Risperidone (Risperdal)

Risperidone brand names

Risperidone is the generic name for the drug, and it is also known as the brand name Risperdal ^[3]

What is Risperidone prescribed for?

In the United States, oral risperidone is approved for schizophrenia in adults and adolescents aged 13–17, acute manic or mixed episodes of bipolar I disorder in adults and children aged 10–17, and irritability associated with autistic disorder in children aged 5–17^[2].

Clinicians may prescribe risperidone for other uses. Ask your prescriber why it is recommended and what benefits and risks apply to you^[3].

How does Risperidone work?

Risperidone affects brain chemicals, including dopamine and serotonin, to help control symptoms. It does not cure the underlying condition^[4].

How is Risperidone usually taken?

Risperidone can be taken orally, by tablet, in oral solution, or as dissolvable tablets with or without food. It is also available in a long-acting injection form. It is always important to follow your health provider's directions regarding how to take risperidone. Risperidone dissolvable tables should not be cut or chewed^{[2] [3]}.

Your healthcare provider will determine the form of risperidone and the best dose for you based on your health condition, symptoms, symptom severity, health history, and age^[2]. Drug dosing varies based on age, the status of the disorder (first-time episode or maintenance therapy), and the type of disorder.

Schizophrenia dosing

Adults 65 and younger

The usual adult starting dose for schizophrenia is 2 mg daily. The prescriber adjusts it according to response and side effects; the labeled target is 4–8 mg daily. Higher doses are not necessarily more effective and can increase adverse effects^[1].

Adults 65 and older

Older adults usually start at 0.5 mg twice daily. The prescriber may increase this slowly to 1–2 mg twice daily according to response^[5].

Children 13 to 17 years of age

Dosing starts with 0.5 mg taken orally once daily, either in the morning or at night. Your physician may adjust the dose as needed, but the maximum dose is 6 mg or less daily^[2].

Acute manic/mixed bipolar disorder

Adults 65 and younger

Dosing ranges from 1 to 6 mg daily and typically starts with 2 to 3 mg taken each day orally. Your physician may adjust the dose as needed, but the maximum dose is 6 mg or less daily^[2].

Adults 65 and older

Older adults usually start at 0.5 mg twice daily. The prescriber may increase this slowly to 1–2 mg twice daily according to response^[5].

Children 10 to 17 years of age

Dosing starts with 0.5 mg taken orally once daily, either in the morning or at night. Your physician may adjust the dose as needed, but the maximum dose is 6 mg or less daily^[2].

How long does Risperidone stay in your system?

How long risperidone acts depends on the formulation and individual factors. Long-acting injections release medicine for weeks. Ask your prescriber about the product you use; do not change your dosing schedule based on an estimated clearance time^[5].

Risperidone side effects

Medications offer many benefits to improve symptoms of disorders, but side effects are possible. Drugs can affect different people differently, but often the benefits outweigh the possibility of adverse effects, so it is important to discuss options with your physician. Risperidone can cause a range of mild to severe physical and mental side effects. The most common side effects are ^{[2] [3]}:

• Drowsiness, sleepiness, or fatigue
• Increased appetite, weight gain
• Indigestion or heartburn
• Nausea or vomiting
• Rhinitis (inflammation in the inside lining of your nose)
• Dry mouth or coughing
• Increased saliva
• Upper respiratory tract infection
• Urinary incontinence
• Constipation
• Heart palpitations
• Fever or rash
• Abdominal pain
• Anxiety, agitation, or restlessness,
• Dizziness or tremors (involuntary shaking, like hands)
• Conjunctivitis
• Pain in extremities or body
• Vision changes, such as blurry vision
• Sexual problems ^{[2] [3]}:

You may experience one or more of these milder symptoms for a short time after starting risperidone, but after some time, when your body adjusts, they may go away. If symptoms worsen or persist, talk to your physician.

Older adults with dementia-related psychosis have an increased risk of death when treated with antipsychotic medicines. Risperidone is not approved for this use. Serious side effects can occur, and your prescriber should discuss your individual risks^[1].

