Effective titration of risperidone in patients with schizophrenia

Objective : Subsequent clinical experiences in risperidone treatment indicated that the initially recommended dose schedule resulted in too rapid increment of doses to the maintenance dose. The goal of this study was to establish a new optimal dose-schedule recommendation for risperidone in patients with schizophrenia. Methods : Two hundred and eighteen schizophrenic patients were randomly assigned to the following three groups. For the first group, 1 mg of risperidone was administered on the first day, 2 mg on the second day, and the dose was increased from the third day depending on the clinical status of the patients. For second group, 0.5 mg was administered on the first two days, 1 mg on the 3-5th day, 1.5 mg on the 6-7th day, 2 mg on the 8th day, and the dose was increased from the 9th day depending on the clinical status. For third group, 0.5 mg was administered on the first three days, 1 mg on the 4-8th day, 1.5 mg on the 9-13th day, 2 mg on the 14th day, and the dose was increased from the 15th day depending on the clinical status. The schizophrenic symptoms were rated by the Positive and Negative Syndrome Scale (PANSS) on days 0, 7, 14, 28 and 48 of the risperidone treatment. The tolerance of the treatment was checked by ESRS, modified UKU, and Global Impression of tolerability. The efficacy and tolerability were compared among the three regimen groups. Results : After 8 weeks of treatment, the PANSS total scores, positive scores and negative scores were not significantly different among the three groups. There were no differences among the three groups regarding tolerability ratings and ESRS rating except gait/posture and tremor items which scores were high in first group at the end of the study. The sedation and fatigability items scores in the first group was significantly more higher than in the second and third group. Conclusion : These data suggest that the 2-week titration of risperidone may be the most favorable strategy in the treatment of schizophrenia.ope