Appendix: Psychotropic Medication Reference Tables

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Appendix: Psychotropic Medication Reference Tables How to Use these Tables These reference tables are designed to provide clinic staff with specific medication related criteria for the Polypharmacy, Cardiometabolic Risk, Dose, and Youth Indicator sets. For the Polypharmacy indicator set, the tables serve to classify psychotropic medications. For example, if an adult is on four of more of the medications listed below, that individual meets criteria for psychotropic polypharmacy. Similarly, if an individual is on two antidepressants listed in the same category, that individual meets criteria for antidepressant polypharmacy (2AD). For the Cardiometabolic indicator set, the Antipsychotic Tables indicate whether the medication is considered to be low, moderate, or high risk for adults and youth. For the Dose indicator set, the tables indicate the maximum dose used to determine whether an individual is prescribed a higher than recommended dose. For the Youth indicator set, the tables below represent all medications considered to be psychotropics for the purpose of psychotropic polypharmacy and psychotropics prescribed to very young children, and include the dose used to determine whether a child/adolescent is prescribed a higher than recommended dose of medication.

Psychotropic Medications: imum Dose by Age Group and Cardiometabolic Risk First Generation Antipsychotics Drug generic < 13 Cardiometabolic Risk Youth/Adult Second Generation Antipsychotics Drug generic <13 Adults 18 Cardiometabolic Risk Youth/Adult Chlorpromazine Thorazine 500 mg 1000 mg 1000 mg Higher/Higher Fluphenazine Prolixin 10 mg 10 mg 20 mg Higher/Lower Haloperidol Haldol 3 mg 6 mg 20 mg Higher/Lower Loxapine Loxitane 100 mg 100 mg 100 mg Higher/Lower Molindone Moban 100 mg 100 mg 150 mg Lower/Lower Perphenazine Trilafon 64 mg 64 mg 64 mg Higher/Lower Perphenazineamitriptyline Triavil 12/150 mg 12/150 mg 16/200 mg Higher/Lower Pimozide Orap 10 mg 10 mg 10 mg Higher/Lower Thioridazine Mellaril 120 mg 210 mg 800 mg Higher/Higher Thiothixene Navane 50 mg 50 mg 50 mg Higher/Lower Trifluoperazine Stelazine 15 mg 15 mg 50 mg Higher/Lower Aripiprazole Abilify 15 mg 30 mg 30 mg Lower/Lower Asenapine Saphris 20 mg 20 mg 20 mg Not included in indicator Clozapine Clozaril 300 mg 600 mg 800 mg Not included in indicator Iloperidone Fanapt 24 mg 24 mg 24 mg Not included in indicator Lurasidone Latuda 0 mg 80 mg 80 mg Not included in indicator Olanzapine Zyprexa 12.5 mg 20 mg 20 mg Higher/Higher Olanzapine Symbyax 12.5/60 12.5/60 18/75 mg Higher/Higher Fluoxetine mg mg Olanzapine pamoate Relprevv 0 mg 0 mg 10 mg Higher/Higher Paliperidone Invega 15 mg 15 mg 15 mg Higher/Lower Quetiapine Seroquel 300 mg 600 mg 750 mg Higher/Higher Risperidone Risperdal 3 mg 6 mg 8 mg Higher/Lower Risperidone Consta 0 mg 0 mg 50 mg (PDR) Not included in indicator microspheres Ziprasidone Geodon 160 mg 160 mg 160 mg Lower/Lower

