin-modulating antidepressants
Vilazodone (Viibryd)	MDD	20–40 mg/day	40
Vortioxetine (Trintellix)	MDD	20 mg/day	20^†			^†Dosage should not exceed 10 mg/day in CYP2D6 poor metabolizers or be administered with strong CYP2D6 inhibitors.

Noradrenergic-specific serotonin antidepressant (NaSSA)
Mirtazapine (Remeron)	MDD	15–45 mg/day at bedtime	45

Selective serotonin 1A receptor partial agonist antidepressant
Gepirone extended-release (Exxua)	MDD	Start with 18.2 mg/day. Dosage may be increased to 36.3 mg/day on day 4, and may be further titrated to 54.5 mg/day after day 7 and to 72.6 mg/day after an additional week.	72.6
Neuroactive steroid GABA-A receptor positive allosteric modulator (PAM) antidepressants
Brexanolone injection (Zulresso)‡	PPD in patients ages 15 years and older	Administered as a continuous IV infusion over 60 hours (2.5 days).^†	—			‡Available only through a REMS drug safety program.
		Refer to manufacturer’s full prescribing information for recommended dosing.
Zuranolone capsules (Zurzuvae)	PPD	Refer to manufacturer’s full prescribing information for recommended dosing.	—			^†A health care provider must be available on site to continuously monitor the patient, and intervene as necessary, for the duration of the infusion.
Monoamine oxidase inhibitor (MAOI) antidepressants
Isocarboxazid (Marplan)	MDD and atypical depression	40–60 mg/day (divided bid–qid)	60
Phenelzine (Nardil)	MDD and atypical depression	40–60 mg/day in divided doses^†	90			^†After maximum benefit is achieved, dosage should be reduced over several weeks. Maintenance dosage can range from 15 mg every other day to 15 mg once daily.
Selegiline transdermal patch (Emsam)	MDD	6–12 mg patch per 24 hours	12
Selegiline hydrochloride (Zelapar ODT [orally disintegrating tablets])	Management of patients with Parkinson’s disease being treated with levodopa/carbidopa	1.25 mg given once daily for at least 6 weeks. After 6 weeks, daily dosage may be escalated up to 2.5 mg.	2.5
Tranylcypromine (Parnate)	MDD and atypical depression	30 mg/day in divided doses	60

