Dosage regimen of drug in psychiatry

Antidepressants
TCA RECOMMENDED DOSES MAX DOSE MEDICATION WARNING/ Note
BLOOD LEVELS** MANAGEMENT
Amitriptyline 1 – 3 mg/kg/d div TID 300 mg/day M=Baseline & follow up A=Increased risk of
Max: 5 mg/kg up to 200 mg/day EKGs, BP, and Pulse suicidal thinking
Therapeutic blood levels Monitor plasma levels.
(AMI + NOR): 100 - 250ng/mL Monitor for depression
and behavior
increasing suicidality
Clomipramine 3 mg/kg/day 250 mg/day M A
Anafranil
FDA INDICATION Therapeutic levels:
FOR CHILDREN 150-300 ng/ml
OCD
Desipramine 2.5 – 5 mg/kg/day 300 mg/day M A
Therapeutic levels:
125 – 300 ng/ml
Doxepin 25 – 300 mg/d 300 mg/day M A
Therapeutic blood levels: Powerful antihistamin
100 - 250 ng/mL agent, very sedating.
Imipramine Enuresis: 10 – 75 mg/day 200 mg/day M A
Tofranil Depression: 1.5 – 5 mg/kg/day
FDA INDICATION Max: 5 mg/kg/day
FOR CHILDREN
Therapeutic plasma levels
nocturnal enuresis (IMI + DMI): 150 – 300 ng/ml
Nortriptyline Enuresis: 10 – 35 mg HS 150 mg/d
Depression: 2 – 3 mg/kg/day
Therapeutic plasma levels:
50 – 150 ng/ml
(SSRIs) RECOMMENDED DOSES MAX DOSE MEDICATION WARNING / Note
BLOOD LEVELS** MANAGEMENT
Escitalopram 5 – 20 mg/day 20 mg/day A
Lexapro
Fluoxetine HCl OCD: 20 – 60 mg/day 80mg/day A
Prozac MDD: 10 – 40 mg/day The first drug of choice to
FDA INDICATION
treat depression in
FOR CHILDREN
depression, OCD children & adolescents
Fluvoxamine OCD: 300 mg/day A
[8-11 y]
FDA INDICATION
Dose: 50-200 mg PO OD
FOR CHILDREN
OCD [12–18 y]
Dose: 50-200 mg PO OD
Paroxetine HCl 10 - 60 mg/d 60mg/day Highly unfavorable A
seroxat risk-benefit ratio

Sertraline HCl OCD: 200 mg/day A

Zoloft [6-12 y]
Dose: 25 mg – 200 mg/day
FDA INDICATION [13-17 y]
FOR CHILDREN Dose: 50 mg - 200 mg OD
Psychiatric: OCD
 Antidepressants
Other RECOMMENDED DOSES MAX DOSE MEDICATION WARNING/ Note
BLOOD LEVELS** MANAGEMENT
Bupropion 1.4 - 6 mg/kg/day 450mg/ day A
ทำให้ ชักได้ ใน ถ้ าให้ > 6 mg/kg/d
CI in bulimia.
Duloxetine 40 - 60 mg/day, with increases at 60 mg/day Monitor BP at base A
Cymbalta intervals of no less than 1 wk and periodically Dual 5-HT , NE
reuptake inhibitor.
Mirtazapine 7.5 – 45 mg HS 45mg/day A
Remeron Antihistimine effects
predominate over α 2 recept
antagonist effects at 7.5 mg,
very sedating at lower dose
Trazodone HCl For depression 600mg/day A
Desirel [6-12 y] Associated with priapism
Trazodel 1.5-6 mg/kg/day PO div tid
[12-18 y] Max: 6 mg/kg/day

