Risperidone (Efficacy)

Risperidone is an atypical or second generation neuroleptic antipsychotic (SGA), similar in efficacy to other high-potency antipsychotics. It is a selective monoaminergic antagonist drug and has a high affinity for serotonergic 5-HT2 and D2 dopaminergic receptors.

Risperidone is effective on persistent positive symptoms of schizophrenia (although it has not yet been compared to the efficacy of clozapine) and is also widely prescribed for the treatment of bipolar disorder.

CAUTIONS

Before prescribing risperidone, caution should be exercised in patients with cardiovascular disease, with a family history of prolongation of the QT cardiac interval and in the concomitant use with medications that can originate this kind of diseases.

Caution when prescribing risperidone to patients with a history of seizures, elderly, renal failure, liver failure, patients with risk of stroke, pre-existing hyperprolactinemia and prolactin-dependent tumors.

Due to its antiemetic effect, it can mask signs and symptoms of overdose of certain medications or disorders such as intestinal obstruction, Reye's syndrome and brain tumors. Evaluate risk/benefit in Parkinson's disease or dementia of Lewis bodies.

Monitor symptoms of hyperglycemia in all patients and especially in diabetic patients. Monitor weight.

Stop treatment if there are signs of NMS (neuroleptic malignant syndrome) and/or tardive dyskinesia or if signs of cerebrovascular stroke appear.

It is highly recommended to analyze physical and social causes of aggressive behavior prior to the prescription of risperidone and to control the sedative effect of the drug before administering to children because it can cause problems of learning ability.

There is a risk of leukopenia, neutropenia and agranulocytosis with the intake of risperidone, so it is recommended to monitor the patient. In the case of the onset of severe neutropenia, discontinue treatment and control white blood cell levels until recovery.

In the injectable presentation, anaphylactic reactions have rarely been reported in patients who have previously tolerated oral risperidone.

SIDE EFFECTS

Infection of the upper respiratory tract, pneumonia, bronchitis, sinusitis, urinary tract infection, influenza.

Hyperprolactinemia, hyperglycemia, weight gain, increased appetite, or on the other hand can also produce, depending on the type of patient, weight loss and decreased appetite.

Insomnia, depression, anxiety, sleep disorders, agitation, parkinsonism, headache, sedation/drowsiness, akathisia, dystonia, dizziness, dyskinesia, tremor; blurry vision.

Tachycardia, hypotension, arterial hypertension, dyspnea, pharyngolaryngeal pain, cough, nasal congestion, abdominal pain, abdominal discomfort, vomiting, nausea, constipation, gastroenteritis, diarrhea, dyspepsia, dry mouth, toothache, rash, muscle spasms, musculoskeletal pain, back pain, arthralgia.

Urinary incontinence, erectile dysfunction, amenorrhea, galactorrhea, edema, pyrexia, chest pain, asthenia, fatigue, pain, increase in transaminases, increase in gammaglutamyltransferase.

In the case of intramuscular administration: anemia, pain at the injection site, reaction at the injection site.

PHARMACOLOGIC INTERACTIONS

Exists risk of increased sedation with: alcohol, opioids, antihistamines and benzodiazepines.

The plasma concentration of risperidone may be diminished by concomitant treatment with carbamazepine, phenytoin, rifampicin, and phenobarbital.

The plasma concentration of risperidone can be increased by concomitant treatment with fluoxetine, paroxetine, verapamil, phenothiazines, tricyclic antidepressants, some β-blockers and itraconazole.

Risperidone can inhibit the effect of levodopa and other dopamine agonists.

There is a risk of hypotension if there is concomitant treatment with antihypertensive agents.

The use with paliperidone is not recommended.

BRAND NAMES

  • Arketin ®
  • Diaforin ®
  • Rispemylan ®
  • Risperdal ®
  • Risperdal Flas ®

Gene or region studied

  • GRM7
  • MEIS2
  • TJP1
  • TNFRSF11A
  • PPA2
  • GLPR1
  • 11q23.1
  • DRD3
  • 16q21
  • CNTNAP5
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