PL Detail-Document #310701

−This PL Detail-Document gives subscribers

additional insight related to the Recommendations published in−
PHARMACIST’S LETTER / PRESCRIBER’S LETTER
July 2015

Comparison of Atypical Antipsychotics

Second generation or “atypical” antipsychotics have a lower propensity than the first generation agents to cause extrapyramidal side effects and
tardive dyskinesia, but are by no means devoid of these adverse effects.4 Clozapine may be the most effective atypical for schizophrenia, but its use is
limited due to the risk of agranulocytosis.1,2,13 All carry “black box” warnings regarding mortality risk in dementia-related psychosis, and suicidality if
indicated for depression. Atypicals pose varying risks of QT prolongation, drug interactions, and metabolic adverse effects. Extrapyramidal side
effects are low with quetiapine and olanzapine, and high with lurasidone, paliperidone, and risperidone.3-5,9,13 Hyperprolactinemia, associated with
sexual dysfunction, gynecomastia, and irregular periods, seems most common with risperidone and paliperidone.4,6,13 These factors, plus cost and
dosing frequency, are all considerations in choice of agent. The chart below compares atypicals in regard to adult indications and dosing, metabolic
side effects, sedation, QT prolongation, CYP metabolism, and cost. Prescribers can bill for IM antipsychotic injections under their supervision using
CPT code 96372, and add the medication code.

NOTE: *Usual or target daily adult dosage range may not include initial and maximum doses. Use lowest effective dose. Dosing in special
populations (e.g., renal impairment) is not included. Maximum doses of oral aripiprazole, lurasidone, olanzapine, paliperidone, quetiapine
XR, and risperidone are approved for once-daily administration. Divide asenapine, iloperidone, and ziprasidone twice daily.
Generic FDA-Approved Indication(s) for Adults Metabolic Adverse Effectsa,1,2,4,7,10-13 QT CYP450 Sedationa,8,13
c a
(Brand)/ and Usual or Target Adult Daily Weight Diabetes Dyslipidemia Prolonging Metabolism
Costb Dosage Range (mg/day)*,a Gain Risk
Aripiprazole Schizophrenia: 10-15 mg Low Low Low Yes CYP2D6, Low
(Abilify, CYP3A4
Bipolar I disorder (manic or mixed
generics) See
episodes and maintenance): 15 mg
10 mg footnotes e Specific dosing
(monotherapy or with lithium or
$758.17 and h. may be advised
valproate)
for CYP450
Oral solution Major depression (adjunct): 5-10 mg interactions.
& orally
disintegrating
tablet
available.

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 (PL Detail-Document #310701: Page 2 of 9)

Generic FDA-Approved Indication(s) for Adults Metabolic Adverse Effectsa,1,2,4,7,10-13 QT CYP450 Sedationa,8,13
(Brand)/ and Usual or Target Adult Daily Prolongingc Metabolisma
Weight Diabetes Dyslipidemia
Costb Dosage Range (mg/day)a,*
gain Risk
Aripiprazole Agitation associated with schizophrenia or Low Low Low Yes CYP2D6, Low
(Abilify bipolar I mania: 9.75 mg IM (5.25 mg CYP3A4
injection) may be given). May repeat in 2 hours. See
9.75 mg Max daily dose 30 mg. footnotes e
$27.84/dose and h.
Aripiprazole Schizophrenia: 400 mg IM (gluteal) once Low Low Low Yes CYP2D6, Low
(Abilify monthly. Reduce dose if CYP2D6 poor CYP3A4
Maintena metabolizer. Avoid with CYP3A4 inducers See
long-acting for more than 14 days. Continue oral agent footnotes e Specific dosing
injection) for 14 days after first dose, then stop. If and h. may be advised
400 mg >6 weeks elapse since last dose (>5 weeks if for CYP450
$1584.46 2nd or 3rd dose is missed), restart oral interactions.
aripiprazole x 14 days with the next dose.
Asenapine Schizophrenia: 10 mg (acute), 10-20 mg Low to Low Low Yes CYP1A2, Low to
(Saphris) (maintenance) moderate CYP3A4 Moderate
10 mg See footnote (minor),
Bipolar I disorder (manic or mixed CYP2D6 (minor)
$689.66 d.
episodes): 10-20 mg (Weak CYP2D6
• For sublingual use. Avoid food/drink inhibitor.)
for 10 min afterward.
Specific dosing
may be advised
for CYP450
interactions.
Clozapinef Schizophrenia (treatment-resistant): High High High Yes CYP1A2, High
(Clozaril, etc, 300-450 mg CYP3A4,
generics) Recurrent suicidal behavior risk reduction See footnote CYP2D6
400 mg in schizophrenia & schizoaffective h.
$156.77 disorder: 300-450 mg Specific dosing
Oral may be advised
suspension and
NOTE: initial dose is 12.5 mg once or for CYP450
generic orally
disintegrating twice daily (for both indications). interactions.
tablet available.
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 (PL Detail-Document #310701: Page 3 of 9)

