High dose antipsychotic therapy

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The Consensus statement on high-dose antipsychotic medication (Royal College of Psychiatry Council Report CR190, November 2014)1 defines high-dose antipsychotic use as:

A total daily dose of a single antipsychotic which exceeds the upper limit stated in the summary of product characteristics (SPC) or BNF with respect to the age of the patient and the indication being treated.


A total daily dose of two or more antipsychotics which exceeds the summary of product characteristics (SPC) or BNF maximum using the percentage method.

High dose antipsychotic use should be the exception rather than the rule. Overall, the evidence from randomised controlled trials (RCTs) to support the use of combined antipsychotics in schizophrenia remains scarce. There is little convincing evidence that antipsychotics higher than the maximum licensed dose are more effective than standard dosage for treatment-resistant schizophrenia. In addition, the evidence for combining non-clozapine antipsychotics is generally weak.

This policy sets out the monitoring required within this group of patients and outlines the roles and responsibilities of the multidisciplinary team.

This policy applies to all staff working within NHS GG&C Mental Health Services. This includes Adult, Older Adult, Learning Disability, Addiction, Forensic and Child & Adolescent Mental Health Services.

NOTE: This guideline is hosted on the NHSGGC MyPsych website. Clicking the link below will open the guideline in a new window.


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Mental Health