APPENDIX

Psychiatric Medications

Robert H. Chew, Pharm.D.

		Adult			Pediatric
Medication	Approved indications	Usual dosage	Maximum (mg/day)		Usual dosage	Maximum (mg/day)	Comments
ANTIDEPRESSANTS
Tricyclic and tetracyclic antidepressants
Secondary tricyclics
Desipramine (Norpramin)	MDD	100–200 mg/day (at bedtime or in divided doses)	300		Ages ≥13 years: 25–100 mg/day (at bedtime or in divided doses)	150
Nortriptyline (Pamelor)	MDD	75–100 mg/day (once daily or divided tid–qid)	150		Ages 6–12 years: 1–3 mg/kg/day (divided tid–qid Ages >12 years: 30–50 mg/day (once daily or divided tid–qid	150 150
Protriptyline (Vivactil)	MDD	15–40 mg/day (divided tid–qid)	60		Ages ≥12 years: 15 mg/day (divided tid)	60
Tertiary tricyclics
Amitriptyline (Elavil)	MDD	50–150 mg/day (at bedtime or in divided doses)	300		Ages ≥12 years: 50–100 mg/day (once daily or in divided doses)	200
	MDD, hospitalized patients	100–200 mg/day (at bedtime or in divided doses)	300
Clomipramine (Anafranil)	OCD	150–250 mg/day (at bedtime or in divided doses)	250		Ages ≥10 years: 100–200 mg/day (at bedtime or in divided doses)	3 mg/kg/day or 200 mg/day, whichever is smaller
Doxepin	Depression and/or anxiety
	Mild–moderate symptoms	75–150 mg/day (at bedtime or in divided doses)	150
	Severe symptoms	300 mg/day (at bedtime or in divided doses)	300
Doxepin tablets (Silenor)	Insomnia	3–6 mg at bedtime	6
Imipramine (Tofranil)	MDD	50–150 mg/day (at bedtime or in divided doses)	200		Ages ≥13 years: 30–40 mg/day (at bedtime or in divided doses)	100
	MDD, hospitalized patients	250–300 mg/day (in divided doses)	300
	Nocturnal enuresis				Ages 6–12 years: 10–50 mg at bedtime	50
					Ages >12 years: 10–75 mg at bedtime	75
Trimipramine (Surmontil)	MDD	50–150 mg/day (at bedtime or in divided doses)	200		Ages ≥13 years: 50–100 mg/day (at bedtime or in divided doses)	100
	MDD, hospitalized patients	250–300 mg/day (at bedtime or in divided doses)	300
Tetracyclics
Amoxapine	MDD	200–300 mg/day (at bedtime or in divided doses)	400
	MDD, hospitalized patients		600
Maprotiline	MDD	75–150 mg/day (at bedtime or in divided doses)	150
	MDD, hospitalized patients	150–225 mg/day (at bedtime or in divided doses)	225
Selective serotonin reuptake inhibitor (SSRI) antidepressants
Citalopram (Celexa)	MDD	20–40 mg/day	40
Escitalopram (Lexapro)	MDD	10–20 mg/day	20		Ages 12–17 years: 10–20 mg/day	20
	GAD	10–20 mg/day	20
Fluoxetine (Prozac)	MDD	20–80 mg/day in morning or divided bid; or 90 mg weekly†	80		Ages ≥8 years: 10–20 mg/day in morning	20	†Fluoxetine 90-mg delayed-release capsule.
	OCD	20–60 mg/day in morning or divided bid	80		Ages ≥7 years: 20–60 mg/day in morning or divided bid	60
	Panic disorder	20–60 mg/day	60
	Bulimia nervosa	20–60 mg/day	60
Fluoxetine (Sarafem)	PMDD	20–60 mg/day†	80				†Administered throughout menstrual cycle or during luteal phase of menstrual cycle.
Fluvoxamine	OCD	100–300 mg/day (divided bid)	300		Ages 8–17 years: 50–200 mg/day (divided bid) Ages >17 years: 100–300 mg/day (divided bid)	200 300
Fluvoxamine extended-release (Luvox CR)	OCD	100–300 mg/day at bedtime	300
Paroxetine (Paxil) Paroxetine extended-release (Paxil CR)	MDD	20–50 mg/day in morning ER: 25–62.5 mg/day	50 62.5
	GAD	20–50 mg/day	50
	Social anxiety disorder	20–60 mg/day ER: 12.5–37.5 mg/day	60 37.5		Ages 8–17 years: 10–60 mg/day in morning*	60	*Off-label use.
	Panic disorder	40 mg/day in morning ER: 12.5–75 mg/day in morning	60 75
	OCD	20–60 mg/day in morning	60		Ages 7–17 years: 10–60 mg/day in morning*	60	*Off-label use.
	PTSD	20–50 mg/day in morning	50
	PMDD	ER: 12.5–25 mg/day in morning†	25				†Administered throughout menstrual cycle or during luteal phase of menstrual cycle.
Sertraline (Zoloft)	MDD	50–200 mg/day in morning	200		Ages ≥6 years: 25–200 mg/day in morning*	200	*Off-label use.
	Social anxiety disorder	50–200 mg/day	200
	Panic disorder	50–200 mg/day in morning	200
	OCD	50–200 mg/day in morning	200		Ages 6–12 years: 25–200 mg/day	200
					Ages 13–17 years: 50–200 mg/day	200
	PTSD	50–200 mg/day in morning	200
	PMDD	50–200 mg/day in morning†	150				†Administered throughout menstrual cycle or during luteal phase of menstrual cycle.
Serotonin–norepinephrine reuptake inhibitor (SNRI) antidepressants
Desvenlafaxine (Pristiq)	MDD	50 mg/day	50
Duloxetine (Cymbalta)	MDD	40–60 mg/day (once daily or divided bid)	120
	GAD	60 mg/day	120		Ages 7–17 years: 30–60 mg/day	120
	Fibromyalgia	60 mg/day	60
	Diabetic neuropathic pain	60 mg/day	60
	Musculoskeletal pain	60 mg/day	60
Levomilnacipran (Fetzima)	MDD	40–120 mg/day	120
Milnacipran (Savella)	Fibromyalgia	100 mg/day (divided bid)	200
Venlafaxine	MDD	75–225 mg/day	225
Venlafaxine extended-release (Effexor ER)	MDD	75–225 mg/day	225
	GAD	75–225 mg/day	225
	Social anxiety disorder	75 mg/day	75
	Panic disorder	75–225 mg/day	225
Norepinephrine–dopamine reuptake inhibitor antidepressant (putative‡)							‡Bupropion’s precise mechanism of action is not known.
Bupropion immediate-release	MDD	300 mg/day (divided tid)	150 mg/dose; 450 mg/day
	ADHD*	300 mg/day (divided tid)	†		Ages ≥6 years: 1.4–6.0 mg/kg/day (divided bid)	†	*Off-label use. †Maximum dosing (adult and pediatric) for bupropion IR: 150 mg/dose; 450 mg/day
Bupropion sustained-release (Wellbutrin SR)	MDD	SR: 300 mg/day (divided bid)	400
	ADHD*	SR: 300 mg/day (divided bid)	400		Ages ≥12 years: 3–6 mg/kg/day (divided bid)	400	*Off-label use.
Bupropion extended-release
Bupropion XL	MDD, seasonal affective disorder	300 mg/day in morning	450
	ADHD*	300 mg/day in morning	300		Ages ≥12 years: 3–6 mg/kg/day in morning	400	*Off-label use.
Aplenzin	MDD, seasonal affective disorder	348 mg/day in morning	522
Multimodal serotonin antagonist antidepressants
Nefazodone	MDD	300–600 mg/day (divided bid)	600
Trazodone	MDD	150–300 mg/day (divided bid–tid)	400
	Insomnia*	25–100 mg at bedtime	200				*Off-label use.
Trazodone extended-release (Oleptro)	MDD	150–375 mg/day at bedtime	375
Vortioxetine (Trintellix)	MDD	20 mg/day	20†				†Dosage should not exceed 10 mg/day in CYP2D6 poor metabolizers or be administered with strong CYP2D6 inhibitors.
Vilazodone (Viibryd)	MDD	20–40 mg/day	40
Noradrenergic-specific serotonin antidepressant (NaSSA)
Mirtazapine (Remeron)	MDD	15–45 mg/day at bedtime	45
Monoamine oxidase inhibitor (MAOI) antidepressants
Isocarboxazid (Marplan)	MDD and atypical depression	40–60 mg/day (divided bid–qid)	60
Phenelzine (Nardil)	MDD and atypical depression	40–60 mg/day in divided doses†	90				†After maximum benefit is achieved, dosage should be reduced over several weeks. Maintenance dosage can range from 15 mg every other day to 15 mg once daily.
