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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