Risperidone: Difference between revisions

Latest revision as of 04:10, 7 March 2021

Administration

Type: Atypical antipsychotic
Dosage Forms: 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg; 1mg/mL
Routes of Administration: Oral, IM
Common Trade Names: Risperdal

Adult Dosing

Schizophrenia

<65 yo, 1st episode
- 1-3 mg/day PO divided qd/bid
  - Max: 16mg/day
<65 yo, maintenance
- 1-4 mg/day PO divided qd/bid
65+ yo
- 1-4 mg/day PO divided qd/bid
  - Doses >4 mg/day rarely more effective

Bipolar disorder, Type 1, Acute manic

1-6 mg/day PO divided qd/bid
- Max: 6 mg/day

Tourette Syndrome

0.25-3 mg/day PO divided qd-bid
- Max 6 mg/day

Pediatric Dosing

Pediatric procedural sedation

0.01mg/kg/dose IM (typically 0.25-4mg/dose)

Schizophrenia

1-6 mg/day PO divided qd/bid

Bipolar disorder, Type 1, Acute mania

0.5-6mg/day PO divided qd/bid

Irritability, Autistic disorder associated

0.5-3 mg/day PO divided qd/bid

Tourrette syndrome

0.75-3 mg/day PO divided qd/bid

Special Populations

Pregnancy Rating: C
Lactation risk: Infant risk cannot be ruled out
Renal:
- Adult:
  - CrCl <30: Start 0.5 mg BID then increase by 0.5mg BID weekly
  - HD: Not defined
- Pediatric:
  - Not defined, see adult dosing.
Hepatic:
- Adult:
  - Child-Pugh Class C: Start 0.5 mg BID and increase by 0.5mg BID weekly
- Pediatric:
  - Not defined, see adult dosing.

Contraindications

Allergy to class/drug
Caution:
- Pediatric/adolescent pts
- Pregnancy 3rd trimester
- Elderly pts
- Dementia-related psychosis
- Renal impairment
- Hepatic impairment
- Parkinson's Disease
- Neuroleptic malignant syndrome history
- Seizure history
- Cardiovascular disease
- Diabetes mellitus
- Suicide risk

Adverse Reactions

Serious

Hypotension, syncope
Extrapyramidal symptoms: tardive dyskinesia
Neuroleptic malignant syndrome, hyperthermia
Hyperglycemia, diabetes mellitus, DKA
Seizure, Priapism, Stroke, TIA
Dysphagia
Leukopenia, Neutropenia, Agranulocytosis
Suicidality
Pancreatitis

Common

Akathisia, dystonia, parkinsonism, tremor
Sedation/fatigue, dizziness, blurred vision, anxiety, confusion
Rash
Hyperprolactinemia, weight gain, increased appetite
Constipation, diarrhea, nausea/vomiting
Urinary incontinence
Cough, URI
Photosensitivity, visual disturbance

Pharmacology

Half-life: 20h (PO); 3-6 day (IM)
Metabolism: Hepatic, CYP2D6
Excretion: Urine 70%, Feces 14%

Mechanism of Action

Unknown
5HT-2 inhibitor, weaker D2 inhibitor

Comments

References

Authors:

