Second-generation (atypical) antipsychotic
Antagonist at dopamine D2 and serotonin 5-HT2A receptors; also blocks alpha-1 adrenergic and histamine H1 receptors, contributing to sedation and orthostatic hypotension
Schizophrenia, bipolar disorder (acute manic or mixed episodes), irritability associated with autism spectrum disorder (ASD)
Augmentation in major depressive disorder (MDD), agitation and aggression in dementia, management of post-ictal psychosis in epilepsy, post-stroke affective lability, post-stroke aggression, agitation and aggression in neurodevelopmental conditions
Oral tablets, orally disintegrating tablets (ODT), oral solution, long-acting injectable (Risperdal Consta)
0.25–0.5 mg p.o. daily, titrated slowly based on clinical response and tolerability
0.5–6 mg/day
Half-life ~3 hours (parent drug), active metabolite (9-hydroxyrisperidone) half-life ~20 hours; metabolized primarily via CYP2D6 and CYP3A4; steady state ~1–2 days
Sedation, weight gain, extrapyramidal symptoms (EPS), orthostatic hypotension, hyperprolactinemia, dizziness, fatigue
Neuroleptic malignant syndrome (NMS), tardive dyskinesia, cardiac arrhythmias, leukopenia
Monitor weight, fasting glucose, lipids, prolactin levels, blood pressure, and EPS every 3–6 months
Increased risk of mortality in elderly patients with dementia-related psychosis
Risperidone may be used short-term to manage psychotic symptoms following seizure clusters in post-ictal psychosis, typically at low doses. Caution is warranted in patients with Parkinson’s disease (PD), dementia (including AD and LBD), and elderly individuals due to increased risk of sedation and extrapyramidal symptoms. It may be cautiously used for short-term management of agitation or delusions following stroke, with careful fall risk assessment. Avoid use in patients highly sensitive to dopamine antagonism due to risk of severe EPS or prolactin elevation.