Risperidone (Risperdal)

Contents

Clinical Information

 

HALF-LIFE: 20 hours

METABOLISM: Liver (Primarily via CYP2D6); has active metabolites

STARTING DOSE: 0.5mg-1mg PO BID

TARGET DOSING RANGE: 4mg-6mg per day

BEST TIME TO DOSE: Bedtime

HOW TO DOSE:

Children 33-44 lbs: 0.25mg PO daily for 4-7 days. Increase to 0.5mg per day for additional 2 weeks. Increase dose by 0.25mg/day every 2-4 weeks

Children >44lbs: 0.5mg PO daily for 4-7 days. Increase to 1mg per day for additional 2 weeks. Increase dose by 0.5mg/day every 2-4 weeks.

Adults: Initial 0.5mg-1mg PO BID. Increase by 0.5mg-1mg per day every 2-7 days until response (maximum dose 6mg/day)

PREGNANCY: Minimal data on safety

BREASTFEEDING: Minimal data on safety

Side Effects

Sedation, dizziness, dry mouth, nausea, upset stomach, metabolic side effects (insulin resistance), weight gain, increased appetite, elevated prolactin levels (menstrual irregularities, sexual dysfunction, breast tenderness, headaches, galactorrhea), orthostatic hypotension, movement disorders, seizures (rare), Neuroleptic Malignant Syndrome (Rare), Arrhythmias (rare), extrapyramidal symptoms (parkinsonism, dystonia), akathisia/restlessness

FDA Indications

  1. Schizophrenia, 13yo and older
  2. Bipolar disorder (manic/mixed), 10yo and older
  3. Irritability symptoms of autism spectrum disorders, 5yo and older

Mechanism(s) of Action

  • Dopamine 2 (D2) Receptor Antagonist, Dopamine 1 (D1) Receptor Antagonist, 5HT2 Receptor Antagonist, 5HT1 Receptor Antagonist, alpha-1 receptor antagonist, alpha-2 receptor antagonist, H1 receptor antagonist

Additional Information

  • Risperidone acts as an atypical antipsychotic at lower doses but becomes more typical at higher doses (>6mg/day)
  • High risk for EPS and prolactin elevation
  • Little additional benefit with doses >6mg/day
  • Long term depot (consta given every 2 weeks)
  • Oral disintegrating tablet (M-tab) and Liquid available

References:

  1. Cooper, J. R., Bloom, F. E., & Roth, R. H. (2003). The biochemical basis of neuropharmacology (8th ed.). New York, NY, US: Oxford University Press.
  2. Iversen, L. L., Iversen, S. D., Bloom, F. E., & Roth, R. H. (2009). Introduction to neuropsychopharmacology. Oxford: Oxford University Press.
  3. Puzantian, T., & Carlat, D. J. (2016). Medication fact book: for psychiatric practice. Newburyport, MA: Carlat Publishing, LLC.
  4. J. Ferrando, J. L. Levenson, & J. A. Owen (Eds.), Clinical manual of psychopharmacology in the medically ill(pp. 3-38). Arlington, VA, US: American Psychiatric Publishing, Inc.
  5. Schatzberg, A. F., & DeBattista, C. (2015). Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing.
  6. Schatzberg, A. F., & Nemeroff, C. B. (2017). The American Psychiatric Association Publishing textbook of psychopharmacology. Arlington, VA: American Psychiatric Association Publishing.
  7. Stahl, S. M. (2014). Stahl’s essential psychopharmacology: Prescriber’s guide (5th ed.). New York, NY, US: Cambridge University Press.
  8. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY, US: Cambridge University Press.
  9. Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincotts illustrated reviews: pharmacology. Philadelphia, PA: Wolters Kluwer.