Introduction Clinical guidelines recommend the use of a single antipsychotic drug at standard doses. In clinical practise high-dose and combined antipsychotics are common. Methods A clinical audit of antipsychotic prescribing for patients in a forensic ward in a Malaysian hospital was undertaken using Prescribing Observatory for Mental Health-UK (POMH) standards and compared to POMH data. Results The level of high dose prescribing between Malaysian and the UK was comparable. There were low levels of the use of ‘as required’ (PRN) medication in Malaysia compared to the UK. The use of combined prescribing was more common in Malaysia. Discussion Levels of high dose antipsychotic prescribing are unsatisfactory across both jurisdictions. Specific quality improvements in Malaysia need to centre on the use of combination antipsychotics.