Cloril Dosage/Direction for Use

The dosage must be adjusted individually. For each patient the lowest effective dose should be used. Dose adjustment is indicated in patients receiving drugs interacting with CLORIL, such as benzodiazepines, or selective serotonin re-uptake inhibitors.
The following dosages for oral administration are recommended: Starting therapy 12.5 mg once or twice on the 1^st day, followed by one or two 25 mg tablets on the 2^nd day. If well tolerated, the daily dose may then be increased slowly in increments of 25 mg to 50 mg in order to achieve a dose level of up to 300 mg/day within 2 to 3 weeks. Thereafter, if required, the daily dose may be further increased in increments of 50 mg to 100 mg at half-weekly or, preferably, weekly intervals.
Use in the elderly: It is recommended to initiate treatment at a particularly low dose (12.5 mg given once on the 1st day) and to restrict subsequent dose increment to 25 mg/day.
Therapeutic dose range: In most patients, antipsychotic efficacy can be expected with 300 to 450 mg/day given in divided dose. Some patients may be treated with lower doses, and some patients may require doses up to 600 mg/day. The total daily dose may be divided unevenly, with the larger portion at bedtime. Maximum dose to obtain full therapeutic benefit, a few patients may require larger dose, in which case judicious increments (i.e. not exceeding 100 mg) are permissible up to 900 mg/day. The possibility of increased adverse reactions (in particular seizures) occurring at doses over 450 mg/day must be borne in mind.
Maintenance dose: After achieving maximum therapeutic benefit, many patients can be maintained effectively on lower doses. Careful downward titration is therefore recommended. Treatment should be maintained for at least 6 months. If the daily dose does not exceed 200 mg, once daily administration in the evening may be appropriate. Ending therapy in the event of planned termination of CLORIL therapy, a gradual reduction in dose over a 1 to 2 week period is recommended. If abrupt discontinuation is necessary (e.g. because of leucopenia), the patient should be carefully observed for the recurrence of psychotic symptoms and symptoms related to cholinergic rebound such as headache, nausea, vomiting and diarrhoea.
Re-starting therapy: In patients in whom the interval since the last dose of CLORIL exceeds 2 days, treatment should be re-initiated with 12.5 mg given once or twice on the 1^st day. If this dose is well tolerated, it may be feasible to titrate the dose to the therapeutic level more quickly than is recommended for initial treatment. However, in any patient who has previously experienced respiratory or cardiac arrest with initial dosing, but was then able to be successfully titrated to a therapeutic dose, re-titration should be done with extreme caution. Switching from a previous neuroleptic therapy to CLORIL. When CLORIL therapy is to be initiated in a patients undergoing oral neuroleptic therapy, it is recommended that the other neuroleptic should first be discontinued by tapering the dosage downwards over a period of approximately 1 week. Once the neuroleptic has been completely discontinued for at least 24 hours, CLORIL treatment can be started as described above. It is generally recommended that CLORIL should not be used in combination with other neuroleptics.