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{{MedTemplate
{{MedTemplate
| generic           = Risperidone
| generic           = Risperidone
| brand             = Risperdal
| brand             = Risperdal (oral), Risperdal M-Tab (ODT), Risperdal Consta (biweekly IM LAI), Perseris (monthly SC LAI), Uzedy (monthly/bimonthly SC LAI), Rykindo (biweekly IM LAI)
| structure         =  
| structure         =
| classes           = Antipsychotic, Neuroleptic
| classes           = [[:Category:Neuroleptics|Neuroleptic]], [[:Category:Atypical neuroleptics|Atypical neuroleptic (second-generation)]], [[:Category:Benzisoxazoles|Benzisoxazole]], [[:Category:Mood stabilizers|Mood stabilizer]]
| mechanism          = D2/5-HT2A antagonist
| uses              = <vote slug="schizophrenia-use">Schizophrenia (FDA)</vote>, <vote slug="bipolar-mania-mixed-use">Bipolar I mania and mixed episodes (FDA)</vote>, <vote slug="autism-irritability-pediatric-use">Autism spectrum disorder-associated irritability (FDA, pediatric ages 5+)</vote>, <vote slug="schizoaffective-disorder-use">Schizoaffective disorder (off-label)</vote>, <vote slug="severe-agitation-dementia-use">Severe agitation in dementia (off-label; with mortality-warning caveats)</vote>
| uses              =  
| starting_dose    = Schizophrenia / mania: 1 mg PO BID, titrate to 4-8 mg/day. Pediatric autism irritability: 0.25-0.5 mg/day, weight-titrated. Consta LAI: 25 mg IM every 2 weeks after oral overlap
| starting_dose     =  
| preparations     = Tablets 0.25, 0.5, 1, 2, 3, 4 mg; M-Tab ODT 0.5, 1, 2, 3, 4 mg; oral solution 1 mg/mL; Consta LAI 12.5, 25, 37.5, 50 mg; Perseris SC LAI 90, 120 mg monthly
| preparations      =  
| fda_max          = 16 mg/day (schizophrenia, adult); 6 mg/day (bipolar maintenance, autism irritability)
| fda_max           =  
| pill_id           =
| routes             =  
| routes           = Oral, intramuscular (LAI), subcutaneous (LAI)
| onset             =  
| onset             = Neuroleptic effect emerges over days to weeks
| duration           =  
| duration         = 24 hours (oral); 2-4 weeks (LAI formulations)
| halflife           =
| halflife          = Risperidone 3-20 hours; '''9-hydroxy-risperidone (paliperidone) ~20-24 hours''' is the major active metabolite and is separately marketed as a parent compound (Invega)<ref name="risperdal-label">FDA Prescribing Information, Risperdal (risperidone), Janssen, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020272s068,020588s053,021444s041lbl.pdf</ref>
| bioavailability    =
| bioavailability   = ~70% (oral)<ref name="risperdal-label" />
| pregnancy         =  
| pregnancy        = Signal for neonatal extrapyramidal symptoms and withdrawal with third-trimester exposure.{{citation needed}}
| legal              =  
| legal             = [[USLegal:Prescription only|Rx-only]] in US. Carries the atypical-neuroleptic '''Boxed Warning''' for increased mortality in elderly patients with dementia-related psychosis<ref name="risperdal-label" />
| intro              =
| mechanism         = <vote slug="risperidone-mech-claim">'''D2 dopamine receptor antagonist plus 5-HT2A serotonin receptor antagonist''', the classical atypical-neuroleptic signature originally derived from clozapine but with a more dopamine-tilted occupancy profile than olanzapine or quetiapine. The high D2 occupancy at therapeutic doses produces the highest rates of '''hyperprolactinemia''' among second-generation neuroleptics (galactorrhea, amenorrhea, sexual dysfunction, and bone density loss with chronic use), along with dose-dependent extrapyramidal symptoms above ~6 mg/day.</vote> CYP2D6 substrate; CYP2D6 poor metabolizers have higher plasma exposure and may benefit from lower initial dosing. CPIC PGx guidance applies<ref name="cpic-cyp2d6">CPIC Guideline for CYP2D6 Genotype and Neuroleptic Dosing. https://cpicpgx.org/guidelines/</ref>.
| pharmacokinetics   =  
| pharmacodynamics  =  
| indications        =  
| dosing             =  
| effects            =  
| interactions      = <pharmaInteractions/>
| pregnancy_details  =
| monitoring         =  
| counseling        =  
| anecdotes          =
| seealso            =
| references        =  
}}
}}


