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risperidone
Risperdal · Risperdal Consta (LAI) · Perseris · Uzedy
Second-generation antipsychotic⚠ Unverified beta content
At a glance
- Class
- Atypical antipsychotic (benzisoxazole)
- Black box
- ⚠ Increased mortality in elderly patients with dementia-related psychosis
- Key monitoring
- Metabolic monitoring (ADA/APA schedule) — Weight/BMI, waist, BP, fasting glucose/A1c, fasting lipids
- EPS / akathisia / AIMS
- Usual adult dose
- Schizophrenia: Start 1–2 mg/day; usual 2–8 mg/day
- Call provider / escalate if
- High fever, severe stiffness, confusion, sweating (NMS) • Muscle spasms of neck/eyes/jaw (dystonia), severe restlessness • Involuntary face/tongue movements
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- risperidone (Risperdal, Risperdal Consta (LAI), Perseris) — atypical antipsychotic (benzisoxazole).
- Used for: Schizophrenia; Bipolar I – acute mania/mixed; Irritability associated with autistic disorder.
Usual adult dosing
- Schizophrenia: Start 1–2 mg/day; usual 2–8 mg/day (Max 16 mg/day; EPS risk rises above ~6 mg/day.)
- Bipolar mania: 2–3 mg/day start; 1–6 mg/day
- Elderly / renal / hepatic impairment: Start 0.5 mg BID
- Long-acting injection (Consta): 25–50 mg IM every 2 weeks (Needs oral coverage ~3 weeks at start.)
Boxed warning
- Increased mortality in elderly patients with dementia-related psychosis: not approved for treatment of dementia-related psychosis.
Monitor
- Metabolic monitoring (ADA/APA schedule) — Weight/BMI, waist, BP, fasting glucose/A1c, fasting lipids [Baseline; weight at 4, 8, 12 wks then quarterly; BP/glucose/lipids at 12 wks then annually (lipids q5y if normal); more often if abnormal]
- EPS / akathisia / AIMS [Baseline; each visit during titration; AIMS ≥ every 6–12 months]
Nursing priorities
- Baseline psychiatric symptoms, suicidality, aggression risk.
- Baseline vitals incl. orthostatic BP, weight/BMI, waist circumference.
- Assess for EPS, akathisia, and abnormal movements each shift/visit (AIMS at baseline and periodically per policy).
- Check orthostatic vitals; teach slow position changes; fall precautions.
- Weigh regularly and encourage healthy diet and activity.
Major interactions
- Strong CYP2D6 inhibitors (fluoxetine, paroxetine): ↑ risperidone levels – may need dose reduction.
Key teaching
- Take it every day even when you feel well. Do not stop suddenly.
- It can make you dizzy when you stand up – rise slowly.
- Regular weight and blood tests check for weight gain and changes in blood sugar and cholesterol.
Optional: AI explanation
Off by default. To enable, add your own API key in Settings (stored only on this device).
Boxed warning
- Increased mortality in elderly patients with dementia-related psychosis: not approved for treatment of dementia-related psychosis.
Other serious warnings
- NMS
- Tardive dyskinesia
- Metabolic changes
- Hyperprolactinemia
- Orthostatic hypotension
- QT prolongation (modest)
- Leukopenia/neutropenia
- Seizures
- Priapism
- Cerebrovascular adverse events in elderly with dementia
- Dysphagia
Sources: FDA label (DailyMed): RISPERDAL (RISPERIDONE) TABLET RISPERDAL M-TAB (
- Metabolic monitoring (ADA/APA schedule)Target: Weight/BMI, waist, BP, fasting glucose/A1c, fasting lipidsWhen: Baseline; weight at 4, 8, 12 wks then quarterly; BP/glucose/lipids at 12 wks then annually (lipids q5y if normal); more often if abnormal
- EPS / akathisia / AIMSWhen: Baseline; each visit during titration; AIMS ≥ every 6–12 months
- Orthostatic BP / HR
- Prolactin-related symptomsCheck prolactin if symptomatic
- CBCIf history of low WBC or fever/infection
- ECGIf cardiac risk or QT-prolonging drugs
Sources: FDA label (DailyMed): RISPERDAL (RISPERIDONE) TABLET RISPERDAL M-TAB ( · ADA/APA Consensus Development Conference on Antipsychotic Drugs and Ob
Assessment
- Baseline psychiatric symptoms, suicidality, aggression risk.