Selegiline transdermal patch (Emsam)	MDD	6–12 mg patch per 24 hours	12
Tranylcypromine (Parnate)	MDD and atypical depression	30 mg/day in divided doses	60
N-methyl-d-aspartate (NMDA) receptor antagonist
Ketamine	Relief of acute depression with suicidal ideation*	0.5 mg/kg IV over 40 minutes	—				*Off-label use.
ANXIOLYTICS
Benzodiazepines
Alprazolam (Xanax)	GAD	0.25–0.5 mg tid	4
	Panic disorder	1.5–9 mg/day (divided tid)	10
Alprazolam extended-release (Xanax XR)	GAD	3–6 mg/day	6
Chlordiazepoxide	GAD, mild– moderate	5–10 mg tid–qid	†		Ages ≥6 years: 5–10 mg bid–tid	†	†There is no well-established chlordiazepoxide maximum dosage for the approved indications.
	GAD, severe	20–25 mg tid–qid	†
	Acute alcohol withdrawal	50–100 mg prn	300
Clonazepam (Klonopin)	Panic disorder	1–4 mg/day (divided bid)	4
Clorazepate	GAD	15–30 mg/day (at bedtime or divided bid)	60
	Acute alcohol withdrawal	Dosage titration†					†Day 1: 30 mg, then 30–60 mg in divided doses. Day 2: 45–90 mg in divided doses. Day 3: 22.5–45 mg in divided doses. Day 4: 15–30 mg in divided doses; then reduce to 7.5–15 mg/day in divided doses (bid–tid).
Diazepam (Valium)	GAD	2–10 mg bid–qid	40
	Acute alcohol withdrawal	10 mg tid–qid for first 24 hours; then 5 mg tid–qid prn	—
Lorazepam (Ativan)	GAD	2–6 mg/day (divided bid–tid)	10
	Insomnia	2–4 mg at bedtime	4
Lorazepam injection (Ativan Injection)	Acute agitation*	0.5–1 mg IM prn every 30–60 minutes	—				*Off-label use.
Oxazepam	GAD	10–30 mg tid–qid	120
	Acute alcohol withdrawal	15–30 mg tid–qid	—
Nonbenzodiazepine
Buspirone	GAD	20–30 mg/day (divided bid–tid)	60
AGENTS FOR TREATMENT OF INSOMNIA
Benzodiazepines
Estazolam		1–2 mg at bedtime	2
Flurazepam (Dalmane)		15–30 mg at bedtime	30
Quazepam (Doral)		7.5–15 mg at bedtime	15
Temazepam (Restoril)		7.5–30 mg at bedtime	30
Triazolam (Halcion)		0.125–0.5 mg at bedtime	0.5; 0.25 in elderly
Nonbenzodiazepines
Eszopiclone (Lunesta)		1–3 mg at bedtime	3
Ramelteon (Rozerem)		8 mg at bedtime	8
Suvorexant (Belsomra)		10–20 mg at bedtime	20
Tasimelteon (Hetlioz)	Non-24-hour sleep–wake disorder	20 mg at bedtime	20
Zaleplon (Sonata)		10–20 mg at bedtime	20
Zolpidem (Ambien)		5–10 mg at bedtime	10
Zolpidem extended-release (Ambien CR)		6.5–12.5 mg	12.5
Zolpidem sublingual (SL) (Intermezzo)	Middle-of-night awakening†	Women: 1.75 mg prn Men: 3.5 mg prn	Once per night				†Take as needed if unable to return to sleep after middle-of-night-awakening.
ANTIPSYCHOTICS
First-generation (typical) antipsychotics
Chlorpromazine	Psychotic disorders	200–600 mg/day (divided tid–qid)	1,000
	Acute manic states, hospitalized patients	200–800 mg/day (divided tid–qid)	2,000
Chlorpromazine injection	Acute agitation, hospitalized patients	25 mg IM, repeat 25–50 mg in 1 hour; up to 400 mg IM every 4–6 hours prn	—
Fluphenazine	Psychotic disorders	2.5–10 mg/day (divided tid–qid)	40
Fluphenazine hydrochloride injection	Acute agitation	2.5–10 mg/day IM every 6–8 hours prn	10
Fluphenazine decanoate injection	Management of psychotic disorders and schizophrenia	25–50 mg IM every 3 weeks†	—				†Approximate conversion ratio of decanoate to oral is 12.5 mg (0.5 mL) every 3 weeks for every 10 mg of oral fluphenazine daily.