NMDA receptor antagonist antidepressants
Dextromethorphan hydrobromide/bupropion hydrochloride extended-release tablets (Auvelity)	MDD	Start with 1 tablet (45 mg/105 mg) daily taken in the morning. After 3 days, increase to maximum recommended dosage of 1 tablet taken twice daily, separated by at least 8 hours.	Do not exceed two 1-tablet doses taken within the same day.
Esketamine nasal spray (Spravato)‡	Treatment-resistant depression	Refer to manufacturer’s full prescribing information for recommended dosing.^†	—			‡Available only through a REMS drug safety program.
	Depressive symptoms with acute suicidal ideation or behavior in patients with MDD		—			^†Administer intranasally under the supervision of a health care provider.
Ketamine	Relief of acute depression with suicidal ideation*	0.5 mg/kg IV infusion over 40 minutes	—			*Off-label use.
ANXIOLYTICS
Benzodiazepine GABA-A receptor PAMs
Alprazolam (Xanax)	GAD	0.25–0.5 mg tid	4
	Panic disorder	1.5–9 mg/day (divided tid)	10
Alprazolam extended-release (Xanax XR)	GAD	3–6 mg/day	6
Chlordiazepoxide	GAD, mild to moderate	5–10 mg tid–qid	^†	Ages ≥ 6 years: 5–10 mg bid–tid	^†	^†There is no well-established chlordiazepoxide maximum dosage for treatment of GAD.
	GAD, severe	20–25 mg tid–qid	^†
	Acute alcohol withdrawal	50–100 mg prn	300
Clonazepam (Klonopin)	Panic disorder	1–4 mg/day (divided bid)	4
Clorazepate	GAD	15–30 mg/day (at bedtime or divided bid)	60
	Acute alcohol withdrawal	Refer to manufacturer's full prescribing information for recommended dosing guidelines and titration schedules.	—
Diazepam (Valium)	GAD	2–10 mg bid–qid	40
	Acute alcohol withdrawal	10 mg tid–qid for first 24 hours; then 5 mg tid–qid prn	—
Lorazepam (Ativan)	GAD	2–6 mg/day (divided bid–tid)	10
	Anxiety-associated insomnia	2–4 mg at bedtime	4
Lorazepam injection (Ativan Injection)	Acute agitation*	0.5–1 mg IM prn every 30–60 minutes	—			*Off-label use.
Lorazepam extended-release capsules (Loreev XR)	Anxiety disorders in adults who are receiving stable, evenly divided, three-times-daily dosing with lorazepam tablets	Refer to manufacturer's full prescribing information for recommended dosing.	—
Oxazepam	GAD	10–30 mg tid–qid	120
	Acute alcohol withdrawal	15–30 mg tid–qid	—
Serotonin-1A receptor partial agonist
Buspirone	GAD	20–30 mg/day (divided bid–tid)	60
AGENTS FOR TREATMENT OF INSOMNIA
Benzodiazepine GABA-A receptor PAMs
Estazolam	Insomnia (sleep onset/maintenance; nocturnal or early-morning awakening)	1–2 mg at bedtime	2
Flurazepam (Dalmane)	Insomnia (sleep onset/maintenance)	15–30 mg at bedtime	30
Quazepam (Doral)	Insomnia (sleep onset; nocturnal or early-morning awakening)	7.5–15 mg at bedtime	15
Temazepam (Restoril)	Insomnia (sleep onset/maintenance)	7.5–30 mg at bedtime	30
Triazolam (Halcion)	Insomnia (sleep onset/maintenance)	0.125–0.5 mg at bedtime	0.5; 0.25 in elderly
Nonbenzodiazepine GABA-A receptor PAMs
Eszopiclone (Lunesta)	Insomnia (sleep onset/maintenance)	1–3 mg at bedtime	3
Zaleplon (Sonata)	Insomnia (middle-of-night awakening)	10–20 mg at bedtime	20
Zolpidem (Ambien)	Insomnia (sleep onset)	5–10 mg at bedtime	10
Zolpidem extended-release (Ambien CR)	Insomnia (sleep onset/maintenance)	6.5–12.5 mg	12.5
Zolpidem sublingual (SL) (Intermezzo)	Insomnia (sleep initiation)^†	Women: 1.75 mg prn Men: 3.5 mg prn	Once per night			^†Take as needed if unable to return to sleep after middle-of-night-awakening.
Melatonin receptor agonists
Ramelteon (Rozerem)	Insomnia (sleep onset)	8 mg at bedtime	8
Tasimelteon (Hetlioz)	Non-24-hour sleep-wake disorder	20 mg at bedtime	20
	Nighttime sleep disturbance in Smith-Magenis syndrome (SMS) in patients ages 16 years and older	20 mg taken 1 hour before bedtime	20	20 mg taken 1 hour before bedtime	20
	Nighttime sleep disturbance in SMS in pediatric patients ages 3–15 years			20 mg taken 1 hour before bedtime; if weight less than 28 kg, 0.7 mg/kg taken 1 hour before bedtime	0.7 mg/kg

Orexin receptor antagonists
Daridorexant (Quviviq)	Insomnia (sleep onset/maintenance)	25–50 mg at bedtime	50
Lemborexant (Dayvigo)	Insomnia (sleep onset/maintenance)	5–10 mg once per night, immediately before going to bed, with at least 7 hours remaining before the planned time of awakening	10
Suvorexant (Belsomra)	Insomnia (sleep onset/maintenance)	10–20 mg at bedtime	20
ANTIPSYCHOTICS
First-generation (typical) antipsychotics
Chlorpromazine	Psychotic disorders	200–600 mg/day (divided tid–qid)	1,000
	Acute manic states, hospitalized patients	200–800 mg/day (divided tid–qid)	2,000
Chlorpromazine injection	Acute agitation, hospitalized patients	25 mg IM, repeat 25–50 mg in 1 hour; up to 400 mg IM every 4–6 hours prn	—
Fluphenazine	Psychotic disorders	2.5–10 mg/day (divided tid–qid)	40
Fluphenazine hydrochloride injection	Acute agitation	2.5–10 mg/day IM every 6–8 hours prn	10
Fluphenazine decanoate injection	Management of psychotic disorders and schizophrenia	25–50 mg IM every 3 weeks^†	—			^†Approximate conversion ratio of decanoate to oral is 12.5 mg (0.5 mL) every 3 weeks for every 10 mg of oral fluphenazine daily.
Haloperidol	Psychotic disorders	0.5–5 mg bid–tid	100	Ages 3–12 years: 0.05–0.15 mg/ kg/day	0.15 mg/kg/day
				Ages > 12 years: 0.5–5 mg bid–tid	15
	Tourette’s disorder	0.5–5 mg bid–tid	100	Ages 3–12 years: 0.05–0.075 mg/ kg/day	0.15 mg/kg/day
				Ages > 12 years: 0.5–5 mg bid–tid	15
	Behavioral disorders, severe			Ages 3–12 years: 0.05–0.075 mg/ kg/day	0.15 mg/kg/day
				Ages > 12 years: 0.5–5 mg bid–tid	15
Haloperidol lactate injection (Haldol Injection)	Acute psychosis	2–10 mg IM every 4–8 hours prn	20
Haloperidol decanoate injection (Haldol Decanoate)	Management of psychotic disorders and schizophrenia	50–200 mg IM every month	—
Loxapine (Loxitane)	Psychotic disorders	60–100 mg/day in divided doses	250
Loxapine inhalation (Adasuave)‡	Acute agitation	10 mg/day^†	10			‡Available only through a REMS drug safety program. ^†Must be administered by a health care professional.
Perphenazine	Psychotic disorders	4–8 mg tid	24
	Psychotic disorders, hospitalized patients	8–16 mg bid–qid	64
Pimozide (Orap)	Tourette’s disorder	2–10 mg/day	10	Ages ≥ 12 years: 0.05–0.2 mg/ kg/day	0.2 mg/kg/day, up to 10 mg/day
Thioridazine	Psychotic disorders	200–800 mg/day (divided bid–qid)	800
Thiothixene	Psychotic disorders	20–30 mg/day in divided doses	60
Trifluoperazine	Psychotic disorders	15–20 mg/day (once daily or divided bid)	40	Ages 6–12 years: 1 mg/day (once daily or divided bid)	15
				Ages ≥ 13 years: 15–20 mg/day (once daily or divided bid)	40
	Nonpsychotic anxiety	1–2 mg bid	6

