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Fine-tuning risperidone dosage for acutely exacerbated schizophrenia: clinical determinants

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Abstract

Rationale

Risperidone doses for acute schizophrenia were rather high in most recent studies.

Objectives

We tested a hypothesis that fine-tuning risperidone dosage to relieve side effects still yields efficacy. Clinical factors influencing the dosing were also determined.

Methods

One hundred and forty-six schizophrenia inpatients with acute exacerbation entered a prospective, 6-week, repeated measures study. Risperidone doses were titrated to 6 mg/day (if tolerable) within 7 days, but were lowered thereafter if adverse reactions appeared. Efficacy and safety were measured biweekly.

Results

Forty-eight patients tolerated the 6-mg/day target dose well, while the other 98 received lower final doses (mean±SD=3.4±0.9 mg/day) to curtail adverse effects. At endpoint, 64.3% of the low-dose patients and 43.8% of the high-dose subjects responded to treatment [≥20% reduction in the Positive and Negative Syndrome Scale (PANSS) total score] (P=0.018). In detail, the low-dose individuals were significantly superior in percentage changes in the PANSS total and general-subscale scores at endpoint. The low-dose group also tended to improve more (albeit statistically insignificantly) in the PANSS positive and negative subscales and other efficacy measures. Compared to the patients with undifferentiated subtype, those with disorganized subtype received higher dosage by 0.90 mg/day, after controlling for other variables (P=0.008). Paranoid subtype was similar to undifferentiated subtype in drug doses. Patients with longer illness duration also showed a trend to use higher dosage (P=0.078).

Conclusions

These findings suggest that dosage adjustment to diminish side effects does not compromise risperidone response and that disorganized patients and perhaps patients with longer illness duration are prone to receive larger doses.

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Acknowledgments

This work was supported by grants NSC 91-2314-B-320-005 and NSC 92-2314-B-039-017 from the National Science Council; NHRI-EX-92–9134PI from the National Health Research Institutes; and CMU92-TH-03 form the China Medical University, Taiwan.

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Authors and Affiliations

  1. Department of Psychiatry, China Medical University and Hospital, No. 2 Yuh-Der Road, 404, Taichung, Taiwan

    Hsien-Yuan Lane & Cher-Yeang Lin

  2. Department of Mathematics, Tamkang University, 251, Tamsui, Taiwan

    Yue-Cune Chang

  3. Laboratory of Biological Psychiatry, Taipei City Psychiatric Center, 104, Taipei, Taiwan

    Chih-Chiang Chiu & Sue-Hong Lee

  4. Department of Psychiatry, Tzu-Chi University, No. 701, Section 3, Chung-Yan Road, 970, Hualien City, Taiwan

    Wen-Ho Chang

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  1. Hsien-Yuan Lane
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  4. Sue-Hong Lee
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Correspondence to Wen-Ho Chang.

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Lane, HY., Chang, YC., Chiu, CC. et al. Fine-tuning risperidone dosage for acutely exacerbated schizophrenia: clinical determinants. Psychopharmacology 172, 393–399 (2004). https://doi.org/10.1007/s00213-003-1685-6

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  • DOI: https://doi.org/10.1007/s00213-003-1685-6

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