risperidone
Risperidone (Risperdal) is an atypical antipsychotic that's used to improve mood, thoughts, and behaviors in people with schizophrenia, bipolar disorder, and autism. It's taken by mouth, typically once or twice daily. Common side effects of risperidone (Risperdal) include sleepiness, movement problems, and weight gain. Risperidone (Risperdal) can interact with some medications, such as certain antidepressants or blood pressure medications. Taking these medications together can make certain side effects worse.
What is Risperidone (Risperdal)?
What is Risperidone (Risperdal) used for?
Schizophrenia - people ages 13 years and older
Manic or mixed episodes associated with bipolar I disorder - people ages 10 years and older
Irritability associated with autism - children ages 5 to 17 years old
How Risperidone (Risperdal) works
Risperidone (Risperdal) is an atypical antipsychotic. It's not completely known how risperidone (Risperdal) works, but it's thought to work by balancing out the levels of chemicals (dopamine and serotonin) in your brain to help control your thoughts, mood, and behaviors.
Drug Facts
More on Risperidone (Risperdal) essentials
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What are the side effects of Risperidone (Risperdal)?
Common Side Effects
- Muscle stiffness, muscle tightening, difficulty with movement (25%)
- Extreme sleepiness (11%)
- Restlessness, trouble remaining still (9%)
- Tremor (6%)
- Dizziness (6%)
- Nausea (5%)
- Repetitive movements, abnormal postures (5%)
- Extreme sleepiness (up to 56%)
- Dizziness (up to 16%)
- Nausea or vomiting (up to 16%)
- Stomach pain (up to 16%)
- Muscle stiffness, muscle tightening, difficulty with movement (up to 12%)
- Heartburn (up to 10%)
- Sore throat (up to 10%)
Other Side Effects
- Diarrhea
- Drooling
- Blurry vision
- Stomach discomfort
- Feeling tired or having low energy
- Blurry vision
- Diarrhea
- Feeling more hungry
- Restlessness, trouble remaining still
- Repetitive movements, abnormal postures
- Anxiety
- Rash
Serious Side Effects
- Neuroleptic malignant syndrome: fever, sweating, stiff muscles, confusion, not aware of your surroundings, fast or irregular heartbeat
- Stroke: numbness or weakness typically on one side of the body, loss of balance, headache, blurred vision, difficulty speaking
- 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:Â DailyMed
More on Risperidone (Risperdal) side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Aggressive behavior
agitation
changes in vision, including blurred vision
difficulty concentrating
difficulty speaking or swallowing
inability to move the eyes
increase in amount of urine
loss of balance control
mask-like face
memory problems
muscle spasms of the face, neck, and back
problems with urination
restlessness or need to keep moving (severe)
shuffling walk
skin rash or itching
stiffness or weakness of the arms or legs
tic-like or twitching movements
trembling and shaking of the fingers and hands
trouble sleeping
twisting body movements
Rare
Confusion
dizziness
drowsiness
extreme thirst
fast, shallow breathing
fast, weak heartbeat
headache
increased thirst
lip smacking or puckering
loss of appetite
muscle cramps
pale, clammy skin
poor coordination
prolonged, painful, inappropriate erection of the penis
puffing of the cheeks
rapid or worm-like movements of the tongue
shivering
talking, feeling, and acting with excitement and activity that cannot be controlled
uncontrolled chewing movements
uncontrolled twisting movements of neck, trunk, arms, or legs
unusual bleeding or bruising
unusual facial expressions or body positions
Incidence not known
Actions that are out of control
bleeding gums
blood in the urine or stools
bluish lips or skin
change in mental status
chills
clay-colored stools
clumsiness
cold sweats
cool, pale skin
dark or bloody urine
decrease in the frequency of urination
decrease in urine volume
decreased awareness or responsiveness
difficulty in passing urine (dribbling)
fainting
fast or irregular heartbeat
flushed, dry skin
fruit-like breath odor
hostility
increased hunger
increased urination
indigestion
irregular heartbeat, recurrent
irritability
large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
loss of consciousness
low body temperature muscle ache, twitching, or weakness
nervousness
nightmares
pains in the stomach, side, or abdomen, possibly radiating to the back
pinpoint red spots on the skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
rapid weight gain
seizures
severe constipation
severe sleepiness
shakiness
slurred speech
stomach pain
swelling of the face, ankles, or hands
tightness in the chest
troubled breathing
unexplained weight loss
unpleasant breath odor
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
vomiting
vomiting of blood
weak or feeble pulse
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Absent, missed, or irregular menstrual periods
body aches or pain
breast swelling or soreness
dandruff
darkening of skin color
decreased interest in sexual intercourse
ear congestion
inability to have or keep an erection
increase in body movements
increased watering of the mouth
joint pain
loss in sexual ability, desire, drive, or performance
loss of voice
oily skin
pain or tenderness around the eyes and cheekbones
stopping of menstrual bleeding
toothache
unusual breast milk production
Incidence not known
change in taste
enlargement of the penis or testes
growth of pubic hair
loss of taste
rapid increase in height
sleepwalking
thinning or loss of hair
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Risperidone (Risperdal)
Pros
Taken by mouth
Available as a pill, dissolving tablet, and liquid
Can be used in both adults and children
Available as a lower-cost generic
Cons
Higher risk of sexual problems, compared to other atypical antipsychotics
Can cause weight gain
Can cause changes to sleep or movement problems
Shouldn't be mixed with alcohol
Pharmacist tips for Risperidone (Risperdal)
You can take risperidone (Risperdal) with or without food, but if it's causing stomach problems, try taking your dose with food to help.
If you feel more sleepy while taking risperidone (Risperdal), try taking your dose in the evening.
If you're having trouble swallowing the tablets, ask your provider if you can switch to the risperidone (Risperdal) dissolvable tablets or oral solution.
For the risperidone (Risperdal) dissolvable tablet (ODT), make sure your hands are dry before handling the medication. Peel off the foil backing, and remove the tablet from the blister card. Don't try to push the tablet through the foil; this can damage the medication. Place the tablet on the tongue to let it dissolve, and swallow with saliva. You don't need to drink anything.
It's best to avoid alcohol while taking risperidone (Risperdal) because it can worsen side effects (e.g., drowsiness, dizziness) as well as worsen symptoms of schizophrenia or bipolar disorder.
Risperidone (Risperdal) can make you sleepy and dizzy, or it can make it difficult to sleep. Don't drive or do anything requiring concentration until you know how this medication affects you.
Risperidone (Risperdal) interacts with a lot of commonly-used medications, such as certain selective serotonin reuptake inhibitor (SSRIs) and blood pressure medications. Let your provider know about all the medications you're taking before starting risperidone (Risperdal). Don't start any new medications without talking to your provider or pharmacist first.
Don't change your dose or suddenly stop taking risperidone (Risperdal) without talking to your provider first.
Risperidone (Risperdal) 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 risperidone (Risperdal).
Risperidone (Risperdal) 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 risperidone (Risperdal).
Risperidone (Risperdal) 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, seek medical help right away.
Although rare, risperidone (Risperdal) 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.
Risperidone (Risperdal) 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.
More tips for the risperidone (Risperdal) oral solution:
Store risperidone (Risperdal) oral solution at room temperature and keep it in the original bottle it came in from the pharmacy.
Measure the dose of risperidone (Risperdal) oral solution using a dosing syringe or measuring cup provided. Don't use household spoons or measuring cups, because they're not accurate and might cause you to take the wrong dose. Make sure you know how to give yourself the medication to avoid wasting it.
Become familiar with the Instructions for Use. Contact your pharmacist or provider if you have any questions.
Frequently asked questions about Risperidone (Risperdal)
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What are the risks and warnings for Risperidone (Risperdal)?
Risperidone (Risperdal) 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 risperidone (Risperdal). If risperidone (Risperdal) 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 risperidone (Risperdal).
Neuroleptic malignant syndrome
Taking antipsychotic medications like risperidone (Risperdal) can cause a rare, but life-threatening condition called neuroleptic malignant syndrome. Be aware of symptoms, such as fever, sweating, stiff muscles, confusion, not aware of your surroundings, and fast or irregular heartbeat. If you experience any of these symptoms while taking risperidone (Risperdal), get medication attention as soon as possible. Your provider will likely have you stop taking risperidone (Risperdal) 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 risperidone (Risperdal) | Taking risperidone (Risperdal) for a long time
Risperidone (Risperdal) 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 risperidone (Risperdal) 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
Risperidone (Risperdal) 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 risperidone (Risperdal) 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 risperidone (Risperdal).
High prolactin levels
Risperidone (Risperdal) 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 risperidone (Risperdal) doses | Liver or kidney problems | 65 years or older
Risperidone (Risperdal) 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 risperidone (Risperdal), contact your provider.
