Safety and Tolerability of a Rapidly Escalating Dose-Loading Regimen for Risperidone
J Clin Psychiatry 2000;61(12):909-911
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Risperidone is an
"atypical" antipsychotic with strong binding affinity
for dopamine-2 and serotonin-2 receptors. Risperidone is often
used to treat hospitalized patients who have acute psychotic
decompensation, and the therapeutic target dose commonly used is
2 to 6 mg/day. The most common clinical practice is to titrate
the dose of risperidone to the target therapeutic dose over
several days. This study investigated the safety and tolerability
of a rapid oral-loading regimen for risperidone developed to
achieve therapeutic doses of this antipsychotic within 24 hours.
Method: Rapid-loaded risperidone was initiated
with 1 mg. Subsequent doses were increased by 1 mg every 6 to 8
hours up to 3 mg. Dose increases were contingent on tolerance of
last administered dose.
Results: Of a sample of 11 consecutive
inpatients admitted to an acute psychiatric facility who were
treated with this protocol, 7 tolerated the most rapid titration,
achieving a standing dose of 3 mg b.i.d. in 16 hours. Three
required a slightly slower titration and achieved this target
dose in 24 hours. One patient could not tolerate the 3-mg dose
but tolerated a standing regimen of 2 mg t.i.d. No patient
experienced serious extrapyramidal side effects, sedation, or any
other adverse event during the rapid titration, and in no case
did risperidone have to be discontinued.
Conclusion: These results suggest that
aggressive dosing of risperidone is well tolerated in most