Risperidone side effects

Edleman RJ. Risperidone side effects. J Am Acad Child Adolesc Psychiatry 1996 35(l) 4-5. 

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

Side Effect Clozapine Risperidone Olanzapine Quetiapine Ziprasidone Aripiprazole Haloperidol... 

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

Current or past anti-cholinergic side effects Risperidone, quetiapine, aripiprazole ziprasidone Olanzapine (low dose)... 

Ari pi prazole, olanzapine, quetiapine, risperidone, and ziprasidone are effective as monotherapy or as add-on therapy to lithium or valproate for acute mania. Prophylactic use of antipsychotics can be needed for some patients with recurrent mania or mixed states, but the risks versus benefits must be weighed in view of long-term side effects (e.g., obesity, type 2 diabetes, hyperlipidemia, hyperprolactinemia, cardiac disease, and tardive dyskinesia). 

Risperidone and its active metabolite 9-OH-resperidone are metabolized by CYP2D6. Polymorphic metabolism should be considered in those with side effects at low doses (approximately 40% of African Americans and Asians can have increased side effects from risperidone and other drugs metabolized through CYP2D6). 

Risperidone (Risperdal). Risperidone is also approved by the FDA for the treatment of acute mania. It acts as an atypical antipsychotic at doses up to 4-6mg/day. Over this dose, and at lower doses in children and the elderly, risperidone acts more like a typical antipsychotic in that extrapyramidal side effects are common. 

Risperidone can be administered once or twice daily in doses ranging from 2 to 6mg/day. Risperidone is well tolerated with comparatively few mild side effects. It can cause drowsiness, weight gain, dizziness, nausea, indigestion, diarrhea, and sexual dysfunction. Finally, risperidone does not increase the risk for agranulocytosis or seizures. 

We prefer low doses of atypical antipsychotics as a first-line treatment. In this way, the threat of extrapyramidal symptoms is largely avoided without having to use a second anticholinergic medication to offset antipsychotic side effects. Risperidone 0.25-0.5mg/day, olanzapine 2.5mg/day, quetiapine 25mg/day, ziprasidone 20mg/day, or aripiprazole 2.5-5mg/day are reasonable starting doses. The typically higher doses used to treat schizophrenia are usually not necessary. 

Antipsychotics in a few small studies have been shown to be helpful. To date this research is limited to typical antipsychotics. Nevertheless, the excellent track record of atypical antipsychotics in treating schizophrenia and the lower burden of side effects lead us to recommend atypical antipsychotics as a first-line treatment for STPD as well. Low doses of risperidone, olanzapine, quetiapine, ziprasidone, or aripiprazole are all reasonable options. If no therapeutic effect is observed, doses should be increased. 

Nevertheless, some dopamine-blockade side effects can still be found with the atypicals. Prolactin elevation still occurs, particularly with risperidone. The risk of... 

Given that limitation, the only ways to counteract elevated prolactin are to lower the dose of the antipsychotic or to switch to another antipsychotic that does not elevate prolactin. We prefer switching (especially if the problem has been encountered with an older style typical antipsychotic) to an atypical antipsychotic if side effects of elevated prolactin become problematic. Most atypical antipsychotics, with the exception of risperidone when used in high doses, do not elevate prolactin. There are few compelling reasons to use a typical antipsychotic compared to the newer atypical agents. 

The conventional antipsychotics have little effect on the negative psychotic symptoms such as autism, stupor and emotional withdrawal. The so-called atypical antipsychotics, or second-generation antipsychotics, like the heterocyclic compound risperidone, the benzamide sulpiride and several diben-zepines of which clozapine is the best known, have a broader spectrum which means that they also have an effect on the negative psychotic symptoms. Most share a common attribute of working on serotonin receptors as well as dopamine receptors. They have a low risk of extrapyramidal side effects. 

A variety of relatively uncommon dermatological side effects have been noted to be associated with antipsychotic agents. These include maculopapular rashes, urticaria, and erythema multiforme (Arana, 2000). Photosensitivity and skin pigmentation can also occur during treatment with these drugs. Although skin pigmentation has been most frequently reported with chlorpromazine, this can occur with thioridazine and trifluoperazine (Harth and Rapoport, 1996). In addition, treatment-induced alopecia has been reported for haloperidol, olanzapine, and risperidone (Mercke et ah, 2000). 

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