risperidone: clinical use

Prescribing considerations

• Assess indication, previous antipsychotic response, adherence, comorbidity and interaction risks.
• For Alzheimer’s dementia, assess stroke and mortality risk, document failure of non-pharmacological approaches and reassess need.
• Use particular caution with cardiovascular or cerebrovascular disease, Parkinson’s disease, dementia with Lewy bodies, seizures, diabetes, dehydration, venous-thromboembolism risks and prolactin-dependent conditions.
• Confirm oral risperidone tolerability and effectiveness before the selected prolonged-release injection.
• Renal or hepatic impairment can increase exposure; the selected prolonged-release injection is not recommended in moderate to severe renal impairment.

Contraindications and cautions

• Hypersensitivity to risperidone or a formulation excipient.

Monitoring

• Weight and metabolic risk, including hyperglycaemia
• Extrapyramidal symptoms, akathisia and tardive dyskinesia
• Blood pressure where postural hypotension is likely
• Prolactin when clinically indicated
• White-cell count in people with relevant previous leucopenia or neutropenia
• Stroke symptoms and continuing need in Alzheimer’s dementia aggression
• Renal and hepatic function where impairment is present or suspected

Clinical pharmacology

Risperidone is a selective monoaminergic antagonist with high affinity for serotonin 5-HT2 and dopamine D2 receptors. Risperidone and 9-hydroxyrisperidone form the active antipsychotic fraction.

Formulation and product differences

• Film-coated tablets are swallowed; suitability for splitting depends on the product.
• Orodispersible tablets dissolve on the tongue and may contain aspartame.
• Oral solution is measured using the supplied device; excipients differ between products.
• The selected prolonged-release injection is for adult schizophrenia, requires immediate reconstitution and intramuscular administration, and is not licensed for dementia-related aggression or paediatric use.

Dispersible tablet

Route: Oral

Strengths: 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg