Horowitz, 2020 Tapering Antipsychotic Treatment

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Horowitz MA, Murray RM, Taylor D.

Tapering Antipsychotic Treatment. 

JAMA Psychiatry. Published online August 05, 2020. doi:10.1001/jamapsychiatry.2020.2166

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2769191

 

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This Viewpoint discusses principles for tapering antipsychotic treatment when deprescribing them.

 

Mad in America published an article on the above study:

 

https://www.madinamerica.com/2020/09/slow-taper-best-antipsychotic-discontinuation/

 

"Antipsychotics’ effect on the brain follows a “hyperbolic” pattern. That is, doubling the dose doesn’t result in a doubled effect; instead, doubling the dose creates a linear increase in the drugs’ effect. Thus, to slowly taper off of the drug, the best strategy is a hyperbolic reduction—halving the amount of drug used every three to six months, resulting in eventual infinitesimal amounts of the drug.

 

According to the researchers, each time the dose is halved, the D2 blockade reduces by a small, linear amount (about 10%):

 

For example, risperidone doses of 8 mg, 4 mg, 2 mg, 1 mg, 0.5 mg, 0.25 mg, 0.125 mg, and 0 mg produce roughly 10–percentage point reductions in the extent of D2 blockade. This pattern of reduction may be less likely to provoke relapse because it avoids large increases in dopaminergic signaling.

 

They write that the final dose may need to be tiny, about 2.5% of the initial amount, and that liquid formulations might be an effective way of being able to provide these minimal doses."

Edited September 22 by Altostrata
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