What is the appropriate use and dosage of Tenipride (tiapride) 20mg in treating schizophrenia?

Tiapride (Tenipride) 20mg in Schizophrenia Treatment

Tiapride is not recommended as a first-line treatment for schizophrenia, as there is insufficient evidence supporting its efficacy for this indication compared to established antipsychotics. 1

Current Evidence on Tiapride Use

• Tiapride is an atypical antipsychotic that acts as a selective dopamine D2-receptor antagonist, with preferential activity at receptors previously sensitized to dopamine and those located extrastriatally 2
• Current evidence for tiapride primarily supports its use in alcohol withdrawal, agitation in elderly patients with dementia, and dyskinesias - not schizophrenia 1
• A systematic review of tiapride found a lack of solid evidence for its efficacy in psychiatric disorders, with no studies specifically supporting its use in schizophrenia 1

Recommended Antipsychotics for Schizophrenia

• For first-episode psychosis or schizophrenia, treatment should be initiated with atypical antipsychotics at low doses, with examples of appropriate initial target doses being risperidone 2 mg/day or olanzapine 7.5-10.0 mg/day 3
• The initial choice of antipsychotic should be made collaboratively with the patient based on side-effect and efficacy profiles 3
• Antipsychotic treatment should be given at a therapeutic dose for at least 4 weeks before considering a switch due to inadequate response 3

Treatment Algorithm for Schizophrenia

1. First-line treatment: Start with an atypical antipsychotic at appropriate dosage (e.g., risperidone 2 mg/day or olanzapine 7.5-10.0 mg/day) 3
2. Second-line treatment: If inadequate response after 4 weeks, switch to an alternative antipsychotic with a different pharmacodynamic profile 3
3. Treatment-resistant cases: If positive symptoms remain significant following a second antipsychotic trial, consider clozapine 3

Monitoring and Side Effect Management

• Before starting antipsychotic treatment, obtain baseline measurements including BMI, waist circumference, blood pressure, HbA1c, glucose, lipids, prolactin, liver function tests, urea and electrolytes, full blood count, and electrocardiogram 3
• Monitor BMI, waist circumference, and blood pressure weekly for 6 weeks after initiation or switching of antipsychotics 3
• Repeat all baseline measurements after 3 months of treatment and annually thereafter 3

Special Considerations

• Extrapyramidal side-effects from antipsychotic treatment should be avoided to encourage future medication adherence 3
• Low doses of antipsychotic medication may not have a rapid effect on distress or functional impairment 3
• Families should be included in the assessment process and treatment plan, as they are usually in crisis at the point of treatment initiation and require emotional support and practical advice 3

Conclusion on Tiapride for Schizophrenia

• While tiapride 20mg has been studied for conditions like agitation in the elderly (at doses of 100-300 mg/day) 4, there is insufficient evidence supporting its use specifically for schizophrenia 1
• Current guidelines and evidence strongly favor other antipsychotics with established efficacy and safety profiles for schizophrenia treatment 3