II. Class
- Atypical Antipsychotic (Second Generation agent)
- Neuroleptic
III. Indications
- Schizophrenia
- Bipolar Disorder
- Autism related irritability
- Agitation in Dementia (not FDA approved)
- Obsessive Compulsive Disorder Adjunctive Therapy (not FDA approved)
- Posttraumatic Stress Disorder (not FDA approved)
IV. Mechanism
- Antagonist at Serotonin, Dopamine, alpha adrenergic and Histamine H1 receptors
- Active metabolites include Paliperidone
V. Adverse Effects
- Sedation or Somnolence
- Insomnia
- Hypotension
- Weight gain
- Hyperglycemia and increased Diabetes Mellitus risk
- Constipation
- Sialorrhea
- Dizziness
- Serum Prolactin increased
-
Extrapyramidal Side Effects
- Low risk when daily dose under 10 mg
- Hyperkinesis
- Exacerbates Parkinson's Disease movement, Fall Risk (and increased risk of Neuroleptic Malignant Syndrome)
- Akathisia
- Dystonia
- Peristent Tardive Dyskinesia
- Lower Incidence than with other Neuroleptics
VI. Dosing: General
- Precautions
- Do not stop abruptly
- Decrease dose in liver and kidney Impairment, and in the elderly
- Somnolence may be decreased by splitting dose twice daily
- Initial
- Adult: 1 mg orally twice daily
- Child age 13 to 17 years: 0.5 mg orally daily (or divided twice daily)
- Elderly: 0.25 mg daily to 0.5 mg orally twice daily
- Slow titration to average dosing
- Adult: 2 to 4 mg orally daily (or divided twice daily)
- Child: 0.5 to 1.5 mg orally daily or divided twice daily
- Elderly with Dementia: 0.5 to 0.75 mg orally twice daily
- Maximum
- Adult: 16 mg/day
VII. Dosing: Schizophrenia or Bipolar Disorder
- Adult Immediate Release Tablet
- Start 2 mg orally daily (or divided twice daily)
- Increase by 1 to 2 mg/day every 2 days
- Target: 4 to 8 mg/day (2 to 3 mg daily in Bipolar Disorder)
- Maximum: 16 mg/day (6 mg/day in Bipolar Disorder)
- Doses >6 mg do not appear more effective than lower doses
- Children Ages 13 to 17 years old Immediate Release Tablet
- Start 0.5 mg orally daily
- Increase by 0.5 to 1 mg/day every 24 hours or more
- Target: 3 mg/day (as effective as 6 mg/day dose)
- Maximum: 6 mg/day
- Decreased dose in elderly, debiltated patients, or in renal (eGFR <30 ml/min) or liver impaired function
- Start 0.5 mg orally daily or twice daily
- Increase by 0.5 to 1 mg/day every few days (weekly for doses >1.5 mg)
- Maximum: 6 mg/day (most effective dose is 3 mg/day or less)
- Adult Long-Acting IM Injection (Risperdal Consta, Rykindo)
- Trial oral dosing before starting IM Injection
- Start 25 mg IM every 2 weeks
- Continue oral Risperidone for the first 3 weeks of IM Injections
- May increase IM dose by 12.5 mg every 4 weeks up to a maximum of 50 mg IM
- Adult Long-Acting SQ Injection (Perseris)
- Trial oral dosing before starting IM Injection
- Base Perseris SQ dose on Risperidone oral dosing
- Risperidone oral daily dose <3 mg/day: Avoid Perseris
- Risperidone oral daily dose 3 mg/day: Perseris 90 mg SQ every month
- Risperidone oral daily dose 4 mg/day: Perseris 120 mg SQ every month
- Risperidone oral daily dose >4 mg/day: Avoid Perseris
- Adult Long-Acting SQ Injection (Uzedy)
- Trial oral dosing before starting IM Injection
- Base Uzedy SQ dose on Risperidone oral dosing
- Risperidone oral daily dose 2 mg/day: Uzedy 50 mg SQ monthly (or 100 mg q2 months)
- Risperidone oral daily dose 3 mg/day: Uzedy 75 mg SQ monthly (or 150 mg q2 months)
- Risperidone oral daily dose 4 mg/day: Uzedy 100 mg SQ monthly (or 200 mg q2 months)
- Risperidone oral daily dose 5 mg/day: Uzedy 125 mg SQ monthly (or 250 mg q2 months)
VIII. Dosing: Autism Related Irritability (Age 5 to 16 years old)
- Weight <20 kg
- Start 0.25 mg orally daily
- May increase after 4 days to target dose 0.5 mg orally daily
- May increase every 14 days as needed in 0.25 mg/day increments
- Weight >20 kg
- Start 0.5 mg orally daily
- May increase after 4 days to target dose 1 mg orally daily
- May increase every 14 days as needed in 0.5 mg/day increments
- Target Dose: 0.5 to 3 mg daily
IX. Monitoring
- See Antipsychotics
- Consider EKG, Electrolyte and Magnesium monitoring due to QT Interval prolongation risk
X. Drug Interactions
- Metabolized by CYP2D6, CYP3A4