Antidepressants Subclass Drug generic < 13 TCA Amitriptyline Elavil 150 mg 150 mg 150 mg Amoxapine Ascendin 400 mg 400 mg 400 mg Clomipramine Anafranil 200 mg 200 mg 250 mg Desipramine Norpramin 150 mg 150 mg 300 mg Doxepin Sinequan 300 mg 300 mg 300 mg Imipramine Tofranil 100 mg 100 mg 200 mg Nortriptyline Pamelor 50 mg 50 mg 150 mg Trimipramine Surmontil 100 mg 100 mg 200 mg SSRI Citalopram Celexa 40 mg 60 mg 60 mg Escitalopram Lexapro 20 mg 20 mg 20 mg Fluoxetine Prozac 60 mg 60 mg 80 mg Fluvoxamine Luvox 200 mg 300 mg 300 mg Paroxetine Paxil 0 mg 40 mg 60 mg Paroxetine Paxil CR 0 mg 40 mg 75 mg controlled release Sertraline Zoloft 200 mg 200 mg 200 mg SNRI Duloxetine Cymbalta 120 mg 120 mg 120 mg Desvenlafaxine Pristiq 400 mg 400 mg 400 mg Venlafaxine Effexor 120 mg 225 mg 375 mg Milnacipran Savella 0 mg 0 mg 200 mg MAOI Isocarboxazid Marplan 60 mg 60 mg 60 mg Phenelzine Nardil 90 mg 90 mg 90 mg Selegiline Emsam 0 mg 12 mg 12 mg transdermal patch Tranylcypramine Parnate 60 mg 60 mg 60 mg Other Bupropion Wellbutrin 240 mg 400 mg 400 mg Bupropion Wellbutrin SR, 240 mg 450 mg 450 mg Wellbutrin XL Bupropion Aplenzin 278 mg 522 mg 522 mg Bupropion Zyban 300 mg 300 mg 300 mg Maprotiline Ludiomil 150 mg 150 mg 150 mg Mirtazapine Remeron 30 mg 30 mg 45 mg Nefazodone` Serzone 600 mg 600 mg 600 mg Trazodone Desyrel 200 mg 200 mg 400 mg

Anxiolytic/hypnotics Drug generic <13 13 18 Alprazolam Xanax 4 mg 4 mg 4 mg Buspirone BuSpar 50 mg 50 mg 60 mg Chloral hydrate Somnote 1500 mg 1500 mg 2000 mg Chlordiazepoxide Librium 30 mg 30 mg 100 mg Clonazepam Klonopin 4 mg 4 mg 4 mg Chlorazepate Tranxene 60 mg 60 mg 60 mg Diazepam Valium 12 mg 14 mg 40 mg Estazolam ProSom 2 mg 2 mg 2 mg Esczopiclone Lunesta 3 mg 3 mg 3 mg Flurazepam Dalmane 30 mg 30 mg 30 mg Hydroxyzine Vistaril 100 mg 100 mg 400 mg Lorazepam Ativan 4 mg 4 mg 6 mg Meprobamate Milltown 600 mg 600 mg 2400 mg Oxazepam Serax 120 mg 120 mg 120mg Phenobarbital Luminal 275 mg 400 mg 400mg Quazepam Doral 0 mg 0 mg 15 mg rameleton Rozerem 8 mg 8 mg 8 mg Secobarbital Seconal 100 mg 100 mg 100 mg Temazepam Restoril 30 mg 30 mg 30 mg Triazolam Halcion 0.5 mg 0.5 mg 0.5 mg Zaleplon Sonata 20 mg 20 mg 20 mg Zolpidem Ambien 10 mg 10 mg 10 mg Zolpidem Ambien CR 12.5 mg 12.5 mg 12.5 mg Mood Stabilizers Drug generic < 13 Carbamazepine Tegretol, 1000 mg 1000 mg 1200 mg Equetro Divalproex, valproic Depakote 2400 mg 4200 mg 4200 mg acid Gabapentin Neurontin 2000 mg 3600 mg 3600 mg Lamotrigine Lamictal 200 mg 400 mg 400 mg Lithium Eskalith 1800 mg 1800 mg 1800 mg Oxcarbazepine Trileptal 1500 mg 1800 mg 2400 mg Topiramate Topamax 1600 mg 1600 mg 1600 mg

Stimulants/ADHD Medications Drug generic < 13 Dose/day 13 18 Amphetamine dextroamphetamine Adderall 40 mg 40 mg 60 mg Amphetamine dextroamphetamine Adderall XR 30 mg 30 mg 60 mg extended release Armodafinil Nuvigil 250 mg 250 mg 250 mg Atomoxotine Strattera 100 mg 100 mg 100 mg Clonidine Catapres 0.4 mg 0.4mg 0 mg Dexmethylphenidate Focalin 20 mg 20 mg 20 mg Dexmethylphenidate extended release Focalin XR 20 mg 30 mg 40 mg Dextroamphetamine Dexedrine 40 mg 40 mg 60 mg Guanfacine Intuniv 4 mg 4 mg 0 mg lisdexamfetamine Vyvanse 70 mg 70 mg 70 mg Methamphetamine Desoxyn 25 mg 25 mg 25 mg Methylphenidate Ritalin 60 mg 60 mg 60 mg Methylphenidate OROS Concerta 60 mg 72 mg 72 mg Modafinil Provigil 200 mg 200 mg 200 mg Phentermine Adipex P 37.5 mg 37.5mg 37.5 mg

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