Second-generation (atypical) antipsychotics
Aripiprazole (Abilify)	Schizophrenia	10–15 mg/day	30	Ages 13–17 years: 10 mg/day	30
	Bipolar I disorder	10–15 mg/day	30	Ages 10–17 years: 10 mg/day	30
	MDD, as adjunctive therapy with antidepressants	2–15 mg/day	15
	Tourette’s disorder			Ages 6–18 years, < 50 kg: 5 mg/day	10
				Ages 6–18 years, ≥ 50 kg: 10 mg/day	20
	Irritability associated with autism spectrum disorder			Ages 6–17 years: 5–10 mg/day	15
Aripiprazole long-acting IM injection (Abilify Maintena)	Schizophrenia	300–400 IM every month	—
Aripiprazole lauroxil long-acting IM injection (Aristada)	Schizophrenia	441–882 IM every 4–6 weeks	—
Asenapine SL (Saphris)	Schizophrenia	10–20 mg/day SL (divided bid)	20
	Bipolar I disorder, monotherapy	10–20 mg/day SL (divided bid)	20	Ages 10–17 years: 5–10 mg/day SL (divided bid)	20
	Bipolar I disorder, as adjunctive therapy with lithium or valproate	10 mg/day SL (divided bid)	20
Asenapine transdermal system (Secuado)	Schizophrenia	One 3.8 mg patch every 24 hours; may increase dosage to 5.7 mg/24 hours or 7.6 mg/24 hours after 1 week	7.6
Brexpiprazole (Rexulti)	Schizophrenia	2–4 mg/day	4	Ages 13–17 years: 2–4 mg/day	4
	MDD, as adjunctive therapy with antidepressants	2 mg/day	3
Second-generation (atypical) antipsychotics (continued)
Brexpiprazole (Rexulti) (continued)	Agitation associated with dementia due to Alzheimer’s disease‡	2 mg/day	3			‡Limitations of use: Not indicated as an as-needed (prn) treatment for this indication; not approved for treatment of dementia-related psychosis WITHOUT agitation associated with dementia due to Alzheimer’s disease
Cariprazine (Vraylar)	Schizophrenia	1.5–6 mg/day	6
	Bipolar I disorder	3–6 mg/day	6
	Bipolar depression	1.5–3 mg/day	3
	MDD, as adjunctive therapy with antidepressants	1.5–3 mg/day	3
Clozapine (Clozaril)‡	Schizophrenia, refractory	150–300 mg bid	900			‡Available only through a REMS drug safety program.
	Schizophrenia with high suicide risk	150–300 mg bid	900			‡Available only through a REMS drug safety program.
Iloperidone (Fanapt)	Schizophrenia	6–12 mg bid	24
Lumateperone (Caplyta)	Schizophrenia	42 mg/day	42
	Bipolar depression, as monotherapy or as adjunctive therapy with lithium or valproate	42 mg/day	42
Lurasidone (Latuda)	Schizophrenia	40–160 mg/day	160	Ages 10–17 years: 40–80 mg/day	80
	Bipolar depression, as adjunctive therapy with lithium or valproate	20–120 mg/day	120
	Bipolar depression, as monotherapy	20–120 mg/day	120	Ages 10–17 years: 20–80 mg/day	80
Olanzapine (Zyprexa)	Schizophrenia	10–20 mg/day	20	Ages ≥ 13 years: 10 mg/day	20
	Bipolar I disorder	5–20 mg/day	20	Ages ≥ 13 years: 10 mg/day	20
Olanzapine IM injection (Zyprexa Intramuscular)	Acute agitation	10 mg IM; may repeat after 2 hours one time; repeat prn 4 hours after second dose	30
Olanzapine long-acting IM injection (Zyprexa Relprevv)‡	Schizophrenia	Refer to manufacturer's recommended dosing guidelines and titration schedules.				‡Available only through a REMS drug safety program.
Olanzapine/fluoxetine (Symbyax)	Bipolar I disorder, acute depressive episodes	6 mg/25 mg/day– 12 mg/50 mg/ day	12/50	Ages 10–17 years: 3 mg/25 mg/day	12/50
	Treatment-resistant depression	6 mg/25 mg/day	12/50
Olanzapine/samidorphan (Lybalvi)	Schizophrenia	Starting: 5 mg/10 mg or 10 mg/10 mg	20/10
		Recommended: 10 mg/10 mg, or 15 mg/10 mg, or 20 mg/10 mg
	Bipolar I disorder, manic or mixed episodes, as monotherapy	Starting: 10 mg/10 mg or 15 mg/10 mg	20/10
		Recommended: 5 mg/10 mg, or 10 mg/10 mg, or 15 mg/10 mg, or 20 mg/10 mg
	Bipolar I disorder, as adjunctive therapy with lithium or valproate	Starting: 10 mg/10 mg	20/10
		Recommended: 10 mg/10 mg, or 15 mg/10 mg, or 20 mg/10 mg
Paliperidone (Invega)	Schizophrenia	6 mg/day	12	Ages 12–17 years: 3 mg/day	12