For acute sleep difficulties

25 – 100 mg HS
Venlafaxine HCl Start: 37.5 mg PO bid, 375 mg/day Take with food
Effexor XR incr. dose q4 days
 Antipsychotics
First Generation RECOMMENDED DOSES MAX DOSE MEDICATION WARNING/ Note
BLOOD LEVELS** MANAGEMENT
Chlopromazine HCl Child > 12 yrs: 200-800 mg/day 2000mg/day FDA INDICATION FOR CHILD
PO div tid-qid severe behavior disorders
Preoperative sedation
Intraoperative
n/v,tetanus (adjunct treat )
Fluphenazine Start: 1.25 x PO OD dose 100mg/dose
decanoate or 12.5-25 mg IM q3-6wk; หรื อ
Deca เพิม่ ทีละ 12.5-25 mg q3-6wk 100 mg/ 3wk
Fluphenazine HCl Children age >12 10mg/day
0.25 –0.5 mg BID
Haloperidol [3 – 12 yrs] 100mg/day Significant EPS
0.05-0.15 mg/kg/day PO
FDA FOR CHILDREN div bid-tid
severe behavior [ > 12 yrs]
disturbance, 0.5-5 mg PO bid-tid
psychosis,agitation, Max: 100 mg/day for
Tourette’s syndrome severe, refractory cases
Haloperidol Start at 10 – 20 เท่า ของ ยากิน 450 mg/mo
decanoate dose. 50 – 100 mg/dose initially
50mg every 4 wk
ในรายทีจำ
่ เป็ นเพิม
่ ทีล
่ ะ
50mg จนถึง300mg/4 wk
Perphenazine 8-16 mg PO bid-qid 64 mg/day
Psychiatric: (> 12 y)
schizophrenia
Thioridazine HCl [2- 12 years] 800 mg/day Baseline & follow up Proarrhythmia effects
Mellaril 0.5 mg- 3 mg/kg/day EKG, K+ Prolonged QTc interval and
FDA INDICATION [>13 years] torsades de pointes and sudden
FOR CHILDREN
50 – 100 mg TID death.Use restricted to schiz
Refractory resistant to standard
schizophrenia treatments
Flupentixol deca เริ่มให้ 20mg แล ้ว อีก อย่างน้ อย 7 วันจึง 400 mg/wk
Fluanxol ให้ ซ้ำ อีก 20-40 mg แล ้วให ้เป็ น ทุก 2-
4 wk, จากนั ้น ปรับ dose จนผู้ป่วย ตอบสนอง
Maintenance dose 50mg/4 wk
to 300mg every 2 weeks.
Zuclopenthixol 50 - 150 mg i.m., ซ้ำได้ โดยเว้นช่วงห่าง 2 - 600 mg/wk
Clopixol Acuphase 3 วัน ในบางราย ให้เพิ่มได้อีก ใน 1 – 2 วัน
Clopixol Acuphase ไม่ใช้ใน long-term
และ ใช้ไม่เกิน 2 weeks Doseสะสมสูงสุด
ไม่ควรเกิน 400 mg โดยการฉีดไม่เกิน 4 ครั้ง
Trifluoperazine HCl [6-12 years] 1 mg QID or BID 40mg/day
Triflazine [> 12 years] 1 -5 mg BID

Antipsychotics
Second Generation American Diabetic Association recommends ให ้ผู ้ป่ วยทีใ่ ห ้ยากลุม
่ นี้ ควร monitored ดู development ของmetabolic
(Atypical) syndrome with baseline and follow-up weight, waist circumference, BP,FBS, and fasting lipid profile.
Second Generation RECOMMENDED DOSES MAX DOSE MEDICATION WARNING/ Note
BLOOD LEVELS** MANAGEMENT
Aripiprazole 6 – 12 years] 2.5 – 5 mg/day 30mg/day P = Baseline and Dementia related psychosis
Abilify Max: 15 mg/day followup FBS,BP, (Unique pharmacological
[12 – 18 years] 10 – 15 mg/day blood cholesterol/ profile for antipsychotic drug
Schiz (13-17 y) Dosages มากกว่า 10 mg ไม่ได ้ triglyceride levels mixed dopamine
ทำให ้ผลการรักษาดีขน ึ้ agonist/antagonist activity)
Clozapine [< 12 years] 900mg/day Monitor WBC, ANC Agranulocytosis,seizures,
3 -6 mg/kg/day qwk x 6 mo, q2wk x myocarditis,
[> 12 years] 6 mo, then qmo until orthostatic hypotension w or
12.5 mg/kg OD – BID, D/C. P & Also,Mg, K, w/o syncope,
increase dosage 25 – 50 and EKG at baseline dementia related psychosis
mg q3 – 7 days and follow-up.
Check qwk x4wk
after D/C
Olanzepine 0.12 -0.20 mg/kg OD 20mg/day P Dementia related psychosis
Zyprexa