Generic FDA-Approved Indication(s) for Adults Metabolic Adverse Effectsa,1,2,4,7,10-13 QT CYP450 Sedationa,8,13
(Brand)/ and Usual or Target Adult Daily Prolongingc Metabolisma
Weight Diabetes Dyslipidemia
Costb Dosage Range (mg/day)a,*
gain Risk
Iloperidone Schizophrenia: 12-24 mg Moderate Low Low Yes CYP3A4, Low
(Fanapt) CYP2D6
12 mg See footnote
$942.34 g. Specific dosing
may be advised
for CYP450
interactions.
Lurasidone Schizophrenia: 40-160 mg Low Low Low No12 Contraindicated Low to
(Latuda) with strong Moderate
40 mg Bipolar depression: 20 to 120 mg See footnote CYP3A4
$769.50 e. inhibitors or
inducers. Specific
• Take with food (at least 350 kcal).
dose decrease
may be advised
with moderate
inhibitors.
Olanzapine Schizophrenia: 10 mg High High High Yes CYP1A2, Moderate
(Zyprexa, CYP2D6
generics) Bipolar I disorder (manic or mixed See
10 mg episodes and maintenance): 5-20 mg footnotes e
$15.68 (monotherapy or with lithium or valproate) and h.

Generic orally Bipolar depression, with fluoxetine:

disintegrating 5-12.5 mg
tablet
available. Depression (treatment-resistant), with
fluoxetine: 5-20 mg
Olanzapine Agitation associated with psychosis or High High High Yes CYP1A2, Moderate
(Zyprexa bipolar I mania: 10 mg (lower dose [5 mg, CYP2D6
Intra- 7.5 mg] may be given). May repeat dose in See
Muscular) two hours. A third dose may be given no footnotes e
10 mg sooner than four hours after the second dose. and h.
$39.06/dose

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 (PL Detail-Document #310701: Page 4 of 9)

Generic FDA-Approved Indication(s) for Adults Metabolic Adverse Effectsa,1,2,4,7,10-13 QT CYP450 Sedationa,8,13
(Brand)/ and Usual or Target Adult Daily Prolongingc Metabolisma
Weight Diabetes Dyslipidemia
Costb Dosage Range (mg/day)a,*
gain Risk
Olanzapine Schizophrenia: After loading regimen, High High High Yes CYP1A2, Moderate
(Zyprexa dosed every 2 or 4 weeks IM (gluteal). CYP2D6
Relprevv) Establish tolerability and target dose with See Rare risk of
300 mg oral olanzapine first. In clinical trial, oral footnotes e post-
$1684 agent was stopped 2-7 days before first and h. injection
dose. Available only through a restricted delirium/
distribution program requiring prescriber, sedation
facility, patient, and pharmacy enrollment. syndrome.
Monitor for
at least 3
hours post-
dose.
Paliperidone Schizophrenia: 3-12 mg Low to Low Low Yes CYP2D6 (minor), Low
(Invega) moderate CYP3A4 (minor)
6 mg Schizoaffective disorder: 3-12 mg See footnote
$849.89 (monotherapy or adjunct to mood d.
stabilizers or antidepressants)

Paliperidone Schizophrenia or schizoaffective disorder: Low to Low Low Yes CYP2D6 (minor), Low
(Invega IM monthly after 2 doses one week apart. moderate CYP3A4 (minor)
Sustenna) Establish tolerability with oral See footnote
117 mg paliperidone or risperidone before use. d.
$967.03 Stop oral agent with first dose. When
switching from a long-acting injectable,
start in place of the next scheduled dose.
Missed maintenance dose: resume regular
monthly dosing if up to 2 weeks late.
Details on handling other missed dosing
scenarios are provided in the product
labeling.

