- patients who achieved usual plasma drug levels on the usual recommended dosages (normal clearance)
- those who achieved levels below the usual expected range, despite good compliance (rapid clearance).
These two groups could then be randomized to continued exposure to the usual dosing range or higher-than-usual dosing. Patients with rapid clearance would be predicted to have a greater response to higher-than-usual dosing, compared with those with usual clearance.
In the absence of such trials, the clinician should proceed cautiously—if at all—to use higher-than usual antipsychotic dosages in his or her patients. The prescriber must always consider whether the risks outweigh the potential benefits, taking into account:
- the drug’s therapeutic index
- evidence of safety and tolerability problems in the individual patient as the dosage is escalated.
Related resources
- Preskorn SH. The recommended dosage range: How is it established and why would it ever be exceeded? J Psychiatry Pract 2004;10(4):249-54.