Risperidone (Risperdal)


Clinical Information


HALF-LIFE: 20 hours

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


TARGET DOSING RANGE: 4mg-6mg per day



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


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