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 (PL Detail-Document #310701: Page 5 of 9)

Generic FDA-Approved Indications for Adults Metabolic Adverse Effectsa,1,2,4,7,10-13 QT CYP450 Sedationa,8,13
(Brand)/ and Usual or Target Adult Daily Prolongingc Metabolisma
Weight Diabetes Dyslipidemia
Costb Dosage Range (mg/day)a,*
gain Risk
Paliperidone Schizophrenia, after adequate treatment Low to Low Low Yes CYP2D6 (minor), Low
(Invega with Invega Sustenna for at least moderate CYP3A4 (minor)
Trinza) 4 months: IM every 3 months. Dose See footnote
410 mg depends on previous Invega Sustenna d. Avoid CYP3A4
$1004.74 dose. Can give up to 2 weeks early or up and/or P-
to one month late. Details on handling glycoprotein
missed doses are provided in the product inducers, if
labeling. possible.
Quetiapine Schizophrenia: 150-750 mg Moderate Moderate Moderate Yes CYP3A4 Moderate
(Seroquel,
generics) Bipolar depression: 300 mg See footnote Specific dosing
400 mg d. may be advised
$23.18 Bipolar mania or bipolar I maintenance for CYP450
(monotherapy [acute] or as an adjunct to interactions.
lithium or valproate [acute, maintenance]):
400-800 mg

Quetiapine Schizophrenia: 400-800 mg Moderate Moderate Moderate Yes CYP3A4 Moderate

(Seroquel
XR) Bipolar depression (acute): See footnote Specific dosing
400 mg 300 mg d. may be advised
$694.69 for CYP450
Bipolar I manic or mixed episode
interactions.
(monotherapy [acute] or as an adjunct to
lithium or valproate [acute, maintenance]):
400-800 mg

Major depressive disorder (adjunct to

antidepressants):
150-300 mg

• Take without food or with a light

meal (about 300 kcal).
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 (PL Detail-Document #310701: Page 6 of 9)

Generic FDA-Approved Indications for Adults Metabolic Adverse Effectsa,1,2,4,7,10-13 QT CYP450 Sedationa,8,13
(Brand)/ and Usual or Target Adult Daily Prolongingc Metabolisma
Weight Diabetes Dyslipidemia
Costb Dosage Range (mg/day)a,*
gain Risk
Risperidone Schizophrenia: 4-8 mg Moderate Moderate Low Yes CYP2D6, Low
(Risperdal, CYP3A4
generics) Bipolar I disorder (manic or mixed See (minor)14
4 mg episodes): 1-6 mg footnotes e
$5.09 and h. Specific dosing
may be advised
Oral solution for CYP450
and orally interactions.
disintegrating
tablet
available.

Risperidone Schizophrenia: 25 mg IM every 2 weeks Moderate Moderate Low Yes CYP2D6, Low
(Risperdal CYP3A4
Consta) Bipolar I maintenance (monotherapy or as See (minor)14
25 mg an adjunct to lithium or valproate): 25 mg footnotes e
$682.76 IM every 2 weeks and h. Specific dosing
may be advised
• Continue oral agent for 3 weeks after for CYP450
first dose, then discontinue. interactions.

Missed dose, and <4 consecutive doses

received: Give injection, plus oral agent
for 3 weeks.15
Missed dose, and 4 or more consecutive
doses received: If only 3-6 weeks have
passed since last injection, give injection
alone. If >6 weeks have passed since last
injection, give injection, plus oral agent
for 3 weeks.15

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 (PL Detail-Document #310701: Page 7 of 9)

Generic FDA-Approved Indications for Adults Metabolic Adverse Effectsa,1,2,4,7,10-13 QT CYP450 Sedationa,8,13
(Brand)/ and Usual or Target Adult Daily Prolongingc Metabolisma
Weight Diabetes Dyslipidemia
Costb Dosage Range (mg/day)a,*
gain Risk
Ziprasidone Schizophrenia: 40-160 mg Low Low Low Yes CYP3A4, Moderate
(Geodon, CYP1A2
Bipolar manic or mixed episodes;
generics) See footnote (minor)
maintenance [adjunct to lithium or
80 mg g.
valproate]):
$38.20
80-160 mg
• Take with food.

