|Systematic (IUPAC) name|
|Trade names||Risperdal, other|
|Oral (tablets and liquid form), IM|
|Metabolism||Liver (CYP2D6 mediated to 9-hydroxyrisperidone)|
|Biological half-life||20 hours (Oral), 3–6 days (IM)|
|Excretion||Urinary (70%) feces (14%)|
|Molar mass||410.485 g/mol|
Risperidone, sold under the trade name Risperdal among others, is an antipsychotic medication. It is mainly used to treat schizophrenia, bipolar disorder, and irritability in people with autism. It is taken either by mouth or by injection into a muscle. The injectable version is long acting and lasts for about two weeks.
Common side effects include movement problems, sleepiness, trouble seeing, constipation, and increased weight. Serious side effects may include the potentially permanent movement disorder tardive dyskinesia, as well as neuroleptic malignant syndrome, an increased risk of suicide, and high blood sugar levels. In older people with psychosis as a result of dementia it may increase the risk of dying. It is unclear if it is safe for use in pregnancy. Risperidone is an atypical antipsychotic. Its mechanism of action is not entirely clear, but is believed to be related to its action as a dopamine antagonist.
Study of risperidone began in the late 1980s and it was approved for sale in the United States in 1993. It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system. It is available as a generic medication. The wholesale price is between 0.01 and 0.60 USD per day as of 2014. In the United States it costs between 3.30 and 10.00 USD per day for a typical dose.
Studies evaluating the utility of the oral form of risperidone for maintenance therapy have reached varying conclusions. A 2012 systematic review concluded that there is strong evidence that risperidone is more effective than all first generation antipsychotics other than haloperidol, but that evidence directly supporting its superiority to placebo is equivocal. A 2011 review concluded that risperidone is more effective in relapse prevention than other first and second generation antipsychotics with the exception of olanzapine and clozapine. A 2010 Cochrane review found a slight benefit during the first few weeks of treatment of schizophrenia but the article raised concerns regarding bias favoring risperidone.
Long-acting injectable formulations of antipsychotic drugs provide improved compliance with therapy and reduce relapse rates relative to oral formulations. The efficacy of risperidone long acting injection appears to be similar to that of long acting injectable forms of first generation antipsychotics.
Second generation antipsychotics, including risperidone, are effective in the treatment of manic symptoms in acute manic or mixed exacerbations of bipolar disorder. In children and adolescents, risperidone may be more effective than lithium or divalproex, but has more metabolic side effects. As maintenance therapy, risperidone is effective for the prevention of manic episodes but not depressive episodes. The long-acting injectable form of risperidone may be advantageous over long acting first generation antipsychotics, as it is better tolerated (fewer extrapyramidal effects) and because long acting injectable formulations of first generation antipsychotics may increase the risk of depression.
Compared to placebo, risperidone treatment reduces certain problematic behaviors in autistic children, including aggression toward others, self-injury, temper tantrums, and rapid mood changes. The evidence for its efficacy appears to be greater than that for alternative pharmacological treatments. Weight gain is an important adverse effect. Some authors recommend limiting the use of aripiprazole to those with the most challenging behavioral disturbances in order to minimize the risk of drug-induced adverse effects. Evidence for the efficacy of risperidone in autistic adolescents and young adults is less persuasive.
Risperidone has no benefit in the treatment of eating disorders or personality disorders.
While antipsychotic medications such as risperidone have a slight benefit in people with dementia, they have been linked to higher incidences of death and stroke. Because of this increased risk of death, treatment of dementia-related psychosis with risperidone is not FDA approved.
- Carbamazepine and other enzyme inducers may reduce plasma levels of risperidone. If a person is taking both carbamazepine and risperidone, the dose of risperidone will likely need to be increased. The new dose should not be more than twice the patient's original dose.
- CYP2D6 inhibitors, such as SSRI medications, may increase plasma levels of risperidone.
- Since risperidone can cause hypotension, its use should be monitored closely when a patient is also taking anti-hypertensive medicines to avoid severe low blood pressure.
