TDMHMR Drug Formulary 2004 page 11
Psychotropic Dosage Guidelines
PSYCHOTROPIC DOSAGE GUIDELINES
The following is a list of psychotropic drug dosages. These guidelines are not intended
to establish rigid standards of treatment but to assist in monitoring the
pharmacotherapy of the patient. Furthermore, guidelines for special patient populations
are not intended to be absolute. For those medications that have a well established
therapeutic serum range, the dosage should be based upon the desired serum range
and response rather than a specific maximum administered daily dosage. These
guidelines should be used in conjunction with sound clinical judgment and the
prescriber’s experience.
In children and adolescents, metabolic and physiologic differences from adults should
be considered when prescribing. Dosing based on body weight may be more accurate
when treating these patients.
Different dosage requirements are usually necessary in the geriatric population. Since
there is no standard definition for “geriatric”, the arbitrary age of 65 has been chosen to
identify geriatric patients. In general, geriatric patient dosing guidelines should reflect a
“go low, go slow” approach. Standard reference books should be consulted if needed
for appropriate dosages when treating this population.
In general, when treating patients with developmental disabilities, a “go low, go slow”
approach is recommended when increasing or decreasing psychotropic medication.
The use of psychotropic medication can be therapeutic and empowering for a person
with both mental retardation and a mental illness. The primary goal is to obtain an
accurate diagnosis of behavioral and psychiatric symptoms so that the patients’
treatment is appropriate. A functional analysis by a psychologist is vital prior to starting
any psychotropic medication except in an emergency. The U. S. Health Care Financing
Administration now states that the least intrusive and most positive intervention to treat
behavioral or psychiatric symptoms in a person with mental retardation may be the use
of a psychotropic medication.
Prescribing psychotropic medication should be based on the following resources:
TDMHMR Prescribing of Medications-Mental Health, Chapter 405, Subchapter A
TDMHMR Prescribing of Psychotropic Medication-Mental Retardation Facilities,
Chapter 405, Subchapter B
Other useful resources that reflect current Standards of Care for the mentally ill include
but are not limited to the following:
Treatment Guidelines of Various Psychiatric Disorders
Examples include:
APA Practice Guideline for the treatment of Patients with Schizophrenia. Am J
Psychiatry 1997; 154: 4 (April supplement)
APA Practice Guideline for Major Depressive Disorder in Adults. Am J Psychiatry
