Abstract
Although the optimal dosing of an antipsychotic medication is known to be essential in the long-term management of schizophrenia, in case of novel drugs such as cariprazine, determining the right dosing strategy is not that simple. Without decades of experience with a particular compound, evidence regarding dosing and titration comes primarily from double-blind, placebo controlled clinical trials that are not necessarily mirroring the real-life experiences of doctors. Via summarizing data from both clinical data (n = 3275) and real-world evidence (observational study n = 116, case studies n = 29), this perspective paper aims to shed a light on the appropriate dosing strategies of cariprazine from treatment initiation through switching strategies to concomitant medications.
Highlights
Antipsychotic medication, has been prescribed as the first line of treatment in schizophrenia since the 1950s (1, 2)
While the so-called typical or first-generation antipsychotics (FGAs) such as haloperidol have been associated with considerable side effects, atypical or second-generation antipsychotics (SGAs) changed the view of psychosis treatment by offering similar level of efficacy as FGAs but with much lower rates and severity of adverse events (3)
Throughout the past few decades third-generation antipsychotics (TGAs), have been in the spotlight given their ability to improve positive but potentially negative and cognitive symptoms as well (4–7). Many of these atypical antipsychotics are characterized by dopamine partial agonism (8), which explains their improved efficacy and safety profile (9) and the fact why practitioners feel challenging to find the right strategy to dose them (10, 11)
Summary
Antipsychotic medication, has been prescribed as the first line of treatment in schizophrenia since the 1950s (1, 2). Throughout the past few decades third-generation antipsychotics (TGAs), have been in the spotlight given their ability to improve positive but potentially negative and cognitive symptoms as well (4–7). Many of these atypical antipsychotics are characterized by dopamine partial agonism (8), which explains their improved efficacy and safety profile (9) and the fact why practitioners feel challenging to find the right strategy to dose them (10, 11). Discontinuation and frequent switching between different antipsychotics due to adverse events or insufficient therapeutic response are highly common in schizophrenia patients (13, 14)—many practitioners switch or start polypharmacy before optimizing the current medication dose in order to address the patients’ complains and to avoid non-adherence (12)
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