モーズレイ処方ガイドライン第14版（The Maudsley PrescribingGuidelines inPsychiatry 14thEdition）menu open
TOP統合失調症および関連する精神病抗精神病薬最小有効量

最小有効量

統合失調症の初回または複数回のエピソードに対して有効とされる抗精神病薬の最小量を表1.1に示す。ほとんどの患者はこれらの用量で反応するが，より高用量が必要になる患者もいる。個々の患者によって反応は異なるので，表に示した用量はおおよその値と考えるべきである。一次文献が入手できた場合はそれを示したが，一部の用量はコンセンサスオピニオンに基づいている。本表には一般的に用いられる経口治療薬のみを示した。

表1.1　最小有効量（1日あたりの用量）─抗精神病薬

薬剤 初回エピソード 複数回エピソード
FGA
クロルプロマジン1 200mg＊ 300mg
ハロペリドール2-7 2mg 4mg
スルピリド8 400mg＊ 800mg
trifluoperazine9, 10 10mg＊ 15mg
SGA
amisulpride11-16 300mg＊ 400mg＊
アリピプラゾール7, 17-22 10mg 10mg
アセナピン7, 22, 23 10mg＊ 10mg
ブロナンセリン24 不明 8mg
ブレクスピプラゾール25-27 2mg＊ 4mg
cariprazine28, 29 1.5mg＊ 1.5mg
iloperidone7, 21, 22, 30 4mg＊ 8mg
lumateperone31 不明 42mg＊
ルラシドン7, 32 40mg（塩酸塩）/37mg（塩基）＊ 40mg（塩酸塩）/37mg（塩基）
オランザピン4, 7, 33-35 5mg 7.5mg
パリペリドン22 3mg＊ 3mg
pimavanserin36-38 不明 34mg＊＊
クエチアピン39-44 150mg＊（より高用量が用いられることが多い45） 300mg
リスペリドン3, 7, 46-49 2mg 4mg
ziprasidone7, 21, 50-52 40mg＊ 80mg