Severe side effects

• Cerebrovascular events: Stroke and transient ischemic attack have been reported in older adults with dementia-related psychosis^[2].
• Seizures ^[1]
• Metabolic changes may increase cardiovascular/cerebrovascular risk – hyperglycemia, dyslipidemia, and weight gain.
• Hormonal imbalances: Risperidone may cause hormonal imbalances that can lead to an increase in breast tissue (gynecomastia) ^[1]
• Extrapyramidal symptoms (EPS): EPS can happen when starting a treatment or when dosing is changed^[2].
• Acute dystonia: muscle spasms that cause unusual postures, typically of the head and neck^[2].
• Akathisia: Feeling restless, pacing^[2].
• Tardive dyskinesia (TD): Involuntary movements that may persist. In some people symptoms improve after treatment changes^[2].
• Parkinsonian features: Symptoms vary after the medication is stopped. Muscle rigidity, tremors, shuffling gait, and bradykinesia^[2].
• Neuroleptic malignant syndrome (NMS): is a life-threatening condition that can cause an altered mental status, fever, "lead pipe" rigidity ^[2], autonomic instability, hypertension, tachypnea, and tachycardia^[2].

Risperidone precautions

Tell your prescriber about your medical conditions, pregnancy or breastfeeding, and all medicines before taking risperidone^[3].

• Pregnancy, plans for pregnancy, or breastfeeding
• Females and males who plan to have children
• Children or elderly adults
• Kidney or liver impairment
• Parkinson's disease Lewy Body Dementia
• Low blood pressure (hypotension)
• Tardive dyskinesia
• If you have leukopenia (low white blood cell count) or have a family history of leukopenia.
• Trouble swallowing (dysphagia)
• Problems regulating body temperature
• If you have suicidal thoughts or behaviors.
• Metabolic or hemodynamic conditions ^{[2] [3]}

Neuroleptic Malignant Syndrome (NMS) is a life-threatening reaction to dopamine-antagonist antipsychotic drugs^[1]. If you or someone taking risperidone shows any of the following symptoms, seek emergency help immediately.

• Fever
• Severe muscle stiffness
• Confusion
• Heavy sweating
• Fast or irregular heartbeat^{[1] [3]}

Risperidone interactions

Certain medications taken with risperidone may increase the risk of more severe side effects. Be sure to talk to your doctor about any prescriptions or over-the-counter medicines you are taking. Do not take risperidone if you are allergic to it or paliperidone (a metabolite of risperidone)^[2]. Avoid alcohol while taking risperidone^[1]. Risperidone can interact with other medications.

If you take any of the following medications, talk to your healthcare provider before starting risperidone (This is not a complete list, there are others):

• Other medicines that act on the brain, and alcohol, can increase sedating effects. Ask your prescriber before combining them^[1].
• Levodopa and dopamine agonists: Risperidone may reduce the effects of these medicines^[1].
• Fluoxetine and paroxetine can increase risperidone exposure; your prescriber may adjust the dose^[1].
• Blood-pressure medicines may increase the risk of low blood pressure^[1].
• Methylphenidate: Taking it with risperidone, especially when either dose changes, may increase the risk of abnormal movements^[1].
• Clozapine may slow the clearance of risperidone^[1].
• Carbamazepine and other enzyme inducers can lower risperidone levels. Your prescriber may need to adjust treatment^[1].

Risperidone storage

Keep risperidone in its original, tightly closed container, away from children. Store at room temperature, away from excess heat and moisture; do not freeze the oral solution^[3].

Prescription medications should not be shared or given to someone else. Failure to keep drugs away from children and others can cause severe health problems and may be fatal. It is illegal to share or sell medication with others.

You should not flush unused medication or throw it in the trash. You can check with your local pharmacy or health provider's office about how to safely dispose of unused medicines or for information on drug-take-back programs.

Subject matter expert

Leila Khurshid, Pharm.D.

Clinical pharmacy and medication

What to do if you overdose on Risperidone

Deliberate or accidental overdose of risperidone can increase the side effects that you experience and cause more serious side effects of the medication. Symptoms of overdose include ^{[1][2] [3]}:

• Drowsiness or sedation
• Rapid heartbeat
• Low blood pressure
• Abnormal movements
• Seizures^[2]

If you accidentally took too much of your medication, contact your healthcare provider or the poison control center (800-222-1222) for additional information. If someone has collapsed, is unconscious, has a seizure, or has problems breathing after taking risperidone, immediately call 911 for emergency services. Delaying treatment of severe symptoms can cause long-term damage or even death.

Frequently asked questions about risperidone

Does risperidone calm you down?

Some people feel calmer and think more clearly as symptoms improve. Risperidone can also cause sleepiness. Its effects and the time needed to benefit vary^[4].

Can you take Risperdal for life?

Some people take risperidone long term to control symptoms. Your prescriber should review its benefits and side effects. Do not stop it without discussing a plan with your prescriber^[4].

Is risperidone good for anxiety?

Risperidone is not FDA-approved specifically for anxiety disorders. If it is prescribed for anxiety symptoms, ask your clinician about the reason, expected benefit, and alternatives^{[2] [3]}.