The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotic treatment to avoid acute withdrawal syndrome or rapid relapse. Some have argued the additional somatic and psychiatric symptoms associated with dopaminergic super-sensitivity, including dyskinesia and acute psychosis, are common features of withdrawal in individuals treated with neuroleptics. This has led some to suggest the withdrawal process might itself be schizomimetic, producing schizophrenia-like symptoms even in previously healthy patients, indicating a possible pharmacological origin of mental illness in a yet unknown percentage of patients currently and previously treated with antipsychotics. This question is unresolved, and remains a highly controversial issue among professionals in the medical and mental health communities, as well the public.
Older people with dementia-related psychosis are at a higher risk of death if they take risperidone compared to those who do not. Most deaths are related to heart problems or infections.
Risperidone is available as an oral tablet, oral dissolving tablet, or intramuscular injection. The intramuscular preparation, marketed as Risperdal Consta, can be given once every two weeks. It is slowly released from the injection site. This method of administration may be used on sanctioned patients (detained), who are refusing, or consenting patients who may have disorganized thinking and cannot remember to take their daily doses.
Risperidone undergoes hepatic metabolism and renal excretion. Lower doses are recommended for patients with severe liver and kidney disease.
Risperidone has been classified as a "qualitatively atypical" antipsychotic agent with a relatively low incidence of extrapyramidal side effects (when given at low doses) that has more pronounced serotonin antagonism than dopamine antagonism. It has actions at several 5-HT (serotonin) receptor subtypes. These are 5-HT2C, linked to weight gain, 5-HT2A, linked to its antipsychotic action and relief of some of the extrapyramidal side effects experienced with the typical neuroleptics.
Risperidone acts on the following receptors:
Dopamine receptors: This drug is an antagonist of the D1 (D1, and D5) as well as the D2 family (D2, D3 and D4) receptors. This drug has "tight binding" properties, which means it has a long half-life and like other antipsychotics, risperidone blocks the mesolimbic pathway, the prefrontal cortex limbic pathway, and the tuberoinfundibular pathway in the central nervous system. Risperidone may induce extrapyramidal side effects, akathisia and tremors, associated with diminished dopaminergic activity in the striatum. It can also cause sexual side effects, galactorrhoea, infertility, gynecomastia and, with chronic use reduced bone mineral density leading to breaks all of which are associated with increased prolactin secretion.
Serotonin receptors: Its action at these receptors may be responsible for its lower extrapyramidal side effect liability (via the 5-HT2A/2C receptors) and improved negative symptom control compared to typical antipsychotics such as haloperidol for instance. Its antagonistic actions at the 5-HT2C receptor may account, in part, for its weight gain liability.
Alpha α1 adrenergic receptors: This action accounts for its orthostatic hypotensive effects and perhaps some of the sedating effects of risperidone.
Alpha α2 adrenergic receptors: Perhaps greater positive, negative, affective and cognitive symptom control.
Histamine H1 receptors: effects on these receptors account for its sedation and reduction in vigilance. This may also lead to drowsiness and weight gain.
Though this medication possesses similar effects to other typical and atypical antipsychotics, it does not possess an affinity for the muscarinic acetylcholine receptors. In many respects, this medication can be useful as an "acetylcholine release-promoter" similar to gastrointestinal drugs such as metoclopramide and cisapride.
|Receptor||Binding Affinity (Ki [nM])||Action|
|5-HT7||6.60||Irreversible (or pseudo-irreversible) antagonist|
Society and culture
Risperidone was approved by the United States Food and Drug Administration (FDA) in 1994 for the treatment of schizophrenia. On August 22, 2007, risperidone was approved as the only drug agent available for treatment of schizophrenia in youths, ages 13–17; it was also approved that same day for treatment of bipolar disorder in youths and children, ages 10–17, joining lithium. Risperidone contains the functional groups of benzisoxazole and piperidine as part of its molecular structure. Although not a butyrophenone, it was developed with the structures of benperidol and ketanserin as a basis. In 2003, the FDA approved risperidone for the short-term treatment of the mixed and manic states associated with bipolar disorder. In 2006, the FDA approved risperidone for the treatment of irritability in autistic children and adolescents. The FDA's decision was based in part on a study of autistic people with severe and enduring problems of violent meltdowns, aggression, and self-injury; risperidone is not recommended for autistic people with mild aggression and explosive behavior without an enduring pattern.
Janssen's patent on risperidone expired on December 29, 2003, opening the market for cheaper generic versions from other companies, and Janssen's exclusive marketing rights expired on June 29, 2004 (the result of a pediatric extension).
Risperidone is available as a tablet, an oral solution, and an ampule, Risperdal Consta, which is a depot injection administered once every two weeks. It is also available as a wafer known in the United States and Canada as Risperdal M-Tabs and elsewhere as Risperdal Quicklets.
Risperidone became available as a generic drug in October 2008 from Teva Pharmaceuticals, Dr. Reddy's Laboratories, Inc. and Patriot Pharmaceutics. The Patriot generic is an authorized generic pharmaceutical. The drug is currently marketed in India under several brand names including Risperdal, Risdon and Sizodon.
On 11 April 2012, Johnson & Johnson and its subsidiary Janssen Pharmaceuticals Inc. were fined $1.2 billion by Judge Timothy Davis Fox of the Sixth Division of the Sixth Judicial Circuit of the U.S. state of Arkansas. The jury found the companies had downplayed multiple risks associated with risperidone (Risperdal). The verdict was later reversed by the Arkansas State Supreme court.
According to the Wall Street Journal on June 20, 2012, "Johnson & Johnson and the U.S. Justice Department [we]re close to settling a protracted investigation into the company’s promotion of the antipsychotic Risperdal, for what would be one of the highest sums to date in a drug-marketing case. The sides are trying to wrap together a number of lawsuits, state investigations and other probes of alleged illegal marketing, and are discussing a payment of $1.5 billion or higher." The fine ultimately imposed totaled $2.2 billion.
In August 2012, Johnson & Johnson agreed to pay $181 million to 36 U.S. states in order to settle claims that it had promoted risperidone for off-label uses including for dementia, anger management, and anxiety.
Brand names include Risperdal, Risperdal Consta, Risperdal M-Tab, Risperdal Quicklets.
- "Risperidone". The American Society of Health-System Pharmacists. Retrieved Dec 1, 2015.
- Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. pp. 434–435. ISBN 9781284057560.
- Hasnain M, Vieweg WV, Hollett B (July 2012). "Weight gain and glucose dysregulation with second-generation antipsychotics and antidepressants: a review for primary care physicians". Postgraduate Medicine 124 (4): 154–67. doi:10.3810/pgm.2012.07.2577. PMID 22913904.
- Nemeroff, edited by Alan F. Schatzberg, Charles B. (2009). The American Psychiatric Publishing textbook of psychopharmacology (4th ed.). Washington, D.C.: American Psychiatric Pub. p. 627. ISBN 9781585623099.
- "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
- "Risperidone". International Drug Price Indicator Guide. Retrieved 2 December 2015.
- "Respiridone". The American Society of Health-System Pharmacists. Retrieved 3 April 2011.
- Leucht S, Cipriani A, Spineli L, et al. (September 2013). "Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis". Lancet 382 (9896): 951–62. doi:10.1016/S0140-6736(13)60733-3. PMID 23810019.
- Osser DN, Roudsari MJ, Manschreck T (2013). "The psychopharmacology algorithm project at the Harvard South Shore Program: an update on schizophrenia". Harv Rev Psychiatry 21 (1): 18–40. doi:10.1097/HRP.0b013e31827fd915. PMID 23656760.
- Barry SJ, Gaughan TM, Hunter R (2012). "Schizophrenia". Clin Evid (Online) 2012. PMC 3385413. PMID 23870705.
- Glick ID, Correll CU, Altamura AC, et al. (December 2011). "Mid-term and long-term efficacy and effectiveness of antipsychotic medications for schizophrenia: a data-driven, personalized clinical approach". J Clin Psychiatry 72 (12): 1616–27. doi:10.4088/JCP.11r06927. PMID 22244023.
- Rattehalli RD, Jayaram MB, Smith M (2010). Rattehalli, Ranganath, ed. "Risperidone versus placebo for schizophrenia". Cochrane Database Syst Rev (1): CD006918. doi:10.1002/14651858.CD006918. PMID 20091611.
- Leucht C, Heres S, Kane JM, Kissling W, Davis JM, Leucht S (April 2011). "Oral versus depot antipsychotic drugs for schizophrenia--a critical systematic review and meta-analysis of randomised long-term trials". Schizophr. Res. 127 (1-3): 83–92. doi:10.1016/j.schres.2010.11.020. PMID 21257294.
