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Medication Written by Pharmacists Reviewed by Doctors

Pharmacy Author: Annette O. Gbemudu PharmD, MBA
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: risperidone

BRAND NAME: Risperdal

DRUG CLASS AND MECHANISM: Risperidone is an atypical antipsychotic drug that is used for treating schizophrenia, bipolar mania and autism. Other atypical antipsychotic drugs include Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon), Aripiprazole (Abilify) and paliperidone (Invega). Atypical antipsychotics differ from typical antipsychotics due to the lesser degree of extrapyramidal (movement) side effects and constipation.

The exact mechanism of action of risperidone is not known, but, like other anti-psychotics, it is believed that risperidone affects the way the brain works by interfering with communication among the brain's nerves. Nerves communicate with each other by making and releasing chemicals called neurotransmitters. The neurotransmitters travel to other nearby nerves where they attach to receptors on the nerves. The attachment of the neurotransmitters either stimulates or inhibits the function of the nearby nerves. Risperidone blocks several of the receptors on nerves including dopamine type 2, serotonin type 2, and alpha 2 adrenergic receptors. It is believed that many psychotic illnesses are caused by abnormal communication among nerves in the brain and that by altering communication through neurotransmitters, risperidone can alter the psychotic state. Risperidone was approved by the FDA in December, 1993.

PRESCRIPTION: Yes.

GENERIC AVAILABLE: Yes.

PREPARATIONS: Tablets: 0.25, 0.5, 1, 2, 3, and 4mg. Oral solution: 1 mg/mL. Orally disintegrating tablets: 0.5, 1, 2, 3, and 4 mg.

STORAGE: Tablets should be kept at room temperature, 15-25 C (59-77 F).

PRESCRIBED FOR: Risperidone is used to treat schizophrenia, bipolar mania [as a sole therapy or combination therapy with lithium (Eskalith, Lithobid) or valproate (Depakene, Depacon) and for the treatment of irritability associated with autistic disorder in children and adolescents. Clinical studies involving small numbers of patients have shown some benefit in using risperidone for stuttering and Tourette syndrome (non FDA-approved uses). Another non-FDA approved use of risperidone is for obsessive-compulsive disorders.

DOSING: Risperidone can be administered once or twice daily. Initial dosing is generally 2 mg/day. Dose increases can occur in increments of 1-2 mg/day, as tolerated, to a recommended dose of 4-8 mg/day. In children, risperidone should be initiated at 0.5 mg once daily, and can be increased in increments of 0.5 or 1 mg/day, as tolerated, to a recommended dose of 2.5 mg/day. Risperidone can be given with or without meals.

DRUG INTERACTIONS: Risperidone may interfere with elimination by the kidneys of clozapine (Clozaril), a different type of antipsychotic medication, causing increased levels of clozapine in the blood. This could increase the risk of side effects with clozapine.

Serotonin reuptake inhibitors such as paroxetine (Paxil), Sertraline (Zoloft), and fluoxetine (Prozac) when taken with risperidone causes the metabolism (breakdown) of risperidone by the liver to be inhibited, which in turn causes elevated blood levels of risperidone, and may increase the risk of adverse reactions.

Antifungal drugs such as fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral) when taken with risperidone cause the metabolism (breakdown) of risperidone by the liver to be inhibited, which in turn causes elevated blood levels and may increase the risk of adverse reactions.

PREGNANCY: There are no adequate studies of risperidone in pregnant women. Some unwanted effects have been reported in animal studies. Risperidone can be used in pregnancy if the physician feels that the benefits outweigh the potential but unknown risks.

NURSING MOTHERS: Risperidone is excreted in human breast milk. Women receiving risperidone should not breastfeed.

SIDE EFFECTS: The most commonly-noted side effects associated with risperidone are extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes), dizziness, hyperactivity, tiredness, abdominal pain, fatigue, fever and nausea. Risperidone may cause a condition called orthostatic hypotension during the early phase of treatment (the first week or two). Patients who develop orthostatic hypotension have a drop in their blood pressure when they rise from a lying position and may become dizzy or even lose consciousness.

Studies involving risperidone suggest an increased risk of hyperglycemia-related adverse reactions as seen in diabetes. Although there is no clear link between risperidone and diabetes, patients should be tested during treatment for elevated blood sugars. Additionally, persons with risk factors for diabetes, including obesity or a family history of diabetes, should have their fasting levels of blood sugar tested before starting treatment and periodically throughout treatment to detect the onset of diabetes. Any patient developing symptoms that suggest diabetes during treatment should be tested for diabetes.


Last Editorial Review: 3/27/2009




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  • Schizophrenia - Get information on schizophrenia symptoms (delusions, hallucinations), causes (genetics), diagnosis, treatment of schizophrenics (antipsychotic drugs) and types (paranoid).
  • Bipolar Disorder (Mania) - Read about bipolar disorder (BD or manic-depressive illness), a brain disorder that causes dramatic mood swings (highs and lows) and affects a person's energy levels and ability to function. These highs and lows are episodes of mania and depression. The mania symptoms of manic depression include increased energy, extreme irritability, spending sprees, and increased sex drive. Depression symptoms include feelings of hopelessness and worthlessness, decreased energy, thoughts of death or suicide, and chronic pain. Long-term preventive treatment combining medication and psychosocial treatment is recommended.
  • Obsessive Compulsive Disorder (OCD) - Obsessive compulsive disorder (OCD) is an anxiety disorder that causes a person to suffer repeated obsessions and compulsions. Learn symptoms, diagnosis and treatment.

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