This report reflects the consensus views of a group of clinicians on the risks and benefits of high-dose antipsychotic medication for a range of clinical indications for which antipsychotic medication is commonly used in psychiatric practice. For each of these indications, the members of the Consensus Working Group took account of the evidence from the published literature and their clinical experience, and considered the clinical implications.
While there is little convincing evidence that off-label prescription of doses of antipsychotic medication above the licensed dosage range has any therapeutic advantage in any clinical setting, there is clear evidence for a greater side-effect burden and the need for appropriate safety monitoring. The key recommendation is that any prescription of high-dose antipsychotic medication should be seen as an explicit, time-limited individual trial with a distinct treatment target. There should be a clear plan for regular clinical review including safety monitoring. The high-dose regimen should only be continued if the trial shows evidence of benefit that is not outweighed by tolerability or safety problems.
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