TaperCommunityrisperidone
Boxed Warning
Increased mortality in elderly patients with dementia-related psychosis.
Risperidone is an atypical antipsychotic approved for schizophrenia, bipolar mania, and irritability associated with autistic disorder. It has high affinity for dopamine D2 and serotonin 5-HT2A receptors and carries a notable risk of hyperprolactinemia.
0.5mg, 1mg, 2mg, 3mg, 4mg
Tablets: 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg; Orally disintegrating tablets (M-Tab): 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg; Oral solution: 1mg/mL; Long-acting injection (Risperdal Consta): 12.5mg, 25mg, 37.5mg, 50mg
Category C (risk cannot be ruled out)
Potent antagonist at dopamine D2 and serotonin 5-HT2A receptors. Also antagonizes alpha-1, alpha-2 adrenergic, and histamine H1 receptors. Higher D2 affinity than most atypicals contributes to EPS risk at higher doses and hyperprolactinemia.
Liquid formulation (1mg/mL) available for precise dosing. Withdrawal can include supersensitivity psychosis.
Oral solution provides precise dosing. Extremely gradual taper essential, especially for long-term use. Risk of dopamine supersensitivity.
Toxicity
Hyperprolactinemia (highest among atypicals). Extrapyramidal symptoms at higher doses. Metabolic effects (weight gain, hyperglycemia, dyslipidemia). Orthostatic hypotension. Tardive dyskinesia. NMS rarely.
Pharmacokinetics
Well absorbed after oral administration. Bioavailability ~70% (oral solution) to ~66% (tablets). Tmax ~1 hour. Food does not significantly affect absorption.
~1–2 L/kg
Hepatic via CYP2D6 (primary) to the active metabolite 9-hydroxyrisperidone (paliperidone), which has similar pharmacological activity. CYP3A4 is a minor pathway.
Renal (~70%) and fecal (~14%). In extensive CYP2D6 metabolizers, active moiety (risperidone + 9-OH-risperidone) half-life is ~20 hours.
~90% (risperidone), ~77% (9-hydroxyrisperidone)
~5–8 mL/min/kg (total active moiety clearance)
Browse our map of deprescribing-informed providers worldwide.