Adult Schizophrenia Initially 25 mg bd on day 1, increase in steps of 25-50 mg bd-tds on days 2 & 3 to reach target dose range of 300-400 mg bd-tds daily by day 4. Institute further dose adjustments, if indicated, at intervals of ≥2 days, in steps of 25-50 mg bd.
Acute manic episodes associated w/ bipolar I disorder Administer bd. Total daily dose for 1st 4 days of the therapy: 100 mg (day 1), 200 mg (day 2), 300 mg (day 3) & 400 mg (day 4). Further dosage adjustments up to 800 mg daily by day 6 should be in increments of not >200 mg daily. Adjust dose w/in range of 200-800 mg daily depending on clinical response & tolerability of the patient. Usual effective dose range: 400-800 mg daily.
Depressive episodes associated w/ bipolar disorder Administer once daily at bedtime. Titration should be: 50 mg (day 1), 100 mg (day 2), 200 mg (day 3) & 300 mg (day 4). May be titrated to 400 mg on day 5 & up to 600 mg by day 8. Antidepressant efficacy was demonstrated at 300 & 600 mg, however, no additional benefit was seen in the 600-mg group.
Maintenance treatment of bipolar I disorder as adjunct to lithium & divalproex 400-800 mg daily in 2 divided doses.
Prevention of recurrence in bipolar disorder 300-800 mg daily in 2 divided doses.
Hepatic impairment Initial dose: 25 mg daily, increase in steps of 25-50 mg daily to effective dose.
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