Compliance with an attending physician’s prescriptions is a strong predictor of a positive outcome. For patients with severe schizophrenia, mistrust of doctors and medications is often a prominent element of their psychoses. Even people without profound psychoses often fail to comply with their prescriptions. For example, people with breathing problems like chronic obstructive pulmonary disease or asthma may have an aversion to swallowing pills. On the other hand, those with major depression may simply lack the motivation to rigorously follow a prescription. Several studies have been conducted to determine whether changing the delivery method of medication has any benefit for noncompliant patients. At the same time, these studies have also looked into the effectiveness and safety of alternative formulations.
Risperdal (risperidone) is a member of the class of drugs known as atypical antipsychotics. These drugs have proven to be just as effective as the typical antipsychotics but with fewer undesirable side effects. With Risperdal, the most frequently reported side effect is headache. Rarely are side effects bothersome enough to cause a patient to discontinue usage. As with any medication, the effectiveness of Risperdal depends on patient compliance. In an attempt to improve compliance among all patient groups, an orally disintegrating version of the medication was recently developed and tested. Patients with four distinct psychiatric conditions—schizophrenia, major depressive disorder, depression, and bipolar—were included in this trial.
The results of the test were extremely promising. Patients reported no issue with the nature of the medication itself. For those in psychotic states, compliance was improved because the medication dissolves in the mouth so quickly. These patients might previously have kept a tablet in their cheek to spit out later, but the orally disintegrating formulation made such behaviors impossible. In addition, patients who perhaps had trouble swallowing could more easily consume this form of Risperdal. Most important, the therapeutic benefits of the medication were clearly shown to be intact. In fact, baseline scores on a psychiatric inventory showed an improvement for schizophrenic patients over the standard Risperdal formulation, no doubt as result of the better compliance. Furthermore, adverse side effects were on par with the conventional tablet form of the drug.
Physicians often worry that a switch in delivery method may worsen a patient’s symptoms or lead to additional side effects. In the case of Risperdal, at least, that seems not to be the case. The orally disintegrating formulation offers all the benefits of the tablet with comparable side effects. And in many patients, compliance is significantly better.
Chue, P., Prinzo, R. S., Binder, C. E. (2007). Do formulation switches exacerbate existing medical illness? Results of an open-label transition to orally disintegrating risperidone tablets. Human Psychopharmacology: Clinical and Experimental, 22, 307-314.
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