Skip to content

risperidone

AntipsychoticLAI available

Brands: RISPERDAL

Last reviewed 2025-12-28

Reviewed by PsychMed Editorial Team.

View details

Quick answers

  • What is risperidone?

    Risperidone (brand Risperdal and numerous generics) is a second-generation antipsychotic available in oral, orally disintegrating, solution, and long-acting injectable forms for schizophrenia, bipolar disorder, and irritability in autism.

  • What is RISPERDAL?

    RISPERDAL is a brand name for risperidone.

  • What is RISPERDAL (risperidone) used for?

    Label indications include: Schizophrenia; acute mania or mixed episodes (bipolar I) as monotherapy or adjunct; irritability associated with autistic disorder.

  • What drug class is RISPERDAL (risperidone)?

    Antipsychotic.

  • What is the mechanism of action of RISPERDAL (risperidone)?

    Dopamine D2 and serotonin 5‑HT2A receptor antagonism; also alpha‑1 and H1 activity.

  • What strengths does RISPERDAL (risperidone) come in?

    Tablets: 0.25–4 mg; orally disintegrating tablets 0.5–4 mg.

  • Is RISPERDAL (risperidone) a controlled substance?

    No — it is not scheduled as a controlled substance under U.S. federal law.

  • What is RISPERDAL (risperidone) dosing for schizophrenia?

    Schizophrenia (adults): start 1–2 mg/day; increase by 1–2 mg/day to 4–6 mg/day (doses >6 mg/day increase EPS).

  • How is risperidone started as a long-acting injectable (LAI)?

    Long-acting injectables: Risperdal Consta 25 mg IM every 2 weeks with 3-week oral overlap (range 12.5–50 mg); Perseris 90 mg or 120 mg subcutaneous monthly.

  • What is the maximum recommended dose of RISPERDAL (risperidone)?

    Maximum recommended oral dose 16 mg/day, though doses above 6 mg/day rarely improve efficacy and substantially raise EPS and prolactin risk.

Snapshot

  • Class: Antipsychotic
  • Common US brands: RISPERDAL
  • Long-acting injectable formulation available.
  • Therapeutic drug monitoring not routinely recommended.
  • Last reviewed: 2025-12-28

Label indications

Schizophrenia; acute mania or mixed episodes (bipolar I) as monotherapy or adjunct; irritability associated with autistic disorder.

View labelExact

Clinical Highlights

Risperidone (brand Risperdal and numerous generics) is a second-generation antipsychotic available in oral, orally disintegrating, solution, and long-acting injectable forms for schizophrenia, bipolar disorder, and irritability in autism. This profile highlights schizophrenia, bipolar I mania/mixed episodes, and long-acting injectable maintenance where predictable dosing and depot options are valuable.

Read more
  • Risperidone mechanism of action centres on dopamine D2 and serotonin 5-HT2A antagonism, producing a metabolite (paliperidone) that carries the therapeutic effect into once-daily and depot schedules.
  • Widely used due to efficacy and depot options, though clinicians monitor prolactin elevation, EPS, and weight gain. Often chosen for predictable oral-to-LAI conversions.
  • Pair this profile with the Paliperidone summary when comparing parent-metabolite strategies or troubleshooting high prolactin.
  • The compare view can help contrast prolactin, metabolic, and LAI-readiness profiles, and the Risperidone evidence feed can support adjustments to therapy.
  • Schizophrenia (adults) (FDA 1993)
  • Schizophrenia (adolescents 13–17) (FDA 2007)
  • Bipolar I mania/mixed (adults) (FDA 2003)

Dosing & Formulations

Tablets: 0.25–4 mg; orally disintegrating tablets 0.5–4 mg. Oral solution: 1 mg/mL.

