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