Insomnia risperidone

First, optimize current mood stabilizer or initiate mood-stabilizing medication lithium,0 valproate,0 or carba-mazepine0 Consider adding a benzodiazepine (lorazepam or clonazepam) for short-term adjunctive treatment of agitation or insomnia if needed Alternative medication treatment options carbam-azepine0 if patient does not respond or tolerate, consider atypical antipsychotic (e.g., olanzapine, quetiapine, risperidone) or oxcarbazepine. 

Insomnia, hypotension, agitation, headache, and rhinitis are the most common side effects of risperidone. These tend to lessen with time. Overall, the drug tends to be well tolerated. Average weight gain associated with risperidone after 10 weeks of treatment is 2.10 kg (AUison et al. 1999). Risperidone does not have significant anticholinergic side effects. Hyperprolactinemia is common. 

The four drugs were administered by psychiatrists blinded to treatment group assignment of patients. The 14-week study consisted of an 8-week dose escalation and fixed dose and a 6-week variable-dose period. The mean dose levels (mg/day) of the four compounds after the first 8 weeks were 452 for clozapine. 20.2 for olanzapine. 8.3 for risperidone and 19.6 for haloperidol. Patients on haloperidol received prophylactic anticholinergic medication to prevent extrapyramidal symptoms, and a few other drugs were permitted to treat agitation and insomnia. 

Other classes of medications that may be used for pediatric insomnia include mood stabilizers/anticonvulsants (depakote), other classes of antidepressants (mir-tazapine), atypical antipsychotics (risperidone), and chloral hydrate, as well as herbal... 

Risperdal has a particular tendency to produce adverse stimulant effects, including insomnia, agitation, and anxiety. Probably because of these stimulant effects, it may have an increased risk of causing mania (Dwight et al., 1994). Stimulation may also account for risperidone-induced... 

Clozapine has also been compared with risperidone in 60 treatment-resistant patients with schizophrenia in India (16). There was clinical improvement (a more than 20% reduction from baseline PANSS scale scores) in 80% of the clozapine-treated patients and 67% of the risperidone-treated patients. The predominant adverse effects with clozapine (n = 30) were tachycardia (77%), hypersalivation (60%), sedation (60%), weight gain (43%), and constipation (30%) one patient had a seizure. The adverse effects of risperidone (n = 30) were constipation (50%), dry mouth (47%), weight gain (43%), akathisia (37%), insomnia (33%), tachycardia (30%), and impotence (27%). The final mean daily doses after 16 weeks of treatment were 343 mg for clozapine and 5.8 mg for risperidone. 

Patients with bipolar disorders may benefit from risperidone. This has been observed in an open trial of ten patients with rapid cycling bipolar disorder who were refractory to lithium carbonate, carbamazepine, and valproate eight improved after 6 months of treatment. One patient dropped out through non-adherence to therapy and one because of adverse effects (agitation, anxiety, insomnia, and headache) (5). There was a similar beneficial effect in eight adults with moderate to profound mental retardation (6). Risperidone was associated with a significant reduction in aggression and self-injurious behavior, whereas adverse effects were primarily those of sedation and restlessness. 

The medical records of 151 hospitalized elderly psychiatric patients (mean age 71 years) have been analysed (8). Of 114 patients treated with risperidone (mean duration of treatment 17 days mean dose 3 mg/day), 78% responded. Adverse events were reported in 20 patients, including new-onset extrapyramidal effects in four tremor in four sedation in three hypotension in three diarrhea in two tardive dyskinesia in two and chest pain, anxiety, restlessness, itching, insomnia, and falls in one each. 

Finally, of 192 patients who had remained symptomatically stable for at least 1 month with another major second-generation antipsychotic drug, olanzapine (mean age 38 years 63% men), 70% completed a 6-month study with injectable risperidone treatment-related adverse events were reported by 121 patients (63%), mostly anxiety (12%), exacerbation of disease (10%), insomnia (9%), depression (6%), and akathisia (5%) (231). 

The safety, tolerability, and efficacy of risperidone have been assessed in 103 patients with schizophrenia (52 men and 51 women) aged 65 years or older in an open, multicenter, 12-week study (141). The mean risperidone dose at end-point was 2.4 mg/day. Adverse events occurred in 91 patients and included dizziness (n = 23), insomnia (n = 17), agitation (n = 15), somnolence (n = 15), injury (n = 12), constipation (n = 11), and extrapyramidal disorders (n = 10) 11 patients withdrew because of adverse events. Among the 91 patients with normal baseline QTc intervals (below 450 ms), 9 had a prolonged QTc interval during the study (range 450-516 ms). 

Observational studies Numerous open studies of ziprasidone promoted by Pfeer, the marketing authorization holder, have previously been published [SEDA-32, 111] and further studies, similarly promoted, have emerged. Of 185 subjects who were switched from olanzapine or risperidone to ziprasidone, 72 completed a 1-year extension study [136 ]. The most common adverse effects were insomnia (23%) and somnolence (11%) no patient had a corrected QT interval over 500 ms at any time during the study. 

A post hoc subgroup analysis of a randomised, double-blind trial of paliperidone palmitate and risperidone microspheres found the most common adverse events with paliperidone palmitate were insomnia, headache and injection site pain, and with risperidone microspheres were insomnia and headache... 

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