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Table 2 Up-titration with cariprazine in acute and maintenance settings

From: Treating schizophrenia with cariprazine: from clinical research to clinical practice. Real world experiences and recommendations from an International Panel

Fast
Acute
Slow
Maintenance
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