Brand names:
- Risperdal®
- Tablet: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
- Orally disintegrating tablet: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
- Solution: 1 mg/ml
- Risperdal Consta®
- Extended-release injectable suspension: 12.5 mg, 25 mg, 37.5 mg, 50 mg
- Perseris®
- Extended-release injectable suspension: 90mg, 120 mg
Generic name: risperidone [ris PER i done]
All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.
What Is Risperidone And What Does It Treat?
Risperidone is a medication that works in the brain to treat schizophrenia. It is also known as a second generation antipsychotic [SGA] or atypical antipsychotic. Risperidone rebalances dopamine and serotonin to improve thinking, mood, and behavior.
Symptoms of schizophrenia include:
- Hallucinations — imagined voices or images that seem real
- Delusions — beliefs that are not true [e.g., other people are reading your thoughts]
- Disorganized thinking or trouble organizing your thoughts and making sense
- Little desire to be around other people
- Trouble speaking clearly
- Lack of motivation
Risperidone may help some or all of these symptoms.
Risperidone is also FDA approved for the following indications:
- Acute treatment of manic or mixed episodes of bipolar disorder
- Maintenance [long-term] treatment of bipolar disorder
- Irritability associated with autistic disorders
This medication sheet will focus primarily on schizophrenia. Find more information about bipolar disorder and autism spectrum disorders here.
Risperidone may also be helpful when prescribed “off-label” for adjunctive treatment of major depression disorder [risperidone is used in addition to an antidepressant], delusional parasitosis, post-traumatic stress disorder [PTSD], Tourette syndrome, and other mental health conditions. “Off-label” means that it has not been approved by the Food and Drug Administration for this condition. Your mental health provider should justify his or her thinking in recommending an “off-label” treatment. They should be clear about the limits of the research around that medication and if there are any other options.
What Is The Most Important Information I Should Know About Risperidone?
Schizophrenia requires long-term treatment. Do not stop taking risperidone, even when you feel better.
With input from you, your health care provider will assess how long you will need to take the medicine.
Missing doses of risperidone may increase your risk for a relapse in your symptoms.
Do not stop taking risperidone or change your dose without talking to with your healthcare provider first.
For risperidone to work properly, the tablet form should be taken every day as ordered by your healthcare provider. One of the long-acting injectable forms, known as Risperdal Consta®, should be received every 2 weeks as ordered by your healthcare provider. The other long-acting injectable form, known as Perseris®, should be received every month. Both of the long-acting injections are the same medication as in the tablet form.
Are There Specific Concerns About Risperidone And Pregnancy?
If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications. People living with schizophrenia who wish to become pregnant face important decisions. This is a complex decision since untreated schizophrenia has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.
Antipsychotic use during the third trimester of pregnancy has a risk for abnormal muscle movements [extrapyramidal symptoms [EPS]] and/or withdrawal symptoms in newborns following delivery. Symptoms in the newborn may include agitation, feeding disorder, hypertonia, hypotonia, respiratory distress, somnolence, and tremor; these effects may be self-limiting or require hospitalization.
Caution is advised with breastfeeding since risperidone does pass into breast milk.
What Should I Discuss With My Healthcare Provider Before Taking Risperidone?
- Symptoms of your condition that bother you the most
- If you have thoughts of suicide or harming yourself
- Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
- If you ever had muscle stiffness, shaking, tardive dyskinesia, neuroleptic malignant syndrome, or weight gain caused by a medication
- If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
- Any psychiatric or medical problems you have, such as heart rhythm problems, long QT syndrome, heart attacks, diabetes, high cholesterol, or seizures
- If you have a family history of diabetes or heart disease
- All other medications you are currently taking [including over the counter products, herbal and nutritional supplements] and any medication allergies you have
- Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
- If you are pregnant, plan to become pregnant, or are breast-feeding
- If you smoke, drink alcohol, or use illegal drugs
How Should I Take Risperidone?
Risperidone tablets and solution are usually taken 1 or 2 times per day with or without food.
Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.
The oral dose usually ranges from 1mg to 6 mg. The dose of the injection usually ranges from 12.5 mg to 50 mg. Only your healthcare provider can determine the correct dose for you.