Paliperidone palmitate long-acting IM injection	Schizoaffective disorder	^†	—			^†Refer to manufacturer’s full prescribing information for dosing guidelines.
Invega Sustenna (IM monthly injection)		^†	—
Invega Trinza (IM injection every 3 months)	Patients who have been adequately treated with once- a-month Invega Sustenna for at least 4 months	Depends on previous Invega Sustenna once-a-month dosage^†	—
Invega Hafyera (IM injection every 6 months)	Patients who have been adequately treated with either 1) once-a-month Invega Sustenna for at least 4 months or 2) every-3-month Invega Trinza for at least one 3-month cycle	Depends on previous Invega Sustenna once-a-month dosage^†	—			^†Refer to manufacturer's full prescribing information for dosing guidelines.
Pimavanserin (Nuplazid)	Hallucinations and delusions associated with Parkinson’s disease	34 mg taken orally as two 17-mg tablets once daily, without titration	34
Quetiapine (Seroquel)	Schizophrenia	150–750 mg/day (divided bid–tid)	750	Ages 13–17 years: 400–800 mg/day (divided bid–tid)	800
	Bipolar I disorder, acute manic/ mixed episodes	400–800 mg/day (divided bid)	800	Ages 10–17 years: 400–600 mg/day (divided bid–tid)	600
	Bipolar I disorder, depressive episodes	300 mg/day at bedtime	300
Quetiapine extended-release (Seroquel XR)	Schizophrenia	400–800 mg/day	800	Ages 13–17 years): 400–800 mg/day	800
	Bipolar I disorder, acute manic/ mixed episodes	400–800 mg bid	800	Ages 10–17 years): 400–600 mg/day	600
	Bipolar I disorder, depressive episodes	300 mg/day at bedtime	300
	MDD, as adjunctive therapy with antidepressants	150–300 mg/day	300
Risperidone (Risperdal)	Schizophrenia	4–8 mg/day (once daily or divided bid)	16	Ages 13–17 years: 1–6 mg/day (once daily or divided bid)	6
	Bipolar I disorder, acute manic/ mixed episodes	1–6 mg/day (once daily or divided bid)	6	Ages 10–17 years: 1–2.5 mg/day (once daily or divided bid)	6
	Irritability associated with autism spectrum disorder			Ages 5–17 years, weight < 20 kg: 0.5 mg/day (once daily or divided bid)^†	3	^†Weight < 20 kg: Start at 0.25 mg/day before increasing dosage.
				Ages 5–17 years, weight ≥ 20 kg: 1 mg/day (once daily or divided bid)^†	3	^†Weight ≥ 20 kg: Start at 0.5 mg/day before increasing dosage.
Risperidone long-acting IM injection (Risperdal Consta)	Schizophrenia	25–50 mg IM every 2 weeks	—
	Bipolar I disorder	25–50 mg IM every 2 weeks	—
Ziprasidone (Geodon)	Schizophrenia	20 mg bid	160
	Bipolar I disorder	80–160 mg/day (divided bid)	160
Ziprasidone IM injection (Geodon Injection)	Acute agitation	10 mg IM every 2 hours prn or 20 mg IM every 4 hours prn	—
MOOD STABILIZERS
Lithium
Lithium carbonate	Bipolar disorder	900–1,200 mg/day (divided tid–qid)^†	2,400	Ages ≥ 6 years, weight < 30 kg: 15–40 mg/kg/day (divided tid–qid)^†	60 mg/kg/day	^†Dosage adjustment based on clinical response and trough levels of serum lithium between 0.6 and 1.2 mEq/L.
				Ages ≥ 6 years, weight ≥ 30 kg: 15–40 mg/kg/day (divided tid–qid)^†	60 mg/kg/day, up to 2,400 mg
Lithium extended-release (Lithobid)	Bipolar disorder	900–1,800 mg/day (divided bid–tid)	1,800	Ages ≥ 6 years, weight < 30 kg: 15–40 mg/kg/day (divided tid–qid)	60 mg/kg/day
				Ages ≥ 6 years, weight ≥ 30 kg: 15–40 mg/kg/day (divided tid–qid)	60 mg/kg/day, up to 1,800 mg
Anticonvulsants
Carbamazepine (Tegretol)	Bipolar I disorder*	800–1,200 mg/day (divided bid–qid)	1,600			*Off-label use.
Carbamazepine extended-release (Equetro,^† Tegretol XR)	Bipolar I disorder	400–600 mg bid	1,600			^†Equetro is the only carbamazepine formulation approved for the treatment of bipolar I disorder.
Gabapentin (Neurontin)	Postherpetic neuralgia	300–600 mg tid	1,800
	Neuropathic pain*	300–1,200 mg tid	3,600			*Off-label use.
