Safety and tolerability of a rapidly escalating dose-loading regimen for risperidone

Background: Risperidone is an "atypical" antipsychotic with strong binding affinity for dopamine-2 and serotonin-2 receptors. Risperidone is often use d to treat hospitalized patients who have acute psychotic decompensation, a nd the therapeutic target dose commonly used is 2 to 6 mg/day. The most com mon clinical practice is to titrate the dose of risperidone to the target t herapeutic dose over several days. This study investigated the safety and t olerability of a rapid oral-loading regimen for risperidone developed to ac hieve 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 c ontingent on tolerance of last administered dose. Results: Of a sample of 11 consecutive inpatients admitted to an acute psyc hiatric 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. Thre e 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 standin g 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 psychiatric inpatients.