Optimizing dosing in atypical neuroleptic monotherapy

Atypical neuroleptics have become the first line of treatment for psychotic disorders, but some questions remain: what are their optimal dosages and is more medication more efficacious? For clozapine, it is recommended to aim for a plasma level above 350 ng/mL for nonresponders and partial responders. It should be specified that this plasma level should be obtained exactly 12 h after the last dose. For risperidone, optimal daily doses range between 4 and 8 mg, and there is no indication that a higher dose would bring additional improvement. For olanzapine, a quite different situation is encountered. There is a good indication that daily doses of 30 and 40 mg can increase clinical response. It appears that plasma levels above 23 ng/mL may predict response. For quetiapine, reports on the utility of dosages greater than 800 mg/day are anecdotal at this point, and more studies should be conducted. For ziprasidone, dosages above 40 mg/day should be used, but daily doses above 200 mg have not yet been systematically investigated.