	Bipolar I disorder*	600–3,600 mg/day (divided tid)	3,600			*Off-label use.
	GAD*	600–3,600 mg/day (divided tid)	3,600			*Off-label use.
Lamotrigine (Lamictal, Lamictal XR)	Bipolar I disorder					^†Refer to manufacturer’s titration schedules, particularly for patients taking valproate or enzyme‐inducing medications concomitantly. Lamictal Starter/Titration Kits are available to guide lamotrigine dosing for monotherapy as well as comedication scenarios.
	Monotherapy^†	200 mg/day	200
	With valproate^†	100 mg/day	100
	With enzyme inducers (e.g., carbamazepine)^†	200 mg bid	400
	Bipolar depression*	50–200 mg/day	200			*Off-label use.
Oxcarbazepine (Trileptal)	Bipolar I disorder*	1,200–2,400 mg/ day (once daily or divided bid)	2,400			*Off-label use.
Oxcarbazepine extended- release (Oxtellar XR)	Bipolar I disorder*	1,200–2,400 mg/ day (once daily or divided bid)	2,400
Pregabalin (Lyrica)	GAD*	300 mg bid	600			*Off-label use.
	Fibromyalgia	150–225 mg bid	450
	Diabetic neuropathy	100 mg tid	300
	Neuropathic pain associated with spinal cord injury	300 mg/day within 1 week	600
	Postherpetic neuralgia	300 mg/day within 1 week	600
Pregabalin extended-release (Lyrica CR)	Pain—diabetic peripheral neuropathy	165 mg/day	330
	Pain—postherpetic neuralgia	165 mg/day	660
Topiramate (Topamax)	Bulimia nervosa*	300–400 mg/day (divided bid)	400			*Off-label use.
	Depressive disorders, as adjunctive therapy with antidepressants*	100–200 mg/day (divided bid)	—			*Off-label use.
	Alcohol use disorder*	300 mg/day in divided doses	300			*Off-label use.
Valproate, divalproex sodium (Depakote, Depakote ER)	Bipolar I disorder, manic episodes	15–20 mg/kg/day Rapid oral loading:^† 20–30 mg/kg/day	60 mg/kg/ day			^†In treatment of acute mania, a rapid oral loading regimen may be used, with dosage increases (based on response/tolerance) of 250–500 mg every 1–3 days until serum concentrations are between 45 and 125 mcg/mL.
		Delayed‐release tablets (Depakote): Take in divided doses.
		Extended‐release tablets (Depakote ER): Take once daily.
PSYCHOSTIMULANTS FOR TREATMENT OF ADHD AND NARCOLEPSY
Amphetamine formulations
Amphetamine extended- release (Dyanavel XR)	ADHD in patients ages 6 years and older^†	Starting dose is 2.5 mg or 5 mg once daily taken in the morning. Increase ***in increments of 2.5–10 mg/day every 4–7 days.	20	Starting dose is 2.5 mg or 5 mg once daily taken in the morning. Increase in increments of 2.5–10 mg/day every 4–7 days.	20	^†Safety and effectiveness have been established in pediatric patients ages 6–17 years, but not in those younger than 6 years.
Amphetamine/dextroamphetamine (Adderall)	ADHD	5–40 mg/day (once daily or divided bid)	40	Ages 3–5 years: 2.5–40 mg/day (once daily or divided bid)	40
Amphetamine/dextroamphetamine (Adderall)				Ages ≥ 6 years: 5–40 mg/day (once daily or divided bid)	40
Amphetamine/dextroamphetamine (Adderall) (continued)	Narcolepsy^†	5–60 mg/day in divided doses	60	5–60 mg/day in divided doses	60	^†Only the immediate‐release Adderall tablets are approved for treatment of narcolepsy.
Amphetamine/dextroamphetamine extended-release (Adderall XR)	ADHD	20 mg/day in morning	60	Ages 6–12 years: 10 mg/day in morning	30
				Ages 13–17 years: 10–20 mg/day in morning	40
Dextroamphetamine (Dexedrine)	ADHD			Ages ≥ 6 years: 5–40 mg/day (once daily or divided bid)	40
	Narcolepsy	5–60 mg/day (once daily or divided bid)	60	Ages ≥ 12 years: 5–60 mg/day (once daily or divided bid)	60
Methamphetamine (Desoxyn)	ADHD	20–25 mg/day (once daily or divided bid)	25	Ages ≥ 6 years: 20–25 mg/day (once daily or divided bid)	25
Lisdexamfetamine (Vyvanse)	ADHD	30–70 mg/day in morning	70	Ages ≥ 6 years: 30–70 mg/day in morning	70
	Binge-eating disorder	50–70 mg/day in morning	70

