The dosing of atypical antipsychotics

Jose De Leon, Scott C. Armstrong, Kelly L. Cozza

Research output: Contribution to journalArticlepeer-review

108 Scopus citations

Abstract

Drug-drug interactions or genetic variability may require using doses different from those recommended for atypical antipsychotics. Dosage alterations of olanzapine and clozapine, dependent on cytochrome P450 1A2 (CYP1A2) for clearance, and quetiapine, dependent on cytochrome P450 3A (CYP3A), may be necessary when used with other drugs that inhibit or induce their metabolic enzymes. Smoking cessation can significantly increase clozapine, and perhaps olanzapine, levels. Ziprasidone pharmacokinetic drug-drug interactions are not likely to be important. Genetic variations of cytochrome P450 2D6 (CYP2D6) and drug-drug interactions causing inhibition (CYP2D6 and/or CYP3A) or induction (CYP3A) may be important for risperidone, and perhaps for aripiprazole, dosing. Adding inhibitors may cause side effects more easily in drugs with a narrow therapeutic window, such as clozapine or risperidone, than in those with a wide therapeutic window, such as olanzapine or aripiprazole. Adding inducers may be associated with a gradual development of lost efficacy.

Original languageEnglish
Pages (from-to)262-273
Number of pages12
JournalPsychosomatics
Volume46
Issue number3
DOIs
StatePublished - 2005

Bibliographical note

Funding Information:
During the last 2 years, Dr. de Leon had researcherinitiated proposals funded by Eli Lilly Research Foundation and Roche Molecular Systems. He was on the advisory board of Astra-Zeneca and Bristol-Myers-Squibb and lectured once supported by Eli Lilly.

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Applied Psychology
  • Psychiatry and Mental health

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