risperidone RISPERDAL

Class: Second Generation Antipsychotic/​Benzisothiazole Derivative
FDA Indications: Schizophrenia, Bipolar Maintenance, Acute/mixed Mania, Autism-related Irritability
Off-Label Use: Agitation And Aggression In Dementia, Behavioral Disturbances With Dementia, OCD (augmenting W/ SSRI), Depression (adjunct), PTSD
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 (following injection the main release of drug starts from 3 weeks onwards, is maintained from 4 to 6 weeks and subsides by week 7)
Stopping: Taper 6-8 weeks, rapid d/c can lead to rebound psychosis

NAMI drug fact sheet

Serious Side Effects: , , , , Hyperprolactinemia
Possible Risk of TdP, Drugs to Avoid in Congenital Long QT
Side Effects: weight gain (18%), sedation/somnolence, EPS, dizziness, insomnia, headache, anxiety, constipation, nausea, tachycardia, sexual dysfunction, orthostatic hypotension
1° MOA: 5HT2A–D2 antagonist
Target: Antagonism at:
t½: 23° TMAX: 1-2°
Substrate of: 2D6; 3A4
Inhibits: ∅ ; Induces:
Active Metabolites: 9-OH-risperidone a.k.a. paliperidone (t½ 23°)
  • - though risperidone's t½ is only 3°, its secondary active metabolite 9-OH-risperidone has a 23° t½ 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

2019 BEE℞S Recommendation: Avoid, except in schizophrenia or bipolar disorder. Increased risk of CVA and greater rate of cognitive decline and mortality in persons with dementia. Avoid antipsychotics for behavioral problems of dementia or delirium unless nonpharmacological options have failed or are not possible and the older adult is threatening substantial harm to self or others.

Start at 0.5 mg qhs and ↑ slowly/cautiously

Start at 0.5 mg qhs and ↑ slowly/cautiously


Developed & Designed by Kevin M. Nasky, D.O. • Built with Bootstrap, PHP & MySQL • Hosted by SiteGround
Last updated February 29 2024 20:54:18. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.