Methylphenidate formulations
Dexmethylphenidate (Focalin)	ADHD	5–10 mg/day (divided bid)	20	Ages ≥ 6 years: 5–20 mg/day (divided bid)	20
Dexmethylphenidate extended-release (Focalin XR)		20–40 mg/day in morning	40	Ages ≥ 6 years: 10–30 mg/day in morning	30
Methylphenidate
Short-acting^†						^†Short-acting (IR) methylphenidate formulations have durations of action of 3–5 hours and generally require two- or three-times-daily dosing.
Ritalin, Methylin	ADHD	20–30 mg/day (divided bid–tid)	60	Ages ≥ 6 years: 15–30 mg/day (divided bid–tid)	60
	Narcolepsy	20–30 mg/day (divided bid–tid)	60
Intermediate-acting^†						^†Intermediate-acting (extended-release, single pulse) methylphenidate formulations have durations of action of approximately 8 hours, with once- or twice-daily dosing.
Metadate ER	ADHD	20–40 mg/day (once daily or divided bid)	60	Ages ≥ 6 years: 20 mg/day (once daily or divided bid)	60
	Narcolepsy	20–30 mg/day (once daily or divided bid)	60
Long-acting^†	ADHD					^†Long-acting (extended-release, dual pulse) methylphenidate formulations have durations of action of approximately 8–12 hours, with once-daily dosing in the morning.
Aptensio XR		10–60 mg/day in morning	60	Ages ≥ 6 years: 10–60 mg/day in morning	60
Concerta		18–72 mg/day in morning	72	Ages 6–12 years: 18–54 mg/day in morning	54
				Ages 13–17 years: 18–72 mg/day in morning	72
Daytrana Transdermal System		10–30 mg patch per day^†	30	Ages ≥ 6 years: 10–30 mg patch per day	30	^†Wear patch for 9 hours; remove for 15 hours.
Metadate CD, Quillivant XR, Ritalin LA		20–60 mg/day in morning	60	Ages ≥ 6 years: 20–60 mg/day in morning	60