Paliperidone* [12 – 18 years] 6 mg/day P Dementia related psychosis

Invega Follow-up prolactin Invega is not a preferred
levels, if symptomatic Medication because:
ต ้องสัง่ ใช ้โดย specialist 1) No advantage over
ระวังการใช ้ใน liver risperidone,
failure. 2) Responsible for the
Invega เป็ น active hyperprolactinemia
metabolite ของ 3) there is no experience use in
Risperidone the pediatric
Quetiapine [< 12 y] 50 – 400 mg/day 800mg/day P Increased risk of suicidal
Seroquel [12 – 18 y] 100 – 800 mg/day Baseline and followup thinking and behavior
EKG, K,Mg Dementia related psychosis
Risperidone [< 12 years] 0.25 – 3 mg/day 16mg/day P&Follow-up prolactin Dementia related psychosis
[12 – 18 years] 0.5 – 6 mg/day levels,
If symptomatic FDA INDICATION
RISPERDAL CONSTA FOR CHILDREN
50mg/2 wk
Irritability due to autistic
disorder, bipolar disorder,
acute mania, 10-17 y
schizophrenia,13-17 y

Ziprasidone Initiation - 20 mg b.i.d 160mg/day P Dementia related psychosis

Zeldox Max: 80 mg b.i.d Baseline and followup
EKG, K ,Mg

Mood Stabilizers
 Anticonvulsant RECOMMENDED DOSES MAX DOSE MEDICATION WARNING/ Note
BLOOD LEVELS** MANAGEMENT
And other
Carbamazepine < 25 kg: 20 – 30 mg/kg/day 1600mg/day CBC with differential Aplastic anemia/
400 mg and platelet count at agranulocytosis
baseline and followup Stevens Johnson syndrome
FDA INDICATION 25 to 40 kg: 400 - 800 mg And TEN significantly more
FOR CHILDREN > 40 kg: 800 - 1200 mg common in patients with the
Epilepsy plasma level 4 – 12 µg/ml human leukocyte antigen
(HLA) allele, HLAB* 1502
Asia, South Asian,Indians
Gabapentin* [3 – 4 years] 40 mg/kg/day 3.6gm / day Creatinine clearance
Max: 50 mg/kg/day at baseline in patients
Neurontin [5 – 12 years] 25–35 mg/kg/day with impaired renal
Max: 50 mg/kg/day functioning
[> 12 years] 300 – 600 mg TID
Max: 3,600 mg/day
Lamotrigine [2 – 12 years] 5 – 15 mg/kg/day 400 mg/day Baseline and followup Stevens-Johnson syndrome,
Lamictal Max: 200 mg/day CBC with rate 2.4/10,000
[> 12 years] 50mg OD wk 1-2 differential, liver TEN
Lennox-Gastaut 100mg div wk 3-4 function tests
seizures, 200 – 400mg to maintenance discontinued if a
partial seizures rash develops.
Oxcarbazepine 4 – 16 y:Start: 8-10 mg/kg/day 2400mg/day CBC, electrolytes, Causes hyponatremia in
Trileptal 20-24kg serum creatinine, 2.5% of patients treated.
Max: 300-450 mg PO bid LFT
25-34kg oxcarbazepine was
Max: 600 mg PO bid associated with serious
35-44kg psychiatric side effects
Max: 450-750 mg PO bid requiring hospitalization.
45-49kg
Max: 600-750 mg PO bid
50-59kg
Max: 600-900 mg PO bid
60-69kg
Max: 600-1050 mg PO bid
> 70kg
Max: 750-1050 mg PO bid
> 16 y: Max: 2400 mg/day
Topiramate [2 – 16 years] 5 – 9 mg/kg/day 400mg/day Baseline & followup cause hyperchloremic,
Topamax Serum bicarbonate non-anion gap metabolic
Lennox-Gastaut acidosis in 3-11% of patients on
seizures, topiramate
partial seizures, Significant adverse
general tonic - clonic effect on cognitive function
seizures at dosages > 400 mg/d
Valproate sodium 15 – 20 mg/kg/day 2500mg/day Baseline and followup
