Mental Illnesses Treatment Support & Programs How You Can Help Find Your Local NAMI NAMIWalks

Risperdal^® (risperidone)

All FDA warnings are at the end of this fact sheet. Please consult them before taking this medication.

Brand/Generic Names

Brand name: Risperdal®
- Tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
- Liquid: 1 mg/ml liquid in a 30 ml bottle
- Risperidal-M® Orally disintegrating tablets: 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
- Risperdal Consta® Long Acting Injection: 12.5 mg, 25 mg, 37.5 mg, 50 mg
Generic name: risperidone

What is Risperdal® and what does it treat?

Risperidone is a second generation antipsychotic (SGA) medication approved for the treatment of schizophrenia and bipolar disorder. Bipolar disorder involves episodes of depression and/or mania. Risperidone can improve symptoms of schizophrenia such as: hallucinations, delusions, and disorganized thinking; in some people, improvement in social isolation, reduced speech productivity and motivation also occur. It can also help control the mood swings of bipolar mania. The remainder of this medication sheet will focus primarily on schizophrenia.

Risperidone long acting injection is an injection (“shot”) formulation. It contains the same medication that is in the oral tablets and solution. The medication in risperidone long acting injection is enclosed in tiny beads called “microspheres”. After the microspheres are injected into the muscle, they slowly dissolve, releasing a constant amount of the risperidone medication.

What is the most important information I should know about Risperdal®?

Relapse is very common in schizophrenia and is the most frequent cause that patients stop taking their medication. Even when medication is taken exactly as prescribed, relapse may still occur for some people. Therefore it is recommended that you take your medication exactly as prescribed by your healthcare provider as this has been shown to decrease relapse.

Schizophrenia requires long-term treatment. Only your healthcare provider can determine the length of risperidone treatment that is right for you.
Do not stop taking risperidone or change your dose without talking to your healthcare provider first.
Some people may develop side effects on risperidone such as extrapyramidal effects (restlessness, tremor, stiffness) or tardive dyskinesia (slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements). These symptoms are likely to be less severe and occur less often with the newer antipsychotic medications than with the older antipsychotic medications (e.g., Haldol® [haloperidol], Prolixin® [fluphenazine], and Thorazine® [chlorpromazine]). If you develop movements that you cannot control, call your healthcare provider immediately.
Many second generation or atypical antipsychotics may cause an increase in weight, blood sugar levels, or lipid levels. If you gain more than 5% of your original weight during therapy, talk to your healthcare provider about whether switching to another antipsychotic medication should be considered.
Risperidone treatment may be associated with strokes and/or transient ischemic attacks (TIAs) in elderly people with dementia and accompanying behavior problems. This safety concern has not been proven confidently, but there is some evidence. Talk with your health care provider if you are concerned or have questions.
Both older first and newer second generation antipsychotics have been associated with the risk of sudden cardiac death due to an arrhythmia (irregular conduction of an electrical impulse in the heart). To minimize this possibility, antipsychotic medications should be used in the smallest effective dose in situations where the benefits outweigh the risks, such as schizophrenia or bipolar disorder. Often an EKG tracing may be ordered to monitor for conduction changes.
Risperidone treatment must be monitored by a healthcare provider. Be sure to keep all of your scheduled appointments so that you stay healthy while on risperidone.
You should not take illegal drugs or drink alcohol while taking risperidone.

Are there specific concerns about Risperdal® and pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider so that he/she can best manage your medications. People living with schizophrenia who wish to become pregnant face important decisions, each with risks and benefits related to how the illness, medications and the risks to the fetus may interact. This is a complex decision as untreated schizophrenia has risks to the fetus as well as the mother. There are many dimensions to these choices, so be sure to confer with your doctor and caregivers.

Regarding breast-feeding, caution is advised since risperidone does pass into breast milk.

What should I discuss with my healthcare provider before taking Risperdal®?

