A Risperidone

Discuss a risperidone dosing plan and list side effects AG may experience on this medication. 

Csernansky J, Okamoto A. Risperidone vs haloperidol for prevention of relapse in schizophrenia and schizoaffective disorder. Presented at the Annual Meeting of the American College of Neuropsychopharmacology, Acapulco, December 12-16,1999. 

Ercan ES, Kutlu A, Cikoglu S, Veznedaroglu B, Erermis S, Varan A. Risperidone in children and adolescents with conduct disorder a single-center, open-label study. Curr Ther Res 2003 64 55-64. 

Fleischhacker WW, Lemmens P, van Baelen B. A qualitative assessment of the neurological safety of antipsychotic drugs an analysis of a risperidone database. Pharmacopsychiatry 2001 34(3) 104-10. 

Grahovac T, Ruzic K, Medved P, Pavesic-Radonja A, Dadic-Hero E. H5fperprolactinaemia—a risperidone side-effect. Psychiatr Danub 2010 22 120-2. 

Kaufmann A, Boesch S, Fleischhacker WW, Hofer A. Management of a risperidone-induced tardive Pisa syndrome a case report. J Clin Psychopharmacol 2012 32(3) 418-20. 

Correlation between clinical effectiveness and receptor affinities, however, can be seen with other receptors in addition to the dopamine D2 receptor. These include other dopaminergic receptors, as well as noradrenergic and serotonergic receptors. For example, most antipsychotics also have high affinity for a -adrenoceptors and 5-HT2 receptors (225). Some antipsychotics have been shown to be selective for the adrenoceptor versus the a -adrenoceptor, for example, spiperone [749-02-0] (226) and risperidone (61) (221]... 

Risperidone (11) is a new type of an atypical antipsychotic with relatively pronounced effects on negative symptoms and low extrapyramidal side... 

Risperidone (11) was also included among a a 1-adrenergic receptor antagonists to study a quantitative structure-activity relationship (99BMC2437). A pharmacophore model for atypical antipsychotics, including 11, was established (00MI41). An increased plasma level of 11 and 9-hydroxyrisperidone (12) was observed in combination with paroxetine (01 MI 13). The effect of vanlafaxine on the pharmacokinetics of 11 was reported (99MI13). 

Jha A, Fourie H Risperidone treatmenr of amphetamine psychosis fietter). Br J Psychiatry 174 366, 1999... 

McDougle CJ, Price LH, Palumbo JM, et al Dopaminergic responsivity during cocaine abstinence a pilot smdy. Psychiatry Res 43 77-85, 1992 McDougle CJ, Black JE, Malison RT, et al Noradrenergic dysregulation during discontinuation of cocaine use in addicts. Arch Gen Psychiatry 51 713-719,1994 Misra L, Kofoed L Risperidone treatment of methamphetamine psychosis (letter). Am J Psychiatry 154 1170, 1997... 

Patients seen for flashbacks are treated with oral diazepam (15—30 mg/day for adults) if symptoms of anxiety are severe (Rumack 1987). Neuroleptics, especially haloperidol, have been implicated in a transient increase in visual flashbacks and are not recommended (Moskowitz 1971 Strassman 1984). Risperidone and selective serotonin reuptake inhibitors may also worsen symptoms of hallucinogen persisting perception disorder (Halpern and Pope 2003). The patient needs assurance of the self-limiting nature of the phenomenon and its decreasing frequency of reoccurrence with time. The patient should be reminded that any future use of hallucinogens or marijuana may precipitate similar symptoms (Strassman 1984). 

Sellers EM, Naranjo CA, Harrison M, et al Diazepam loading simplified treatment of alcohol withdrawal. Clin Pharmacol Ther 34 822-826, 1983 Sharp CW Introduction to inhalant Abuse, in Inhalant Abuse A Volatile Research Agenda (NIDA Research Monograph 129). Edited by Sharp CW, Beuvais F, Spence R. Rockville, MD, National Institute on Drug Abuse, 1992, pp 1-10 Smelson DA, Losonczy MF, Davis CW, et al Risperidone decreases craving and relapses in individuals with schizophrenia and cocaine dependence. Can J Psychiatry 47 671-675, 2002... 

Uncontrolled mirror-image studies (Table 2.4) largely support these findings. Of seven published studies, five suggested that the use of risperidone reduced hospital bed-stay and some calculated savings in health-care expenditure resulting from this. Conversely, Viale et al (1997) calculated that in-patient savings were offset by increases in community services costs, and Hammond et al (1999) estimated a substantial overall cost increase for community patients switched to risperidone for at least 3 months. 

Only two randomized, controlled trials have been completed, and neither provides anything like compelling data (Table 2.6). Chouinard and Albright (1997) conducted a unique evaluation of a subset of patients from a previously conducted clinical trial. Subjects were categorized and profiled at baseline and end point according to clinical severity, and a group of psychiatric nurses were asked to rate various aspects of likely outcome and quality of life to each profile (mild, moderate or severe symptoms). Health state utilities were then calculated risperidone was found to provide more than double the number of quality-adjusted life years compared with haloperidol. Csernansky and Okamoto (1999) conducted a rather more conventional trial, but included no economic analyses. However, they did find that the use of risperidone substantially reduced relapse rates compared with haloperidol—an outcome likely to have a positive impact on cost-effectiveness. 

Direct comparisons of atypical dmgs are outlined in Table 2.8. Overall, little can be gleaned from these studies. Comparisons of risperidone and olanzapine are dominated by data gathered from a manufacturer-sponsored, 6-month clinical comparison (Tran et al,... 

A search of Medline, EMBASE and PsycLIT was conducted in August 2000, using the following terms Amisulpride, clozapine, olanzapine, risperidone, sertindole, zotepine, ziprasidone, economics, healthcare, costs. All manufacturers of atypical antipsychotic drugs were contacted in April 2000 and asked to supply primary reference data on their product, and all companies had complied with this request by August 2000. A further manual search was conducted of files and journals kept in the National Centre for Information on Psychotropics at the Maudsley Hospital. Reference sections from all retrieved papers were scrutinized for further relevant references. 

Addington DE, Jones B, Bloom D, et al (1993). Reduction of hospital days in chronic schizophrenic patients treated with risperidone a retrospective study. Clin Ther 15,917-26. 

Albright PS, Livingstone S, Keegan DL (1996). Reduction of healthcare resource utilisation and costs following the use of risperidone for patients with schizophrenia previously treated with standard antipsychotic therapy a retrospective analysis using the Saskatchewan Health Linkable Databases. Clin Drug Invest 11,289-99. 

Almond S, O Donnell O, McKendrick J (1999). A cost analysis of olanzapine compared with haloperidol and risperidone in the treatment of schizophrenia in the UK. Poster presented at the 12th Congress of the European College of Neuropsychopharmacology, London, 21-25 September 1999. 

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