Use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member or a friend to remind you or check in with you to be sure you are taking your medication.
Risperidone orally disintegrating tablets must remain in their original packaging. Open the package with clean dry hands before each dose. Do not try to put tablets in a pillbox if you take the orally disintegrating tablets.
Risperidone orally disintegrating tablets will dissolve in your mouth within seconds and can be swallowed with or without liquid.
Risperidone liquid should be measured with a dosing spoon or oral syringe, which you can get from your pharmacy.
Risperdal Consta® [risperidone long-acting injection] should be received every 2 weeks. It should be administered by your health care professional through an injection into your upper arm or buttocks area. The medication effects last for approximately 2 weeks. If you are new to taking Risperdal Consta® [risperidone long-acting injection], your health care provider may want you to take the tablet form or risperidone daily for up to 3 weeks.
Perseris® [risperidone long-acting injection] should be received every month. It should be administered by your health care professional through an injection under the skin of your abdominal area. After establishing tolerability with oral risperidone, you may be switched to Perseris® [risperidone long-acting injection]. Supplemental oral risperidone is not recommended after receiving your first Perseris® [risperidone long-acting injection] dose. After receiving the injection, you may have a lump for several weeks that will decrease in size over time. It is important that you not rub or massage the injection site and to be aware of the placement of any belts or clothing waistbands.
What Happens If I Miss A Dose Of Risperidone?
If you miss a dose of risperidone, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed. If you miss a dose of Risperdal Consta® or Perseris® [risperidone long-acting injections], see your healthcare provider to receive your dose as soon as possible.
What Should I Avoid While Taking Risperidone?
Avoid drinking alcohol or using illegal drugs while you are taking risperidone. They may decrease the benefits [e.g., worsen your confusion] and increase adverse effects [e.g., sedation] of the medication.
What Happens If I Overdose With Risperidone?
If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.
A specific treatment to reverse the effects of risperidone does not exist.
What Are Possible Side Effects Of Risperidone?
Common side effects
Sedation, drowsiness, extrapyramidal symptoms, insomnia, fatigue, headache, anxiety, dizziness, drooling, restlessness, increased prolactin, weight gain, increased appetite, vomiting, constipation, upper abdominal pain, nausea, urinary incontinence, tremor, cold symptoms, cough, runny nose, fever
Risperdal Consta® [risperidone long-acting injection]: injection site pain
Perseris® [risperidone long-acting injection]: injection site pain, redness, and a lump that may be present for several weeks
Rare/serious side effects
Risperidone may increase the blood levels of a hormone called prolactin. Side effects of increased prolactin levels include females losing their period, production of breast milk and males losing their sex drive or possibly experiencing erectile problems. Long term [months or years] of elevated prolactin can lead to osteoporosis, or increased risk of bone fractures.
Some people may develop muscle related side effects while taking risperidone. The technical terms for these are “extrapyramidal symptoms” [EPS] and “tardive dyskinesia” [TD]. Symptoms of EPS include restlessness, tremor, and stiffness. TD symptoms include slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements.
Temperature regulation: Impaired core body temperature regulation may occur; caution with strenuous exercise, heat exposure, and dehydration.
Second generation antipsychotics [SGAs] increase the risk of weight gain, high blood sugar, and high cholesterol. This is also known as metabolic syndrome. Your healthcare provider may ask you for a blood sample to check your cholesterol, blood sugar, and hemoglobin A1c [a measure of blood sugar over time] while you take this medication.
Information on healthy eating and adding exercise to decrease your chances of developing metabolic syndrome may be found at the following sites:
- //www.helpguide.org/articles/healthy-eating/healthy-eating.htm
- //www.helpguide.org/home-pages/exercise-fitness.htm
SGAs have been linked with higher risk of death, strokes, and transient ischemic attacks [TIAs] in elderly people with behavior problems due to dementia.
All antipsychotics have been associated with the risk of sudden cardiac death due to an arrhythmia [irregular heartbeat]. To minimize this risk, antipsychotic medications should be used in the smallest effective dose when the benefits outweigh the risks. Your doctor may order an EKG to monitor for irregular heartbeat.
Neuroleptic malignant syndrome is a rare, life threatening adverse effect of antipsychotics which occurs in