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Tratamiento a largo plazo de la esquizofrenia crónica con risperidona: un estudio con concentraciones plasmáticas

Published online by Cambridge University Press:  12 May 2020

M. C. Mauri ,
V. Laini ,
L. Boscati ,
R. Rudelli ,
V. Salvi ,
R. Orlandi  and
P. Papa
M. C. Mauri
Affiliation:
Departamento de Psiquiatría Clínica, Unidad de Neuropsicofarmacología Clínica, Universidad de Milán, IRCCS Ospedale Maggiore, Vía F. Sforza 35, 20122Milán, Italia
V. Laini
Affiliation:
Departamento de Psiquiatría Clínica, Unidad de Neuropsicofarmacología Clínica, Universidad de Milán, IRCCS Ospedale Maggiore, Vía F. Sforza 35, 20122Milán, Italia
L. Boscati
Affiliation:
Departamento de Psiquiatría Clínica, Unidad de Neuropsicofarmacología Clínica, Universidad de Milán, IRCCS Ospedale Maggiore, Vía F. Sforza 35, 20122Milán, Italia
R. Rudelli
Affiliation:
Departamento de Psiquiatría Clínica, Unidad de Neuropsicofarmacología Clínica, Universidad de Milán, IRCCS Ospedale Maggiore, Vía F. Sforza 35, 20122Milán, Italia
V. Salvi
Affiliation:
Departamento de Psiquiatría Clínica, Unidad de Neuropsicofarmacología Clínica, Universidad de Milán, IRCCS Ospedale Maggiore, Vía F. Sforza 35, 20122Milán, Italia
R. Orlandi
Affiliation:
Departamento de Toxicología, IRCCS Policlínico S. Matteo, Pavia, Italia
P. Papa
Affiliation:
Departamento de Toxicología, IRCCS Policlínico S. Matteo, Pavia, Italia
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Resumen

Se trató a 24 pacientes ambulatorios esquizofrénicos crónicos con una edad media de 37,21 años ± 9,96 DT con risperidona (RSP) en una dosis de 2-9 mg/día (media = 4,46 mg/día ± 1,30 DT, media = 0,06 mg/kg ± 0,01 DT) durante un año.

La evaluación clínica se realizó con la Escala de Evaluación Psiquiátrica Breve (BPRS), la Escala de Síntomas Positivos y Negativos (PANSS), la Escala de Evaluación de los Efectos Secundarios Extrapiramidales (EPSE) y una lista para los Efectos Secundarios Anticolinérgicos (ACS) en T0 y luego después de 1 (TI), 2 (T2), 3 (T3), 6 (T6), 9 (T9) y 12 (TI2) meses. Se determinaron las concentraciones de RSP y 9-hidroxi-risperidona (9OH-RSP) en T12 por el método CLAR. Los valores medios de la BPRS y la PANSS mostraron una mejoría significativa durante el estudio. No resultó ninguna correlación entre la dosis de RSP (mg/kg) y las concentraciones plasmáticas de RSP, de 9OH-RSP o el grupo activo. Se observó una correlación positiva entre la edad y el gmpo activo y también entre las concentraciones plasmáticas de RSP y 9OH-RSP Se observó una relación curvilínea entre el grupo activo y la mejoría en la PANSS (%). Los pacientes con la mejora mayor en la PANSS mostraron concentraciones plasmáticas de RSP + 9OH-RSP de 15-30 ng/mL. La RSP parece ser un fármaco bastante efectivo. Sin embargo, parece difícil idear programas de dosis apropiados y la determinación de la concentración plasmática parece ser necesaria en algunos casos.

Keywords

9 hidroxi-risperidonafarmacocinéticaconcentraciones plasmáticasrisperidonaesquizofrenia
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 8 , Issue 3 , April 2001 , pp. 155 - 162