- Lafeuille MH, Dean J, Carter V, et al. (August 2014). "Systematic review of long-acting injectables versus oral atypical antipsychotics on hospitalization in schizophrenia". Curr Med Res Opin 30 (8): 1643–55. doi:10.1185/03007995.2014.915211. PMID 24730586.
- Nielsen J, Jensen SO, Friis RB, Valentin JB, Correll CU (September 2014). "Comparative Effectiveness of Risperidone Long-Acting Injectable vs First-Generation Antipsychotic Long-Acting Injectables in Schizophrenia: Results From a Nationwide, Retrospective Inception Cohort Study". Schizophr Bull. doi:10.1093/schbul/sbu128. PMID 25180312.
- Muralidharan K, Ali M, Silveira LE, et al. (September 2013). "Efficacy of second generation antipsychotics in treating acute mixed episodes in bipolar disorder: a meta-analysis of placebo-controlled trials". J Affect Disord 150 (2): 408–14. doi:10.1016/j.jad.2013.04.032. PMID 23735211.
- Nivoli AM, Murru A, Goikolea JM, et al. (October 2012). "New treatment guidelines for acute bipolar mania: a critical review". J Affect Disord 140 (2): 125–41. doi:10.1016/j.jad.2011.10.015. PMID 22100133.
- Yildiz A, Vieta E, Leucht S, Baldessarini RJ (January 2011). "Efficacy of antimanic treatments: meta-analysis of randomized, controlled trials". Neuropsychopharmacology 36 (2): 375–89. doi:10.1038/npp.2010.192. PMC 3055677. PMID 20980991.
- Peruzzolo TL, Tramontina S, Rohde LA, Zeni CP (2013). "Pharmacotherapy of bipolar disorder in children and adolescents: an update". Rev Bras Psiquiatr 35 (4): 393–405. doi:10.1590/1516-4446-2012-0999. PMID 24402215.
- Gitlin M, Frye MA (May 2012). "Maintenance therapies in bipolar disorders". Bipolar Disord. 14 Suppl 2: 51–65. doi:10.1111/j.1399-5618.2012.00992.x. PMID 22510036.
- Gigante AD, Lafer B, Yatham LN (May 2012). "Long-acting injectable antipsychotics for the maintenance treatment of bipolar disorder". CNS Drugs 26 (5): 403–20. doi:10.2165/11631310-000000000-00000. PMID 22494448.
- Kirino E (2014). "Efficacy and tolerability of pharmacotherapy options for the treatment of irritability in autistic children". Clin Med Insights Pediatr 8: 17–30. doi:10.4137/CMPed.S8304. PMC 4051788. PMID 24932108.
- "www.janssenpharmaceuticalsinc.com" (PDF).
- Sharma A, Shaw SR (2012). "Efficacy of risperidone in managing maladaptive behaviors for children with autistic spectrum disorder: a meta-analysis". J Pediatr Health Care 26 (4): 291–9. doi:10.1016/j.pedhc.2011.02.008. PMID 22726714.
- McPheeters ML, Warren Z, Sathe N, et al. (May 2011). "A systematic review of medical treatments for children with autism spectrum disorders". Pediatrics 127 (5): e1312–21. doi:10.1542/peds.2011-0427. PMID 21464191.
- Dove D, Warren Z, McPheeters ML, Taylor JL, Sathe NA, Veenstra-VanderWeele J (October 2012). "Medications for adolescents and young adults with autism spectrum disorders: a systematic review". Pediatrics 130 (4): 717–26. doi:10.1542/peds.2012-0683. PMC 4074627. PMID 23008452.
- Maher AR, Theodore G (June 2012). "Summary of the comparative effectiveness review on off-label use of atypical antipsychotics". J Manag Care Pharm 18 (5 Suppl B): S1–20. PMID 22784311.
- "Risperdal Prescribing Information Label" (PDF). Drugs@FDA: FDA Approved Drug Products. Jannsen Pharmaceuticals, Inc. Retrieved 17 April 2014.
- Risperdal [Package Insert]. Titusville, NJ: Janssen Pharmaceuticals; April 2014. http://www.janssenpharmaceuticalsinc.com/assets/risperdal.pdf Accessed November 2, 2014
- BMJ Group, ed. (March 2009). "4.2.1". British National Formulary (57 ed.). United Kingdom: Royal Pharmaceutical Society of Great Britain. p. 192. ISSN 0260-535X.
Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse.
