From the Research
Soluble atypical antipsychotics recommended for patients include risperidone (Risperdal M-Tab), olanzapine (Zyprexa Zydis), aripiprazole (Abilify Discmelt), asenapine (Saphris), and paliperidone (Invega). These medications are available in orally disintegrating tablet formulations that dissolve quickly in the mouth without water, making them suitable for patients with swallowing difficulties or those who might try to "cheek" or hide their medication.
Key Points
- Typical starting doses are lower than standard tablets: risperidone 0.5-1mg, olanzapine 5-10mg, aripiprazole 10-15mg, asenapine 5mg, and paliperidone 3-6mg daily, with gradual titration based on response and tolerability 1.
- These formulations are particularly useful in acute psychiatric settings, for elderly patients, and for improving adherence in community settings.
- The rapid dissolution ensures quicker absorption through the oral mucosa in some cases, potentially leading to faster onset of action.
- However, these medications still carry similar side effect profiles to their standard formulations, including metabolic effects, extrapyramidal symptoms, and sedation, so regular monitoring of weight, blood glucose, lipids, and movement disorders remains essential.
Comparison of Soluble Antipsychotics
- Risperidone may produce more extrapyramidal side effects than some other atypical antipsychotics, such as olanzapine and quetiapine, but may be more efficacious than ziprasidone in terms of general mental state improvement 1.
- Risperidone also increases prolactin levels more than most other atypical antipsychotics, except for amisulpride and sertindole.
- The choice of soluble antipsychotic should be based on individual patient needs and medical history, as well as the potential for side effects and interactions with other medications.
Dosing and Titration
- The dosing and titration of soluble antipsychotics should be done gradually and carefully, with close monitoring of the patient's response and tolerability.
- The goal is to find the minimum effective dose that achieves the desired therapeutic effect while minimizing side effects.
- Regular follow-up and adjustment of the treatment plan as needed is crucial to ensure optimal outcomes and minimize the risk of adverse effects.