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Uzedy
risperidone
Black Box Warnings .
Dementia-Related Psychosis
not approved for dementia-related psychosis; incr. mortality risk in elderly patients on antipsychotic tx for dementia-related psychosis; most deaths due to cardiovascular or infectious events
Adult Dosing .
Dosage forms: INJ (pre-filled syringe): 50 mg per 0.14 mL, 75 mg per 0.21 mL, 100 mg per 0.28 mL, 125 mg per 0.35 mL, 150 mg per 0.42 mL, 200 mg per 0.56 mL, 250 mg per 0.7 mL
schizophrenia
- [conversion from risperidone 2 mg/day PO]
- Dose: 50 mg SC qmo or 100 mg SC q2mo; Start: day after last PO dose; Info: to switch between qmo and q2mo dosing regimen, give 1st dose of new regimen at next scheduled dose of prior regimen; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
- [conversion from risperidone 3 mg/day PO]
- Dose: 75 mg SC qmo or 150 mg SC q2mo; Start: day after last PO dose; Info: to switch between qmo and q2mo dosing regimen, give 1st dose of new regimen at next scheduled dose of prior regimen; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
- [conversion from risperidone 4 mg/day PO]
- Dose: 100 mg SC qmo or 200 mg SC q2mo; Start: day after last PO dose; Info: to switch between qmo and q2mo dosing regimen, give 1st dose of new regimen at next scheduled dose of prior regimen; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
- [conversion from risperidone 5 mg/day PO]
- Dose: 125 mg SC qmo or 250 mg SC q2mo; Start: day after last PO dose; Info: to switch between qmo and q2mo dosing regimen, give 1st dose of new regimen at next scheduled dose of prior regimen; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
renal dosing
- [adjust dose amount]
- renal impairment: 50 mg SC qmo
- HD/PD: not defined
hepatic dosing
- [adjust dose amount]
- hepatic impairment: 50 mg SC qmo
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to paliperidone
- caution: hypersensitivity to tartrazine (some generic tab forms)
- caution: CNS depressant use, concurrent
- caution: alcohol use, concurrent
- caution: elderly patients
- caution: psychosis, dementia-associated
- caution: dementia w/ Lewy bodies
- caution: Parkinson dz
- caution: seizure history
- caution: seizure risk
- caution: cerebrovascular dz
- caution: cardiovascular dz
- caution: hypotension risk
- caution: hypovolemia
- caution: dehydration
- caution: environmental temperature, high
- caution: aspiration pneumonia risk
- caution: PKU (phenylalanine-containing form)
- caution: diabetes mellitus
- caution: diabetes mellitus risk
- caution: leukopenia history, drug-induced
- caution: neutropenia history, drug-induced
- caution: leukopenia
- caution: neutropenia
- caution: renal impairment
- caution: hepatic impairment
Drug Interactions .
Overview
risperidone
atypical antipsychotic
- CYP2D6 substrate
- CYP3A4 substrate
- CNS depression
- decreases central histamine effects
- dopamine antagonist
- extrapyramidal effects
- hyperglycemic effects
- hyperprolactinemic effects
- hyperthermia
- hypotensive effects
- lowers seizure threshold
Avoid/Use Alternative
- aripiprazole lauroxil
- bromocriptine
- clonidine
- codeine
- ethanol
- kava
- metoclopramide
- midazolam
- promethazine
- rasagiline
- selegiline transdermal
- thalidomide
- triptorelin
Monitor/Modify Tx
- acarbose
- acebutolol
- alfuzosin
- aliskiren
- alogliptin
- alprazolam
- amifostine
- amiloride
- amitriptyline
- amlodipine
- amoxapine
- apraclonidine ophthalmic
