Key takeaways:
Risperidone (Risperdal) is an atypical antipsychotic that’s used to treat certain symptoms of schizophrenia and bipolar disorder.
There are many medications that can interact with risperidone. Some interactions can cause risperidone to be less effective. Others can raise the risk of side effects.
Talking to your healthcare provider and pharmacist about all medications, supplements, and other substances you’re taking can help prevent or manage risperidone interactions.
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Each year across the U.S., millions of people experience symptoms of a mental health condition. Treatment for these conditions often includes therapy, medication, or both. Risperidone (Risperdal) is a medication that can help manage symptoms of schizophrenia and bipolar disorder. It works by balancing the levels of serotonin and dopamine in the brain.
However, risperidone interacts with many medications and supplements. The body uses a certain enzyme (protein) to break down risperidone. Interactions often hap pen when other substances change how this enzyme works. Some interactions raise the risk of experiencing side effects from risperidone, while others make the medication less effective.
So which interactions should you watch out for when taking risperidone? Let’s take a look at seven notable ones. Keep in mind that this isn’t a complete list of possible interactions, so it’s important to discuss the medications you take with your healthcare provider and pharmacist.
1. Carbamazepine
Carbamazepine (Tegretol, Equetro) is used to treat seizures. It’s also sometimes prescribed for people living with bipolar disorder. It causes risperidone to break down and leave the body faster. This can lead to lower levels of risperidone in your blood and make the medication less effective.
Some people may need to take both risperidone and carbamazepine. Your healthcare provider may prescribe a higher dose of risperidone if you’re taking these two medications together.
2. Levodopa
Levodopa (a component of Sinemet) is a medication that can help relieve symptoms of Parkinson’s disease. It raises dopamine levels in the brain, while risperidone lowers dopamine levels. So these two medications reduce each other’s effectiveness.
You shouldn’t take risperidone together with medications that contain levodopa. It’s likely your healthcare provider may change your prescriptions to avoid this interaction.
3. Certain SSRIs
Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to treat depression and other mental health conditions. Certain SSRIs, such as fluoxetine (Prozac) and paroxetine (Paxil), cause the body to clear risperidone more slowly. This can cause risperidone to build up in the body, raising the risk of side effects. These may include nausea, diarrhea, or uncontrollable body movements.
You can still take both medications, but you may need a dose change. Your healthcare provider may lower your dose of risperidone if you’re also taking one of these SSRIs. However, they may also choose to switch you to an antidepressant that doesn’t interact with risperidone.
4. Alcohol
Mental health conditions like schizophrenia and bipolar disorder are thought to be caused by chemical imbalances in the brain. Risperidone works to balance those chemicals. Alcohol can cause changes to the same brain chemicals. So drinking alcohol can worsen symptoms of mental health conditions.
What’s more, drinking while taking risperidone can make certain side effects, like drowsiness and dizziness, more intense. It’s best to avoid alcohol. But you should have an open and honest conversation with your healthcare provider about how much and how often you drink. They can provide helpful information and guidance on how to reduce or stop drinking, if needed.
5. Medications that cause drowsiness
Many common medications are central nervous system (CNS) depressants. This means they slow down or calm brain activity and can cause drowsiness. CNS depressants include opioids prescribed for pain relief and sleeping medications like zolpidem (Ambien). Benzodiazepines, such as alprazolam (Xanax) and clonazepam (Klonopin), are CNS depressants that are commonly prescribed for anxiety.
There are risks when taking both risperidone and a CNS depressant. Side effects, such as sleepiness and feeling less alert, may be more severe. Taking risperidone with an opioid can dangerously slow down your breathing.
It’s possible that you may need to take both risperidone and a CNS depressant. If this is the case, be extra cautious about any side effects you experience. Avoid activities that require you to be alert — like driving — until you know how this combination affects you. If you notice severe drowsiness or slowed breathing, seek medical care immediately.
6. Blood pressure medications
Low blood pressure is a possible side effect of risperidone. This most often happens when you change positions from sitting to standing. You may feel dizzy or like you’re going to faint. The risk of this side effect is higher if you’re also taking blood pressure medications.
If you’re taking blood pressure medication, you may already be checking your blood pressure at home. Your healthcare provider may ask you to check it more often if you also take risperidone. If you’re having any symptoms of low blood pressure (such as lightheadedness, dizziness, or blurry vision), let your healthcare provider know.
7. Medications that can increase prolactin levels
One side effect of risperidone is that it can cause your prolactin levels to go up. Prolactin is a hormone that helps the body produce breast milk while nursing. High prolactin levels can cause problems for both men and women, including sexual dysfunction, irregular periods, and infertility.
There are other medications that can also raise prolactin levels:
Cimetidine (Tagamet HB)
Metoclopramide (Reglan)
Typical antipsychotics, such as haloperidol
Tricyclic antidepressants, such as amitriptyline
This isn’t a complete list of medications that raise prolactin levels. Taking these medications with risperidone can raise your risk of high prolactin. Your healthcare provider may recommend having regular blood tests done to keep an eye on your prolactin levels.
When should I contact my healthcare provider about a risperidone interaction?
Before starting risperidone, make sure you share a complete medication list with your healthcare provider and pharmacist. Don’t forget to include over-the-counter supplements, herbal remedies, and other substances (like alcohol) as well. And let your healthcare provider know if you start any new medications while taking risperidone. Knowing everything you’re consuming will help them thoroughly check for interactions.
You should also contact your healthcare provider if you think you’re experiencing a risperidone interaction. If you notice new or worse side effects, like uncontrollable body movements or excessive drowsiness, talk to your provider right away. You should also let them know if your symptoms haven’t improved or have worsened. But don’t stop taking risperidone or change your dose without talking to your healthcare provider first — even if you think you’re experiencing an interaction with other medications.
The bottom line
Risperidone is often an effective medication for mental health conditions like schizophrenia and bipolar disorder. There are quite a few medications that interact with risperidone, including carbamazepine and some SSRIs. Some interactions can make risperidone less effective. Others raise the risk of side effects.
The best way to manage risperidone interactions is to make sure your healthcare provider and pharmacist are aware of everything you’re taking. It’s also important to be honest with them about any substances, like alcohol, you’re using as well.
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References
La Torre, D., et al. (2007). Pharmacological causes of hyperprolactinemia. StatPearls.
McNeil, S. E., et al. (2022). Risperidone. StatPearls.
National Alliance on Mental Illness. (2022). Mental health by the numbers.
National Institute on Drug Abuse. (2018). Prescription CNS depressants drug facts.
Torrent Pharmaceuticals Limited. (2022). Risperdal [package insert].
U.S. Food and Drug Administration. (2017). FDA Drug Safety Communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning.
