Department of Psychiatry, Dalhousie University, Canada.
Am J Psychiatry. 2010 Jun;167(6):686-93. doi: 10.1176/appi.ajp.2009.09060802. Epub 2010 Apr 1.
Potency equivalents for anti-psychotic drugs are required to guide clinical dosing and for designing and interpreting research studies. Available dosing guidelines are limited by the methods and data from which they were generated.
With a two-step Delphi method, the authors surveyed a diverse group of international clinical and research experts, seeking consensus regarding antipsychotic dosing. The authors determined median clinical dosing equivalents and recommended starting, target range, and maximum doses for 61 drugs, adjusted for selected clinical circumstances.
Participants (N=43) from 18 countries provided dosing recommendations regarding treatment of psychotic disorders for 37 oral agents and 14 short-acting and 10 long-acting parenteral agents. With olanzapine 20 mg/day as reference, estimated clinical equivalency ratios of oral agents ranged from 0.025 for sulpiride to 10.0 for trifluperidol. Seventeen patient and treatment characteristics, including age, hepatic and renal function, illness stage and severity, sex, and diagnosis, were associated with dosing modifications.
In the absence of adequate prospective, randomized drug-drug comparisons, the present findings provide broad, international, expert consensus-based recommendations for most clinically employed antipsychotic drugs. They can support clinical practice, trial design, and interpretation of comparative antipsychotic trials.
抗精神病药物的效价等价物对于指导临床剂量和设计及解释研究具有重要意义。现有的剂量指南受到了其生成方法和数据的限制。
采用两步德尔菲法，作者调查了一组来自不同国家的国际临床和研究专家，就抗精神病药物剂量问题达成共识。作者确定了 61 种药物的中位数临床剂量等价物，并根据选定的临床情况，为 37 种口服药物和 14 种短效及 10 种长效注射剂推荐了起始剂量、目标范围和最大剂量。
来自 18 个国家的 43 名参与者就 37 种口服药物和 14 种短效及 10 种长效注射剂治疗精神障碍提供了剂量建议。以奥氮平 20mg/天为参照，口服药物的估计临床等效比范围从舒必利的 0.025 到三氟哌多的 10.0。17 种患者和治疗特征，包括年龄、肝肾功能、疾病阶段和严重程度、性别和诊断，与剂量调整有关。
在缺乏充分的前瞻性、随机药物比较的情况下，目前的研究结果为大多数临床应用的抗精神病药物提供了广泛的、国际性的、基于专家共识的推荐剂量。它们可以支持临床实践、试验设计和比较抗精神病药物试验的解释。