＊推定量：データ不十分
＊＊パーキンソン病精神病に対するFDA承認用量；統合失調症に対する用量は不明

（谷　英明）

参照文献
  1. Dudley K, et al. Chlorpromazine dose for people with schizophrenia. Cochrane Database Syst Rev 2017; 4:Cd007778.
  2. McGorry PD. Recommended haloperidol and risperidone doses in first-episode psychosis. J Clin Psychiatry 1999; 60:794–795.
  3. Schooler N, et al. Risperidone and haloperidol in first-episode psychosis: a long-term randomized trial. Am J Psychiatry 2005; 162:947–953.
  4. Keefe RS, et al. Long-term neurocognitive effects of olanzapine or low-dose haloperidol in first-episode psychosis. Biol Psychiatry 2006; 59:97–105.
  5. Donnelly L, et al. Haloperidol dose for the acute phase of schizophrenia. Cochrane Database Syst Rev 2013; Cd001951.
  6. Oosthuizen P, et al. A randomized, controlled comparison of the efficacy and tolerability of low and high doses of haloperidol in the treatment of first-episode psychosis. Int J Neuropsychopharmacol 2004; 7:125–131.
  7. Leucht S, et al. Dose equivalents for second-generation antipsychotics: the minimum effective dose method. SchizophrBull 2014; 40:314–326.
  8. Soares BG, et al. Sulpiride for schizophrenia. Cochrane Database Syst Rev 2000; CD001162.
  9. Armenteros JL, et al. Antipsychotics in early onset schizophrenia: systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2006; 15:141–148.
  10. Koch K, et al. Trifluoperazine versus placebo for schizophrenia. Cochrane Database Syst Rev 2014; Cd010226.
  11. Mota NE, et al. Amisulpride for schizophrenia. Cochrane Database Syst Rev 2002; CD001357.
  12. Puech A, et al. Amisulpride, and atypical antipsychotic, in the treatment of acute episodes of schizophrenia: a dose-ranging study vs. haloperidol. The Amisulpride Study Group. Acta Psychiatr Scand 1998; 98:65–72.
  13. Moller HJ, et al. Improvement of acute exacerbations of schizophrenia with amisulpride: a comparison with haloperidol. PROD-ASLP Study Group. Psychopharmacology 1997; 132:396–401.
  14. Sparshatt A, et al. Amisulpride – dose, plasma concentration, occupancy and response: implications for therapeutic drug monitoring. Acta Psychiatr Scand 2009; 120:416–428.
  15. Buchanan RW, et al. The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. SchizophrBull 2010; 36:71–93.
  16. Galletly C, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 2016; 50:410–472.
  17. Taylor D. Aripiprazole: a review of its pharmacology and clinical utility. Int J Clin Pract 2003; 57:49–54.
  18. Cutler AJ, et al. The efficacy and safety of lower doses of aripiprazole for the treatment of patients with acute exacerbation of schizophrenia. CNS Spectr 2006; 11:691–702.
  19. Mace S, et al. Aripiprazole: dose-response relationship in schizophrenia and schizoaffective disorder. CNS Drugs 2008; 23:773–780.
  20. Sparshatt A, et al. A systematic review of aripiprazole – dose, plasma concentration, receptor occupancy and response: implications for therapeutic drug monitoring. J Clin Psychiatry 2010; 71:1447–1456.
  21. Liu CC, et al. Aripiprazole for drug-naive or antipsychotic-short-exposure subjects with ultra-high risk state and first-episode psychosis: an open-label study. J Clin Psychopharmacol 2013; 33:18–23.
  22. Leucht S, et al. Dose-response meta-analysis of antipsychotic drugs for acute schizophrenia. Am J Psychiatry 2020; 177:342–353.
  23. Citrome L. Role of sublingual asenapine in treatment of schizophrenia. Neuropsychiatr Dis Treat 2011; 7:325–339.
  24. Tenjin T, et al. Profile of blonanserin for the treatment of schizophrenia. Neuropsychiatr Dis Treat 2013; 9:587–594.
  25. Correll CU, et al. Efficacy of brexpiprazole in patients with acute schizophrenia: review of three randomized, double-blind, placebo-controlled studies. Schizophr Res 2016; 174:82–92.
  26. Malla A, et al. The effect of brexpiprazole in adult outpatients with early-episode schizophrenia: an exploratory study. Int Clin Psychopharmacol 2016; 31:307–314.
  27. Kane JM, et al. A multicenter, randomized, double-blind, controlled phase 3 trial of fixed-dose brexpiprazole for the treatment of adults with acute schizophrenia. Schizophr Res 2015; 164:127–135.
  28. Garnock-Jones KP. Cariprazine: a review in schizophrenia. CNS Drugs 2017; 31:513–525.
  29. Citrome L. Cariprazine for acute and maintenance treatment of adults with schizophrenia: an evidence-based review and place in therapy. Neuropsychiatr Dis Treat 2018; 14:2563–2577.
  30. Crabtree BL, et al. Iloperidone for the management of adults with schizophrenia. Clin Ther 2011; 33:330–345.
  31. Correll CU, et al. Efficacy and safety of lumateperone for treatment of schizophrenia: a randomized clinical trial. JAMA Psychiatry 2020; 77:349–358.
  32. Meltzer HY, et al. Lurasidone in the treatment of schizophrenia: a randomized, double-blind, placebo- and olanzapine-controlled study. Am J Psychiatry 2011; 168:957–967.
  33. Sanger TM, et al. Olanzapine versus haloperidol treatment in first-episode psychosis. Am J Psychiatry 1999; 156:79–87.
  34. Kasper S. Risperidone and olanzapine: optimal dosing for efficacy and tolerability in patients with schizophrenia. Int Clin Psychopharmacol 1998; 13:253–262.
  35. Bishara D, et al. Olanzapine: a systematic review and meta-regression of the relationships between dose, plasma concentration, receptor occupancy, and response. JClinPsychopharmacol 2013; 33:329–335.
  36. Mathis MV, et al. The US Food and Drug Administration’s Perspective on the New Antipsychotic Pimavanserin. J Clin Psychiatry 2017; 78:e668–e673.
  37. Ballard C, et al. Pimavanserin in Alzheimer’s Disease Psychosis: efficacy in patients with more pronounced psychotic symptoms. J Prev Alzheimers Dis 2019; 6:27–33.
  38. Nasrallah HA, et al. Successful treatment of clozapine-nonresponsive refractory hallucinations and delusions with pimavanserin, a serotonin 5HT-2A receptor inverse agonist. Schizophr Res 2019; 208:217–220.
  39. Small S, et al. Quetiapine in patients with schizophrenia. A high- and low-dose double-blind comparison with placebo. Seroquel Study Group. Arch Gen Psychiatry 1997; 54:549–557.
  40. Peuskens J, et al. A comparison of quetiapine and chlorpromazine in the treatment of schizophrenia. Acta Psychiatr Scand 1997; 96:265–273.
  41. Arvanitis LA, et al. Multiple fixed doses of ‘Seroquel’ (quetiapine) in patients with acute exacerbation of schizophrenia: a comparison with haloperidol and placebo. Biol Psychiatry 1997; 42:233–246.
  42. Kopala LC, et al. Treatment of a first episode of psychotic illness with quetiapine: an analysis of 2 year outcomes. Schizophr Res 2006; 81:29–39.
  43. Sparshatt A, et al. Quetiapine: dose-response relationship in schizophrenia. CNS Drugs 2008; 22:49–68.
  44. Sparshatt A, et al. Relationship between daily dose, plasma concentrations, dopamine receptor occupancy, and clinical response to quetiapine: a review. J Clin Psychiatry 2011; 72:1108–1123.
  45. Pagsberg AK, et al. Quetiapine extended release versus aripiprazole in children and adolescents with first-episode psychosis: the multicentre, double-blind, randomised tolerability and efficacy of antipsychotics (TEA) trial. Lancet Psychiatry 2017; 4:605–618.
  46. Lane HY, et al. Risperidone in acutely exacerbated schizophrenia: dosing strategies and plasma levels. J Clin Psychiatry 2000; 61:209–214.
  47. Williams R. Optimal dosing with risperidone: updated recommendations. J Clin Psychiatry 2001; 62:282–289.
  48. Ezewuzie N, et al. Establishing a dose-response relationship for oral risperidone in relapsed schizophrenia. J Psychopharm 2006; 20:86–90.
  49. Li C, et al. Risperidone dose for schizophrenia. Cochrane Database Syst Rev 2009; Cd007474.
  50. Bagnall A, et al. Ziprasidone for schizophrenia and severe mental illness. Cochrane Database Syst Rev 2000; CD001945.
  51. Taylor D. Ziprasidone – an atypical antipsychotic. Pharm J 2001;
    52. 266:396–401.
  52. Joyce AT, et al. Effect of initial ziprasidone dose on length of therapy in schizophrenia. Schizophr Res 2006; 83:285–292.