[[Category:Second-generation neuroleptics]]
== References ==
<references />
 
[[Category:Neuroleptics]]
[[Category:Neuroleptics]]
[[Category:Atypical neuroleptics]]
[[Category:Benzisoxazoles]]
[[Category:Mood stabilizers]]

Revision as of 07:14, 23 May 2026

Neuroleptic, Atypical neuroleptic (second-generation), Benzisoxazole, Mood stabilizer
Risperidone
Risperdal (oral), Risperdal M-Tab (ODT), Risperdal Consta (biweekly IM LAI), Perseris (monthly SC LAI), Uzedy (monthly/bimonthly SC LAI), Rykindo (biweekly IM LAI)

Experience

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Problems

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Titration strategies

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Effects

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Summary
Classes
Neuroleptic, Atypical neuroleptic (second-generation), Benzisoxazole, Mood stabilizer
Common uses
Schizophrenia (FDA)0, Bipolar I mania and mixed episodes (FDA)0, Autism spectrum disorder-associated irritability (FDA, pediatric ages 5+)0, Schizoaffective disorder (off-label)0, Severe agitation in dementia (off-label; with mortality-warning caveats)0
Pharmacy
Starting dose
Schizophrenia / mania: 1 mg PO BID, titrate to 4-8 mg/day. Pediatric autism irritability: 0.25-0.5 mg/day, weight-titrated. Consta LAI: 25 mg IM every 2 weeks after oral overlap
Preparations
Tablets 0.25, 0.5, 1, 2, 3, 4 mg; M-Tab ODT 0.5, 1, 2, 3, 4 mg; oral solution 1 mg/mL; Consta LAI 12.5, 25, 37.5, 50 mg; Perseris SC LAI 90, 120 mg monthly
US FDA Max
16 mg/day (schizophrenia, adult); 6 mg/day (bipolar maintenance, autism irritability)
Pharmacology
Routes
Oral, intramuscular (LAI), subcutaneous (LAI)
Onset
Neuroleptic effect emerges over days to weeks
Duration
24 hours (oral); 2-4 weeks (LAI formulations)
Half-life
Risperidone 3-20 hours; 9-hydroxy-risperidone (paliperidone) ~20-24 hours is the major active metabolite and is separately marketed as a parent compound (Invega)[2]
Bioavailability
~70% (oral)[2]
Pregnancy
Signal for neonatal extrapyramidal symptoms and withdrawal with third-trimester exposure.[citation needed]
Legal status
Rx-only in US. Carries the atypical-neuroleptic Boxed Warning for increased mortality in elderly patients with dementia-related psychosis[2]
Purported mechanism
D2 dopamine receptor antagonist plus 5-HT2A serotonin receptor antagonist, the classical atypical-neuroleptic signature originally derived from clozapine but with a more dopamine-tilted occupancy profile than olanzapine or quetiapine. The high D2 occupancy at therapeutic doses produces the highest rates of hyperprolactinemia among second-generation neuroleptics (galactorrhea, amenorrhea, sexual dysfunction, and bone density loss with chronic use), along with dose-dependent extrapyramidal symptoms above ~6 mg/day.0 CYP2D6 substrate; CYP2D6 poor metabolizers have higher plasma exposure and may benefit from lower initial dosing. CPIC PGx guidance applies[1].

References

  1. ↑ CPIC Guideline for CYP2D6 Genotype and Neuroleptic Dosing. https://cpicpgx.org/guidelines/
  2. ↑ 2.0 2.1 2.2 FDA Prescribing Information, Risperdal (risperidone), Janssen, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020272s068,020588s053,021444s041lbl.pdf
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