Risperidone, administration

Krahenmaim R, Kuchenhoff B, Boker H, Schick M. Katatones Dilemma unter Kombi-nationsbehandlung mit Lithium und Risperi-don. [Catatonic dilemma in a schizoaffective patient with combined hthium-risperidone administration.] Psychiatr Prax 2010 37(6) 306-9. 

Introduced in clinical practice in the 1960s, lithium was the first mood stabilizer to be used in China. This was followed by carbamazepine and sodium valproate. For many years, these were the only treatment options available as mood stabilizers. Although lamotrigine was approved for maintenance treatment of bipolar I disorder in 2003 by FDA (Food and Drug Administration) in the USA, this indication has not yet been approved by the Chinese authorities. At present, only one atypical antipsychotic drug, risperidone, has been approved for treating acute mania (February 2005 by SFDA [State Food and Drug Administration]) in China (see Table 6.1). 

Administration of/M- Administer risperidone injection every 2 weeks by deep IM gluteal injection. A health care professional should administer each injection using the enclosed safety needle. Alternate injections between the 2 buttocks. Do not administer IV. 

Do not combine 2 different dosage strengths of risperidone injection in a single administration. 

Long-acting, parenteral, antipsychotic administration remains an important option in various clinical situations. Presently, only neuroleptics are available in this formulation, but it is anticipated that depot formulations of novel antipsychotics (e.g., risperidone, olanzapine) may soon be approved. The advent of such agents should significantly improve the efficacy and safety of this strategy. 

Rosengarten, H. Quartermain, D. 2002, Effect of prenatal administration of haloperidol, risperidone, quetiapine and olanzapine on spatial learning and retention in adult rats, Pharmacol.Biochem.Behav., vol. 72, no. 3, pp. 575-579. 

Risperdal was first marketed in 1994 as an atypical neuroleptic. The clinical trials, most of which lasted a few weeks, were too short to determine the rate of tardive dyskinesia and many other adverse effects. Indeed, the brief controlled clinical trials used for the approval of both clozapine and risperidone do not provide sufficient information to determine either efficacy or safety since the drugs would be used for months and years in individual patients, rather than for a few weeks (see chapter 13). Patients taking the medications over the coming years will provide the experimental data. However, since Risperdal is a potent dopamine blocker, it should have been anticipated that it would cause similar adverse reactions as the older neuroleptics. In my own experience, I have evaluated many cases of tardive dyskinesia caused by Risperdal, Zyprexa, and Geodon. Meanwhile, the Food and Drug Administration (FDA) has required the same tardive dyskinesia and neuroleptic malignant syndrome warnings on the labels of clozapine and risperidone as on the labels of the older neuroleptics. 

The U.S. Food and Drug Administration today approved Risperdal (risperidone) for the treatment of schizophrenia in adolescents, ages 13 to 17, and for the short-term treatment of manic or mixed episodes of bipolar I disorder in children and adolescents ages 10 to 17. This is the first FDA approval of an atypical antipsychotic drug to treat either disorder in these age groups. 

Kline, A., Massucci, J., Zafonte, R., Dixon, C., DeFeo, J., Rogers, E. (2000). Differential effects of single versus multiple administration of haloperidol and risperidone on functional outcome after experimental brain trauma. Critical Care Medicine, 35, 919-924. 

Although the neuroleptic malignant syndrome has been reported in patients taking these atypical neuroleptic drugs, it is less common than in patients taking typical neuroleptic drugs, and lithium may have increased the risk in these cases. Co-administration of lithium and risperidone has been associated with the rabbit syndrome (638), but this reaction was probably caused by the risperidone, and the role of lithium was not clear. 

Bourgeois JA, Kahn DR. Neuroleptic mahgnant syndrome following administration of risperidone and lithium. J Chn Psychopharmacol 2003 23 315-17. 

US Food and Drug Administration. 2003 Safety alert RISPERDAL (risperidone). http //www.fda. gov./med-watch/S AFETY/2003/risperdal.htm... 

Adults with autistic disorder (n = 17) or pervasive developmental disorder not otherwise specified (n = 14) participated in a randomized, 12-week, double-blind, placebo-controlled trial of risperidone (41). Among those who completed the study, risperidone (n = 14) was superior to placebo (n = 16) in reducing the symptoms of autism, and the most prominent adverse effect was mild transient sedation during the initial phase of drug administration. Abnormal gait was reported in one patient taking risperidone. 

Co-administration of lithium and risperidone has been associated with the rabbit syndrome (105). This reaction was probably caused by the risperidone, and the role of lithium was not clear. 

Mean plasma concentrations of risperidone and 9-hydroxyrisperidone (5 ng/ml and 35 ng/ml) fell significantly during carbamazepine co-administration (2.5 ng/ ml and 19 ng/ml) in 11 schizophrenic patients taking risperidone 6 mg/day and then carbamazepine 400 mg/day for 1 week the changes in risperidone concentrations... 

Reveley MA, Libretto SE for the RIS-GBR-31 investigators. Treatment outcome in patients with chronic schizophrenia during long-term administration with risperidone. J Clin Psychopharmacol 2004 24 260-7. 

Zhao Q, Xie C, Pesco-Koplowitz L, Jia X, Parier J-L. Pharmacokinetic and safety assessments of concurrent administration of risperidone and donepezil. J Clin Pharmacol 2003 43 180-6. 

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