GENERIC NAME: risperidone

BRAND NAME: Risperdal

DRUG CLASS AND MECHANISM: Risperidone is an antipsychotic medication that works by interfering with the communication among nerves in the brain. The nerves communicate with one another by producing and releasing chemicals called neurotransmitters. The neurotransmitters attach to receptors on other nearby nerves, and the attachment of the neurotransmitter causes changes in the cells that have the receptor on them. Risperidone blocks several of the receptors on nerves including dopamine type 2, serotonin type 2, and alpha 2 adrenergic receptors and this blocks communication among nerves. Risperidone is a relatively new antipsychotic medication that probably has fewer side effects than many of the older medications.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Tablets of 1, 2, 3, and 4 mg.

STORAGE: Tablets should be kept at room temperature, 15-30°C (59-86°F).

PRESCRIBED FOR: Risperidone is used for the treatment of psychotic disorders, for example, schizophrenia. It also is used in combination with lithium or valproate for the treatment of acute manic or mixed episodes associated with bipolar I disorder.

DOSING: Risperidone usually is begun as two small doses each day. The doses often are increased every few days or each week until the optimal dose is found. Patients who are elderly or have kidney disease may need lower doses since the kidneys, which are partially responsible for removing risperidone from the blood, remove risperidone more slowly, and this can lead to toxic levels of risperidone in the blood. Similarly, patients with liver disease may need lower doses since the liver also is partially responsible for removing risperidone.

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.

PREGNANCY: There are no adequate studies of risperidone in pregnant women. Some studies in animals suggest no important effects on the fetus, whereas others suggest an ill-effect. Risperidone can be used in pregnancy if the physician feels that the benefits outweigh the potential but unknown risks.

NURSING MOTHERS: It is not known if risperidone is secreted in breast milk.

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, 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.

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: 12/31/1997

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