Risperdal (Risperidone) - Oral

Warning:

The Food and Drug Administration (FDA) issued a boxed warning for the use of antipsychotics in adults aged 65 years and older with dementia-related psychosis. Risperdal should not be used in older adults with dementia-related psychosis, as it can increase the risk of death.

What Is Risperdal?

Risperdal (risperidone) is a prescription medication used to treat mental illnesses, including schizophrenia, autism-related irritability, and bipolar I. It’s an atypical antipsychotic that is thought to work on binding sites in the brain (blocking dopamine type 2 (D2) and serotonin type 2 (5HT2) receptors). Atypical antipsychotics are also known as second-generation antipsychotics (SGAs).

Oral versions of Risperdal include a solution, tablets, and oral disintegrating tablets (ODT).

Drug Facts

  • Generic Name: Risperidone
  • Brand Name: Risperdal
  • Drug Availability: Prescription
  • Therapeutic Classification: Antipsychotic
  • Available Generically: Yes
  • Controlled Substance: N/A
  • Administration Route: Oral
  • Active Ingredient: Risperidone
  • Dosage Form: Tablet, disintegrating tablet, solution

What Is Risperdal Used For?

In the United States, mental illness affects approximately 1 in 5 adults and 1 in 6 children (6 to 17 years old). Although many available medications and other options exist, only about half of people will seek treatment. Risperdal can be used to treat mental illnesses such as schizophrenia, autism-related irritability, and bipolar I.

Schizophrenia

People with schizophrenia may experience symptoms that affect the following: 

  • Perception: People with schizophrenia may experience psychosis (ex., hallucinations or delusions). They may also experience abnormal movements or difficulty organizing their thoughts. 
  • Emotion: Individuals with schizophrenia may have some trouble showing their emotions. So, they may appear depressed or withdrawn.
  • Thinking and reasoning: Some people may experience difficulties with mental focus and using the information to make decisions.

Autism-related irritability

People with autism tend to experience issues with social interactions and communication. Additionally, they may have repetitive behaviors and highly focused interests. For autism, first-line treatment usually involves therapy that addresses behavior, social interaction, and educational concerns. Then, if necessary, medications—like risperidone—are added.

Bipolar I

In bipolar I, people may have a manic episode for at least one week. Manic symptoms can be so severe that hospitalization is necessary. These individuals can also switch to a depressive episode that may last for a minimum of two weeks. They can also have a mixture of these episodes at the same time. During a mixed episode, people with bipolar I might be very agitated and restless—but having thoughts of suicide.

The Food and Drug Administration (FDA) approved risperidone to treat bipolar I during an acute manic episode or mixed episode. Risperidone can be used by itself or in combination with other medications—like lithium or valproate.

How to Take Risperdal

In general, take Risperdal once or twice a day with or without food.

If you’re taking the oral solution, make sure to use the measuring dropper that came with the medication. The smallest amount the calibrated dropper can measure is 0.25 milliliters (mL). If your dose is smaller than 0.25 milliliters, please consult your prescriber. If desired, the medication can be mixed with the following before taking.

  • Coffee
  • Low-fat milk
  • Orange juice
  • Water

Avoid mixing Risperdal solution with soda or tea.

As for the oral disintegrating tablet (ODT) version, use dry hands to peel the backing of the blister. Remove the tablet from the blister without pushing the tablet through the foil. Only remove the medication from the blister pack when you’re ready to take it. Place the ODT directly on your tongue and allow it to dissolve before swallowing. No water is needed. Don’t crush or split the tablet.

How to Store Risperdal

Since risperidone is a non-controlled prescription medication, your healthcare provider can give you refills for up to one year from the original written date. 

Once you pick up the medication from the pharmacy, all versions of Risperdal can be stored at room temperature between 59 degrees to 77 degrees Fahrenheit. Additionally, protect the medication from light, moisture, and freezing conditions.

