Risperidone (Risperdal)
Indications
Bipolar Disorder-Acute Manic or Mixed (see Bipolar Disorder , [[Bipolar Disorder]])
Irritability Associated with Autism
Psychosis (see Psychosis , [[Psychosis]])
Schizophrenia , see Schizophrenia , [[Schizophrenia]])
Contraindications
Dementia-Related Psychosis
Increased Risk of Cerebrovascular Accident (CVA) When Used in Elderly Patients with Dementia-Related Psychosis
Increased Mortality in When Used in Elderly Patients with Dementia-Related Psychosis
Pharmacology
Atypical Anti-Psychotic Agent
Dopamine D2 Receptor Antagonist
Serotonin 5HT2 Receptor Antagonist
Also binds to α1/α2 adrenergic and H1 histamine receptors
Administration
PO (acute mania) : starting dose of 1 mg BID -> increase dose qday by adding 0.25 mg BID to max dose of 6 mg/day
Dose Adjustment
Patient >65 y/o : lower starting dose to 0.5 BID
Hepatic : lower starting dose to 0.5 mg PO BID
Renal : lower starting dose to 0.5 mg PO BID
Adverse Effects
Cardiovascular Adverse Effects
Hypotension/Orthostatic Hypotension (see Hypotension , [[Hypotension]])
Endocrinologic Adverse Effects
Gastrointestinal Adverse Effects
Hematologic Adverse Effects
Neurologic Adverse Effects
Akathisia (see Akathisia , [[Akathisia]])
Dizziness (see Dizziness , [[Dizziness]])
Extrapyramidal Symptoms/Dystonia
Increased Risk of Cerebrovascular Accidents (CVA) in Elderly Patients with Dementia-Related Psychosis (see Ischemic Cerebrovascular Accident , [[Ischemic Cerebrovascular Accident]])
Parkinsonism (see Parkinson’s Disease , [[Parkinsons Disease]])
Seizures (see Seizures , [[Seizures]])
Somnolence : may be associated with impaired cognition, judgement, and motor skills
Tardive Dyskinesia
Tremor
Renal Adverse Effects
Rheumatologic/Orthopedic Adverse Effects
Other Adverse Effects
Hypothermia (see Hypothermia , [[Hypothermia]])
Increased Mortality in Elderly Patients with Dementia-Related Psychosis
Neuroleptic Malignant Syndrome (see Neuroleptic Malignant Syndrome , [[Neuroleptic Malignant Syndrome]])
Priapism
References
Atypical Antipsychotic Drugs and the Risk for Acute Kidney Injury and Other Adverse Outcomes in Older Adults: A Population-Based Cohort Study. Ann Intern Med. 2014;161(4):242-248. doi:10.7326/M13-2796
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