Haldol (haloperidol) vs. Risperdal (risperidone): What's the difference?

What is haloperidol? What is Risperdal?

Haloperidol is an antipsychotic medication used to treat schizophrenia, acute psychosis, and tics and vocal utterances of Tourette's syndrome. Haloperidol interferes with the effects of neurotransmitters in the brain by blocking receptors for the neurotransmitters (specifically, dopamine and serotonin type 2 receptors) on the nerves. As a result, the nerves are not "activated" by the neurotransmitters released by other nerves.

Risperdal (risperidone) is an atypical antipsychotic used to treat schizophrenia, bipolar mania, and autism. Atypical antipsychotics differ from typical antipsychotics because they cause a lesser degree of movement (extrapyramidal) side effects and constipation. The mechanism of action of Risperdal is unknown, but like other anti-psychotics, it is believed to affect 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 that 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. Risperdal blocks several of the receptors on nerves including dopamine type 2, serotonin type 2, and alpha 2 adrenergic receptors. Many psychotic illnesses are believed to be caused by abnormal communication among nerves in the brain and by altering communication through neurotransmitters, Risperdal can alter the psychotic state.

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What are the side effects for haloperidol and Risperdal?

Haloperidol

The most common side effects associated with Haldol are:

  • extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes, muscle stiffness, akathisia, Parkinsonism),
  • dizziness,
  • hyperactivity,
  • tiredness, and
  • nausea.

Other important side effects are:

Haldol may cause a condition called "orthostatic hypotension" during the early phase of treatment (first week or two). Orthostatic hypotension causes patients to become dizzy upon arising from a lying or sitting position because of a drop in blood pressure.

Haldol also may cause abnormal heart beats, sudden death, seizures, decreases in red and white blood cells, and withdrawal symptoms.

Elderly patients with dementia-related psychosis and treated with antipsychotic drugs such as Haldol are at an increased risk of death.

Risperdal

The most commonly-noted side effects associated with risperidone are:

Another important side effect which may also occur include extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes) also occur. 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 people with 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.

What is the dosage for haloperidol vs. Risperdal?

Haloperidol

  • The recommended oral dose for schizophrenia is 0.5-5 mg two or three times daily up to a maximum dose of 30 mg daily. The lactate solution dose is 2-5 mg every 4-8 hours as needed by intramuscular injection. The lactate solution may also be administered by intravenous injection at 1-2 mg every 2-4 hours and titrated to effect. The maximum single injection dose is 50 mg and the maximum daily dose is 500 mg daily. The dose for the decanoate solution is 10-20 times the daily oral dose once monthly by intramuscular injection. The decanoate solution should not be administered intravenously.
  • The recommended dose for treating Tourette's syndrome is 0.5-5 mg orally two or three times daily.

Risperdal

Risperidone can be administered once or twice daily. Initial oral dosing for treating schizophrenia 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 older than 13 years of age, 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.

The recommended dose of Risperdal Consta is 12.5 to 25 mg injected into the deltoid or gluteal muscle every two weeks. Dosage should not be adjusted more frequently than every 4 weeks. Patients who have never received risperidone are started on oral risperidone in order to evaluate tolerability. Patients then may be transitioned to Risperdal Consta if oral risperidone is tolerated.

Bipolar mania is treated with oral doses of 2-3 mg/day initially. Dose may be increased by 1 mg/day at every 24 hours up to a dose of 6 mg/day. The dose of Risperdal Consta for bipolar mania is 12.5 to 25 mg injected into the deltoid or gluteal muscle every two weeks. Dosage should not be adjusted more frequently than every 4 weeks.

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What is the dosage for haloperidol vs. Risperdal?

Haloperidol

  • The recommended oral dose for schizophrenia is 0.5-5 mg two or three times daily up to a maximum dose of 30 mg daily. The lactate solution dose is 2-5 mg every 4-8 hours as needed by intramuscular injection. The lactate solution may also be administered by intravenous injection at 1-2 mg every 2-4 hours and titrated to effect. The maximum single injection dose is 50 mg and the maximum daily dose is 500 mg daily. The dose for the decanoate solution is 10-20 times the daily oral dose once monthly by intramuscular injection. The decanoate solution should not be administered intravenously.
  • The recommended dose for treating Tourette's syndrome is 0.5-5 mg orally two or three times daily.

Risperdal

Risperidone can be administered once or twice daily. Initial oral dosing for treating schizophrenia 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 older than 13 years of age, 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.
The recommended dose of Risperdal Consta is 12.5 to 25 mg injected into the deltoid or gluteal muscle every two weeks. Dosage should not be adjusted more frequently than every 4 weeks. Patients who have never received risperidone are started on oral risperidone in order to evaluate tolerability. Patients then may be transitioned to Risperdal Consta if oral risperidone is tolerated.

Bipolar mania is treated with oral doses of 2-3 mg/day initially. Dose may be increased by 1 mg/day at every 24 hours up to a dose of 6 mg/day. The dose of Risperdal Consta for bipolar mania is 12.5 to 25 mg injected into the deltoid or gluteal muscle every two weeks. Dosage should not be adjusted more frequently than every 4 weeks.

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What drugs interact with haloperidol and Risperdal?

Haloperidol

Haldol causes sedation, and sedation may be greater if Haldol is taken with alcohol and other drugs that can cause sedation such as the benzodiazepine class of anti-anxiety drugs for example:

The narcotic class of pain medications and its derivatives for example:

The tricyclic class of antidepressants for example:

Some antihistamines for example:

Certain antihypertensive medications for example:

Carbamazepine (Tegretol) may increase the elimination of Haldol, rendering the Haldol less effective. Rifampin (Rifadin) may decrease the elimination of Haldol, increasing the risk of side effects from Haldol.

Risperdal

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 from 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 from risperidone. Antifungal drugs such as fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral) when taken with risperidone also 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 from risperidone.

Are haloperidol and Risperdal safe to use while pregnant or breastfeeding?

Haloperidol

  • Neonates exposed to antipsychotics during the 3rd trimester of pregnancy may develop withdrawal symptoms and extrapyramidal symptoms.
  • Haldol is secreted into breast milk. It should not be used while breast feeding.

Risperdal

  • 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.
  • Risperidone is excreted in human breast milk. Women receiving risperidone should not breastfeed.

Summary

Haldol (haloperidol) and Risperdal (risperidone) are different types of antipsychotic medications used to treat schizophrenia. Haloperidol is also used to treat acute psychosis and for tics and vocal utterances of Tourette's syndrome. Risperidone is also used to treat bipolar mania and autism.

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Medically Reviewed on 8/1/2019
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