Ziprasidone Agitation associated with schizophrenia: Low Low Low Yes CYP3A4, Moderate
(Geodon 10 mg IM q 2 hrs or 20 mg q 4 hrs. Max CYP1A2
injection) 40 mg/day. See footnote (minor)
20 mg g.
$26.19/dose

a. Per U.S. product information: Abilify (December 2014), Abilify Maintena (December 2014), Saphris (March 2015), Clozaril (December
2014), Fanapt (April 2014), Latuda (July 2013), Zyprexa and Zyprexa IntraMuscular (December 2014), Zyprexa Relprevv (December 2014),
Invega (April 2014), Invega Sustenna (February 2015), Invega Trinza (May 2015), Seroquel (October 2013), Seroquel XR (October 2013),
Risperdal (April 2014), Risperdal Consta (June 2014), Geodon (December 2014).
b. Wholesale average cost of 30-day supply of dose (daily if oral) specified of generic, if available.
c. Per FDA-approved product labeling and www.crediblemeds.org. A “yes” in the QT column means, at minimum, QT prolongation has been
reported in patients taking the medication, regardless of causality. Some of these medications have contraindications or recommendations to
avoid use related to QT prolongation (see pertinent footnotes).
d. Avoid use in patients with long QT syndrome, or history of cardiac arrhythmias, or with medications that prolong the QT interval. Avoid in
patients with risk factors for QT prolongation (e.g., bradycardia, hypomagnesemia, hypokalemia, etc).
e. Aripiprazole, olanzapine, and lurasidone may pose relatively lower torsades risk vs other antipsychotics based on product labeling and
literature review. Risperidone may pose more moderate risk vs higher-risk atypical antipsychotics. In a QT study, lurasidone was associated
with QT prolongation vs baseline at 120 mg and 600 mg daily.

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 (PL Detail-Document #310701: Page 8 of 9)

f. Clozapine is associated with agranulocytosis, seizures, and myocarditis. Hematological monitoring required. Clozapine is only available
through manufacturer-specific registration and distribution systems. Prescribers may obtain details by calling the number in the
manufacturer’s product information.
g. Consider relatively strong capacity to prolong QT interval when selecting an atypical agent. Avoid in patients with significant cardiovascular
disease (e.g., QT prolongation, cardiac arrhythmia, uncompensated heart failure, recent heart attack), or with drugs that prolong the QT
interval. Use iloperidone with caution with drugs that inhibit its metabolism (e.g., CYP2D6 and CYP3A4 inhibitors), and in patients with
reduced CYP2D6 activity. Check baseline and periodic potassium and magnesium levels in patients at risk for electrolyte disturbance.
h. Product labeling does not advise to avoid in long QT syndrome, but www.crediblemeds.org does (accessed June 9, 2015).

Users of this PL Detail-Document are cautioned to use their own professional judgment and consult any other necessary or appropriate sources prior to making
clinical judgments based on the content of this document. Our editors have researched the information with input from experts, government agencies, and national
organizations. Information and internet links in this article were current as of the date of publication.

More. . .
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 (PL Detail-Document #310701: Page 9 of 9)
Project Leader in preparation of this PL Detail- maintenance treatment of schizophrenia. Clin Ther
Document: Melanie Cupp, Pharm.D., BCPS 2008;30:231-48.
8. Miller DD. Atypical antipsychotics: sleep, sedation,
and efficacy. Prim Care Companion J Clin
References Psychiatry 2004;6(Suppl 2):3-7.
1. American Diabetes Association; American 9. Caccia S, Pasina L, Nobili A. New atypical
Psychiatric Association; American Association of antipsychotics for schizophrenia: iloperidone. Drug
Clinical Endocrinologists; North American Des Devel Ther 2010;4:33-48.
Association for the Study of Obesity. Consensus 10. Bishara D, Taylor D. Upcoming agents for the
Development Conference on antipsychotic drugs and treatment of schizophrenia: mechanism of action,
obesity and diabetes. Diabetes Care 2004;27:596- efficacy and tolerability. Drugs 2008;68:2269-92.
601. 11. Potkin SG, Cohen M, Panagides J. Efficacy and
2. Lieberman JA, Stroup TS, McEvoy JP, et al. tolerability of asenapine in acute schizophrenia: a
Effectiveness of antipsychotic drugs in patients with placebo- and risperidone-controlled trial. J Clin
chronic schizophrenia. N Engl J Med Psychiatry 2007;68:1492-500.
2005;353:1209-23. 12. Citrome L. Lurasidone for schizophrenia: a brief
3. Rummel-Kluge C, Komossa K, Schwarz S, et al. review of a new second-generation antipsychotic.
Second-generation antipsychotic drugs and Clin Schizophr Relat Psychoses 2011;4:251-7.
extrapyramidal side effects: a systematic review and 13. Leucht S, Cipriani A, Spineli L, et al. Comparative
meta-analysis of head-to-head comparisons. efficacy and tolerability of 15 antipsychotic drugs in
Schizophr Bull 2012;38:167-77. schizophrenia: a multiple-treatments meta-analysis.
4. McDonagh MS, Peterson K, Carson S, et al. Drug Lancet 2013;382:951-62.
class review: atypical antipsychotic drugs: final 14. Clinical Pharmacology [database online]. Tampa, FL:
report update 3 [Internet]. Portland, OR: Oregon Gold Standard, Inc; 2015.
Health & Science University, June 2010. http://www.clinicalpharmacology.com. (Accessed
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0009 June 10, 2015).
352/pdf/TOC.pdf. (Accessed May 31, 2015). 15. Janssen Medical Information. Risperdal Costa
5. Chwieduk CM, Keating GM. Paliperidone extended (risperidone). Dosing-dosage and administration.
release: a review of its use in the management of http://www.janssenmedicalinformation.com/assets/pd
schizophrenia. Drugs 2010;70:1295-317. f/products/files/Risperdal%20Consta/clinical_replies/
6. Correll CU. Antipsychotic use in children and RC-PSY-DA%20General.pdf. (Accessed June 12,
adolescents: minimizing adverse effects to maximize 2015).
outcomes. J Am Acad Child Adolesc Psychiatry
2008;47:9-20.
7. Fowler JA, Bettinger TL, Argo TR. Paliperidone
extended-release tablets for the acute and
Cite this document as follows: PL Detail-Document, Comparison of Atypical Antipsychotics. Pharmacist’s
Letter/Prescriber’s Letter. July 2015.
Evidence and Recommendations You Can Trust…
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 PL Detail-Document #310701
−This PL Detail-Document gives subscribers
additional insight related to the Recommendations published in−
PHARMACIST’S LETTER / PRESCRIBER’S LETTER
July 2015