Depakine plasma level 50 – 125µg/ml CBC, LFT,
pancreatic enzymes
Seizure disorder
Lithium carbonate < 25 kg: 600 mg 2400mg/day CBC with diff, RFT,
25 to 40 kg: 900 mg TFT, UA at baseline
> 40 kg: 1200 mg Lithium levels q 1 –
serum level 0.6 –1.2 meq/l 2 wks till stable then
q 1 – 2 months
TFTs, UA q 3 – 6
months for F/U
 Anxiolytics
BZD will be approved for acute management of aggression. Usefor insomnia is discouraged and
Benzodiazepines consent will be time limited. SSRIs are the drugs of choice in the treatment of anxiety.
Special consultation is required for consent requests for BZD that exceed 10 days.
Benzodiazepines RECOMMENDED DOSES MAX DOSE MEDICATION WARNING/ Note
And other BLOOD LEVELS** MANAGEMENT
Alprazolam Anxiety 4 mg/day
Xanax 0.25-0.5 mg 3 times/day
Panic disorder 10 mg/day
0.5 mg 3 times/day
เพิม
่ ขึน
้ ทีละ ไม่เกิน 1 mg/day
Chlordiazepoxide Anxiety: 100mg/day FDA approve for
Oral: 15-100 mg Preoperative apprehension and
divided 3-4 times/day. anxiety (> age 6)
I.M., I.V.: Initial: 50-100 mg
followed by 25-50 mg
3-4 times/day as needed.
Preoperative anxiety
I.M.: 50-100 mg ก่อน surgery
Ethanol withdrawal 300mg/day
Oral, I.V.: 50-100 mg to start,
dose may be repeated in 2-4
hours as necessary to a
maximum of 300 mg/24 hours
Clorazepate Anxiety 60 mg/day
Trancon Tab 7.5-15 mg 2-4 times/day .
SR 11.25 or 22.5 mg HS
Ethanol withdrawal 90 mg/day
Initial: 30 mg /15 mg 2-4 ครัง้ ต่อ
วัน
Clonazepam 1 – 6 mg/day 20mg/day
Seizure disorder
Diazepam 5 – 100 mg/ day 40mg/day
Seizure disorder, 100 mg/ day
muscle relaxation
Lorazepam, 0.5-2mg TID 10mg/day
Midazolam Preoperative sedation: Reduce dose in patients with
I.M.: 0.07-0.08 mg/kg 30-60 COPD, high-risk patients,
นาที ก่อน surgery ปกติ 5 patients >/= 60 years of age,
mg and patients receiving other
I.V.: 0.02-0.04 mg/kg; ซ้ำทุก 5 narcotics or CNSdepressants
นาที Sedation in mechanically-
ถ ้าจำเป็ นอาจให ้ถึง 0.1-0.2 mg/kg ventilated patients: I.V.
Conscious sedation continuous infusion:
I.V.: Initial: 0.5-2 mg slow I.V. 100 mg in 250mL D5W or NS
อย่างน ้อย 2 นาที ปกติ 2.5-5 mg; ( fluid-restricted, max conce=
0.5 mg/mL);
Anesthesia: I.V.: Induction: initial dose: 0.02-0.08 mg/kg
Unpremedicated patients: 0.3- (~1 mg to 5 mg in 70kg adult)
0.35 mg/kg (up to 0.6 mg/kg in ซ้ำทีเ่ วลา 5-15 minute นาทีจน
resistant cases) ได ้ที่
Premedicated patients: 0.15 หรือให ้ต่อ infusion rates ที่
to 0.35 mg/kg. 0.04-0.2 mg/kg/hour และ
Maintenance: 0.05-0.3 mg/kg titrate จนได ้ level of sedation.
as needed, or continuous
infusion 0.25-1.5mcg/kg/minute.
 MISCELLANEOUS DRUG/INDICATION

The American Heart Association recommends that children with ADHD should be evaluated before
Psychostimulants starting a stimulant. Specifically, they recommend a cardiac evaluation with an EKG before starting
a stimulant and for patients who are already on a stimulant but who have not had a previous cardiac
evaluation.
Psychostimulants RECOMMENDED DOSES MAX DOSE MEDICATION WARNING/ Note
BLOOD LEVELS** MANAGEMENT
And other
Methylphenidate 0.3 mg/ kg
Max: 2 mg/kg/d or 60
mg/d
(72 mg/d in adolescents
for Concerta)