Other psychostimulants
Armodafinil (Nuvigil)	Narcolepsy Sleep apnea	150–250 mg/day in morning	250
Modafinil (Provigil)	Narcolepsy Sleep apnea	200 mg/day in morning	400
Calcium, magnesium, potassium, and sodium oxybates (Xywav)‡	Idiopathic hypersomnia	Refer to manufacturer's full prescribing information for once-nightly and twice-nightly dosing guidelines.	6–9 g			‡Available only through a REMS drug safety program.
	Narcolepsy		9 g	Ages ≥ 7 years: dosage based on body weight	Based on body weight^†	^†Dosages > 9 g/night have not been studied and should not be administered.

NONPSYCHOSTIMULANTS FOR TREATMENT OF ADHD
Selective norepinephrine reuptake inhibitors
Atomoxetine (Strattera)	ADHD	80–100 mg/day (divided bid)	100	Ages ≥ 6 years, weight < 70 kg: 1.2 mg/kg/day (divided bid)	1.4^†	^†Maximum for children weighing less than 70 kg: 1.4 mg/kg/day; maximum dosage for adult and pediatric is 100 mg/day.
				Ages ≥ 6 years, weight ≥ 70 kg: 80 mg/day (divided bid)	100
Viloxazine extended-release (Qelbree)	ADHD	200 mg/day	600	Ages ≥ 6 years: 100 mg/day	400
Alpha-2 adrenergic receptor agonists
Clonidine extended-release (Kapvay)	ADHD			Ages ≥ 6 years: 0.2–0.4 mg/day (divided bid)	0.4
Guanfacine extended-release (Intuniv)	ADHD			Ages 6–17 years: 0.05–0.12 mg/kg/day (1–7 mg/day)	^†	^†Dosages >4 mg/day (ages 6–12 years) and >7 mg/day (ages 13–17 years) have not been evaluated.

