Br J Psychiatry 2026 May 19;:1-8. doi: 10.1192/bjp.2026.10663.

Experimental evaluation of guideline-recommended pharmaceutical manipulations for hyperbolic tapering of psychiatric drugs.

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BACKGROUND: Hyperbolic tapering is increasingly recommended for the gradual reduction of psychiatric drugs to minimise withdrawal symptoms, yet available formulations rarely accommodate the small dose regimens required. AIMS: To evaluate whether pharmaceutical manipulation strategies - as proposed in clinical guidelines for hyperbolic tapering - can produce progressively smaller haloperidol doses with adequate accuracy and precision. METHOD: Strategies included whole and split tablets, liquid dispensed via dropper or dosing syringe, diluted solutions and tablet suspension, applied under controlled laboratory conditions. Haloperidol was used as a model, following an exponential 10% dose reduction schedule from 5 to 0 mg, generating multiple tapering steps that mirrored real-world scenarios. Drug content was quantified by high-performance liquid chromatography and interpreted according to an adapted pharmacopoeial criterion. RESULTS: All strategies yielded mean doses within 90-110% of expected values, demonstrating satisfactory accuracy and reproducibility. Variability was higher with tablet splitting, drop-based measurements and tablet suspension (relative standard deviation of 8.0%), whereas the use of whole tablets, dosing syringe and diluted liquid improved precision (relative standard deviation of 3.3%). These findings demonstrate the technical feasibility of achieving progressively smaller doses through standardised manipulation strategies, providing experimental support for hyperbolic tapering in clinical practice. CONCLUSIONS: Although off-label, such approaches currently offer the only practical means for safe dose reduction in the absence of smaller dose formulations, highlighting a regulatory gap between product design and clinical needs. Aligned with clinical guidelines, our findings support manipulation strategies as a practical and reliable component of individualised dose reduction in psychiatric care.

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