risperidone RISPERDAL

Class: Second Generation Antipsychotic/​Benzisothiazole Derivative
FDA Indications: Schizophrenia, Bipolar Maintenance, Acute/mixed Mania, Autism-related Irritability
Off-Label Use: Agitation In Dementia, Behavioral Disturbances With Dementia, OCD (augmenting W/ SSRI), Depression (adjunct), PTSD
Prescribing
Forms: 0.25, 0.5, 1, 2, 3, 4mg tablet; 0.5, 1, 2, 3, 4mg ODT a.k.a. "M" tabs; 1 mg/ml po soln; LAI: Consta, 12.5, 25, 37.5 & 50 mg
Dose Range: 0.5-6 mg/day
Starting: 1-2 mg QD or QHS, ↑ to 2 mg BID as needed; ↑ to 6 mg qd only if necessary, since EPS is highly dose dependent
LAI "Consta" dosed at 25 mg IM Q2 weeks
Stopping: Taper 6-8 weeks, rapid d/c can lead to rebound psychosis
Monitoring:

NAMI drug fact sheet

Precautions
Serious Side Effects: , , , , Hyperprolactinemia
Possible Risk of TdP, Drugs to Avoid in Congenital Long QT
Side Effects: headache, sedation/somnolence, dizziness, constipation, nausea, insomnia, sexual dysfunction, anxiety, tachycardia, orthostatic hypotension, EPS, weight gain (18%)
Pharmacodynamics
1° MOA: 5HT2A–D2 antagonist
Target: Antagonism at:
Pharmacokinetics
t½: TMAX: 1-2°
Substrate of: 2D6; 3A4
Inhibits: ∅ ; Induces:
Active Metabolites: 9-OH-risperidone a.k.a. paliperidone (t½ 23°)
DDIs
Misc
  • - essentially zero affinity at cholinergic muscarinic receptors
  • - ↑ incidence of EPS compared to other SGAs
  • - causes the most hyperprolactinemia of all the atypicals
  • - well-recognized for use treating behavioral symptoms in pediatric population, though weight gain & sedation worse in chilldren than adults
Special Populations

Category C—No structural malformations attributable to risperidone have been reported, the number of exposures is too low to fully assess embryo-fetal risk. There is a risk of EPS and/or withdrawal sx in the newborn if used in the 3rd trimester. Nevertheless, risperidone is indicated for severe debilitating mental disease and the benefits to the mother appear to outweigh the potential embryo-fetal risks.

RID 2.8-9.1%; Limited Human Data—Potential Toxicity


Start at 0.5 mg qhs and ↑ slowly/cautiously. All atypicals may increase mortality in elderly patients by 1.7 times greater than placebo

Start at 0.5 mg qhs and ↑ slowly/cautiously


Start at 0.5 mg qhs and ↑ slowly/cautiously

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Last updated January 22 2018 19:18:05. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.