Haloperidol	Psychotic disorders	0.5–5 mg bid–tid	100		Ages 3–12 years: 0.05–0.15 mg/kg/day	0.15 mg/kg/day
					Ages >12 years: 0.5–5 mg bid–tid	15
	Tourette’s disorder	0.5–5 mg bid–tid	100		Ages 3–12 years: 0.05–0.075 mg/kg/day	0.15 mg/kg/day
					Ages >12 years: 0.5–5 mg bid–tid	15
	Behavioral disorders, severe				Ages 3–12 years: 0.05–0.075 mg/kg/day	0.15 mg/kg/day
					Ages >12 years: 0.5–5 mg bid–tid	15
Haloperidol lactate injection (Haldol Injection)	Acute psychosis	2–10 mg IM every 4–8 hours prn	20
Haloperidol decanoate injection (Haldol Decanoate)	Management of psychotic disorders and schizophrenia	50–200 mg IM every month	—
Loxapine (Loxitane)	Psychotic disorders	60–100 mg/day in divided doses	250
Loxapine inhalation (Adasuave)	Acute agitation	10 mg/day†	10				†Each inhalation delivers 10 mg; must be administered by a health care professional.
Perphenazine	Psychotic disorders	4–8 mg tid	24
	Psychotic disorders, hospitalized patients	8–16 mg bid–qid	64
Pimozide (Orap)	Tourette’s disorder	2–10 mg/day	10		Ages ≥12 years: 0.05–0.2 mg/kg/day	0.2 mg/kg/day, up to 10 mg/day
Thioridazine	Psychotic disorders	200–800 mg/day (divided bid–qid)	800
Thiothixene	Psychotic disorders	20–30 mg/day in divided doses	60
Trifluoperazine	Psychotic disorders	15–20 mg/day (once daily or divided bid)	40		Ages 6–12 years: 1 mg/day (once daily or divided bid)	15
					Ages ≥13 years: 15–20 mg/day (once daily or divided bid)	40
	Nonpsychotic anxiety	1–2 mg bid	6
Second-generation (atypical) antipsychotics
Aripiprazole (Abilify)	Schizophrenia	10–15 mg/day	30		Ages 13–17 years: 10 mg/day	30
	Bipolar I disorder	10–15 mg/day	30		Ages 10–17 years: 10 mg/day	30
	MDD, adjunctive therapy	2–15 mg/day	15
	Tourette’s disorder				Ages 6–18 years, ≥50 kg: 10 mg/day	10
					Ages 6–18 years, ≥50 kg: 10 mg/day	20
	Irritability associated with autism spectrum disorder				Ages 6–17 years: 5–10 mg/day	15
Aripiprazole long-acting injection (Abilify Maintena)	Schizophrenia	300–400 IM every month	—
Aripiprazole lauroxil long-acting IM injection (Aristada)	Schizophrenia	441–882 IM every 4–6 weeks	—
Asenapine SL (Saphris)	Schizophrenia	10–20 mg/day SL (divided bid)	20
	Bipolar I disorder, monotherapy	10–20 mg/day SL (divided bid)	20		Ages 10–17 years: 5–10 mg/day SL (divided bid)	20
	Bipolar I disorder, adjunctive therapy with lithium or valproate	10 mg/day SL (divided bid)	20
Brexpiprazole (Rexulti)	Schizophrenia	2–4 mg/day	4
	MDD, adjunctive therapy	2 mg/day	3
Cariprazine (Vraylar)	Schizophrenia	1.5–6 mg/day	6
	Bipolar I disorder	3–6 mg/day	6
Clozapine (Clozaril)	Schizophrenia, refractory	150–300 mg bid	900
	Schizophrenia with high suicide risk	150–300 mg bid	900
Iloperidone (Fanapt)	Schizophrenia	6–12 mg bid	24
Lurasidone (Latuda)	Schizophrenia	40–160 mg/day	160
	Bipolar I disorder, depressive episodes	20–80 mg/day	120
Olanzapine (Zyprexa)	Schizophrenia	10–20 mg/day	20		Ages ≥13 years: 10 mg/day	20
	Bipolar I disorder	5–20 mg/day	20		Ages ≥13 years: 10 mg/day	20
Olanzapine IM injection (Zyprexa Intramuscular)	Acute agitation	10 mg IM; may repeat after 2 hours one time; repeat prn 4 hours after second dose	30
Olanzapine long-acting IM injection (Zyprexa Relprevv)	Schizophrenia	Dosage titration†					†If stabilized on oral 10 mg/day: Start 210 mg IM every 2 weeks x 4 doses or 405 mg every 4 weeks x 2 doses; then 150 mg IM every 2 weeks or 300 mg every 4 weeks. If stabilized on oral 15 mg/day: Start 300 mg IM every 2 weeks x 4 doses, then 210 mg IM every 2 weeks or 405 mg every 4 weeks.