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References

Bibliografía

American, Psychiatric Association. DSM IV diagnostic and statiscal manual of mental disorders. Washington, DC: APA Press; 1994.Google Scholar
Anderson, C, True, J, Ereshefsky, L, Miller, A. Risperidone clinical efficacy: role of the metabolite 9-hydroxy-risperido-ne. Psychopharmacol Bull 1994; 30 Suppl 1: 88.Google Scholar
Bondolfi, G, Dufour, H, Patris, M, May, JP, Billeter, U, Eap, CB, et al. Rispeidone versus clozapine in treatment-resistant chronic schizophrenia: a randomized double-blind study. Am J Psychiatry 1998, 155:499–504.CrossRefGoogle ScholarPubMed
CarmanJ, Peuskens J, Vangeneugden, A. Risperidone in the treatment of negative symptoms of schizophrenia: a metaanalysis. Int Clin Psychopharmacol 1995;10:207–13.CrossRefGoogle Scholar
Chouinard, G, Jones, B, Remington, G, Bloom, D, Addington, D, MacEwan, GW, et al. A Canadian multicenter placebo-controlled study of fixed doses of risperidone and halope-ridol in treatment of chronic schizophrenic patients. J Clin Psychopharmacol 1993;13:25–40.CrossRefGoogle ScholarPubMed
Claus, A, Bollen, J, DeCuyper, H, Eneman, M, Malfroid, M, Peuskens, J, et al. Risperidone versus haloperidol in the treatment of chronic inpatients: a multicentre double-blind comparative study. Acta Psychiatr Scand 1992; 20:295–305.CrossRefGoogle Scholar
Conley, RR, Love, RC, Kelly, DL, Bartko, JJ. Rehospitalization rates of patients recently discharged on a regimen of risperidone or clozapine. Am J Psychiatry 1999;156:863–8.CrossRefGoogle ScholarPubMed
Curry, SH. Commentary: the strategy and valué of neuroleptic drug monitoring. J Clin Psychopharmacol 1985; 5:263–71.CrossRefGoogle Scholar
Diaourta-Tsitouridou, M, Christodoulakis, T, Tsitouridis, S. Efficacy and tolerability of risperidone in drug-naive schizophrenic and schizoaffective patients. Eur Neuropsychopharmacol 1997; 7 Suppl 2: 200.CrossRefGoogle Scholar
Draper, N, Smith, H. Applied regression analysis. 2nd ed. New York: Wiley; 1981.Google Scholar
Ereshefsky, L, LAcombe, S. Pharmacological profile of risperidone. Can J Psychiatry 1993; 38 Suppl 3:80–8.Google ScholarPubMed
Fleischhacker, WW, Hummer, M. Drug treatment of schizophrenia in the 1990s. Achivements and future possibilities in optimising outcomes. Daigs 1997;53:915–29.Google ScholarPubMed
Foster, RH, Goa, KL. Risperidone. A pharmaeconomic review of its use in schizophrenia. Pharmaeconomics 1998;14:97–133.Google ScholarPubMed
Gelders, YG, Heylen, SLE, Vanden, Bussche G, Reyntjens, AJ, Janssen, PAJ. Pilot clinical investigation of risperidone in the treatment of psychotic patients. Pharmacopsychiatry 1990;23:206–11.CrossRefGoogle ScholarPubMed
Grant, S, Fitton, A. Risperidone. A review of its pharmacology and therapeutic potential in the treatment of schizophrenia. Drugs 1994;48:253–73.CrossRefGoogle ScholarPubMed
Heykants, J, Huang, ML, MAnnens, G, Mauldermas, W, Snoeck, E, Van Beijsterveldt, L, et al.The pharmacokinetics of risperidone in humans: a summmary. J Clin Psychiatry 1994;55 Suppl 5: 13–7.Google Scholar
Kay, SR, Fiszbein, A, Opler, LA. The Positivo and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophr Bull 1987,13:261–76.CrossRefGoogle Scholar
Lindstróm, E, Eriksson, B, Hellgren, A, Von Knorring, L, Eberhard, G. Efficacy and safety of risperidone in the long-term treatment of patients with schizophrenia. Clin Ther 1995; 17:402–12.CrossRefGoogle ScholarPubMed
Luchins, DJ, Klass, D, Hanrahan, P, Malan, R, Harris, J. Alteration in the recommended dosing schedule for risperidone. Am J Psychiatry 1998;155:365–6.CrossRefGoogle ScholarPubMed
Mannens, G, Huang, ML, Meudermans, W, Hendrickx, J, Woestenborghs, R, Heykants, J. Absorption, metabolism and excretion of risperidone in humans. Drug Metab Dispos 1993;21:1134–41.Google ScholarPubMed
