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Overview

Risperidone (Risperdal® and generic forms) belongs to a group of medications called “atypical antipsychotics” or “second-generation antipsychotics”.

What is risperidone used for?

Risperidone is used for various issues in children, youth and adults: 

• Symptoms of psychosis such as hallucinations or delusions, in conditions such as schizophrenia
• Aggression and irritability
• Mood/anxiety conditions 

How does risperidone work?

Like other atypical antipsychotics, risperidone affects the levels of certain chemicals in the brain called dopamine and serotonin.

How should risperidone be taken?

Risperidone is usually taken once or twice a day with or without food. Risperidone should be taken at the same time each day as directed by your doctor. Try to connect taking it with something you do each day (like eating breakfast or brushing your teeth) so that you don’t forget. Try to avoid alcohol while taking risperidone.

Risperidone is available in several forms such as:

1. Liquid: If you are taking the liquid form of risperidone, you can mix it with water, orange juice, coffee or low-fat milk. Do not take the liquid with tea or cola beverages.
    
2. Regular tablets
    
3. Fast dissolve tablets (‘Risperdal M-Tab®’)): This medication is prescribed in a “blister pack” (not a bottle)

• ​Use dry hands to peel off the foil from the back of the blister before removing the tablet (wet hands can cause the medication to melt in your hands). Do not push the thin wafer through the foil.
• Place the tablet on your tongue. The tablet will dissolve quickly and may be swallowed with or without water. Try not to chew the tablet.

Usually, your doctor will start with a low dose of risperidone and may gradually increase this dose over several days or weeks based on how you respond to it. You and your doctor can then discuss the best dosage to stay on based on how the medication is tolerated (how well it helps decrease symptoms and how troublesome are the side effects).

When will risperidone start working?

It usually takes a few days to a week before the benefits of risperidone become noticeable. Medications like risperidone do not always work for everyone. Talk with your doctor if you find the medication has not been helpful.

How long should risperidone be taken?

This depends on the symptoms, how frequently they occur and how long they have been there. Your doctor will discuss the benefits and risks of taking risperidone with you. At this time, you can also discuss how long you might need to take this medication.  Risperidone can be stopped abruptly without a problem if you experience side effects that are uncomfortable and are unable to reach your doctor.

Is risperidone addictive?

No, risperidone is not addictive and you will not have “cravings” for this medication like you might with nicotine or street drugs. If you and your doctor decide it is best to stop using risperidone, your doctor will explain how to safely come off this medication so you don’t feel negative effects as your body adjusts to being without it.

What are the side effects of risperidone and what should I do if I get them?

Common side effects

Side effects are usually more common when starting a medication or after a dose increase. If any of these side effects is troublesome for you, please discuss them with your doctor, nurse or pharmacist.

• Dizziness (try getting up slowly from a sitting or lying down position)
• Drowsiness (try taking the dose at bedtime). In patients with problems falling asleep, the side effect of increased drowsiness at night may be helpful.  If there are problems with drowsiness, let the doctor know, so that options may be considered such as changing the dose or time that it is taken. If there are problems with drowsiness, do not drive.
• Fast and irregular heart beat (this effect may be temporary and go away over time)
• Headache (try using a pain reliever like acetaminophen (plain Tylenol®))
• Increase in appetite and weight gain (If this is troublesome, avoid high calorie foods & increase your exercise). In patients who are thin and have poor appetite, the side effect of increased appetite may be helpful.
• Stomach ache (try taking the medication with food)

Uncommon side effects (e.g., those that occur in less than 5% of patients)

Contact your doctor IMMEDIATELY if you have any of these side effects:

• Muscle spasms or stiff muscles (usually relieved by diphenhydramine (Benadryl®) 25mg; call your doctor)
• Agitation and feelings of restlessness (avoid caffeine from energy drinks, colas, coffee and some teas)
• Difficulty swallowing
• Breast tenderness or breast discharge
• Unexplained fever or confusion (This may be a warning sign of a rare, serious side effect)

Delayed/long-term side effects

When taken for long periods of time, the following delayed/long-term side effects are possible:

• Increased risk for metabolic syndrome (which includes several medical disorders), diabetes, or increased lipids (such as cholesterol and triglycerides), as well as an increased level of prolactin (a hormone). These effects may be less likely in individuals with normal blood pressure, who are thin to normal weight, and who have normal blood work and are at low risk for developing diabetes. High levels of prolactin (a hormone) have also been found in individuals taking risperidone for various conditions.
• Tardive dyskinesia, which is a disorder characterized by abnormal movements. Tardive dyskinesia may occur in adults with schizophrenia who take with higher doses over long periods of time. For children with AD/HD who take low doses of risperidone, in one study, the incidence of tardive dyskinesia after one year of continuous use was 2 cases out of 737. In both of these cases, tardive dyskinesia disappeared when the medication was stopped. The risk of tardive dyskinesia in children taking relatively higher doses of risperidone than are typically prescribed for disruptive behaviour disorders was 1 in approximately 370 persons (0.27%) per year of risperidone usage.

What precautions should my doctor and I be aware of when taking risperidone?

Tell your doctor or pharmacist if you:

• Have any allergies or have experienced a reaction to a medication.
• Are taking, or plan to start taking any other prescription or non-prescription medications (including herbal products). Many medications can interact with risperidone, such as carbamazepine (Tegretol®), heart medications, antidepressants, antibiotics, stomach medications and several others. Your doctor may need to change the doses of your medication(s) or monitor you carefully for side effects if you are taking medications that interact with risperidone.
• Have a history of heart disease, kidney or liver disease, a bowel obstruction, diabetes (or a family history of diabetes) or glaucoma.
• Miss a period, are pregnant (or are planning to become pregnant) or are breast-feeding. Tell your doctor if you become pregnant while taking risperidone.
• Are currently using alcohol or street drugs. Combining risperidone with these substances can decrease how well risperidone works for you and/or make you feel excessively sleepy.

What special instructions should I follow while using risperidone?

• Keep all appointments with your doctor and the laboratory. At this time, it is recommended that your doctor order certain lab tests (a blood test which may include checking blood glucose, insulin and prolactin levels, cholesterol and triglyceride levels, and liver tests) before risperidone is prescribed. Your doctor will decide with you how often this testing needs to be repeated (usually once a year at minimum) in order to check how you are responding to risperidone.
• In addition to the laboratory testing above, measurement of height, weight and waist circumference before starting risperidone and at regular intervals is recommended.
• Do not allow anyone else to use your medication.
• If you experience any abnormal movements in your arms, legs, body or face, tell your doctor immediately.

What should I do if I forget to take a dose of risperidone?

If you take risperidone only at bedtime and you forget to take it, skip the missed dose and continue with your regular schedule the next day. DO NOT double your next dose. If you take it more than once a day, take the missed dose as soon as possible. However, if it is almost time for your next dose (e.g., within 4 hours), do NOT take the missed dose or double up on your next dose. Instead, continue with your regular dosing schedule.

What storage conditions are needed for risperidone?

• Keep this medication in the original container, stored at room temperature away from moisture and heat (e.g., not in the bathroom or kitchen) and protected from light.
• Store dissolving tablets in the original sealed packaging and use immediately once opened.
• Keep this medication out of reach and sight of children.

About this document

Special thanks to the Kelty Centre for Mental Health for permission to adapt this document. The original document was developed by health professionals of BC Mental Health and Addiction Services, and reviewed by the staff of the Kelty Mental Health Centre. French translation provided courtesy of the Ontario Centre of Excellence for Child and Youth Mental Health.

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Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.