Risperidone

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

See Also

• Antipsychotics
• Antipsychotic toxicity