Initial antipsychotic medication dosing and time to reach steady state: A) Selected oral SGAs and B) selected long-acting injectable SGAs.
| A) GENERIC NAME (BRAND NAME) | INITIAL DOSE8 | LABELED MAXIMUM DOSE8 | TIME TO STEADY STATE | COST RANGE (PER 30 d) |
|---|---|---|---|---|
| Risperidone (Risperdal) | 1 mg once daily | 6 mg/d | 5 to 6 d9 | $25 to $41 |
| Paliperidone (Invega) | 3 mg once daily | 12 mg/d | 4 to 5 d10 | $120 to $230 |
| Olanzapine (Zyprexa) | 5 mg once daily | 20 mg/d | 7 d11 | $33 to $55 |
| Extended-release quetiapine (Seroquel XR) | 50 mg once daily (antipsychotic effect generally not seen until dose is ≥ 400 mg) | 800 mg/d | 1 to 2 d12 | $57 to $99* |
| Aripiprazole (Abilify) | 10 mg once daily | 30 mg/d | 14 d13 | $45 to $52 |
| Brexpiprazole (Rexulti) | 1 mg once daily | 4 mg/d | 20 d14 | $125 |
| B) GENERIC NAME (BRAND NAME) | INITIAL DOSE AND REQUIREMENT OF ORAL OVERLAP8 | LABELED MAXIMUM DOSE8 | TIME TO STEADY STATE | COST RANGE (PER 30 d) |
|---|---|---|---|---|
| Once-monthly paliperidone (Invega Sustenna) | Day 1: 150 mg IM Day 8: 100 mg IM Then 75 mg IM every 4 wk No oral overlap needed | 150 mg IM every 4 wk | 4 to 5 mo15 | $330 to $665 |
| Risperidone (Risperdal Consta) | 25 mg IM every 2 wk with 3 wk of oral risperidone overlap | 50 mg IM every 2 wk | 2 mo9 | $368 to $708 |
| Aripiprazole (Abilify Maintena) | 400 mg IM every 4 wk with 2 wk of oral aripiprazole overlap | 400 mg IM every 4 wk | 4 mo16 | $483 |
IM—intramuscular, SGA—second-generation antipsychotic medication.
↵* Immediate-release formulation is less costly, but requires twice-daily to 3-times-daily dosing, which is challenging for adherence.