Off-Label Use of Atypical Antipsychotics in Adults

Sixty percent of atypical prescriptions are for an off-label use. But don’t assume that just any atypical will work for a given indication; evidence does
not support a class effect.7 Weight gain and metabolic effects are of concern with atypicals, especially olanzapine,17 and very few of these off-label
uses are backed by large, high-quality, randomized controlled trials. Consider other drug options with more data and fewer side effects first (e.g.,
antidepressants). If an atypical is used, suggested monitoring includes weight, glucose, and lipids. Monitoring for metabolic side effects is outlined
in the product labeling, and in expert recommendations. Also see our PL Chart, Lab Monitoring for Common Medications. Although these agents
pose a lower risk of extrapyramidal side effects (e.g. agitation) and tardive dyskinesia than first-generation agents, they are not devoid of these side
effects.17 The following chart lists common off-label uses for atypicals with at least level B evidence, and therapeutic considerations. See our PL
Chart, Comparison of Atypical Antipsychotics (U.S. subscribers; Canadian subscribers), for approved adult indications, side effects, and CYP
interactions.
a. Inclusion means medication has at least level B evidence. But inclusion does not mean agent is effective for studied indication. See
Therapeutic Considerations column for details.
Use Off-Label Medicationa Therapeutic Considerations
Depression, Risperidone (Risperdal, • When a patient doesn’t respond to an antidepressant, see our PL Charts, Choosing and Switching
treatment- generics) Antidepressants and Combining and Augmenting Antidepressants.
resistant, adjunct Ziprasidone (Geodon, • One more patient in nine will respond when an atypical is added to antidepressant therapy compared
generics; Zeldox to placebo.19
[Canada]) • Abilify (aripiprazole), Seroquel XR (quetiapine), and Zyprexa (olanzapine, with fluoxetine
[Symbyax]) are FDA-approved for adjunctive treatment of treatment-resistant major depressive
disorder.1-3 In Canada, Abilify is approved as an adjunct,18 and Seroquel XR is approved as
monotherapy for treatment-resistant depression.4
• Risperidone’s efficacy may be similar to aripiprazole or quetiapine,5,19 but study results are
inconsistent.22
• Ziprasidone has not proven effective.20,21

Dementia Aripiprazole (Abilify, • Small benefits on agitation in dementia. Risperidone and olanzapine have the best evidence of
behaviors generics [U.S.[) efficacy.5
Olanzapine (Zyprexa, • Use about one-quarter to one-half the usual adult starting dose.6
generics ) • Risperidone has the best evidence for psychosis.5
Continued… Risperidone (Risperdal,
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 (PL Detail-Document #310701: Page 2 of 5)