Olanzapine/fluoxetine (Symbyax)	Bipolar I disorder, acute depressive episodes	6 mg/25 mg/day– 12 mg/50 mg/day	12/50		Ages 10–17 years: 3 mg/25 mg/day	12/50
	Treatment-resistant depression	6 mg/25 mg/day	12/50
Paliperidone (Invega)	Schizophrenia Schizoaffective disorder	6 mg/day	12		Ages 12–17 years: 3 mg/day	12
Paliperidone palmitate long-acting IM injection†							†Refer to manufacturer’s package insert for dosing guidelines.
Invega Sustenna		IM injection every month	—
Invega Trinza		IM injection every 3 months	—
Quetiapine (Seroquel)	Schizophrenia	150–750 mg/day (divided bid–tid)	750		Ages 13–17 years: 400–800 mg/day (divided bid–tid)	800
	Bipolar I disorder, acute manic/mixed episodes	400–800 mg/day (divided bid)	800		Ages 10–17 years: 400–600 mg/day (divided bid–tid)	600
	Bipolar I disorder, depressive episodes	300 mg/day at bedtime	300
Quetiapine extended-release (Seroquel XR)	Schizophrenia	400–800 mg/day	800		Ages 13–17 years): 400–800 mg/day	800
	Bipolar I disorder, acute manic/mixed episodes	400–800 mg bid	800		Ages 10–17 years): 400–800 mg/day	600
	Bipolar I disorder, depressive episodes	300 mg/day at bedtime	300
	MDD, adjunctive therapy	150–300 mg/day	300
Risperidone (Risperdal)	Schizophrenia	4–8 mg/day (once daily or divided bid)	16		Ages 13–17 years: 1–6 mg/day (once daily or divided bid)	6
	Bipolar I disorder, acute manic/mixed episodes	1–6 mg/day (once daily or divided bid)	6		Ages 10–17 years: 1–2.5 mg/day (once daily or divided bid)	6
	Irritability associated with autism spectrum disorder				Ages 5–17 years, weight <20 kg: 0.5 mg/day (once daily or divided bid)†	3	†Weight <20 kg: Start at 0.25 mg/day before increasing dosage.
					Ages 5–17 years, weight ≥20 kg: 1 mg/day (once daily or divided bid)†	3	†Weight ≥20 kg: Start at 0.5 mg/day before increasing dosage.
Risperidone long-acting IM injection (Risperdal Consta)	Schizophrenia Bipolar I disorder	25–50 mg IM every 2 weeks	—
Ziprasidone (Geodon)	Schizophrenia	20 mg bid	160
	Bipolar I disorder	80–160 mg/day (divided bid)	160
Ziprasidone IM injection (Geodon Injection)	Acute agitation	10 mg IM every 2 hours prn or 20 mg IM every 4 hours prn	—
MOOD STABILIZERS
Carbamazepine (Tegretol)	Bipolar I disorder*	800–1,200 mg/day (divided bid–qid)	1,600				*Off-label use.
Carbamazepine extended-release (Equetro,† Tegretol XR)	Bipolar I disorder	400–600 mg bid	1,600				†Equetro is the only carbamazepine formulation approved for the treatment of bipolar I disorder.
Gabapentin (Neurontin)	Postherpetic neuralgia	300–600 mg tid	1,800
	Neuropathic pain*	300–1,200 mg tid	3,600				*Off-label use.
