Fast Acute | Slow Maintenance |
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In acute setting up-titrate to 4.5 mg or 6.0 mg in 1 week—increase 1.5 mg every day up to 6.0 mg if no side effects manifest | Up-titration should be slow in maintenance, whereas fast titration is not necessary in maintenance |
Fast titration appropriate for hospital setting due to the need to shorten the length of stay in the hospital | Stopping in case of side effects 1 week if replaced with another neuroleptic. Reducing dose in case of beginning of metabolic problems, stop immediately in case of worsening psychotic feature (positive symptoms) |
Side effects may delay up-titration, but goal is to reach effective dose as soon as possible | The slower the better if side effects such as akathisia manifest |
When used as monotherapy in highly ‘acute’ cases fast up-titration required | If body weight is over 120 kg should start with the 3.0 mg dosage |
Switch 1.5 mg every 3 days is acceptable and usually less likely to produce akathisia | Vulnerable patients must be titrated much slower |