Risperidone

Indications
Oral
Schizophrenia
Adult: Initially, 2 mg daily, may increase to 4 mg daily on the 2nd day, adjusted further in increments or decrements of 1-2 mg daily at wkly intervals. Doses may be given in 1-2 divided doses. Maintenance: 4-6 mg daily. Max: 16 mg/day.
Elderly: Initially, 0.5 mg bid gradually increased in increments of 0.5 mg bid. Maintenance: 1-2 mg bid.
Renal impairment: Initially, 0.5 mg bid, may increase in steps of 0.5 mg bid, up to 1-2 mg bid. Dose increments above 1.5 mg bid should be made at intervals of at least 1 wk.
Hepatic impairment: Initially, 0.5 mg bid, may increase in steps of 0.5 mg bid, up to 1-2 mg bid. Dose increments above 1.5 mg bid should be made at intervals of at least 1 wk.
Oral
Acute manic episodes of bipolar disorder
Adult: Initially, 2-3 mg once daily. May increase by 1 mg daily at intervals of at least 24 hr. Max: 6 mg daily.
Elderly: Initiate with lower doses.
Renal impairment: Initially, 0.5 mg bid, may increase in steps of 0.5 mg bid, up to 1-2 mg bid. Dose increments above 1.5 mg bid should be made at intervals of at least 1 wk.
Hepatic impairment: Initially, 0.5 mg bid, may increase in steps of 0.5 mg bid, up to 1-2 mg bid. Dose increments above 1.5 mg bid should be made at intervals of at least 1 wk.
Intramuscular
Schizophrenia
Adult: Give oral risperidone for a few days to assess tolerability prior to initiating inj. For patients not stabilised on oral risperidone: 25 mg every 2 wk. Patients stabilised on oral risperidone for at least 2 wk in doses ≤4 mg daily: 25 mg every 2 wk. Patients stabilised on oral risperidone for at least 2 wk in doses >4 mg daily: 37.5 mg every 2 wk. Continue oral risperidone for the 1st 3 wk after the 1st inj.
Elderly: Max dose: 25 mg every 2 wk.

Special Populations: Patients with hepatic or renal impairment: 0.5 mg bid, increased to 1-2 mg bid.
Warnings / Precautions
Preexisting CV diseases; discontinue use if signs and symptoms of tardive dyskinesia occur; renal and hepatic impairment, elderly, epilepsy; parkinsonism; pregnancy. May cause drowsiness and orthostatic hypotension. Gradual withdrawal is recommended. Monitor blood glucose in diabetics and patients at risk of developing diabetes.
Adverse Reactions
Agitation, anxiety, dizziness, headache, somnolence; orthostatic hypotension; constipation, dyspepsia, nausea, vomiting, abdominal pain, blurred vision, erectile dysfunction, priapism, rhinitis, rash and allergy, galactorrhoea, gynaecomastia, menstrual disorders, extrapyramidal symptoms (rarely). weight gain, oedema, tardive dyskinesia.
Potentially Fatal: Neuroleptic malignant syndrome may occur rarely; seizures. May cause increased mortality in elderly with dementia-related psychosis.
Overdose Reactions
May lead to tachycardia, hypotension and extrapyramidal symptoms. In cases of acute overdosage, maintain airway and ensure sufficient oxygenation and ventilation. Gastric lavage and admin of activated charcoal with a laxative may be considered. Monitor ECG and CV status.
Drug Interactions
May antagonise the effects of levodopa and dopamine agonists. May increase serum levels of clozapine when used together. Increased serum levels of carbamazepine when used concurrently. Carbamazepine may also decrease the serum levels of risperidone. Increased risk of neuroleptic malignant syndrome when used with indinavir and ritonavir.
Potentially Fatal: Risperidone may enhance the hypotensive effect of certain antihypertensives.
See Below for More risperidone Drug Interactions
Mechanism of Actions
Risperidone is an atypical antipsychotic. Its activity is mediated through a combination of dopamine (D2) and serotonin (5-HT2) receptor antagonism. It also exhibits affinity to adrenergic (α1 and α2) and histamine (H1) receptors. It is less likely to cause extrapyramidal effects than conventional antipsychotics.
Absorption: Readily absorbed from the GI tract (oral); peak plasma concentrations after 1-2 hr.
Distribution: Protein-binding: 90% (risperidone), 70% (9-hydroxyrisperidone).
Metabolism: Extensively hepatic by hydroxylation.
Excretion: Mainly in the urine and, to a lesser extent in the faeces.
Administration
May be taken with or without food.
Storage Conditions
Oral: Store at 15-25°C.
ATC Classification
N05AX08 - risperidone ; Belongs to the class of other antipsychotics.
Storage
Oral: Store at 15-25°C.
Available As
  • Risperidone 0.5 mg
  • Risperidone 1 mg
  • Risperidone 10 mg
  • Risperidone 2 mg
  • Risperidone 2.0 mg
  • Risperidone 3 mg
  • Risperidone 4 mg
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