	Bipolar I disorder*	600–3,600 mg/day (divided tid)	3,600				*Off-label use.
	GAD*	600–3,600 mg/day (divided tid)	3,600				*Off-label use.
Lamotrigine (Lamictal, Lamictal XR)	Bipolar I disorder     Monotherapy†     With valproate†     With enzyme inducers (e.g., carbamazepine)†	200 mg/day 100 mg/day 200 mg bid	200 100 400				†Refer to manufacturer’s titration schedules, particularly for patients taking valproate or enzyme-inducing medications concomitantly. Lamictal Starter/Titration Kits are available to guide lamotrigine dosing for monotherapy as well as comedication scenarios.
	Bipolar depression*	50–200 mg/day	200				*Off-label use.
Lithium carbonate	Bipolar disorder	900–1,200 mg/day (divided tid–qid)†	2,400		Ages ≥6 years, weight <30 kg: 15–40 mg/kg/day (divided tid–qid)†	60 mg/kg/day	†Dosage adjustment based on clinical response and trough levels of serum lithium between 0.6 and 1.2 mEq/L.
					Ages ≥6 years, weight ≥30 kg: 15–40 mg/kg/day (divided tid–qid)†	60 mg/kg/day, up to 2,400 mg
Lithium extended-release (Lithobid)		900–1,800 mg/day (divided bid–tid)	1,800		Ages ≥6 years, weight <30 kg: 15–40 mg/kg/day (divided tid–qid)	60 mg/kg/day
					Ages ≥6 years, weight ≥30 kg: 15–40 mg/kg/day (divided tid–qid)	60 mg/kg/day, up to 1,800 mg
Oxcarbazepine (Trileptal) Oxcarbazepine extended-release (Oxtellar XR)	Bipolar I disorder*	1,200–2,400 mg/day (once daily or divided bid)	2,400				*Off-label use.
Pregabalin (Lyrica)	GAD*	300 mg bid	600				*Off-label use.
	Fibromyalgia	150–225 mg bid	450
	Diabetic neuropathy	100 mg tid	300
Topiramate (Topamax)	Bulimia nervosa*	300–400 mg/day (divided bid)	400				*Off-label use.
	Depressive disorders, adjunctive therapy*	100–200 mg/day (divided bid)	—				*Off-label use.
	Alcohol use disorder*	300 mg/day in divided doses	300				*Off-label use.
Valproate, divalproex sodium (Depakote, Depakote ER)	Bipolar I disorder, manic episodes	15–20 mg/kg/day Rapid oral loading:† 20–30 mg/kg/day	60 mg/kg/day				†In treatment of acute mania, a rapid oral loading regimen may be used, with dosage increases (based on response/tolerance) of 250–500 mg every 1–3 days until serum concentrations are between 45 and 125 mcg/mL. Delayed-release tablets (Depakote) should be taken in divided doses; extended-release tablets (Depakote ER) should be taken once daily.
PSYCHOSTIMULANTS FOR TREATMENT OF ADHD AND NARCOLEPSY
Amphetamine/dextroamphetamine (Adderall)	ADHD	5–40 mg/day (once daily or divided bid)	40		Ages 3–5 years: 2.5–40 mg/day (once daily or divided bid)	40
					Ages ≥6 years: 5–40 mg/day (once daily or divided bid)	40
	Narcolepsy†	5–60 mg/day in divided doses	60		5–60 mg/day in divided doses	60	†Only the immediate-release Adderall tablets are approved for treatment of narcolepsy.
Amphetamine/dextroamphetamine extended-release (Adderall XR)	ADHD	20 mg/day in morning	60		Ages 6–12 years: 10 mg/day in morning	30
					Ages 13–17 years: 10–20 mg/day in morning	40
Armodafinil (Nuvigil)	Narcolepsy Sleep apnea	150–250 mg/day in morning	250
Modafinil (Provigil)	Narcolepsy Sleep apnea	200 mg/day in morning	400
Dextroamphetamine (Dexedrine)	ADHD				Ages ≥6 years: 5–40 mg/day (once daily or divided bid)	40
	Narcolepsy	5–60 mg/day (once daily or divided bid)	60		Ages ≥12 years: 5–60 mg/day (once daily or divided bid)	60
Lisdexamfetamine (Vyvanse)	ADHD	30–70 mg/day in morning	70		Ages ≥6 years: 30–70 mg/day in morning	70
	Binge-eating disorder	50–70 mg/day in morning	70
Methamphetamine (Desoxyn)	ADHD	20–25 mg/day (once daily or divided bid)	25		Ages ≥6 years: 20–25 mg/day (once daily or divided bid)	25
Dexmethylphenidate (Focalin)	ADHD	5–10 mg/day (divided bid)	20		Ages ≥6 years: 5–20 mg/day (divided bid)	20
Dexmethylphenidate extended-release (Focalin XR)		20–40 mg/day in morning	40		Ages ≥6 years: 10–30 mg/day in morning	30
Methylphenidate
Short-acting†							†Short-acting (IR) methylphenidate formulations have durations of action of 3–5 hours and generally require two- or three-times-daily dosing.