- aprocitentan
- articaine
- atenolol
- avanafil
- azilsartan medoxomil
- benazepril
- berberine
- betaxolol
- betaxolol ophthalmic
- bisoprolol
- bortezomib
- brexpiprazole
- brimonidine ophthalmic
- bumetanide
- bupivacaine
- bupivacaine liposomal
- bupropion
- butorphanol
- canagliflozin
- cannabis
- captopril
- carbamazepine
- carteolol ophthalmic
- carvedilol
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cilostazol
- clevidipine
- clobazam
- clofarabine
- clomipramine
- clorazepate
- clozapine
- cobicistat
- colesevelam
- dacomitinib
- darunavir
- denileukin diftitox
- desflurane
- desipramine
- diltiazem
- dinutuximab
- dipyridamole
- doxazosin
- dronabinol
- droperidol
- dulaglutide
- empagliflozin
- enalapril
- enalaprilat
- entacapone
- entrectinib
- enzalutamide
- eplerenone
- ertugliflozin
- esketamine
- esmolol
- eszopiclone
- ethacrynic acid
- ethanol (in some formulations)
- etomidate
- felodipine
- fentanyl
- ferumoxytol
- flaxseed
- flibanserin
- fluoxetine
- fluphenazine
- flurazepam
- fosinopril
- fosphenytoin
- gabapentin
- garlic
- glimepiride
- glyburide
- haloperidol
- hydrochlorothiazide
- hydroxyzine
- ifosfamide
- iloprost
- iloprost inhaled
- imipramine
- indapamide
- insulin
- iohexol
- iopamidol
- irbesartan
- iron sucrose
- isoflurane
- isosorbide dinitrate
- isosorbide mononitrate
- isradipine
- ivosidenib
- ketamine
- labetalol
- landiolol
- lemborexant
- levobunolol ophthalmic
- levodopa
- lidocaine
- liraglutide
- lithium
- lorazepam
- losartan
- loxapine
- lubiprostone
- lumacaftor/ivacaftor
- lumateperone
- magnesium sulfate
- maraviroc
- meperidine
- metformin
- methadone
- methohexital
- methyldopa
- methylene blue injection
- metolazone
- metoprolol
- miglitol
- milrinone
- minoxidil
- mirtazapine
- mitotane
- moexipril
- molindone
- morphine
- nadolol
- nalbuphine
- nateglinide
- nattokinase
- naxitamab
- nebivolol
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nimodipine
- nisoldipine
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- olanzapine
- oliceridine
- olmesartan medoxomil
- opicapone
- opium
- oxazepam
- oxycodone
- oxymorphone
- paliperidone
- palopegteriparatide
- paroxetine
- pentamidine
- pentazocine
- pentobarbital
- perindopril
- perphenazine
- phenoxybenzamine
- phenytoin
- pioglitazone
- pramipexole
- pramlintide
- prazosin
- pregabalin
- primidone
- procarbazine
- prochlorperazine
- propafenone
- propofol
- propranolol
- protriptyline
- quazepam
- quetiapine
- quinapril
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- ramipril
- remifentanil
- remimazolam
- rifabutin
- riociguat
- ritonavir
- ropinirole
- ropivacaine
- rosiglitazone
- sacubitril
- saxagliptin
- semaglutide
- sevoflurane
- sildenafil
- silodosin
- sitagliptin
- sodium ferric gluconate complex
- sotagliflozin
- sotalol
- sparsentan
- spironolactone
- sufentanil
- tadalafil
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- telmisartan
- temazepam
- terazosin
- terbinafine
- thiothixene
- timolol
- timolol ophthalmic
- tirzepatide
- tizanidine
- tolcapone
- torsemide
- tramadol
- trandolapril
- trazodone
- treprostinil
- triamterene
- triazolam
- trifluoperazine
- trimipramine
- valsartan
- vardenafil
- verapamil
- vosoritide
- yohimbe
- zaleplon
- ziconotide
- zolpidem
Caution Advised
- 5-HTP
- acetazolamide
- aclidinium inhaled
- adagrasib
- allopurinol
- almotriptan
- atazanavir
- atropine
- baclofen
- belladonna alkaloids
- bosentan