Symptoms of schizophrenia which are bothersome to you.
If you had any serious side effects with other antipsychotic medications like muscle stiffness, muscle cramping, shaking, tardive dyskinesia, neuroleptic malignant syndrome, weight gain, or diabetes. (See the NAMI Hearts and Minds Program).
If you have had an allergic reaction to risperidone or paliperidone (Invega®) or any other medication.
History of heart problems, such as heart rhythm problems, long QT syndrome, or heart attacks. These illnesses may make risperidone unsafe for you to take.
Medical problems you have, especially diabetes, high cholesterol or triglycerides, increased body weight, seizures, or kidney disease or impairment.

How should I take Risperdal®?

Risperidone tablets can be taken with or without food but should be taken with a full glass of water.
Risperidone oral disintegrating tablets are administered by placing tablet directly on the tongue. The oral disintegrating tablets will dissolve in your mouth within seconds and can be swallowed with or without liquid. Do NOT split, chew, or swallow whole risperidone oral disintegrating tablets.• Risperidone oral solution can be administered directly from the calibrated dropper, or can be mixed with a beverage prior to administration. Risperdal® oral solution can be safely mixed with coffee, water, orange juice, and low-fat milk. It CANNOT be mixed with cola or tea.
Risperdal Consta® should be administered by a health care professional. It is given as a shot into the muscle of one’s buttock or upper arm every 2 weeks. After the first shot consumers should continue taking the oral risperidone (or other antipsychotic medication) for 3 weeks. This allows time for the injection formulation to start working in one’s body. Your doctor will let you know when you can stop the oral medication.
Only your doctor can determine the correct dose for you. Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.
Use a calendar or pill box to help you remember to take your medication. Or, have a family member or friend remind you or check in with you to be sure you are taking your medication.

What happens if I miss a dose of Risperdal®?

If you miss a dose of risperidone tablets, orally disintegrating tablets, or oral solution, take it as soon as you remember it, if it is not too close to when your next dose is due—discuss this with your health care provider. Do not double your next dose or take more than what is prescribed.

If you miss a dose of risperidone long acting injection, schedule an appointment with your health care provider as soon as possible. Your doctor may have to restart you on the oral medication until you can receive your next shot.

What should I avoid while taking Risperdal®?

Risperidone may cause dizziness or drowsiness, especially when first starting the medication. Make sure you know how you react to the medication before you drive, operate machinery, or plan other activities that may be dangerous if you are not alert.
Avoid drinking alcohol or using illegal drugs while taking risperidone.

What happens if I overdose with Risperdal®?

If an overdose occurs, whether intentional or accidental, immediate medical attention may be necessary. Call your doctor or emergency medical service (911). You may also contact the poison control center at 1-800-222-1222.

What are the possible side effects of Risperdal ®?

What are the common side effects seen with risperidone?

Common side effects that may occur when taking risperidone include drowsiness, restlessness, muscle stiffness, tremors, dry mouth, constipation, and increased appetite. Patients may also experience low blood pressure or dizziness especially when standing up suddenly.
Other side effects may also include extrapyramidal symptoms (muscle stiffness, tremors, and body shakes). At higher doses, extrapyramidal side effects often increase. Cogentin® (benztropine) or Benadryl® (diphenhydramine) can be prescribed to reduce or eliminate stiffness and tremors.
Some of these problems may be reduced by increasing the dose slowly. Patients who already have low blood pressure, have kidney or liver impairment, are elderly, or are in a weakened condition may require close monitoring and even more gradual dose adjustment.
Lactation and tender swollen breasts as well as absent menstrual periods have been noted in persons taking risperidone.
As with any injection, some pain is reported by patients receiving risperidone long acting injection. However, in clinical studies, patients report minimal or no pain.

What are the more serious side effects of antipsychotics?

