Low-Dose Antipsychotic Options

First-Generation (Typical) Antipsychotics

The American Society of Clinical Oncology recommends haloperidol starting dose of 0.5-1 mg orally or subcutaneously, with lower doses of 0.25-0.5 mg for older or frail patients 1, 2
Haloperidol can be administered every 8-12 hours if scheduled dosing is required, and is contraindicated in Parkinson's disease or dementia with Lewy bodies due to extrapyramidal symptom (EPS) risk 1, 2
Chlorpromazine starting dose is 12.5-25 mg orally or rectally, and is more sedating with anticholinergic effects compared to haloperidol 1, 2
Methotrimeprazine (Levomepromazine) starting dose is 5-12.5 mg orally or subcutaneously, with 2.5 mg for older/frail patients, and has sedating with anticholinergic properties 1, 2

Risperidone starting dose is 0.5 mg orally, with target dose of 0.5-2 mg/day for most indications, and has lower EPS risk than typical antipsychotics but increases with doses >6 mg/24h 1, 2
Olanzapine starting dose is 2.5-5 mg orally or subcutaneously, and has significant metabolic effects including weight gain 1, 2
Quetiapine starting dose is 25 mg orally (immediate release), and is highly sedating with lower EPS risk 1, 2
Aripiprazole starting dose is 5 mg orally or intramuscularly, and has lower EPS risk compared to typical antipsychotics 1, 2
Amisulpride low-dose option is 50 mg twice daily for predominant negative symptoms where positive symptoms are not a concern 4

Older adults and frail patients should always start at the lower end of dosing ranges, with haloperidol 0.25-0.5 mg, methotrimeprazine 2.5 mg, and reduced doses in hepatic or renal impairment 1, 2