Risperidone oral
Risperidone guidance for psychosis and acute manic episode when other antipsychotics are not tolerated or have failed.
Therapeutic action
Atypical antipsychotic.
Indications
Acute and chronic psychosis and acute manic episode, in the event of intolerance or treatment failure with other antipsychotics.
For these indications, haloperidol is preferred when suitable.
Forms and strengths
- 1 mg tablet.
- 2 mg tablet.
Dose
Reduce the dose by half, both initial dose and increments, in older patients and in patients with hepatic or renal impairment, with a maximum of 4 mg daily.
Acute or chronic psychosis
- Adult: 1 mg 2 times daily. Gradually increase up to 3 mg 2 times daily if necessary, maximum 10 mg daily.
Acute manic episode
- Adult: 2 mg once daily. Increase in increments of 1 mg per week if necessary, maximum 6 mg daily.
Duration
Acute psychosis: at least 3 months.
Chronic psychosis: at least one year.
Manic episode: 8 weeks after remission of symptoms.
Discontinue treatment gradually over 4 weeks. If signs of relapse occur, increase the dose then decrease it more gradually.
Contra-indications, adverse effects, precautions
- Do not administer to patients with cardiac disorders, dementia, Parkinson's disease, or history of neuroleptic malignant syndrome.
- Administer with caution and carefully monitor use in older patients and in patients with hypokalaemia, hypotension, renal impairment, hepatic impairment, or history of seizures.
- May cause drowsiness, insomnia, headache, extrapyramidal symptoms, agitation, anxiety, orthostatic hypotension, weight gain, hyperprolactinaemia, sexual dysfunction, and rarely neuroleptic malignant syndrome requiring immediate discontinuation.
- In case of extrapyramidal symptoms, try reducing the dose or, if symptoms are severe, add biperiden or trihexyphenidyl.
- Avoid or monitor combination with central nervous system depressants, fluoxetine, paroxetine, sertraline, verapamil, carbamazepine, rifampicin, phenobarbital, phenytoin, antihypertensives, and drugs that prolong the QT interval.
- Avoid alcohol during treatment.
- Pregnancy: re-evaluate whether treatment is still necessary. If continued, use the lowest effective dose and observe the neonate if exposure occurred in the third trimester. If treatment starts during pregnancy, preferably use haloperidol.
- Breast-feeding: if absolutely necessary, do not exceed 6 mg daily.
Source
MSF Essential drugs practical guidelines (January 2026)
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