- Baseline vitals incl. orthostatic BP, weight/BMI, waist circumference.
- Baseline AIMS (abnormal movements) and EPS screen.
- History of diabetes, dyslipidemia, cardiac disease, seizures, dementia.
- Substance use and medication/supplement list.
- Baseline prolactin-related history (menstrual changes, sexual function).
Interventions
- Assess for EPS, akathisia, and abnormal movements each shift/visit (AIMS at baseline and periodically per policy).
- Check orthostatic vitals; teach slow position changes; fall precautions.
- Weigh regularly and encourage healthy diet and activity.
- Monitor adherence.
- Report fever, rigidity, or altered mental status immediately (NMS).
- Assess EPS especially with dose increases; treat per provider order (e.g., anticholinergic).
- For LAI: confirm injection schedule, rotate sites, document.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- High fever, severe stiffness, confusion, sweating (NMS)
- Muscle spasms of neck/eyes/jaw (dystonia), severe restlessness
- Involuntary face/tongue movements
- Fainting
- Erection lasting >4 hours
- Breast discharge/enlargement, missed periods
- Excess thirst/urination
- Fever/infection signs
Sources: FDA label (DailyMed): RISPERDAL (RISPERIDONE) TABLET RISPERDAL M-TAB ( · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- EPS (dose-related): parkinsonism, akathisia, dystonia
- Elevated prolactin (galactorrhea, amenorrhea, sexual dysfunction, gynecomastia)
- Weight gain
- Somnolence, fatigue
- Orthostatic hypotension, dizziness
- Constipation
- Rhinitis, nausea
Sources: FDA label (DailyMed): RISPERDAL (RISPERIDONE) TABLET RISPERDAL M-TAB (
- Strong CYP2D6 inhibitors (fluoxetine, paroxetine) Major↑ risperidone levels – may need dose reduction.
- Carbamazepine / CYP3A4 inducers↓ levels.
- AntihypertensivesAdditive hypotension.
- Levodopa/dopamine agonistsAntagonized effect.
- QT-prolonging drugsAdditive QT effect.
- Alcohol, CNS depressantsAdditive sedation.
Sources: FDA label (DailyMed): RISPERDAL (RISPERIDONE) TABLET RISPERDAL M-TAB (
- Take it every day even when you feel well. Do not stop suddenly.
- It can make you dizzy when you stand up – rise slowly.
- Regular weight and blood tests check for weight gain and changes in blood sugar and cholesterol.
- Report muscle stiffness, restlessness (can’t sit still), shaking, or unusual movements of the face or tongue.
- Avoid alcohol and street drugs.
- You may overheat more easily – drink fluids and avoid extreme heat.
- It can raise a hormone called prolactin – tell your provider about breast tenderness or milk discharge, missed periods, or sexual problems.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Schizophrenia
- Bipolar I – acute mania/mixed
- Irritability associated with autistic disorder (pediatric)
Dosing
- Schizophrenia: Start 1–2 mg/day; usual 2–8 mg/dayMax 16 mg/day; EPS risk rises above ~6 mg/day.
- Bipolar mania: 2–3 mg/day start; 1–6 mg/day
- Elderly / renal / hepatic impairment: Start 0.5 mg BID
- Long-acting injection (Consta): 25–50 mg IM every 2 weeksNeeds oral coverage ~3 weeks at start.
Sources: FDA label (DailyMed): RISPERDAL (RISPERIDONE) TABLET RISPERDAL M-TAB (
Prescriber-oriented details; limited in this beta.
renal Adjustment
- Start 0.5 mg BID; slower titration in renal impairment.
hepatic Adjustment
- Start 0.5 mg BID in severe hepatic impairment.
cyp Notes
- CYP2D6 substrate; 9-OH metabolite (paliperidone) active.
Sources: FDA label (DailyMed): RISPERDAL (RISPERIDONE) TABLET RISPERDAL M-TAB (
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): RISPERDAL (RISPERIDONE) TABLET RISPERDAL M-TAB (RISPERIDONE) TABLET, ORALLY DISINTEGRATING RISPERDAL (RISPE…
- ADA/APA Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes (Diabetes Care 2004) - metabolic monitoring schedule
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified