Indications And Dose
Prophylaxis of postoperative nausea and vomiting [in patients at moderate to high risk and when alternatives ineffective or not tolerated] ▶BY INTRAMUSCULAR INJECTION ▶Adult: 1–2 mg, to be given at induction or 30 minutes before the end of anaesthesia ▶Elderly: 500 micrograms, to be given at induction or 30 minutes before the end of anaesthesia Combination treatment of postoperative nausea and vomiting [when alternatives ineffective or not tolerated] ▶BY INTRAMUSCULAR INJECTION ▶Adult: 1–2 mg ▶Elderly: 500 micrograms Nausea and vomiting in palliative care ▶BY MOUTH ▶Adult: Initially 1.5 mg 1–2 times a day, increased if necessary to 5–10 mg daily in divided doses ▶BY SUBCUTANEOUS INFUSION ▶Adult: 2.5–10 mg/24 hours Schizophrenia and schizoaffective disorder ▶BY MOUTH ▶Adult: 2–10 mg daily in 1–2 divided doses; usual dose 2–4 mg daily, in first-episode schizophrenia, up to 10 mg daily, in multiple-episode schizophrenia, dose adjusted according to response at intervals of 1–7 days. Individual benefit-risk should be assessed when considering doses above 10 mg daily; maximum 20 mg per day ▶Elderly: Initially, use half the lowest adult dose, then adjust gradually according to response up to maximum 5 mg daily, doses above 5 mg daily should only be considered in patients who have tolerated higher doses and after reassessment of the individual benefit-risk Acute delirium [when non-pharmacological treatments ineffective] ▶BY MOUTH ▶Adult: 1–10 mg daily in 1–3 divided doses, treatment should be started at the lowest possible dose and adjusted in increments at 2–4 hourly intervals if required; maximum 10 mg per day ▶Elderly: Initially, use half the lowest adult dose, then adjust gradually according to response up to maximum 5 mg daily, doses above 5 mg daily should only be considered in patients who have tolerated higher doses and after reassessment of the individual benefit-risk ▶BY INTRAMUSCULAR INJECTION ▶Adult: 1–10 mg, treatment should be started at the lowest possible dose and adjusted in increments at 2–4 hourly intervals if required; maximum 10 mg per day ▶Elderly: Initially 500 micrograms, dose adjusted gradually according to response up to maximum 5 mg daily, doses above 5 mg daily should only be considered in patients who have tolerated higher doses and after reassessment of the individual benefit-risk Moderate to severe manic episodes associated with bipolar I disorder ▶BY MOUTH ▶Adult: 2–10 mg daily in 1–2 divided doses, dose adjusted according to response at intervals of 1–3 days. Individual benefit-risk should be assessed when considering doses above 10 mg daily; continued use should be evaluated early in treatment; maximum 15 mg per day ▶Elderly: Initially, use half the lowest adult dose, then adjust gradually according to response up to maximum 5 mg daily, doses above 5 mg daily should only be considered in patients who have tolerated higher doses and after reassessment of the individual benefit-risk; continued use should be evaluated early in treatment Acute psychomotor agitation associated with psychotic disorder or manic episodes of bipolar I disorder ▶BY MOUTH ▶Adult: 5–10 mg, dose may be repeated after 12 hours if necessary; continued use should be evaluated early in treatment; maximum 20 mg per day ▶Elderly: Initially 2.5 mg, dose may be repeated after 12 hours if necessary up to maximum 5 mg daily, doses above 5 mg daily should only be considered in patients who have tolerated higher doses and after reassessment of the individual benefit-risk; continued use should be evaluated early in treatment Rapid control of severe acute psychomotor agitation associated with psychotic disorder or manic episodes of bipolar I disorder [when oral therapy is not appropriate] ▶BY INTRAMUSCULAR INJECTION ▶Adult: 5 mg, dose may be repeated hourly if required— up to 15 mg daily is usually sufficient; continued use should be evaluated early in treatment; maximum 20 mg per day ▶Elderly: 2.5 mg, dose may be repeated hourly if required up to maximum 5 mg daily, doses above 5 mg daily should only be considered in patients who have tolerated higher doses and after reassessment of the individual benefit-risk; continued use should be evaluated early in treatment Persistent aggression and psychotic symptoms in moderate to severe Alzheimer’s dementia and vascular dementia [when non-pharmacological treatments ineffective and there is a risk of harm to self or others] ▶BY MOUTH ▶Adult: 0.5–5 mg daily in 1–2 divided doses, dose adjusted according to response at intervals of 1–3 days. Reassess treatment after no more than 6 weeks ▶Elderly: 500 micrograms daily, reassess treatment after no more than 6 weeks Severe tic disorders, including Tourette’s syndrome [when educational, psychological and other pharmacological treatments ineffective] ▶BY MOUTH ▶Adult: 0.5–5 mg daily in 1–2 divided doses, dose adjusted according to response at intervals of 1–7 days. Reassess treatment every 6–12 months ▶Elderly: Initially, use half the lowest adult dose, then adjust gradually according to response up to maximum 5 mg daily. Reassess treatment every 6–12 months Mild to moderate chorea in Huntington’s disease [when alternatives ineffective or not tolerated] ▶BY MOUTH ▶Adult: 2–10 mg daily in 1–2 divided doses, dose adjusted according to response at intervals of 1–3 days ▶Elderly: Initially, use half the lowest adult dose, then adjust gradually according to response up to maximum 5 mg daily, doses above 5 mg daily should only be considered in patients who have tolerated higher doses and after reassessment of the individual benefit-risk Mild to moderate chorea in Huntington’s disease [when alternatives ineffective or not tolerated and oral therapy inappropriate] ▶BY INTRAMUSCULAR INJECTION ▶Adult: 2–5 mg, dose may be repeated hourly if required; maximum 10 mg per day ▶Elderly: Initially 1 mg, dose may be repeated hourly if required up to maximum 5 mg daily, doses above 5 mg daily should only be considered in patients who have tolerated higher doses and after reassessment of the individual benefit-risk Restlessness and confusion in palliative care ▶BY MOUTH ▶Adult: 2 mg, then 2 mg every 2 hours if required ▶BY SUBCUTANEOUS INJECTION ▶Adult: 2.5 mg, then 2.5 mg every 2 hours if required ▶BY SUBCUTANEOUS INFUSION ▶Adult: 5–15 mg/24 hours l UNLICENSED USE Not licensed for use in palliative care.
Source pages 426, 427