risperidone

(ris peer' i dohn)

Risperdal, Risperdal M-TAB

Pregnancy Category C

Drug classes
Antipsychotic
Benzisoxazole

Therapeutic actions
Mechanism of action not fully understood: Blocks dopamine and serotonin receptors in
the brain, depresses the RAS; anticholinergic, antihistaminic, and alpha-adrenergic
blocking activity may contribute to some of its therapeutic and adverse actions.

Indications
• Treatment of schizophrenia
• Delaying relapse in long-term treatment of schizophrenia
• Unlabeled uses: Bipolar disorder; treatment of patients with dementia-related
psychotic symptoms

Contraindications and cautions

• Contraindicated with hypersensitivity to risperidone, lactation.
• Use cautiously with cardiovascular disease, pregnancy, renal or hepatic
impairment, hypotension.

Available forms
Tablets—0.25, 0.5, 1, 2, 3, 4 mg; oral solution—1 mg/mL; orally disintegrating tablets—
0.5, 1, 2 mg

Dosages
ADULTS
• Initial treatment: 1 mg PO bid; then gradually increase with daily dosage
increments of 1 mg bid on the second and third days to a target dose of 3 mg PO
bid by the third day. Range, 4–8 mg/day.
• Reinitiation of treatment: Follow initial dosage guidelines, using extreme care due
to increased risk of severe adverse effects with reexposure.
• Switching from other antipsychotics: Minimize the overlap period and discontinue
other antipsychotic before beginning risperidone therapy.
• Delaying relapse time in long-term treatment: 3 mg PO bid.
PEDIATRIC PATIENTS
Safety and efficacy not established.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT
Initial dose of 0.5 mg PO bid; monitor patient for adverse effects and response.

Pharmacokinetics
Route Onset Peak Duration
Oral Varies 3–17 hr Weeks

Metabolism: Hepatic; T1/2: 20 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine and feces

Adverse effects
• CNS: Insomnia, anxiety, agitation, headache, somnolence, aggression, dizziness,
tardive dyskinesias
• CV: Orthostatic hypotension, arrhythmias
• Dermatologic: Rash, dry skin, seborrhea, photosensitivity
• GI: Nausea, vomiting, constipation, abdominal discomfort, dry mouth, increased
saliva
• Respiratory: Rhinitis, coughing, sinusitis, pharyngitis, dyspnea
• Other: Chest pain, arthralgia, back pain, fever, neuroleptic malignant
syndrome, diabetes mellitus

Interactions
Drug-drug
• Increased therapeutic and toxic effects with clozapine
• Decreased therapeutic effect with carbamazepine
• Decreased effectiveness of levodopa

Nursing considerations
Assessment
• History: Allergy to risperidone, lactation, CV disease, pregnancy, renal or hepatic
impairment, hypotension
• Physical: T, weight; reflexes, orientation; P, BP, orthostatic BP; R, adventitious
sounds; bowel sounds, normal output, liver evaluation; CBC, urinalysis, liver and
kidney function tests

Interventions
• Maintain seizure precautions, especially when initiating therapy and increasing
dosage.
• Mix oral solution with 3–4 oz of water, coffee, orange juice, or low-fat milk. Do
not mix with cola or tea.
• Open blister units of orally disintegrating tablets individually; do not push tablet
through the foil. Use dry hands to remove tablet—immediately place on tongue.
Do not allow patient to chew tablet.
• Monitor patient regularly for signs and symptoms of diabetes mellitus.
• Monitor T. If fever occurs, rule out underlying infection, and consult physician for
appropriate comfort measures.
• Advise patient to use contraception during drug therapy.
• Follow guidelines for discontinuation or reinstitution of the drug carefully.
Teaching points
• Dosage will be increased gradually to achieve most effective dose. Do not take
more than your prescribed dosage. Do not make up missed doses; contact your
health care provider if this occurs. Do not stop taking this drug suddenly; gradual
reduction of dosage is needed to prevent side effects.
• Mix oral solution in 3–4 oz of water, coffee, orange juice, or low-fat milk. Do not
mix with cola or tea.
• This drug cannot be taken during pregnancy. If you think you are pregnant or
wish to become pregnant, contact your health care provider.
• These side effects may occur: Drowsiness, dizziness, sedation, seizures (avoid
driving, operating machinery, or performing tasks that require concentration);
dizziness, faintness on arising (change positions slowly; use caution); increased
salivation (reversible); constipation; sensitivity to the sun (use a sunscreen or
protective clothing).
• Report lethargy, weakness, fever, sore throat, malaise, mouth ulcers, palpitations.

Adverse effects in Italic are most common; those in Bold are life-threatening.