Risperdal (Risperidone)
Also sold as: Risperdal, Sizodon, Risdone, Resperil, Risnia
Pregnancy
Cat C
Lactation
Avoid
Schedule
H
Forms
Tablet 0.5mg, 1mg, 2mg, 3mg, 4mg +2
Indications
- Schizophrenia — acute and maintenance
- Bipolar disorder — acute mania
- Irritability in autism spectrum disorder (ASD)
- Behavioural disturbances in dementia (short-term, off-label)
- Tourette syndrome (off-label)
Adult Dosing
Schizophrenia
Start 1-2 mg PO BD; increase by 1-2 mg/day every 24 hours to target 4-6 mg/day
Usual effective dose: 4-8 mg/day. Doses >10 mg/day rarely more effective; higher EPS risk.
Acute mania
2-3 mg PO once daily; increase to 1 mg/day to max 6 mg/day
LAI (depot)
25 mg IM every 2 weeks; increase to 37.5-50 mg every 2 weeks if needed
Oral overlap for 3 weeks after first injection (delayed release onset)
Pediatric Dosing
Paediatric use requires specialist guidance. Weight gain significant in children.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl < 30 mL/min | Start 0.5 mg BD; increase slowly to max 4 mg/day |
Hepatic Adjustment
Start 0.5 mg BD; increase cautiously in hepatic impairment
Pregnancy & Lactation
Pregnancy: Category C
Limited data; neonatal extrapyramidal symptoms and withdrawal reported. Use only if benefit outweighs risk; lowest effective dose.
Lactation: Avoid
Excreted in breast milk; neonatal sedation risk. Avoid or discontinue breastfeeding.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| CYP2D6 inhibitors (fluoxetine, paroxetine) | Increase risperidone levels significantly — reduce dose by 50% | Major |
| Carbamazepine / Rifampicin | Reduce risperidone levels by up to 50% — increase dose | Major |
| QT-prolonging drugs (antiarrhythmics, methadone, domperidone) | Additive QT prolongation | Major |
| Antihypertensives | Additive hypotension (alpha-1 blockade) | Moderate |
| Levodopa / Dopamine agonists | Antagonism — worsens Parkinson's symptoms | Major |
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Side Effects
Common
- Extrapyramidal symptoms (EPS) — dose-dependent: rigidity, tremor, akathisia
- Weight gain
- Somnolence
- Hyperprolactinaemia (gynecomastia, amenorrhoea, galactorrhoea)
- Orthostatic hypotension
- QT prolongation
Serious / Discontinue If
- Neuroleptic malignant syndrome (NMS) — fever, rigidity, autonomic instability
- Tardive dyskinesia (long-term)
- Metabolic syndrome (diabetes, dyslipidaemia)
- Cerebrovascular events (elderly with dementia)
- Agranulocytosis (rare)
Contraindications
- QTc > 500 ms
- Concurrent QT-prolonging drugs (relative)
- Dementia-related psychosis in elderly (Black Box — increased mortality)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Sizodon 2mg | Sun Pharma | 10 tab ₹52 |
| Risnia 2mg | Torrent | 10 tab ₹48 |
| Risdone 2mg | Intas | 10 tab ₹44 |
| Risperdal 2mg | Janssen | 10 tab ₹185 |
Monitoring Required
- Weight and BMI monthly × 3 months then quarterly
- Fasting glucose and lipids at baseline, 3 months, annually
- ECG (QT) at baseline
- Prolactin if symptomatic
- AIMS scale for tardive dyskinesia (6-monthly)
- BP (orthostatic)
Patient Counseling Points
- Do NOT stop suddenly — discuss with psychiatrist before stopping
- Take with or without food
- Rise slowly — dizziness on standing common initially
- Report muscle stiffness, restlessness, irregular heartbeat, fever
- Avoid alcohol — worsens sedation
- Weight monitoring important — diet and exercise advised
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Clinically reviewed by: Dr. Ananya Krishnan, MD (Psychiatry), Senior Consultant
Last reviewed: 2026-04-01
References
- BNF — Risperidone
- NICE Schizophrenia Guidelines 2014 (updated 2023)
- APA Schizophrenia Practice Guidelines
- IAP Child Psychiatry Guidelines