- Chouinard G, Jones BD (1980). "Neuroleptic-induced supersensitivity psychosis: clinical and pharmacologic characteristics". Am J Psychiatry 137 (1): 16–21. PMID 6101522.
- Miller R, Chouinard G (Nov 1993). "Loss of striatal cholinergic neurons as a basis for tardive and L-dopa-induced dyskinesias, neuroleptic-induced supersensitivity psychosis and refractory schizophrenia". Biol Psychiatry 34 (10): 713–38. doi:10.1016/0006-3223(93)90044-E. PMID 7904833.
- Chouinard G, Jones BD, Annable L (Nov 1978). "Neuroleptic-induced supersensitivity psychosis". Am J Psychiatry 135 (11): 1409–10. PMID 30291.
- Seeman P, Weinshenker D, Quirion R, Srivastava LK, Bhardwaj SK, Grandy DK, Premont RT, Sotnikova TD, Boksa P, El-Ghundi M, O'dowd BF, George SR, Perreault ML, Männistö PT, Robinson S, Palmiter RD, Tallerico T (Mar 2005). "Dopamine supersensitivity correlates with D2High states, implying many paths to psychosis" (PDF). Proc Natl Acad Sci U S A 102 (9): 3513–8. doi:10.1073/pnas.0409766102. PMC 548961. PMID 15716360.
- Moncrieff J (Jul 2006). "Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse". Acta Psychiatr Scand 114 (1): 3–13. doi:10.1111/j.1600-0447.2006.00787.x. PMID 16774655.
- Antipsychotic Medications, About.com: Mental Health May 30, 2006
- Brunton L, Chabner B, Knollman B. Goodman and Gilman’s The Pharmacological Basis of Therapeutics, Twelfth Edition. McGraw Hill Professional; 2010.
- Abou El-Magd RM, Park HK, Kawazoe T, Iwana S, Ono K, Chung SP, Miyano M, Yorita K, Sakai T, Fukui K (July 2010). "The effect of risperidone on D-amino acid oxidase activity as a hypothesis for a novel mechanism of action in the treatment of schizophrenia". Journal of Psychopharmacology 24 (7): 1055–1067. doi:10.1177/0269881109102644. PMID 19329549.
- Hecht EM, Landy DC (2012). "Alpha-2 receptor antagonist add-on therapy in the treatment of schizophrenia; a meta-analysis". Schizophrenia Research 134 (2–3): 202–6. doi:10.1016/j.schres.2011.11.030. PMID 22169246.
- National Institute ofMental Health. PDSD Ki Database (Internet) [cited 2013 Aug 10]. ChapelHill (NC): University of North Carolina. 1998-2013. Available from: http://pdsp.med.unc.edu/pdsp.php
- Smith, C.; Rahman, T.; Toohey, N.; Mazurkiewicz, J.; Herrick-Davis, K.; Teitler, M. (2006). "Risperidone Irreversibly Binds to and Inactivates the h5-HT7 Serotonin Receptor". Molecular Pharmacology 70 (4): 1264–1270. doi:10.1124/mol.106.024612. ISSN 0026-895X. PMID 16870886.
- "Electronic Orange Book". Food and Drug Administration. April 2007. Retrieved 2007-05-24.
- "FDA approves the first drug to treat irritability associated with autism, Risperdal" (Press release). FDA. October 6, 2006. Retrieved 2009-08-14.
- Scahill L (2008). "How do I decide whether or not to use medication for my child with autism? should I try behavior therapy first?". J Autism Dev Disord 38 (6): 1197–8. doi:10.1007/s10803-008-0573-7. PMID 18463973.
- "Companies belittled risks of Risperdal, slapped with huge fine", Los Angeles Times, 11 April 2012.
- "Arkansas Court Reverses $1.2 Billion Judgment Against Johnson & Johnson - NYTimes.com".
- "Johnson & Johnson to Pay More Than $2.2 Billion to Resolve Criminal and Civil Investigations | OPA | Department of Justice".
- "NY AG: Janssen pays $181M over drug marketing". The Seattle Times. 30 August 2012.
|Wikimedia Commons has media related to Risperidone.|
- PubChem Substance Summary: Risperidone—National Center for Biotechnology Information.
- Drug Information Portal—Risperidone—U.S. National Library of Medicine
- Description of risperidone "Nycomed" medicine, Danish link in English language