Risk of infection (from low white blood cell count)
Risk factors: Poor immune system
Though rare, risperidone (Risperdal) can lower your white blood cell counts (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 risperidone (Risperdal) so your provider can make sure your WBCs are in a safe range. If your WBC count drops too low, you'll likely need to stop taking risperidone (Risperdal). 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 risperidone (Risperdal) | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness
Risperidone (Risperdal) can cause extreme sleepiness and lower 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 risperidone (Risperdal).
Seizures
Risk factors: History of seizures | Health conditions that make it easier to get seizures
Risperidone (Risperdal) 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, risperidone (Risperdal) 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.
Caution use in people with phenylketonuria (PKU) -
The risperidone (Risperdal M-Tab) orally disintegrating tablets (ODTs) contain phenylalanine, a component of the artificial sweetener aspartame. If you have a genetic condition called phenylketonuria (PKU), taking the ODTs can be dangerous for you. Let your provider know if you have PKU so they can prescribe a different formulation of risperidone (Risperdal) that might be safer for you.
Risperidone (Risperdal) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 30ml of 1mg/ml | 1 dropper | $18.90 | $18.90 |
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 0.25mg | 60 orally disintegrating tabs | $40.80 | $0.68 |
| 0.5mg | 60 orally disintegrating tabs | $56.66 | $0.94 |
| 1mg | 30 orally disintegrating tabs | $38.05 | $1.27 |
| 2mg | 30 orally disintegrating tabs | $42.08 | $1.40 |
| 3mg | 28 orally disintegrating tabs | $41.11 | $1.47 |
| 4mg | 30 orally disintegrating tabs | $52.10 | $1.74 |
Typical dosing for Risperidone (Risperdal)
Oral risperidone (Risperdal) is available as oral solution, dissolvable tablets, and tablets.
Your provider will determine you dose of risperidone (Risperdal) based on your condition and whether you have kidney or liver problems. They'll adjust your dose over time, if needed.
Schizophrenia
Adults: The typical starting dose is 2 mg by mouth daily. The typical maintenance dose ranges from 4 mg to 8 mg daily. The maximum daily dose is 16 mg.
Children (ages 13 to 17 years old): The typical starting dose is 0.5 mg by mouth daily. The typical maintenance dose is 3 mg daily. The maximum daily dose 6 mg.
Bipolar I disorder
Adults: The typical starting dose is 2 mg to 3 mg by mouth daily. The typical maintenance dose ranges from 1 mg to 6 mg daily. The maximum daily dose is 6 mg.
Children ages (10 to 17 years old): The typical starting dose is 0.5 mg by mouth daily. The typical maintenance dose ranges from 1 mg to 2.5 mg daily. The maximum daily dose is 6 mg.
Irritability associated with autism
Children ages (5 to 17 years old): Your child's provider will calculate the dose based on their body weight. The typical starting dose is 0.25 mg to 0.5 mg by mouth daily. The typical maintenance dose ranges from 0.5 mg to 1 mg daily. The maximum daily dose is 3 mg.
More on Risperidone (Risperdal) dosage forms
Interactions between Risperidone (Risperdal) and other drugs
More on Risperidone (Risperdal) interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Bromopride
- Cisapride
- Dronedarone
- Levomethadyl
- Mesoridazine
- Metoclopramide
- Pimozide
- Piperaquine
- Saquinavir
- Sparfloxacin
- Terfenadine
- Thioridazine
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acecainide
- Ajmaline
- Amiodarone
- Amisulpride
- Amitriptyline
- Anagrelide
- Apomorphine
- Aprindine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Asenapine
- Astemizole
- Azimilide
- Bretylium
- Buprenorphine
- Bupropion
- Buserelin
- Ceritinib
- Chloral Hydrate
- Chloroquine
- Chlorpromazine
- Citalopram
- Clarithromycin
- Clofazimine
- Clozapine
- Crizotinib
- Dabrafenib
- Dasatinib
- Degarelix
- Delamanid
- Desipramine
- Deslorelin
- Deutetrabenazine
- Dexmethylphenidate
- Dibenzepin
- Disopyramide
- Dofetilide
- Dolasetron
- Domperidone
- Donepezil
- Doxepin
- Droperidol
- Efavirenz
- Encainide
- Encorafenib
- Enflurane
