- Atypical Antipsychotic (Second Generation agent)
- Neuroleptic
- 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)
- Antagonist at Serotonin, Dopamine, alpha adrenergic and Histamine H1 receptors
- Active metabolites include Paliperidone
- 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
- 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
- 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)
- 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
- See Antipsychotics
- Consider EKG, Electrolyte and Magnesium monitoring due to QT Interval prolongation risk
- 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
- 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]
- Risperidone Tablet (DailyMed)
- Risperidone Consta SQ (DailyMed)
- Risperidone Uzedy SQ monthly (DailyMed)
- (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]