Read more
  • Long-acting injectables: Risperdal Consta 25 mg IM every 2 weeks with 3-week oral overlap (range 12.5–50 mg); Perseris 90 mg or 120 mg subcutaneous monthly.
  • Schizophrenia (adults): start 1–2 mg/day; increase by 1–2 mg/day to 4–6 mg/day (doses >6 mg/day increase EPS).
  • Schizophrenia (adolescents): initiate 0.5 mg/day; titrate to 1–6 mg/day.
  • Bipolar mania: start 2–3 mg/day; adjust by 1 mg increments to 2–6 mg/day; pediatric initiation 0.5 mg/day with gradual titration.
  • Maximum recommended oral dose 16 mg/day, though doses above 6 mg/day rarely improve efficacy and substantially raise EPS and prolactin risk.

Monitoring & Risks

Boxed warning: Increased mortality in elderly patients with dementia-related psychosis (class warning). Extrapyramidal symptoms: Akathisia and parkinsonism occur in ~10–20%, dose-dependent.

Read more
  • Hyperprolactinemia: Clinical symptoms (amenorrhea, galactorrhea, gynecomastia) in 20–30%.
  • Weight gain: ≥7% weight gain in ~10–15%.
  • Sedation: About 10% overall.
  • Orthostatic hypotension: 7–10%, particularly during titration.

Drug Interactions

CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine) increase exposure—consider dose reduction and monitor for EPS/prolactin effects. CYP3A4 inducers (carbamazepine, rifampin, St. John’s wort) decrease concentrations—may require higher doses with monitoring.

Read more
  • Additive CNS depression with alcohol, benzodiazepines, opioids.
  • May antagonize dopaminergic agents (levodopa); avoid in Parkinson’s disease.
  • Use caution with antihypertensives due to additive hypotension.

Practice Notes

Implement routine metabolic monitoring (weight, fasting lipids, glucose) at baseline, 3 months, then annually. Short-term trial data: a 7-week double-blind study (n=60) reported greater BMI increase and more frequent appetite increase with risperidone than aripiprazole—ask about appetite early as a practical signal for metabolic risk.

Read more
  • Split dosing or bedtime dosing may reduce daytime sedation and hypotension.
  • Ensure oral tolerability before initiating LAI; follow manufacturer guidance for injection technique and oral overlap.
  • Educate patients about prolactin-related symptoms and sexual/reproductive health effects.
  • Coordinate depot planning with the LAI Navigator and integrate mood-stabilization strategies with the bipolar disorder hub when applicable.
  • For persistent prolactin elevation consider transitioning to Paliperidone LAIs using the compare tool to align expectations.

Long-acting injectable (LAI) options

  • Risperidone microspheres
    Interval
    q2wk
    Oral overlap
    Yes — ~3 weeks due to lag
    Injection site
    Deltoid or gluteal
    Notes
    • 3‑week lag to therapeutic release; continue oral overlap
  • Risperidone (Perseris)
    Interval
    Monthly (q4wk)
    Oral overlap
    None after first injection (establish oral tolerability first)
    Injection site
    Subcutaneous (abdomen or back of arm)
    Notes
    • Neither a loading dose nor oral supplementation is recommended after initiation (verify in labeling)
  • Risperidone (Uzedy)
    Interval
    q4wk or q8wk (by dose)
    Oral overlap
    None after first injection (establish oral tolerability first)
    Injection site
    Subcutaneous (abdomen or back of arm)
    Notes
    • Monthly and every-2-month schedules use different dose strengths (verify conversion tables in label)

References

  1. RISPERDAL prescribing information — DailyMed (2025)
  2. RISPERDAL CONSTA prescribing information — DailyMed (2025)
  3. Assessing THE Metabolic Impact OF Aripiprazole Versus Risperidone IN THE Treatment OF Schizophrenia: A Randomized Double Blind Controlled Clinical Trial — BMC Psychiatry (2025)
  4. Haddad2004 Hyperprolactinemia
  5. Long Acting Injectable Risperidone: Efficacy AND Safety OF THE First Long Acting Atypical Antipsychotic — American Journal of Psychiatry (2003)
  6. Acute AND Continuation Risperidone Monotherapy IN Bipolar Mania: Randomized Placebo Controlled Trials — European Neuropsychopharmacology (2005)
  7. Risperidone in the treatment of schizophrenia — American Journal of Psychiatry (1994)
Risperidone (RISPERDAL) — Summary — PsychMed