Perseris
Perseris (risperidone) is a long-acting injectable atypical antipsychotic. It's used to treat schizophrenia in adults. But this medication is only reserved for people who've been taking and are stable on oral risperidone (Risperdal) 3 mg or 4 mg. Your healthcare provider will inject Perseris (risperidone) under the skin every month. Some common side effects of this medication include weight gain, constipation, and sleepiness.
What is Perseris (risperidone)?
What is Perseris (risperidone) used for?
Schizophrenia in adults
How Perseris (risperidone) works
Perseris (risperidone) is an atypical antipsychotic. It's not completely known how Perseris (risperidone) works, but it's thought to work by balancing out the levels of chemicals (dopamine and serotonin) in the brain to help control thoughts, mood, and behaviors.
Drug Facts
What are the side effects of Perseris (risperidone)?
Common Side Effects
- Weight gain (13%)
- Constipation (7-8%)
- Pain in the arms or legs (up to 8%)
- Sleepiness (7-8%)
- Back pain (4-7%)
- Trouble sitting still (3-7%)
- Anxiety (3-7%)
- Muscle pain (5%)
- Injection-site pain (at least 5%)
Other Side Effects
- Stomach discomfort
- Dry mouth
- Muscle stiffness
- Muscle spasms
- Feeling more hungry
- Uncontrolled body movements
Serious Side Effects
- Neuroleptic malignant syndrome: fever, sweating, stiff muscles, confusion, not aware of your surroundings, fast or irregular heartbeat
- Dangerously high blood sugar: frequently thirsty, needing to urinate often, tiredness, nausea, vomiting, difficulty breathing, having fruity breath, having dry mouth
- Serious infections: fever, headache, chills, body aches, cough, weakness
- Seizures
- Difficulty swallowing
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- High blood sugar (hyperglycemia)—increased thirst or amount of urine, unusual weakness or fatigue, blurry vision
- High fever, stiff muscles, increased sweating, fast or irregular heartbeat, and confusion, which may be signs of neuroleptic malignant syndrome
- High prolactin level—unexpected breast tissue growth, discharge from the nipple, change in sex drive or performance, irregular menstrual cycle
- Infection—fever, chills, cough, or sore throat
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
- Pain or trouble swallowing
- Prolonged or painful erection
- Seizures
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Uncontrolled and repetitive body movements, muscle stiffness or spasms, tremors or shaking, loss of balance or coordination, restlessness, shuffling walk, which may be signs of extrapyramidal symptoms (EPS)
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Constipation
- Drowsiness
- Muscle pain or cramps
- Weight gain
Pharmacist tips for Perseris (risperidone)
Make sure to mark your appointments in your calendar to see your provider and receive your Perseris (risperidone) doses so you don't miss any of your doses.
Perseris (risperidone) interacts with a lot of commonly-used medications. For example, certain selective serotonin reuptake inhibitor (SSRIs) like, paroxetine (Paxil) and fluoxetine (Prozac), can raise the level of risperidone in the body. If you're taking this type of medication with Perseris (risperidone), your provider will consider a lower dose of Perseris (risperidone) for you. Let your provider know about all the medications you're taking before starting Perseris (risperidone).
It's best to avoid alcohol while taking Perseris (risperidone) because it can worsen side effects (e.g., drowsiness, dizziness) as well as worsen symptoms of schizophrenia. But if you drink alcohol regularly and it's hard for you to cut it out completely, let your provider know. They can suggest ways to limit the amount you drink or resources to help you stop drinking.
Don't rub or massage the injection site after receiving Perseris (risperidone). Also, don't wear a belt or tight clothing, sleeves, or cuffs over the injection site.
Perseris (risperidone) can make you sleepy and dizzy. Don't drive or do anything requiring concentration until you know how this medication affects you.
Perseris (risperidone) can raise your blood sugar levels. If you have diabetes, ask your provider if you need to check your blood sugar more often while taking Perseris (risperidone).
Perseris (risperidone) can raise cholesterol (fat) levels in your blood and can cause weight gain. It's important that you eat a healthy and balanced diet low in fat and sugar and maintain a regular exercise routine while taking Perseris (risperidone).
Perseris (risperidone) can cause a drop in blood pressure when moving positions, such as from sitting to standing. This is more common when starting treatment and when your dose changes. Make sure to get up slowly and try to hold onto something for stability. If you end up falling or hitting your head, get medical help right away.
Although rare, Perseris (risperidone) can cause difficulty swallowing, which can raise the risk for choking. Make sure to take small bites of food and eat slowly to lower your risk for choking.
Perseris (risperidone) can make it harder for your body to cool down if your body temperature gets too high. This makes it more likely for you to become dehydrated and your body to overheat. Let your healthcare provider know if you feel very hot or thirsty, notice a change in the amount of sweat or urine you make, or if you notice very dark-colored urine.
Frequently asked questions about Perseris (risperidone)
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What are the risks and warnings for Perseris (risperidone)?
Perseris (risperidone) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Higher risk of death in older adults with dementia-related psychosis
Risk factors: Older adults with dementia-related psychosis
People over the age of 65 who also have dementia sometimes have some of the symptoms of schizophrenia, like hallucinations and delusions. This is called dementia-related psychosis, and it should not be treated with Perseris (risperidone). If Perseris (risperidone) is used for dementia-related psychosis, it can cause death. In clinical studies, the cause of death is often linked to stroke or other blood vessel problems. Let your provider know if you or your loved one has dementia before starting Perseris (risperidone).
