Relationship between plasma risperidone concentrations and clinical features in chronic schizophrenic patients in China

Jing-Wen Xu; Xiao-Bo Guan; Xue-Ying Wang; Yang Feng; Qi Zhang; Jun-Juan Zhu; Jian-Hua Chen

doi:10.5498/wjp.v14.i4.523

Relationship between plasma risperidone concentrations and clinical features in chronic schizophrenic patients in China

World J Psychiatry. 2024 Apr 19;14(4):523-532. doi: 10.5498/wjp.v14.i4.523.

Authors

Jing-Wen Xu¹, Xiao-Bo Guan², Xue-Ying Wang³, Yang Feng⁴, Qi Zhang¹, Jun-Juan Zhu³, Jian-Hua Chen⁵

Affiliations

¹ Department of Medicine, Shanghai No. 3 Mental Health Center of Civil Administration, Shanghai 200435, China.
² The Fourth Sick Ward, Shanghai No. 3 Mental Health Center of Civil Administration, Shanghai 200435, China.
³ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China.
⁴ The First Sick Ward, Shanghai No. 3 Mental Health Center of Civil Administration, Shanghai 200435, China.
⁵ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, China. jianhua.chen@smhc.org.cn.

Abstract

Background: Prior studies have noted great variability in the plasma levels of risperidone (RIS). Plasma concentrations of RIS and its active moiety are highly variable and depend on absorption, metabolism, and other predictors of metabolic dysregulation; however, these factors are poorly understood and the association between metabolic change and change in psychopathology is uncertain.

Aim: To ascertain the characteristics of chronic schizophrenic patients treated with RIS, and to assess their relationship with plasma RIS levels.

Methods: This was a descriptive cross-sectional study of 50 patients with a diagnosis of schizophrenic psychosis treated with RIS in a psychiatric service. The plasma concentrations of RIS and its metabolite 9-hydroxyrisperidone were determined by high performance liquid chromatography. The patients' demographic and clinical characteristics, and psychopathologies were assessed, and the associations between clinical variables and plasma levels of RIS were explored.

Results: Male patients received higher doses of RIS than female ones, but plasma concentrations of RIS and risperidone + 9-hydroxyrisperidone (active moiety) were higher in female patients. Age and the mean scores of the general psychopathology subscale of the Positive and Negative Syndrome Scale (PANSS) were significantly positively correlated with plasma concentrations of risperidone + 9-hydroxyrisperidone adjusted for weight and dose in all 50 subjects. In male subjects, we found a statistically significant positive correlation between the concentrations of risperidone + 9-hydroxyrisperidone in plasma/(dose × kg) and age, mean PANSS negative subscale scores, mean PANSS general psychopathology subscale scores, and mean PANSS total scores.

Conclusion: Long-term use of RIS should be closely monitored in older patients and females to minimize the risk of high concentrations which could induce side effects.

Keywords: 9-hydroxyrisperidone; Antipsychotics; Chronic schizophrenia; Plasma drug concentration monitoring; Risperidone.