If you’re planning to travel with Risperdal, be familiar with the regulations of your final destination. In general, however, keep the medication in its original container or packaging—with your name on it—from the pharmacy. Additionally, to be safe, consider having a copy of your Risperdal prescription.

Off-Label Uses

Risperdal has the following off-label uses.

  • Delusions: Risperidone might be helpful in treating delusions, which may include delusional parasitosis. People with delusional parasitosis believe that bugs are all over their bodies.
  • Depression: Risperidone is sometimes combination with antidepressants for depression that doesn't get better with treatment.
  • Huntington's disease-related chorea: Some people are born with Huntington's disease (HD), which is a medical condition that usually starts between 30 to 50 years old. Symptoms may include chorea—uncontrolled twisting or squirming movements. Risperidone might help with these movements.
  • Hypomania: Hypomania is one of the symptoms of bipolar II. Hypomania is also a less severe version of a manic episode in bipolar I. Risperidone by itself or with a mood stabilizer might be helpful in treating hypomania.
  • Obsessive-compulsive disorder (OCD): Adding risperidone is sometimes used for OCD symptoms that are not completely addressed with antidepressants alone.
  • Severe agitation, aggression, or psychosis: Agitation and aggression could be due to a mental health condition, dementia, medications, or other substances. People with dementia might also experience psychosis. Healthcare providers have used an antipsychotic—like risperidone—for these symptoms. 
  • Tourette syndrome: People with Tourette syndrome may have symptoms of uncontrollable tics, like eye-blinking, throat-clearing, repeating words, and crying out swear words. Antipsychotics—like risperidone—might help this medical condition.

How Long Does Risperdal Take to Work?

You might start noticing an improvement in your symptoms as early as one to two weeks. However, the medication might need two to three months for full effectiveness.

What Are the Side Effects of Risperdal?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Common Risperdal side effects include:

Severe Side Effects

Potential severe side effects with risperidone may include:

While taking Risperdal, if you’re concerned about any of your side effects, notify your healthcare provider and seek immediate medical attention.

Long-Term Side Effects

Some long-term side effects with Risperdal include a higher risk of falls and weight gain. In addition to weight gain, risperidone is linked to high blood sugar and cholesterol—which also raises the risk of stroke and negative effects on the heart.

While taking risperidone, some people can also develop TD, which might last even after stopping the medication. If you notice that you’re experiencing uncontrolled repetitive movements—like frequent eye-blinking, sticking out your tongue, and lip-smacking, immediately let your healthcare provider know to discuss next steps.

There is limited long-term data about risperidone’s effects on growth and development in children.

Report Side Effects

Risperdal may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Risperdal Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (solution, tablets, or orally disintegrating tablets):
    • For bipolar disorder:
      • Adults—At first, 2 to 3 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 6 mg per day.
      • Older adults—At first, 0.5 mg 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 6 mg per day.
      • Children 10 to 17 years of age—At first, 0.5 mg once a day, in the morning or evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 6 mg per day.
      • Children younger than 10 years of age—Use and dose must be determined by your doctor.
    • For irritability associated with autistic disorder:
      • Children 5 to 16 years of age weighing 20 kilograms (kg) or greater—At first, 0.5 milligrams (mg) per day. Your doctor may adjust your dose as needed.
      • Children 5 to 16 years weighing less than 20 kg—At first, 0.25 mg per day. Your doctor may adjust your dose as needed.
      • Children younger than 5 years of age—Use and dose must be determined by your doctor.
    • For schizophrenia:
      • Adults—At first, 2 milligrams (mg) per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 16 mg per day.
      • Older adults—At first, 0.5 mg 2 times a day. Your doctor may adjust your dose as needed.
      • Children 13 to 17 years of age—At first, 0.5 mg once a day, in the morning or evening. Your doctor may adjust your dose as needed. However, the dose is usually not more than 6 mg per day.
      • Children younger than 13 years of age—Use and dose must be determined by your doctor.

Modifications

As previously mentioned, the risperidone oral solution can be mixed with coffee, low-fat milk, orange juice, and water before taking.

