Risperdal (risperidone) is an atypical antipsychotic medication approved for the treatment of schizophrenia, bipolar disorder, and irritability associated with autistic disorder. It functions by modulating dopamine and serotonin activity in the brain, helping to restore chemical balance and alleviate symptoms of psychosis and mood instability. With a well-established efficacy and safety profile, it remains a cornerstone in psychiatric pharmacotherapy, offering patients a pathway toward symptom control and improved daily functioning. Available in oral tablets, orally disintegrating tablets, and a long-acting injectable formulation, Risperdal provides flexible dosing options tailored to individual patient needs and treatment adherence considerations.

Features

• Active ingredient: Risperidone
• Available formulations: Oral tablets (0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg), orally disintegrating tablets, and long-acting injectable (Risperdal Consta®)
• Mechanism of action: Dopamine D2 and serotonin 5-HT2A receptor antagonist
• Half-life: Approximately 20 hours for risperidone; 9-hydroxyrisperidone active metabolite has a half-life of ~24 hours
• Bioavailability: 70% for oral administration
• FDA-approved indications: Schizophrenia, bipolar mania/mixed episodes, irritability associated with autistic disorder

Benefits

• Reduces positive symptoms of schizophrenia such as hallucinations, delusions, and disorganized thinking
• Helps stabilize mood episodes in bipolar disorder, decreasing the frequency and severity of manic symptoms
• Improves negative symptoms of schizophrenia including social withdrawal and emotional blunting
• Long-acting injectable formulation enhances treatment adherence and provides consistent drug delivery
• May improve overall quality of life by enabling better social and occupational functioning
• Lower risk of extrapyramidal symptoms compared to conventional antipsychotics

Common use

Risperdal is primarily prescribed for the management of schizophrenia in adults and adolescents aged 13-17 years. It is also indicated for the acute treatment of manic or mixed episodes associated with bipolar I disorder in adults and pediatric patients aged 10-17 years, both as monotherapy and as adjunctive therapy with lithium or valproate. Additionally, it is used for the treatment of irritability associated with autistic disorder in children and adolescents aged 5-16 years, including symptoms of aggression, self-injury, temper tantrums, and quickly changing moods.

Dosage and direction

Schizophrenia (adults): Initial dose 2 mg daily, may be increased to 4-6 mg daily by day 3. Maximum recommended dose: 16 mg daily.
Schizophrenia (adolescents 13-17 years): Start with 0.5 mg once daily, adjust in 0.5-1.0 mg increments. Effective dose range: 3-6 mg daily.
Bipolar mania (adults): Start with 2-3 mg once daily, adjust by 1 mg daily. Recommended range: 2-6 mg daily.
Bipolar mania (children 10-17 years): Start with 0.5 mg once daily, adjust in 0.5-1.0 mg increments. Recommended dose: 2.5-6 mg daily.
Irritability associated with autistic disorder: Start with 0.25 mg daily (<20 kg) or 0.5 mg daily (≥20 kg). Adjust at ≥2-week intervals. Maximum dose: 3 mg daily.

Take with or without food. Tablets should be swallowed whole; orally disintegrating tablets should be placed on the tongue without water. For Risperdal Consta®, administer by deep intramuscular injection every 2 weeks by healthcare professional.

Precautions

Regular monitoring of weight, blood glucose, and lipid profiles is recommended due to risk of metabolic changes. Orthostatic hypotension may occur, particularly during initial dose titration. Use caution in patients with cardiovascular disease, cerebrovascular disease, or conditions that would predispose to hypotension. Risperdal may impair judgment, thinking, or motor skills—caution patients about operating machinery or driving until they know how the medication affects them. Monitor for signs of neuroleptic malignant syndrome (NMS) and tardive dyskinesia. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at increased risk of death.

Contraindications

Hypersensitivity to risperidone or any component of the formulation. Concomitant use with other drugs that prolong QT interval in patients with known QT prolongation or history of cardiac arrhythmias. Severe hepatic impairment. Risperdal is contraindicated in patients with a history of neuroleptic malignant syndrome. Not recommended in patients with severe renal impairment.

Possible side effects

Common (≥5%): Somnolence, dizziness, insomnia, agitation, anxiety, headache, constipation, nausea, dyspepsia, rhinitis, rash, increased weight
Less common (1-5%): Orthostatic hypotension, tachycardia, hyperprolactinemia, extrapyramidal symptoms, tremor, fatigue, blurred vision, salivary hypersecretion
Rare (<1%): Neuroleptic malignant syndrome, tardive dyskinesia, seizures, priapism, diabetic ketoacidosis, anaphylactic reaction
Metabolic effects: Weight gain, hyperglycemia, dyslipidemia
Endocrine effects: Galactorrhea, amenorrhea, gynecomastia

Drug interaction

Strong CYP2D6 inhibitors (fluoxetine, paroxetine) may increase risperidone concentrations—dose adjustment may be necessary. Carbamazepine and other CYP3A4 inducers may decrease risperidone concentrations. May enhance effects of antihypertensive medications. Concurrent use with other CNS depressants (alcohol, benzodiazepines, opioids) may potentiate sedative effects. May antagonize levodopa and dopamine agonists. Caution with drugs that prolong QT interval (antiarrhythmics, certain antibiotics, antipsychotics).

Missed dose

If a dose is missed, take it as soon as remembered unless it is close to the time for the next dose. Do not double the dose to make up for a missed one. For the long-acting injectable formulation, contact the healthcare provider to reschedule the injection if the appointment is missed.

Overdose

Symptoms may include drowsiness, sedation, tachycardia, hypotension, extrapyramidal symptoms, and QT prolongation. In case of suspected overdose, seek immediate medical attention. Provide supportive care including maintaining airway and adequate ventilation. Cardiovascular monitoring is recommended. There is no specific antidote; symptomatic treatment should be instituted.

Storage

Store at room temperature (15-30°C/59-86°F). Protect from light and moisture. Keep in original container. Keep out of reach of children and pets. Do not use after expiration date. For Risperdal Consta®, store refrigerated (2-8°C/36-46°F); may be kept at room temperature for up to 7 days before use.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. Individual response to medication may vary. Only a healthcare provider can determine the appropriate treatment based on individual medical history, current condition, and other factors. Do not discontinue medication without medical supervision.

Reviews

“After struggling with treatment-resistant schizophrenia for years, Risperdal provided the first significant relief from auditory hallucinations. The transition to the long-acting injection has been particularly beneficial for maintaining consistency.” — M.B., treated for 3 years

“As a psychiatrist, I’ve found Risperdal to be a reliable option for first-episode psychosis, particularly appreciating its relatively favorable metabolic profile compared to some other second-generation antipsychotics.” — Dr. A. Chen, MD

“The initial adjustment period included some sedation, but after dose optimization, my son has shown remarkable improvement in emotional regulation without the significant weight gain we experienced with previous medications.” — Parent of autistic child