AGENTS FOR TREATMENT OF COGNITIVE DISORDERS
Acetylcholinesterase inhibitors
Donepezil (Aricept)	Alzheimer’s disease, mild to moderate	5–10 mg/day	10
	Alzheimer’s disease, moderate to severe	10–23 mg/day	23
Galantamine (Razadyne)	Alzheimer’s disease, mild to moderate	8–12 mg bid	24
Galantamine extended- release (Razadyne ER)	Alzheimer’s disease, mild to moderate	16–24 mg/day	24
Rivastigmine (Exelon)	Alzheimer’s disease, mild to severe	3–6 mg bid	12
	Parkinson’s disease dementia	1.5–6 mg bid	12
Rivastigmine topical patch (Exelon Transdermal)	Alzheimer’s disease, mild to severe	9.5–13.3 mg patch per 24 hours	13.3
	Parkinson’s disease dementia	9.5–13.3 mg patch per 24 hours	13.3

NMDA receptor antagonist
Memantine (Namenda)	Alzheimer’s disease, moderate to severe	10 mg bid	20
Memantine extended-release (Namenda XR)	Alzheimer’s disease, moderate to severe	28 mg/day	28
Memantine/donepezil (Namzaric)	Alzheimer’s disease, moderate to severe	28 mg/10 mg/ day^†	28/10			^†Patient stabilized on donepezil and not currently taking memantine: Start Namzaric 7 mg/ 10 mg once daily and increase by 7-mg increments of memantine every week up to maximum dosage of 28 mg/10 mg once daily.
Monoclonal antibodies directed against aggregated forms of beta amyloid
Aducanumab (Aduhelm) IV injection^‡	Alzheimer’s disease, patients with mild cognitive impairment (confirm presence of amyloid beta pathology prior to initiating treatment)	Refer to manufacturer's full prescribing information for administration guidelines and titration schedules.	—			‡Warning: Amyloid-related imaging abnormalities (ARIAs)—Refer to manufacturer’s full prescribing information for complete boxed warning.
Lecanemab (Leqembi) IV injection‡			—
AGENTS FOR TREATMENT OF MEDICATION-INDUCED MOVEMENT DISORDERS (EPS)
Dopaminergic
Amantadine	Medication-induced EPS	100 mg bid	300
Amantadine extended-release (Gocovri)	Medication-induced EPS	137–274 mg once daily at bedtime	274
Anticholinergics
Benztropine (Cogentin)	Medication-induced EPS	1–2 mg PO/IM bid–tid	6	Ages ≥ 3 years:* 0.02–0.05 mg/kg/day PO/IM (once daily or bid)	^†	*Off-label use. ^†There are no well-established maximum dosages in children.
Benztropine mesylate injection (Cogentin Injection)	Acute dystonic reaction	2 mg IM; repeat once after 30 minutes prn	^†			^†Usual maximum (standard practice) is 2 injections.
Trihexyphenidyl	Medication-induced EPS	5–15 mg/day (divided tid–qid)	15
Antihistaminic
Diphenhydramine (Benadryl)	Medication-induced EPS	25–50 mg PO/IM every 6–8 hours prn	400	Ages < 12 years: 1–2 mg/kg PO/IM every 6–8 hours prn	50 mg/dose; 300 mg/day PO/IM
				Ages ≥ 12 years: 25–50 mg PO/IM every 6–8 hours prn	100 mg/dose; 300 mg/day PO; 400 mg/day IM
	Acute dystonic reaction*	50–100 mg IM/IV; repeat after 20–30 minutes prn	100 mg/dose	Ages ≥ 6 years: 1–2 mg/kg/dose IM/IV; repeat after 20–30 minutes prn	50 mg/dose	*Off-label use.
Beta-adrenergic receptor antagonist
Propranolol (Inderal)	Medication-induced akathisia*	20–120 mg/day (divided tid–qid)	120			*Off-label use.
Vesicular monoamine transporter 2 (VMAT2) inhibitors
Deutetrabenazine (Austedo)	Chorea associated with Huntington’s disease Tardive dyskinesia	6 mg once daily Gradually increase by 6 mg/day at weekly intervals. For total daily dosage of 12 mg or greater, administer as two divided doses	48
Valbenazine (Ingrezza)	Tardive dyskinesia Chorea associated with Huntington’s disease	40 mg once daily After 1 week, increase to recommended dosage of 80 mg once daily	80
AGENTS FOR TREATMENT OF SUBSTANCE USE DISORDERS
Acamprosate	Alcohol abstinence, maintenance	666 mg tid	^†			^†There is no well-established acamprosate maximum dosage for the approved indication.
Bupropion sustained-release (Zyban)	Smoking cessation	150 mg bid	300
Disulfiram (Antabuse)	Alcohol abstinence	125–500 mg/day in morning	500
Lofexidine (Lucemyra)	Opioid withdrawal symptoms	Three 0.18 mg tablets taken orally 4 times daily at 5- to 6-hour intervals. Treatment may be continued for up to 14 days with dosing guided by symptoms.	2.88 (sixteen 0.18-mg tablets)
Naltrexone	Alcohol dependence	50 mg/day	^†			^†There are no well-established naltrexone maximum dosages for the approved indications.
	Opioid dependence	Give 25 mg; if no withdrawal symptoms, start 50 mg/day	^†
Naltrexone IM injection (Vivitrol)	Alcohol dependence	380 mg IM every 4 weeks^†	—			^†Must not be actively drinking at time of first administration.
	Opioid dependence	380 mg IM every 4 weeks^†	—			^†Must be opioid-free for 7–10 days.
AGENTS FOR TREATMENT OF SUBSTANCE USE DISORDERS (continued)
Varenicline (Chantix)	Smoking cessation	Requires dosage titration^†	0.5 mg twice daily			^†Refer to manufacturer's recommended dosing guidelines and titration schedules.

Note. ADHD = attention-deficit/hyperactivity disorder; CYP2D6 = cytochrome P450 2D6 enzyme; EPS = extrapyramidal side effects; GAD = generalized anxiety disorder; MDD = major depressive disorder; OCD = obsessive-compulsive disorder; PMDD = premenstrual dysphoric disorder; PPD = postpartum depression; PTSD = posttraumatic stress disorder; REMS = Risk Evaluation and Mitigation Strategy.

— = not available; bid = twice daily (or divided into 2 doses); IM = intramuscular; IV = intravenous; PO = oral; prn = as needed; qid = four times daily (or divided into 4 doses); SC = subcutaneous; SL = sublingual; tid = three times daily (or divided into 3 doses).

CD = controlled delivery (extended release); CR = controlled release (extended release); ER = extended release; IR = immediate release; LA = long acting (extended release); SR = sustained release (extended release); XL, XR = extended release.

Source. Athenahealth Inc.: epocrates^®; Available at: http://online.epocrates.com; Findling RL (ed): Clinical Manual of Child and Adolescent Psychopharmacology. Washington, DC, American Psychiatric Publishing, 2008; National Institutes of Health, U.S. National Library of Medicine: DailyMed; available at: http://dailymed.nlm.nih.gov; Wolters Kluwer: Facts & Comparisons eAnswers; available at: http://eanswers.factsandcomparisons.com.

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