People with Kidney or Liver Concerns

If you have kidney or liver disease, your healthcare provider may start you at a lower risperidone dose and slowly adjust based on symptoms and side effects.

People with Parkinson’s Disease or Lewy Body Dementia

People with Parkinson’s Disease or Lewy Bodies might have a higher likelihood of side effects, like confusion, unstable posture and frequent falls. They may also experience neuroleptic malignant syndrome-like (syndrome caused by drugs that impact nerves) symptoms and extrapyramidal symptoms (EPS) (uncontrolled body movements) — which includes tardive dyskinesia (TD).  

Pregnant and Nursing Parents

During the third trimester of your pregnancy, taking this medication might lead to extrapyramidal symptoms (uncontrolled body movements) and withdrawal symptoms in your newborn baby. As for nursing, there is limited data on the effects of risperidone in nursing babies. Your healthcare provider may closely monitor your nursing baby’s development and any side effects including drowsiness.

If you become pregnant, immediately let your healthcare provider know. Your healthcare provider will help you weigh the benefits and risks of taking risperidone while pregnant and nursing. 

If you will take risperidone while pregnant, consider contacting the National Pregnancy Registry or calling 1-866-961-2388.

Missed Dose

If you accidentally forgot to take a dose of risperidone, try to take the medication as soon as you remember. If it’s now closer to your next scheduled dose, then take the following dose at the next scheduled time. Don’t try to double up and take more than one dose at one time.

If you miss too many doses in a row, you may experience worsening symptoms of your medical condition.

Overdose: What Happens If I Take Too Much Risperdal?

Taking too much Risperdal might raise the severity of the medication’s common and serious side effects, which may include:

If you accidentally took too many doses of Risperdal, notify your healthcare provider, seek immediate medical attention, or call the Poison Control Center.

What Happens If I Overdose on Risperdal?

If you think you or someone else may have overdosed on Risperdal, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Risperdal, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your or your child's progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Check with your doctor right away if you or your child have any of the following symptoms while using this medicine: convulsions (seizures), difficulty with breathing, a fast heartbeat, a high fever, high or low blood pressure, increased sweating, loss of bladder control, severe muscle stiffness, unusually pale skin, or tiredness. These could be symptoms of a serious condition called neuroleptic malignant syndrome (NMS).

This medicine may cause tardive dyskinesia (a movement disorder). Check with your doctor right away if you or your child have any of the following symptoms while using this medicine: lip smacking or puckering, puffing of the cheeks, rapid or worm-like movements of the tongue, uncontrolled chewing movements, or uncontrolled movements of the arms and legs.

This medicine may increase the amount of sugar in your blood. Check with your doctor right away if you or your child have increased thirst or increased urination. If you have diabetes, you may notice a change in the results of your urine or blood sugar tests. If you have any questions, check with your doctor.

Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help. If the problem continues or gets worse, check with your doctor.

Risperidone can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.

This medicine may cause drowsiness, trouble with thinking, or trouble with controlling body movements, which may lead to falls, fractures or other injuries. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

This medicine may make it more difficult for your body to cool itself down. Use care not to become overheated during exercise or hot weather since overheating may result in heat stroke. Also, use extra care not to become too cold while you are taking risperidone. If you become too cold, you may feel drowsy, confused, or clumsy.

This medicine may increase your or your child's weight. Your doctor may need to check your or your child's weight on a regular basis while using this medicine.

Do not stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. This is to prevent side effects and to keep your condition from becoming worse.

Check with your doctor before using this medicine with alcohol or other medicines that affect the central nervous system (CNS). The use of alcohol or other medicines that affect the CNS with risperidone may worsen the side effects of this medicine, such as dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.

This medicine may increase prolactin blood levels if used for a long time. Check with your doctor if you have breast swelling or soreness, unusual breast milk production, absent, missed, or irregular menstrual periods, stopping of menstrual bleeding, loss in sexual ability, desire, drive, or performance, decreased interest in sexual intercourse, or an inability to have or keep an erection.