- Increase Antipsychotic levels (toxicity risk): Monitor for toxicity
- Decrease Antipsychotic levels (lower efficacy)
- Other effects
- Increased Antihypertensive effect (may result in Hypotension)
- Raises Serum Prolactin levels
- Avoid concurrent use of other medications prolonging QT Interval
XI. Safety
- Avoid in Lactation
- Pregnancy Category C
- However, increased risk of birth malformations with first and second trimester exposure
- Huybrechts (2016) JAMA Psychiatry 73(9): 938-46 +PMID: 27540849 [PubMed]
XII. Resources
- Risperidone Tablet (DailyMed)
- Risperidone Consta SQ (DailyMed)
- Risperidone Uzedy SQ monthly (DailyMed)
XIII. References
- (2016) Med Lett Drugs Ther 58(1510): 160-5
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 42-3
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Jeste (2000) Am J Psychiatry 157:1150-5 [PubMed]
- Motsinger (2003) Am Fam Physician 67(11):2335-40 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
risperidone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
RISPERIDONE 0.25 MG ODT | Generic | $2.95 each |
RISPERIDONE 0.25 MG TABLET | Generic | $0.04 each |
RISPERIDONE 0.5 MG ODT | Generic | $0.79 each |
RISPERIDONE 0.5 MG TABLET | Generic | $0.04 each |
RISPERIDONE 1 MG ODT | Generic | $1.17 each |
RISPERIDONE 1 MG TABLET | Generic | $0.04 each |
RISPERIDONE 1 MG/ML SOLUTION | Generic | $0.27 per ml |
RISPERIDONE 2 MG ODT | Generic | $0.90 each |
RISPERIDONE 2 MG TABLET | Generic | $0.05 each |
RISPERIDONE 3 MG ODT | Generic | $1.16 each |
RISPERIDONE 3 MG TABLET | Generic | $0.07 each |
RISPERIDONE 4 MG TABLET | Generic | $0.09 each |
risperdal (on 1/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
RISPERDAL CONSTA 12.5 MG VIAL | $268.14 each | |
RISPERDAL CONSTA 25 MG VIAL | $535.80 each | |
RISPERDAL CONSTA 37.5 MG VIAL | $803.27 each | |
RISPERDAL CONSTA 50 MG VIAL | $1,072.26 each | |
perseris (on 1/1/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
PERSERIS ER 120 MG SYRINGE KIT | $2,639.32 each | |
PERSERIS ER 90 MG POWDER SYRNG | $1,966.31 each | |
PERSERIS ER 90 MG SYRINGE KIT | $1,966.31 each |
Ontology: Risperidone (C0073393)
Definition (CHV) | a drug used to treat the symptoms of schizophrenia |
Definition (NCI) | A benzisoxazole derivative with antipsychotic property. Risperidone selectively antagonizes serotonin (5-HT) effects via cortical 5-HT2 receptor, and, to a lesser extent, competes with dopamine at the limbic dopamine D2 receptor. The antagonism leads to decreased psychotic effects, such as hallucinations and delusions. In addition, risperidone has low to moderate affinity for histamine H1, 5-HT1A, 5-HT1C, and 5-HT1D receptors, while it has weak affinity for dopamine D1 and haloperidol-sensitive sigma site receptors. |
Definition (MSH) | A selective blocker of DOPAMINE D2 RECEPTORS and SEROTONIN 5-HT2 RECEPTORS that acts as an atypical antipsychotic agent. It has been shown to improve both positive and negative symptoms in the treatment of SCHIZOPHRENIA. |
Definition (CSP) | selective blocker of dopamine D2 and serotonin-5-HT2 receptors that acts as an atypical antipsychotic agent; has been shown to improve both positive and negative symptoms in the treatment of schizophrenia. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D018967 |
SnomedCT | 108386000, 386840002 |
LNC | LP17872-0, MTHU014878 |
English | 4H-Pyrido(1,2-a)pyrimidin-4-one, 3-(2-(4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl)ethyl)-6 ,7,8,9-tetrahydro-2-methyl-, Risperidone, risperidone, risperidone (medication), RISPERIDONE, Risperidone [Chemical/Ingredient], risperiDONE, RisperiDONE, Risperidone (product), Risperidone (substance) |
Swedish | Risperidon |
Czech | risperidon |
Finnish | Risperidoni |
Russian | RISPERIDON, РИСПЕРИДОН |
Japanese | リスペリドン |
Polish | Rysperydon |
Croatian | RISPERIDON |
Spanish | risperidona (producto), risperidona (sustancia), risperidona, Risperidona |
French | Risperidone |
German | Risperidon |
Italian | Risperidone |
Portuguese | Risperidona |
Ontology: Risperdal (C0592071)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
English | Risperdal, risperdal, RisperDAL |