You are basically in the situation where you have to start over with this patient. The patient has not had an adequate trial of this neuroleptic. But, do you really prefer a neuroleptic over one of the new generation of antipsychotics? When would you consider using a depot medication for this patient? Click here to pursue the algorithm for these options.
If you are sure you prefer to continue with (i.e. - restart) this neuroleptic and give it an adequate trial, you should obtain and document informed consent over again (mentioning the significant alternative treatments available and their advantages and disadvantages). Discuss the issues that led to the patient's becoming non-compliant and attempt to resolve them. (1,2,3) Start at a low dose and increase to the point where the patient either improves or minimal parkinsonian side effects develop, and hold at that dose. (4) Do not resume the dose the patient was supposedly taking before (unless it is a low dose typical of what you start patients on). If you were to resume with a high dose, the patient would be at undue risk for acute dystonic reactions or other side effects.
Recommendation #129