- Entrectinib
- Erythromycin
- Escitalopram
- Fingolimod
- Flecainide
- Fluconazole
- Fluoxetine
- Formoterol
- Foscarnet
- Fostemsavir
- Gemifloxacin
- Ginkgo Biloba
- Glasdegib
- Gonadorelin
- Goserelin
- Halofantrine
- Haloperidol
- Histrelin
- Hydroquinidine
- Hydroxychloroquine
- Hydroxyzine
- Ibutilide
- Imipramine
- Inotuzumab Ozogamicin
- Itraconazole
- Ivabradine
- Ivosidenib
- Ketoconazole
- Lefamulin
- Lenvatinib
- Levofloxacin
- Linezolid
- Lithium
- Lofexidine
- Lorcainide
- Macimorelin
- Mefloquine
- Methadone
- Methylphenidate
- Metronidazole
- Milnacipran
- Mirtazapine
- Moxifloxacin
- Nafarelin
- Nilotinib
- Nortriptyline
- Octreotide
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Ozanimod
- Panobinostat
- Paroxetine
- Pasireotide
- Pazopanib
- Pentamidine
- Pimavanserin
- Pitolisant
- Ponesimod
- Posaconazole
- Probucol
- Procainamide
- Prochlorperazine
- Propafenone
- Protriptyline
- Quetiapine
- Quinidine
- Remifentanil
- Ribociclib
- Selpercatinib
- Sematilide
- Serdexmethylphenidate
- Sertindole
- Sertraline
- Sevoflurane
- Simvastatin
- Siponimod
- Solifenacin
- Sotalol
- Spiramycin
- Sulfamethoxazole
- Sulpiride
- Sultopride
- Sunitinib
- Tacrolimus
- Tedisamil
- Telithromycin
- Terbinafine
- Tetrabenazine
- Trazodone
- Triclabendazole
- Trifluoperazine
- Trimethoprim
- Trimipramine
- Triptorelin
- Vandetanib
- Vemurafenib
- Vinflunine
- Voclosporin
- Zotepine
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Carbamazepine
- Cimetidine
- Enzalutamide
- Fosphenytoin
- Lamotrigine
- Levorphanol
- Lumacaftor
- Midodrine
- Mitotane
- Phenobarbital
- Phenytoin
- Ranitidine
- Rifampin
- Ritonavir
- St John's Wort
- Valproic Acid
How much does Risperidone (Risperdal) cost?
Risperidone (Risperdal) contraindications
Allergy to risperidone or paliperidone (Invega)
What are alternatives to Risperidone (Risperdal)?
Schizophrenia - people ages 13 years and older
Manic or mixed episodes associated with bipolar I disorder - people ages 10 years and older
Irritability associated with autism - children ages 5 to 17 years old
Tourette syndrome in children
Depression (add-on treatment)
Irritability associated with autistic disorder in children
Schizophrenia in adults and children age 13 years and older
Bipolar disorder in adults and children age 10 years and older
Add-on to antidepressants for depression (extended-release only)
What is the latest news about Risperidone (Risperdal)?
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References
Best studies we foundAurobindo Pharma Limited. (2023). RISPERIDONE solution [package insert]. DailyMed.
AvKARE. (2023). RISPERIDONE tablet [package insert]. DailyMed.
Bolu, A., et al. (2019). Case of risperidone-induced tardive parkinsonism. Psychiatry and Clinical Neurosciences.
Borison, R. L. (1996). Changing antipsychotic medication: guidelines on the transition to treatment with risperidone. The Consensus Study Group on Risperidone Dosing. Clinical Therapeutics.
Gao, K., et al. (2013). Comparison of somnolence associated with asenapine, olanzapine, risperidone, and haloperidol relative to placebo in patients with schizophrenia or bipolar disorder. Neuropsychiatric Disease and Treatment.
Hikma Pharmaceuticals USA Inc. (2023). RISPERIDONE solution [package insert]. DailyMed.
Mathews, M., et al. (2005). Antipsychotic-induced movement disorders. Psychiatry.
McCracken, J. T., et al. (2002). Risperidone in children with autism and serious behavioral problems. The New England Journal of Medicine.
Mousavi, S. G., et al. (2013). Onset of action of atypical and typical antipsychotics in the treatment of acute psychosis. Journal of Research in Pharmacy Practice.
National Human Genome Institute. (2014). About phenylketonuria.
Par Pharmaceutical, Inc. (2023). RISPERIDONE tablet, orally disintegrating [package insert]. DailyMed.
Pringsheim, T., et al. (2018). The assessment and treatment of antipsychotic-induced akathisia. The Canadian Journal of Psychiatry.
Tanen, D. (2023). Neuroleptic malignant syndrome. Merck Manual Professional Version.
Wang, C., et al. (2010). Risperidone Maintenance Treatment in Schizophrenia: A Randomized, Controlled Trial. American Journal of Psychiatry.
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