Use Off-Label Medicationa Therapeutic Considerations

Dementia, generics) • Reserve for agitation or distress with psychosis (delusions, hallucinations, paranoia), or for
continued Quetiapine (Seroquel) treatment-refractory agitation or aggression, in patients who are a danger to themselves or
others.6,7,33
• Increased risk of metabolic syndrome. Increased risk of stroke and mortality in elderly dementia
patients.6,23 There is one additional death for about every 50 to 100 dementia patients treated for
8-12 weeks.5,6,32 Discuss risks/benefits with patient/family.6
• Try to taper and discontinue the drug every three to six months.6
• Use caution in patients with cerebrovascular disease or hypovolemia.6
• Patients with Parkinson’s dementia and Lewy body dementia are extra-sensitive to antipsychotic
extrapyramidal effects. Low-dose quetiapine is the antipsychotic of choice.8
Insomnia Quetiapine (Seroquel, • Quetiapine appears ineffective for primary insomnia.5,9,24
generics) • Quetiapine has been abused/misused for its sedating and anxiolytic effects.10
• Quetiapine and olanzapine have been used for treatment of insomnia secondary to specific causes
(e.g., depression, drug withdrawal, Parkinson’s disease, fibromyalgia). Data are extremely
limited.5,24
• Avoid for primary insomnia.33 See our PL Charts, Comparison of Insomnia Treatments (U.S.
subscribers; Canadian subscribers), for insomnia treatment options.
Post-traumatic Aripiprazole (Abilify, • Role is for augmentation of antidepressants to reduce hyperarousal and re-experiencing.11
stress disorder, generics [U.S.]) • Risperidone and olanzapine have the best evidence.5,25,27
adjunct Risperidone (Risperdal, • Not all studies have been favorable.15,16,27
generics)
Olanzapine (Zyprexa,
generics)
Quetiapine (Seroquel,
generics)
Obsessive- Aripiprazole (Abilify, • Role is as adjunct to SSRI in treatment-resistant OCD.5
compulsive generics [U.S.]) • Risperidone and aripiprazole have the best evidence of efficacy.5,12,26
disorder, adjunct Risperidone (Risperdal, • Olanzapine, paliperidone, and quetiapine are not consistently better than placebo.12-14,26,27
generics)
Olanzapine (Zyprexa,
generics)
Paliperidone (Invega)
Quetiapine (Seroquel,
generics)
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 (PL Detail-Document #310701: Page 3 of 5)

Use Off-Label Medicationa Therapeutic Considerations

Generalized Quetiapine (Seroquel, • SSRIs and SNRIs are first-line.27 Second-line agents include buspirone or pregabalin.27,34
anxiety disorder generics) • Quetiapine has best evidence of efficacy.5,12,27,28
Risperidone (Risperdal, • Ziprasidone is not better than placebo.12,27
generics)
Olanzapine (Zyprexa,
generics)
Aripiprazole (Abilify,
generics [U.S.]
Ziprasidone (Geodon,
Zeldox [Canada])
Autism Risperidone (Risperdal, • Aripiprazole and risperidone are FDA-approved for irritability associated with autism in pediatrics
generics) (up to age 17 years).2,29
Olanzapine (Zyprexa, • Adults have been included in some risperidone studies.30
generics) • Olanzapine and quetiapine have been studied in an open-label fashion in adults.31
Quetiapine (Seroquel,
generics)
Delirium in Olanzapine (Zyprexa, • Reserve for patients who are severely agitated or distressed.36
hospitalized generics) • Olanzapine may be less effective in patients over 75 years of age.35
patients Quetiapine (Seroquel, • See our PL Chart, Preventing and Treating Delirium in Inpatients, for more information.
(treatment) generics)
Risperidone (Risperdal,
generics)

Users of this PL Detail-Document are cautioned to use their own professional judgment and consult any other necessary or appropriate sources prior to making
clinical judgments based on the content of this document. Our editors have researched the information with input from experts, government agencies, and national
organizations. Information and internet links in this article were current as of the date of publication.

More. . .
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 (PL Detail-Document #310701: Page 4 of 5)
Levels of Evidence 8. Weintraub D, Hurtig HI. Presentation and
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D Anecdotal evidence Augmentation of serotonin reuptake inhibitors in
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Cite this document as follows: PL Detail-Document, Off-Label Use of Atypical Antipsychotics in Adults.
Pharmacist’s Letter/Prescriber’s Letter. July 2015.
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