From the Journals

Optimal antipsychotic dose for schizophrenia relapse identified


 

Patient preference key

The data were insufficient to assess differences between men and women or between older and younger patients, Dr. Leucht noted.

However, post-hoc subgroup analyses turned up some interesting findings, he added. For example, patients who take high-potency first-generation antipsychotics such as haloperidol might do well on a lower dose, said Dr. Leucht.

“They may need a dose even lower than 5 mg, perhaps something like 2.5 mg, because these drugs bind so strongly to dopamine receptors,” he said.

He reiterated that patient preferences should always be considered when deciding on antipsychotic dosage.

“Many patients will say they don’t want to relapse anymore, but others will say these drugs have horrible side effects, and they want to go on a lower dose,” said Dr. Leucht.

Clinicians should also factor in patient characteristics, such as comorbidities or substance abuse, as well as severity of past relapses and properties of individual drugs, he added.

Reflects real-world experience

Commenting on the findings, Thomas Sedlak, MD, PhD, director, Schizophrenia and Psychosis Consult Clinic and assistant professor of psychiatry and behavioral sciences, Johns Hopkins School of Medicine, Baltimore, said the research “is a fine addition” to a previous analysis that explored dose-response relationships of antipsychotic drugs in the acute phase.

Crunching all the data from studies that have different types of patients and extracting a single dosage that provides maximum benefit is “a great challenge,” said Dr. Sedlak, who was not involved with the research.

The fact that most patients won’t get additional benefit above 5 mg, at which point they start getting more adverse events, and that 2.5 mg is sufficient for certain subgroups “agrees well with the experience of many who use these medications regularly,” Dr. Sedlak said.

However, he cautioned that psychiatrists “don’t always intuitively know which patients fall into which dose category or who might require clozapine.”

“Clinicians need to be mindful that it’s easy to overshoot an optimal dose and elicit side effects,” said Dr. Sedlak.

He also noted that severely ill patients are often underrepresented in clinical trials because they are too impaired to participate, “so they may have a different optimal dosage,” he concluded.

Dr. Leucht has reported receiving personal fees for consulting, advising, and/or speaking outside the submitted work from Angelini, Boehringer Ingelheim, Geodon & Richter, Janssen, Johnson & Johnson, Lundbeck, LTS Lohmann, MSD, Otsuka, Recordati, Sanofi Aventis, Sandoz, Sunovion, Teva, Eisai, Rovi, and Amiabel. Dr. Sedlak has reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

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