Cobenfy (KarXT), as a novel antipsychotic drug, is mainly indicated for schizophrenia, and special attention should be paid to dosage adjustment and adverse reaction monitoring during medication. The following is an explanation from three aspects: the scope of indications, medication for special populations, and key precautions to ensure rational use of drugs in clinical practice.

1. Scope of indications

(1) Treatment for schizophrenia

Suitable for the acute and maintenance treatment of schizophrenia in adults over 18 years old, it can significantly improve positive symptoms (such as hallucinations and delusions) and negative symptoms (emotional apathy).

2. Medication precautions

(1) Principle of dose adjustment

The initial dose is 50mg/day, with weekly increments of 50mg based on efficacy and tolerability, and the maximum dose does not exceed 300mg/day. Elderly patients should start at 25mg/day.

(2) Adverse reaction monitoring

In the early stages of treatment, it is necessary to closely observe extrapyramidal reactions (muscle tone disorders, sedentary behavior) and metabolic abnormalities (weight gain, elevated blood sugar), and conduct regular laboratory tests.

(3) Drug interactions

Do not use in combination with potent CYP3A4 inhibitors (such as ketoconazole), and reduce dosage by 50% when used in combination with moderate inhibitors. Avoid co administration with QT interval prolonging drugs.

3. Medication for special populations

(1) Liver and kidney dysfunction

The dosage for patients with moderate liver injury should not exceed 150mg/day, and it is contraindicated for severe liver injury. Patients with creatinine clearance rate<30ml/min need to adjust the dosage.

(2) Pregnancy and lactation period

The use during pregnancy should be balanced with risks, and should not be used during lactation. Women with reproductive potential should adopt efficient contraceptive measures.

(3) Elderly patients

Patients over 65 years old have their starting dose halved and fall prevention measures strengthened, as the risk of orthostatic hypotension significantly increases.