CLINICAL USE


Atypical antipsychotic for schizophrenia

DOSE IN NORMAL RENAL FUNCTION

3–12 mg once daily

PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :426.5
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :74
  • %Excreted unchanged in urine &nbsp &nbsp : 59

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :487 litres

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :23/51

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

    50–80 3 mg once daily and increase according to response30–50 3 mg once daily and increase according to response10–30 3 mg alternate days, increasing to 3 mg daily according to response
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : 3 mg alternate days, increasing to 3 mg daily according to response. Use with caution

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR <10 mL/min

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Unknown dialysability. Dose as in GFR <10 mL/min
  • HDF/high flux &nbsp :Unknown dialysability. Dose as in GFR <10 mL/min
  • CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR=10–30 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs
  • Anaesthetics: enhanced hypotensive effect
  • Anti-arrhythmics: increased risk of ventricular arrhythmias when given with anti-arrhythmics that prolong the QT interval
  • Antidepressants: increases concentration of tricyclics (possibly increased risk of ventricular arrhythmias)
  • Antimalarials: avoidance of antipsychotics advised by manufacturer of artemether/lumefantrine
  • Atomoxetine: increased risk of ventricular arrhythmias with atomoxetine
  • Anti-epileptics: antagonise anticonvulsant effect (convulsive threshold lowered)
  • Antivirals: concentration possibly increased by ritonavir
  • Sibutramine: increased risk of CNS toxicity – manufacturer of sibutramine advises avoid concomitant use

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral

    Rate of Administration

    –

    Comments

    –

    OTHER INFORMATION

    Clearance is reduced by 71% in ERF
  • Contraindicated (by manufacturer) in patients with GFR <10 mL/min, due to lack of experience.
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