@@ Line 1: / Line 1: @@
 ==Administration==
-*Type: Atypical antipsychotic
+*Type: Atypical [[antipsychotic]]
-*Dosage Forms:
+*Dosage Forms: 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg; 1mg/mL
 *Routes of Administration: Oral, IM
 *Common Trade Names: Risperdal
 ==Adult Dosing==
-*2-6mg PO daily
+===[[Schizophrenia]]===
-*25-50mg IM
+*<65 yo, 1st episode
+**1-3 mg/day PO divided qd/bid
+***Max: 16mg/day
+*<65 yo, maintenance
+**1-4 mg/day PO divided qd/bid
+*65+ yo
+**1-4 mg/day PO divided qd/bid
+***Doses >4 mg/day rarely more effective
+===[[Bipolar disorder]], Type 1, Acute manic===
+*1-6 mg/day PO divided qd/bid
+**Max: 6 mg/day
+===Tourette Syndrome===
+*0.25-3 mg/day PO divided qd-bid
+**Max 6 mg/day
 ==Pediatric Dosing==
-*Pediatric procedural sedation: 0.01mg/kg/dose IM (typically 0.25-4mg/dose)
+===Pediatric procedural sedation===
+*0.01mg/kg/dose IM (typically 0.25-4mg/dose)
+===[[Schizophrenia]]===
+*1-6 mg/day PO divided qd/bid
+===[[Bipolar disorder]], Type 1, Acute mania===
+*0.5-6mg/day PO divided qd/bid
+===Irritability, Autistic disorder associated===
+*0.5-3 mg/day PO divided qd/bid
+===Tourrette syndrome===
+*0.75-3 mg/day PO divided qd/bid
 ==Special Populations==
 *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
 *[[Lactation risk categories|Lactation risk]]: Infant risk cannot be ruled out
-*Renal: severe impairment, 0.5mg twice daily, titrate slowly
+*Renal:
-*Hepatic: lower initial dose
+**Adult:
+***CrCl <30: Start 0.5 mg BID then increase by 0.5mg BID weekly
+***HD: Not defined
+**Pediatric:
+***Not defined, see adult dosing.
+*Hepatic:
+**Adult:
+***Child-Pugh Class C: Start 0.5 mg BID and increase by 0.5mg BID weekly
+**Pediatric:
+***Not defined, see adult dosing.
 ==Contraindications==
 *Allergy to class/drug
+*Caution:
+**Pediatric/adolescent pts
+**Pregnancy 3rd trimester
+**Elderly pts
+**Dementia-related psychosis
+**Renal impairment
+**Hepatic impairment
+**Parkinson's Disease
+**[[Neuroleptic malignant syndrome]] history
+**Seizure history
+**Cardiovascular disease
+**[[Diabetes mellitus]]
+**Suicide risk
 ==Adverse Reactions==
 ===Serious===
-*Prolonged QT, sudden cardiac death, syncope
+*[[Hypotension]], [[syncope]]
-*DKA
+*Extrapyramidal symptoms: [[tardive dyskinesia]]
-*Pancreatitis
+*[[Neuroleptic malignant syndrome]], [[hyperthermia]]
-*Cytopenias, TTP
+*[[Hyperglycemia]], [[diabetes mellitus]], [[DKA]]
-*Stroke, seizure, tardive dyskinesia, priapism
+*[[Seizure]], [[Priapism]], [[Stroke]], [[TIA]]
-*Neuroleptic malignant syndrome
+*Dysphagia
+*[[Leukopenia]], [[Neutropenia]], [[Agranulocytosis]]
+*Suicidality
+*[[Pancreatitis]]
 ===Common===
-*Akasthisia, dystonia, parkinsonism
+*Akathisia, dystonia, parkinsonism, tremor
-*Sedation/fatigue, dizziness, blurred vision, anxiety
+*Sedation/[[fatigue]], [[dizziness]], blurred vision, [[anxiety]], confusion
-*Rash
+*[[Rash]]
 *Hyperprolactinemia, weight gain, increased appetite
-*Constipation, diarrea, nausea/vomiting
+*[[Constipation]], [[diarrhea]], [[nausea]]/[[vomiting]]
-*Cough, URI
+*Urinary incontinence
+*[[Cough]], URI
+*[[Photosensitivity]], visual disturbance
 ==Pharmacology==
-*Half-life:
+*Half-life: 20h (PO); 3-6 day (IM)
 *Metabolism: Hepatic, CYP2D6
-*Excretion:
+*Excretion: Urine 70%, Feces 14%
 ==Mechanism of Action==
@@ Line 47: / Line 98: @@
 ==See Also==
-[[Antipsychotics]]
+*[[Antipsychotics]]
+*[[Antipsychotic toxicity]]
 ==References==
 <references/>
 [[Category:Pharmacology]]
+[[Category:Psychiatry]]