ATOMOXETINE < 70 kg: 100mg/day

(STRATTERA) 1.2 mg/kg/day - 1.4mg/kg/day
Indications: ADHD 70 kg: 80 mg/day
for Adults/Children

CARBAMEZPIME 300 mg/day M A

TOPIRAMATE 25 – 300 mg/d 300 mg/day M A

(Topamax) Therapeutic blood levels: Powerful antihistamin
100 - 250 ng/mL agent, very sedating.
OXCARBAZEPINE Enuresis: 10 – 75 mg/day 2400mg/day A
(Trileptal) Depression: 1.5 – 5 mg/kg/day
Max: 5 mg/kg/day
Therapeutic plasma levels
(IMI + DMI): 150 – 300 ng/ml
Nortriptyline Enuresis: 10 – 35 mg HS 150 mg/d
Depression: 2 – 3 mg/kg/day
Therapeutic plasma levels:
50 – 150 ng/ml
(SSRIs) RECOMMENDED DOSES MAX DOSE MEDICATION WARNING / Note
BLOOD LEVELS** MANAGEMENT
Escitalopram 5 – 20 mg/day 20 mg/day A
Lexapro
Fluoxetine HCl OCD: 20 – 60 mg/day 80mg/day A
Prozac MDD: 10 – 40 mg/day The first drug of choice to
FDA INDICATION
treat depression in
FOR CHILDREN
depression, OCD children & adolescents
Fluvoxamine OCD: 300 mg/day A
[8-11 y]
FDA INDICATION
Dose: 50-200 mg PO OD
FOR CHILDREN
OCD [12–18 y]
Dose: 50-200 mg PO OD
Paroxetine HCl 10 - 60 mg/d 60mg/day Highly unfavorable A
seroxat risk-benefit ratio

Sertraline HCl OCD: 200 mg/day A

Zoloft [6-12 y]
Dose: 25 mg – 200 mg/day
FDA INDICATION [13-17 y]
FOR CHILDREN Dose: 50 mg - 200 mg OD
Psychiatric: OCD

Antienuretics
Desmopressin Children aged 6+ Tab Baseline and Children treated with intranasal
Minirin Dosage (tablet): start at 0.6 mg/day periodic sodium DDAVP for nocturnal enuresis
0.2 mg PO hs levels are susceptible to severe
FDA INDICATION Dosage (nasal): Dose: Intranasal hyponatremia and seizures, ดังนัน ้ ,
FOR CHILDREN
start at 20 mcg NAS hs 40 mcg/day minirin intranasal จึงไม่
nocturnal enuresis Give 1/2 dose each nostril
(tablet form only) ถูกapproved ใน long term
Medical: central enuresis
diabetes insipidus ไม่ใช้ ในผู้ป่วย ทีม
่ ภ
ี าวะหรือมีประวัต ิ
hypo Na
ระหว่างใช ้ DDAVP เมือ ่ เป็ นไข ้
อาจทำให ้เกิด fluid or electrolyte
imbalance
Oxybutynin [>6 y] 15 mg/day
Psychiatric: Dose: 0.2 mg/kg PO BID – QID
overactive bladder
associated with
neurological problem
Antihistamines
Diphenhydramine 25 – 50 mg PO HS Cap High dose adults Psychiatric: dystonic reactions,
Benadryl short-term treat of insomnia
Child >10 y ใน case Medical: allergies,anaphylaxis,
100 mg/ day
Acute,generalized antitussive,motion sickness
Adult
200 mg/ day or chronic
urticaria, and
Injection allergic eczema คือ
400 mg/ day 300 – 400 mg /day
Anticholinergic
agents
Benztropine [> 3 years old] 8 mg/day
Cogentin 0.02-0.05 mg/kg PO/IM/IV
OD - BID
Psychiatric:
extrapyramidal
reaction
Trihexyphenidyl HCl 5 - 15 mg PO div TID -QID 15 mg/day
Artane
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