Neuroleptic malignant syndrome
Taking antipsychotic medications like Perseris (risperidone) can cause a rare, but life-threatening condition called neuroleptic malignant syndrome. Symptoms include fever, sweating, stiff muscles, confusion, not being aware of your surroundings, and fast or irregular heartbeat. If you experience any of these symptoms while taking Perseris (risperidone), get medical attention as soon as possible. You provider will likely have you stop taking Perseris (risperidone) and switch you to something else.
Difficulty controlling muscle movements (tardive dyskinesia)
Risk factors: Older adults | Female and 65 years or older | Higher than recommended doses of Perseris (risperidone) | Taking Perseris (risperidone) for a long time
Perseris (risperidone) can cause uncontrolled and possibly permanent muscle movements in the tongue, face, mouth, lips, neck, hands, arms, legs, and feet (tardive dyskinesia). To lower your risk of tardive dyskinesia, take the lowest dose possible for the shortest period of time for your symptoms. Stop taking Perseris (risperidone) and talk to your provider right away if you notice any unusual movements you can't control.
Weight gain, higher blood sugar, and higher cholesterol levels
Risk factors: Diabetes | High cholesterol | Identified as obese
Perseris (risperidone) can raise your blood sugar and cholesterol levels as well as raise your appetite, all of which can lead to weight gain. Your provider will likely order blood tests regularly throughout treatment with Perseris (risperidone) to make sure your blood sugar and cholesterol aren't too high. Make sure to have a healthy and balanced diet low in fat and sugar and maintain a regular exercise routine while receiving Perseris (risperidone).
High prolactin levels
Perseris (risperidone) can cause prolactin hormone levels in your blood to go up. High prolactin levels can lead to symptoms such as milky substances being released from the nipple, enlarged breasts, and absent or irregular menstrual periods. Talk to your healthcare provider if you experience or have any concerns about these symptoms.
Changes in blood pressure and higher risk of falls
Risk factors: Low blood pressure | Taking medications that lower blood pressure | History of medical conditions that can lower blood pressure | High Perseris (risperidone) doses | Liver or kidney problems | 65 years or older
Perseris (risperidone) can make you tired, lower your blood pressure, or cause you to lose your balance, which can lead to falls. When standing from a sitting or lying position, make sure to get up slowly and hold onto something. If you experience a fall while taking Perseris (risperidone), contact your provider.
Risk of infection (from low white blood cell count)
Risk factors: Poor immune system
Though rare, Perseris (risperidone) can lower your white blood cell count (WBCs) and put you at risk for developing infections. You might need to get blood tests done regularly during the first few months of taking Perseris (risperidone) so your provider can make sure your WBC count is in a safe range. If your WBC count drops too low, you'll likely need to stop taking Perseris (risperidone). If you develop any signs of infection, such as fever, tiredness, chills, cough, or trouble breathing, and they don't go away, contact your provider right away.
Difficulty concentrating and extreme sleepiness
Risk factors: Taking high doses of Perseris (risperidone) | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness
Perseris (risperidone) can cause extreme sleepiness and decrease your ability to think, react, and focus. Your risk is higher if you're also taking other medications that can cause drowsiness, such as benzodiazepines, anxiety medications, muscle relaxants, and sleep medications. Make sure you know how this medication affects you before driving a car or doing activities that require your concentration. Talk to your healthcare provider right away if you feel too sleepy from Perseris (risperidone).
Seizures
Risk factors: History of seizures | Health conditions that make it easier to get seizures
Perseris (risperidone) can potentially cause seizures. Before starting this medication, let your provider know if you have a history of seizures or have a medical condition that puts you at risk for getting seizures.
Prolonged and painful erection
Although rare, Perseris (risperidone) can cause prolonged and painful erections, which sometimes requires surgery to treat. If you develop a prolonged erection that lasts longer than 4 hours, get medical attention right away.
Perseris (risperidone) dosage forms
Typical dosing for Perseris (risperidone)
Your provider will calculate your dose of Perseris (risperidone) based on what dose of oral risperidone (Risperdal) you were previously taking. Perseris (risperidone) is only for people who've been taking and are stable on oral risperidone (Risperdal) 3 mg or 4 mg daily.
The typical dose is 90 mg or 120 mg injected under the skin in the stomach or upper arm once per month, by a healthcare provider in a clinic setting.
Your dose might differ if you're taking a medication that interacts with Perseris (risperidone), or if you've kidney or liver problems.
Perseris (risperidone) contraindications
Allergy to risperidone or paliperidone (Invega)
What are alternatives to Perseris (risperidone)?
Schizophrenia in adults
Schizoaffective disorder in adults
Schizophrenia in adults
Bipolar I disorder in adults
Perseris (risperidone) images
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References
Best studies we foundIndivior Inc. (2023). Perseris- risperidone kit [package insert]. dailymed.
Karas, A., et al. (2019). PerserisTM: A new and long-acting, atypical antipsychotic drug-delivery system. Pharmacy and Therapeutics.
Marcinkowska, M., et al. (2020). Management of dementia-related psychosis, agitation and aggression: a review of the pharmacology and clinical effects of potential drug candidates. Central Nervous System Drugs.
National Institute of Mental Health. (2023). Schizophrenia.
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