# Risperdal ### (risperidone)
[**Full Prescribing Information**](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=095630bd-a77e-434e-94ee-f13da445d8f2&type=display)[**DailyMed Drug Information**](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=095630bd-a77e-434e-94ee-f13da445d8f2)
--- **Forms/Strengths** - **Tablets:** 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg - **ODT:** 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg --- ### **Dosing** - **Age:** Adults and pediatric patients (pediatric use approved for irritability in autism, typically ages 5–16 - **Considerations:** Start low (especially in pediatric patients); titrate gradually based on response and tolerability; monitor metabolic parameters and prolactin levels. - **Initial Dose:** - Adults (schizophrenia, bipolar disorder): 1–2 mg/day - Pediatrics (irritability): 0.25–0.5 mg/day - **Titration:** - Increase by 1 mg increments in adults - Increase by 0.25–0.5 mg increments in children - Adjust dosing every few days to weekly based on response and side effects - **Max Dose:** Approximately 6 mg/day in adults; pediatric maximum is weight dependent (often lower than adult maximum) --- ### **Quick Facts** - Atypical antipsychotic; blocks dopamine D2 and serotonin 5-HT2A receptors - Modulates neurotransmission; improves psychotic symptoms, mood, and reduces irritability - Available as oral tablets (including orally disintegrating options) - Common side effects: weight gain, sedation, extrapyramidal symptoms, hyperprolactinemia - Required bloodwork: baseline and periodic fasting glucose, lipid panel, and prolactin levels - Unique dual receptor mechanism provides broad therapeutic effects in psychotic and mood disorders --- ### **Indications** - **Irritability Associated with Autistic Disorder (ICD-10: F84.0):** Reduces aggression, self-injury, and tantrums. - **Schizophrenia (ICD-10: F20.x):** Reduces psychotic symptoms, such as delusions and hallucinations. - **Bipolar Disorder (ICD-10: F31.x):** Controls manic symptoms and helps stabilize mood. --- ### **Off-Label Uses** - **Generalized Anxiety Disorder (ICD-10: F41.1):** Sometimes used adjunctively in treatment-refractory cases. - **Post-Traumatic Stress Disorder (ICD-10: F43.10):** Occasionally employed off-label in patients not responding to first-line treatments. - **Borderline Personality Disorder (ICD-10: F60.3):** May help reduce impulsivity and emotional dysregulation. - **Tourette’s Disorder (ICD-10: F95.2):** Occasionally used off-label to reduce motor and vocal tics. --- ### **How to Take** - Take **once or twice daily**, as directed. - Can be taken **with or without food**. - **Swallow the tablet whole**; do not crush or chew. - If using the **orally disintegrating tablet (ODT)**, place it on the tongue and let it dissolve completely—do not chew. - If using the **oral solution**, measure with a provided dosing syringe or cup—do not mix with tea or cola. - **Do not abruptly stop** taking; tapering may be required to avoid withdrawal effects. --- ### **Side Effects** - Extrapyramidal symptoms (e.g., tremor, rigidity, akathisia) - Hyperprolactinemia (which may cause galactorrhea, menstrual disturbances) - Weight gain and metabolic abnormalities - Sedation and dizziness - Orthostatic hypotension - Potential risk for tardive dyskinesia with long-term use --- ### **Monitoring / Labs**

**Metabolic Monitoring:**

- - Baseline and periodic fasting glucose and lipid profile - Regular weight checks and assessment of body mass index (BMI)

**Prolactin Levels:**

- - Check baseline levels and monitor if symptoms suggest hyperprolactinemia (e.g., galactorrhea, menstrual irregularities) - **Neurological Monitoring:** - Regular assessment for extrapyramidal symptoms and tardive dyskinesia - Monitor blood pressure, particularly during dose adjustments - **Other Considerations:** - In elderly patients with dementia-related psychosis, close monitoring is necessary due to increased mortality risk (not applicable in pediatric use) - Routine laboratory monitoring should be individualized based on clinical status --- ### **Education** - **When to Call the Doctor:** - Severe **mood changes, aggression, or suicidal thoughts**. - Uncontrollable muscle movements (**tardive dyskinesia**). - Fever, muscle stiffness, confusion (**possible neuroleptic malignant syndrome**). - Sudden dizziness, fainting, or irregular heartbeats. - Signs of **high blood sugar** (excessive thirst, frequent urination, blurred vision). - **Safety Tips:** - **Monitor blood sugar levels**, especially in patients with diabetes. - Use caution in patients with **dementia-related psychosis**, as it may increase the risk of stroke. - Avoid **alcohol and sedatives**, which may increase drowsiness. - Rise slowly from sitting or lying positions to prevent dizziness. - **Weight gain and metabolic changes** may occur; monitor diet and physical activity. - **Parent Tips for Pediatric Patients:** - Monitor for **changes in mood, irritability, or aggression**. - Watch for **increased appetite and weight gain**; encourage balanced nutrition. - Observe for **sedation or drowsiness** affecting school performance. - Keep **regular follow-up appointments** to track effectiveness and side effects. - Report any **unusual movements or muscle stiffness** to the healthcare provider. --- ### **Additional Information** - **Contraindications:** - **Hypersensitivity** to risperidone or formulation components. - Use with caution in patients with **cardiovascular disease, seizure disorders, or history of stroke**. - **Pregnancy:** - **Category C**; use only if benefits outweigh risks. - May cause **withdrawal symptoms** in newborns if taken in the third trimester. - **Lactation:** - **Excreted in breast milk**; **not recommended** due to potential adverse effects on the infant. - **Drug Interactions:** - **CNS depressants** (e.g., alcohol, benzodiazepines) may increase sedation. - **Serotonergic drugs** (e.g., SSRIs, SNRIs, MAOIs) may increase the risk of **serotonin syndrome**. - **Antihypertensive medications** may increase the risk of **low blood pressure and dizziness**. - **CYP2D6 inhibitors** (e.g., fluoxetine, paroxetine) may increase risperidone levels, requiring dose adjustments.