Ritalin, Methylin	ADHD	20–30 mg/day (divided bid–tid)	60		Ages ≥6 years: 15–30 mg/day (divided bid–tid)	60
	Narcolepsy	20–30 mg/day (divided bid–tid)	60
Intermediate-acting†							†Intermediate-acting (extended-release, single pulse) methylphenidate formulations have durations of action of approximately 8 hours, with once- or twice-daily dosing.
Metadate ER	ADHD	20–40 mg/day (once daily or divided bid)	60		Ages ≥6 years: 20 mg/day (once daily or divided bid)	60
	Narcolepsy	20–30 mg/day (once daily or divided bid)	60
Long-acting†	ADHD						†Long-acting (extended-release, dual pulse) methylphenidate formulations have durations of action of approximately 8–12 hours, with once-daily dosing in the morning.
Aptensio XR		10–60 mg/day in morning	60		Ages ≥6 years: 10–60 mg/day in morning	60
Concerta		18–72 mg/day in morning	72		Ages 6–12 years: 18–54 mg/day in morning Ages 13–17 years: 18–72 mg/day in morning	54 72
Daytrana Transdermal System		10–30 mg patch per day†	30		Ages ≥6 years: 10–30 mg patch per day	30	†Wear patch for 9 hours; remove for 15 hours.
Metadate CD, Quillivant XR, Ritalin LA		20–60 mg/day in morning	60		Ages ≥6 years: 20–60 mg/day in morning	60
NONPSYCHOSTIMULANTS FOR TREATMENT OF ADHD
Atomoxetine (Strattera)	ADHD	80–100 mg/day (divided bid)	100		Ages ≥6 years, weight <70 kg: 1.2 mg/kg/day (divided bid) Ages ≥6 years, weight ≥70 kg: 80 mg/day (divided bid)	1.4† 100	†Maximum for children weighing less than 70 kg: 1.4 mg/kg/day; maximum dosage for adult and pediatric is 100 mg/day.
Clonidine extended-release (Kapvay)	ADHD				Ages ≥6 years: 0.2–0.4 mg/day (divided bid)	0.4
Guanfacine extended-release (Intuniv)	ADHD				Ages 6–17 years: 0.05–0.12 mg/kg/day	4 (ages 6–12 years); 7 (ages 13–17 years)
AGENTS FOR COGNITIVE DISORDERS
Donepezil (Aricept)	Alzheimer’s disease, mild–moderate	5–10 mg/day	10
	Alzheimer’s disease, moderate–severe	10–23 mg/day	23
Galantamine (Razadyne)	Alzheimer’s disease, mild–moderate	8–12 mg bid	24
Galantamine extended-release (Razadyne ER)	Alzheimer’s disease, mild–moderate	16–24 mg/day	24
Memantine (Namenda)	Alzheimer’s disease, moderate–severe	10 mg bid	20
Memantine extended-release (Namenda XR)	Alzheimer’s disease, moderate–severe	28 mg/day	28
Memantine/donepezil (Namzaric)	Alzheimer’s disease, moderate–severe	28 mg/10 mg/day†	28/10				†Patient stabilized on donepezil and not currently taking memantine: Start Namzaric 7 mg/10 mg once daily and increase by 7-mg increments of memantine every week up to maximum dosage of 28 mg/10 mg once daily.