If you plan to have children, talk with your doctor before using this medicine. Some women using this medicine have become infertile (unable to have children).

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Risperdal?

If you have an allergic reaction to risperidone or its components, avoid this medication. If you had a history of an allergic reaction to another antipsychotic medication called paliperidone, also avoid taking risperidone.

What Other Medications Interact With Risperdal?

If you take the following medications, your healthcare provider might adjust your risperidone dose.

  • CYP3A4-inducing medications: CYP3A4 is a protein in the liver that helps break down risperidone. So, if you take a medication—like carbamazepine—that encourages CYP3A4 to break down risperidone quickly, then risperidone will not be as effective. Therefore, your healthcare provider may recommend a higher dose of risperidone for you.
  • CYP2D6-inhibiting medications: CYP2D6 is another protein in the liver that helps break down risperidone. If you take a medication—like Prozac— that prevents CYP2D6 from working as well, then the higher amounts of risperidone in the body will raise your risk for side effects. So, your healthcare provider may lower your risperidone dose.

If you have any questions or concerns about these drug interactions, speak with your healthcare provider and pharmacist.

What Medications Are Similar?

There are many medications in the second generation antipsychotic (SGA) medication class. Out of those, the following SGAs are commonly used to treat schizophrenia and bipolar:

  • Abilify (aripiprazole)
  • Geodon (ziprasidone)
  • Seroquel (quetiapine)
  • Zyprexa (olanzapine)

Abilify, however, is probably most similar to Risperdal. In addition to schizophrenia and the acute manic or mixed episodes of bipolar I, both medications received FDA approval for the treatment of autism-related irritability. Abilify and Risperdal are also available in a tablet, oral solution and ODT forms.

As far as factors to consider when choosing between Abilify and Risperdal, Risperdal does have a higher likelihood of abnormal breast development. Risperidone is also not recommended in people with a history of Parkinson’s Disease or other movement conditions. Unfortunately, compared to Abilify, Risperdal also has a higher chance for abnormal heart rhythm, high blood sugar, low blood pressure, and weight gain.

Although all of these medications are in the same medication class, healthcare providers have used more than one antipsychotic to treat a mental illness. Since the best antipsychotic or combination therapy varies by person, however, talk with your healthcare provider to help find the best treatment plan for you. Don’t make any medication changes without talking with your healthcare provider first.

Frequently Asked Questions

  • Can I drink alcohol with Risperdal?

    Since Risperdal works on dopamine and serotonin receptors in the brain, avoid drinking alcohol, which also has effects on the brain. Combining risperidone and alcohol might lead to confusion and worsening side effects, like sleepiness.

  • Do I have to take Risperdal for life?

    Risperidone is usually a life-long medication. Even if you’re feeling better, don’t make any changes to your medications without talking with your healthcare provider first.

  • If I am having tardive dyskinesia, what do I do?

    TD is a possible side effect of Risperdal. If you notice that you’re experiencing uncontrolled repetitive movements, don’t stop the medication. Suddenly stopping your medication may worsen your medical condition and raise your likelihood of hospitalization.


    Instead, immediately talk with your healthcare provider to determine the next steps, like lowering your medication dose or switching to another medication. If necessary, your healthcare provider might add another medication to treat TD.

How Can I Stay Healthy While Taking Risperdal?

While taking Risperdal, it’s important to take care of yourself by doing the following:

  • Have a good social support network
  • Share about your medical condition and raising awareness for your loved ones to provide you with the necessary support
  • Work with your mental health team
  • Sleep well
  • Limit your stress triggers
  • Exercise
  • Know how to recognize manic episodes, depressive symptoms, or worsening medical condition
  • Have a crisis plan in case of psychosis, etc.
  • Participate in therapy that addresses behavior, social interaction, and educational concerns to develop good coping mechanisms.

Medical Disclaimer

Verywell Health's drug information is meant for education purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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