Marder, SR, Meibach, RC. Risperidone in the treatment of schizophrenia. Am J Psychiatry 1994; 151:825–35.Google ScholarPubMed
Mauri, MC, Laini, V, Scalvini, M, Boscati, L, Steinhilber, CPC, Invernizzi, G. Risperidone and 900H-risperidone plasma levels in schizophrenic patents. Int J Neuropsychopharmacol 1999;2 Suppl 1: 100.Google Scholar
Mertens, C. Long-term treatment of chronic schizophrenic patients with risperidone. Schizophr Res 1990;3:48.CrossRefGoogle Scholar
Miller, CH, Mohr, F, Umbricht, D, Woerner, M, Fleischhacker, WW, Lieberman, JA. The prevalence of acute extrapyramidal signs and symptoms in patients treated with clozapine, risperidone and conventional antipsychotics. J Clin Psychiatry 1998;58:69–75.CrossRefGoogle Scholar
Móller, HJ, GAgiano, CA, Addington, DE, Von, Knorring L, Torres-Plank, JF, Gaussares, C. Long-term treatment of chronic schizophrenia with risperidone: an open-label multi-center study of 386 patients. Int Clin Psychopharmacol 1998; 13:99–106.CrossRefGoogle Scholar
Nair, NPV. The Risperidone Study Group. Therapeutic equivalence of risperidone given once daily and twice daily in patients with schizophrenia. J Clin Psychopharmacol 1998; 18:103–10.Google ScholarPubMed
Nyberg, S, Eriksson, B, Oxenstierna, G, Halldin, C, Farde, L. Siggested minimal effective dose of risperidone based on PET- measured D2 and 5HT2A receptor occupancy in schizophrenic patients. Am J Psychiatry 1999; 156:869–75.CrossRefGoogle Scholar
Overall, J, Gorham, D. Brief Psychiatry Rating Scale. Psychol Rep 1962; 10:799–812.CrossRefGoogle Scholar
Price, MC, Hoffman, DW. Terapeutic drug monitoring of risperidone and 9-hydroxy-risperidone in serum with solid phase extraction and high-performance liquid cromato-graphy. Titer Drug Monit 1997;19:333–7.CrossRefGoogle Scholar
Reilly, TM, Heylen, SLE. Guidelines for the practical use of risperidone. In: Kane, JM, Moller, HJ, Awouters, F, Eels. Serotonin in antipsychotic treatment. Mechanism and clinical practice. New York: Marcel Dekker Inc; 1996.p.357–68.Google Scholar
Remington, GJ. Clinical considerations in the use of risperidone. Can J Psychiatry 1993;38 Suppl 3: 96–100.Google ScholarPubMed
Simpson, RM, Angus, JSW. A rating scale for Extrapyramidal Side Effects. Acta Psychiatry 1993;38 Suppl 3: 96–100.Google Scholar
Snoeck, E, VAn, Peer A, Sack, M, Horton, M, Mannens, G, Woestenborrghs, R, et al. Influence of age, renal and liver impairment on the pharmacokinetics of risperidone in man. Psychopharmacology 1995; 122:223–9.CrossRefGoogle ScholarPubMed
Van, Beijsterveldt L, Geerts, R, Leysen, J, Megens, A, Van, den Eynde H, Meudermans, W, et al. The regional brain distribution of risperidone and its active metabolite 9-hydroxyris-peridone in the rat. Psychopharmacology 1993; 114:53–62.Google Scholar
Van, Peer AV, Meuldermans, W, Woestenborghs, R, Heykants, J. Clinical pharmacokinetics of risperidone. In: Kane, JM, Moler, HJ, Awouters, F, Eds. Serotonin in antipsychotic treatment. Mechanism and clinical practice. New York: Marcel Dekker Inc; 1996;57:53–60.Google Scholar
Weiden, P, Aquila, R, Standard, J. Atypical antipsychotic drugs and long-term outcome in schizophrenia. J Clin Psychiatry 1996. p. 277–91.Google Scholar
Wirshing, DA, MArshall, BD, Green, MF, Mintz, J, Marcler, SR, Wirshing, EC. Risperidone in treatment-refractory schi Am J Psychiatry 1999; 156: 1374–9.Google ScholarPubMed
Woestenborghs, R, Lorreyne, W, Van, Rompaey F, Heykants, J. Determination of risperidone and 9-hydroxy risperidone in plasma, uriñe and animal tissues by high performance liquid chromatography. J Chromatography 1992; 583:223–30.CrossRefGoogle ScholarPubMed