Class: Benzisoxazole, Antipsychotic
Dosage Forms. Tablet: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg; Tablet, Dispersible: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg; Solution: 1 mg/mL
Common FDA Label Indication, Dosing, and Titration.
1. Autistic disorder, irritability: Children weighing <20 kg, 0.25 mg po daily, titrate to response; Children weighing >20 kg, 0.5 mg po daily, titrate to response
2. Bipolar disorder: Adults, 2-3 mg po daily; may titrate to 6 mg/d; Children 10 y and older, 0.5 mg po daily, may titrate to 2.5 mg/d
3. Schizophrenia: Adults, 1 mg po bid; may titrate to 18 mg/d; Children 13 y and older, 0.5 mg po daily, may titrate to 3 mg/d
1. Agitation, acute psychotic disorder: 3 mg po once
MOA. Risperidone is a potent serotonin-5-HT2 antagonist with dopamine-D2 antagonism. Whereas typical antipsychotics are dopamine antagonists, the additional serotonin antagonism increases efficacy for negative symptoms of schizophrenia and reduces the likelihood of extrapyramidal symptoms.
Drug Characteristics: Risperidone
Medication Safety Issues: Risperidone
Drug Interactions: Risperidone
Adverse Reactions: Risperidone
Efficacy Monitoring Parameters. Improvement in signs and symptoms of schizophrenia, manic or mixed episodes associated with bipolar disorder, depression.
Toxicity Monitoring Parameters. BP, FPG and CBC, eye examination at baseline and periodically during therapy; patients at high-risk for suicide should be closely supervised.
Key Patient Counseling Points. Take with food but avoid alcohol. Avoid activities requiring mental alertness or coordination. Use caution with activities leading to an increased core temperature. Rise slowly from a sitting/supine position. Report signs/symptoms of hyperglycemia, bradycardia, arrhythmia, tardive dyskinesia, or neuroleptic malignant syndrome. Keep dispersible tablet in blister pack until use. Place on tongue and swallow after dissolved. Oral solution may be mixed with water, coffee, orange juice, or low fat milk, but should not be mixed with cola or tea.
Clinical Pearls. Elderly patients with dementia-related psychosis taking risperidone are at an increased risk of death compared to placebo.