Rivastigmine (Exelon)	Alzheimer’s disease, mild–severe	3–6 mg bid	12
	Parkinson’s disease dementia	1.5–6 mg bid	12
Rivastigmine topical patch (Exelon Transdermal)	Alzheimer’s disease, mild–severe	9.5–13.3 mg patch per 24 hours	13.3
	Parkinson’s disease dementia	9.5–13.3 mg patch per 24 hours	13.3
AGENTS FOR TREATMENT OF ANTIPSYCHOTIC-INDUCED EXTRAPYRAMIDAL SIDE EFFECTS
Amantadine	Antipsychotic-induced EPS	100 mg bid	300
Benztropine (Cogentin)	Antipsychotic-induced EPS	1–2 mg PO/IM bid–tid	6		Ages ≥3 years: 0.02–0.05 mg/kg/day PO/IM (once daily or bid)*	†	*Off-label use. †There are no well-established maximum dosages in children.
Benztropine mesylate injection (Cogentin Injection)	Acute dystonic reaction	2 mg IM; repeat once after 30 minutes prn	†				†Usual maximum (standard practice) is 2 injections.
Diphenhydramine (Benadryl)	Antipsychotic-induced EPS	25–50 mg PO/IM every 6–8 hours prn	400		Ages <12 years: 1–2 mg/kg PO/IM every 6–8 hours prn	50 mg/dose; 300 mg/day PO/IM
					Ages ≥12 years: 25–50 mg PO/IM every 6–8 hours prn	100 mg/dose; 300 mg/day PO; 400 mg/day IM
	Acute dystonic reaction*	50–100 mg IM/IV; repeat after 20–30 minutes prn	100 mg/dose		Ages ≥6 years: 1–2 mg/kg/dose IM/IV; repeat after 20–30 minutes prn	50 mg/dose	*Off-label use.
Propranolol (Inderal)	Antipsychotic-induced akathisia*	20–120 mg/day (divided tid–qid)	120				*Off-label use.
Trihexyphenidyl	Antipsychotic-induced EPS	5–15 mg/day (divided tid–qid)	15
AGENTS FOR TREATMENT OF SUBSTANCE USE DISORDERS
Acamprosate	Alcohol abstinence, maintenance	666 mg tid	†				†There is no well-established acamprosate maximum dosage for the approved indication.
Bupropion sustained-release (Zyban)	Smoking cessation	150 mg bid	300
Disulfiram (Antabuse)	Management of alcohol abstinence	125–500 mg/day in morning	500
Naltrexone	Treatment of alcohol dependence	50 mg/day	†				†There are no well-established naltrexone maximum dosages for the approved indications.
	Management of opioid dependence	Give 25 mg; if no withdrawal symptoms, start 50 mg/day	†
Naltrexone injection (Vivitrol)	Treatment of alcohol dependence	380 mg IM every 4 weeks†					†Must not be actively drinking at time of initial administration.
	Management of opioid dependence	380 mg IM every 4 weeks†					†Must be opioid-free for 7–10 days.
Varenicline (Chantix)	Smoking cessation	Requires dosage titration†					†Treatment duration is 12 weeks. Days 1–3: 0.5 mg/day. Days 4–7: 0.5 mg bid. Day 8 through end of treatment: 1 mg bid.
Note. ADHD=attention-deficit/hyperactivity disorder; CYP2D6=cytochrome P450 2D6 enzyme; EPS=extrapyramidal side effects; GAD=generalized anxiety disorder; MDD=major depressive disorder; OCD=obsessive-compulsive disorder; PMDD=premenstrual dysphoric disorder; PTSD=posttraumatic stress disorder. —=not available; bid=twice daily (or divided into 2 doses); IM=intramuscular; IV=intravenous; PO=oral; prn=as needed; qid=four times daily (or divided into 4 doses); SL=sublingual; tid=three times daily (or divided into 3 doses). CD=controlled delivery (extended release); CR=controlled release (extended release); ER=extended release; IR=immediate release; LA=long acting (extended release); SR=sustained release (extended release); XL, XR=extended release. Source. Athenahealth Inc.: epocrates®; Available at: http://online.epocrates.com; Findling RL (ed): Clinical Manual of Child and Adolescent Psychopharmacology. Washington, DC, American Psychiatric Publishing, 2008; National Institutes of Health, U.S. National Library of Medicine: DailyMed; available at: http://dailymed.nlm.nih.gov; Wolters Kluwer: Facts & Comparisons eAnswers; available at: http://eanswers.factsandcomparisons.com.