With newer second generation antipsychotics (SGA), more commonly seen are diabetes/weight gain/increased cholesterol and triglycerides as noted in stronger warnings mandated by the FDA in individual drug labeling. For the relative risk of weight gain and diabetes seen with the various drugs, see Table 2 in the Consensus Conference on Antipsychotic Drugs. These guidelines make recommendations for the monitoring of cardiac risk factors while on atypical antipsychotics.

Please also consult the Metabolic and Diabetes tab on the Hearts and Minds section for the current monitoring information regarding triglycerides, cholesterol, fasting blood glucose, etc. to help plan preventative interventions.
Less commonly seen, but important, is the early death/dementia risk as noted in the FDA boxed warning. In some clinical trials, it was determined that elderly people developed strokes at a higher rate than those on placebo medication (sugar pill). The SGA group has less tardive dyskinesia (TD), neuroleptic malignant syndrome, seizures, and changes in heart rhythm than FGA drugs but not zero.

What do I do about the more serious risks?

Please let your doctors know if you have any of these medical conditions prior to starting risperidone.

It is important to be aware of prevention with attention to nutrition, exercise, and reducing your plate size (because the medications may reduce your ability to feel full after eating). For more ideas, see the NAMI Hearts and Minds Program.

Also, obtain Abnormal Involuntary Movement testing (AIMS) to monitor for TD. While it is less common with newer SGA, it has been reported. If you are taking an older FGA, then regular AIMS testing is needed for monitoring, so you can make good choices about the use of the drug when weighing the risks and benefits.

Are there any risks for taking Risperdal® for long periods of time?

Tardive dyskinesia (TD) is a side effect that may develop with prolonged use of antipsychotics. Medications such as risperidone have been shown to have a much lower risk of TD compared to older antipsychotics, such as Haldol® (haloperidol). Should you develop symptoms of TD, such as grimacing, sucking and smacking of lips, and other movements that you cannot control, contact your healthcare provider immediately.

No one can predict how much weight a person will gain on any medicine, but an approach that includes exercise and diet and monitoring for weight gain and diabetes is recommended.

What other drugs interact with Risperdal®?

Some antidepressants, such as Prozac® (fluoxetine), Paxil® (paroxetine), Cymbalta® (duloxetine), and Wellbutrin® (bupropion) may increase the blood levels of risperidone. It is possible that patients taking risperidone with any of these agents may experience a change in side effects. Tell your doctor if you begin or discontinue any of these treatments.

Some medications, such as Tegretol® (carbamazepine), Dilantin® (phenytoin), phenobarbital, or Rifadin® (rifampin) may decrease the blood levels of risperidone. It is possible that you may experience a decreased effect from risperidone if you also take one of these medications. Tell your doctor if you begin or discontinue any of these treatments.

How long does it take for Risperdal®to work?

Improvement of some symptoms may be noticed in some patients within a few weeks. The full benefit of risperidone may not be seen for 6-12 weeks or longer.

Risperidone long acting injection is made up of “microspheres” that suspend the medicine risperidone in the injection solution. After the microspheres are injected into the body, they slowly dissolve, releasing a constant amount of the risperidone medication. After receiving the first injection it takes 3 weeks before the medicine starts to be released, thus, requiring you to continue taking the oral risperidone for the first three weeks. When using both the combination of oral and the injection at the start of treatment, patients may notice some improvement in symptoms within a few weeks. The full benefit of risperidone may not be seen for 6-12 weeks, or longer.

FDA ALERT [06/06/2008]

Both conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychosis.

Antipsychotics are not indicated for the treatment of dementia-related psychosis.

Updated by
Karen E. Moeller, Pharm.D., BCPP
(July 2010)

NAMI wishes to thank the College of Psychiatric and Neurologic Pharmacists for producing this fact sheet.

Reviewed by Dr. Ken Duckworth, NAMI Medical Director

Join NAMI today!

When you become a member of NAMI, you become part of America's largest grassroots organization dedicated to improving the lives of persons living with serious mental illness. And now you can join online.

Risperdal® (risperidone)