Risperidone (Risperdal)

 HALF-LIFE: 20 hours
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
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

ADDITIONAL INFORMATION

  • Atypical at lower doses
  • Becomes more typical at high 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
  • Moderate risk for weight gain and dyslipidemia

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.

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