- botulinum toxin
- brivaracetam
- brompheniramine
- buspirone
- busulfan
- cannabidiol
- carbinoxamine
- carisoprodol
- cenobamate
- cetirizine
- chamomile, German
- chasteberry
- chlophedianol
- chlorambucil
- chloramphenicol
- chloroquine
- chlorpheniramine
- chlorzoxazone
- citalopram
- clarithromycin
- clemastine
- clidinium
- cyclobenzaprine
- cyproheptadine
- dabrafenib
- dantrolene
- darifenacin
- desvenlafaxine
- deutetrabenazine
- dexbrompheniramine
- dexchlorpheniramine
- dexmethylphenidate
- dichlorphenamide
- dicyclomine
- difelikefalin
- difenoxin
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- disopyramide
- domperidone
- doxepin topical
- efavirenz
- eletriptan
- escitalopram
- eslicarbazepine acetate
- ethosuximide
- etravirine
- felbamate
- fenfluramine
- fesoterodine
- fexinidazole
- flavoxate
- fluvoxamine
- frovatriptan
- galantamine
- ganaxolone
- glofitamab
- glycopyrrolate
- glycopyrrolate inhaled
- glycopyrronium topical
- goserelin
- histrelin
- homatropine
- hydroxychloroquine
- hyoscyamine
- idelalisib
- ipratropium inhaled
- itraconazole
- ketoconazole
- lacosamide
- lamotrigine
- lasmiditan
- leuprolide
- levetiracetam
- levocetirizine
- levoketoconazole
- levomilnacipran
- linvoseltamab
- lonafarnib
- lopinavir/ritonavir
- lorlatinib
- magnesium citrate
- mavacamten
- meclizine
- melatonin
- meprobamate
- methocarbamol
- methscopolamine
- methsuximide
- methylphenidate
- metyrapone
- metyrosine
- mifepristone
- milnacipran
- mitapivat
- modafinil
- mosunetuzumab
- mycophenolate mofetil
- nafcillin
- naltrexone
- naratriptan
- nefazodone
- nelfinavir
- orphenadrine
- oxcarbazepine
- pacritinib
- passion flower
- perampanel
- pexidartinib
- pheniramine
- pimozide
- polyethylene glycol
- polyethylene glycol/electrolytes
- posaconazole
- pyrilamine
- ramelteon
- repotrectinib
- revefenacin inhaled
- ribociclib
- rifapentine
- rivastigmine
- rizatriptan
- rufinamide
- scopolamine
- selinexor
- sertraline
- sodium picosulfate
- sofpironium topical
- solifenacin
- solriamfetol
- sotorasib
- stiripentol
- sulfate bowel prep
- sumatriptan
- tasimelteon
- tetrabenazine
- thiotepa
- tiagabine
- tiotropium inhaled
- tipranavir
- tolterodine
- topiramate
- treosulfan
- trihexyphenidyl
- triprolidine
- trospium
- tucatinib
- umeclidinium inhaled
- valbenazine
- valerian
- valproic acid
- venlafaxine
- vigabatrin
- vilazodone
- viloxazine
- voriconazole
- zolmitriptan
- zonisamide
Adverse Reactions .
Serious Reactions
- hypotension, orthostatic
- syncope
- extrapyramidal sx, severe
- tardive dyskinesia
- dystonia
- neuroleptic malignant syndrome
- hyperglycemia
- diabetes mellitus
- pancreatitis
- SIADH
- seizures
- priapism
- stroke
- TIA
- venous thromboembolism
- ileus
- dysphagia, severe
- hypersensitivity rxn
- angioedema
- anaphylaxis
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- leukopenia
- neutropenia
- agranulocytosis
- thrombocytopenia
- hypothermia
- hyperthermia
- injection site rxn, severe (IM use)
- tumorigenicity (animal studies)
- osteodystrophy (animal studies w/ IM form)
Common Reactions
- somnolence
- hyperprolactinemia
- appetite incr.
- weight gain
- extrapyramidal sx
- insomnia
- fatigue
- headache
- injection site rxn (SC or IM use)
- vomiting
- nasopharyngitis
- constipation
- anxiety
- abdominal pain
- nausea
- fever
- dizziness
- urinary incontinence
- hyperglycemia
- sialorrhea
- rhinorrhea
- nasal congestion
- xerostomia
- pharyngolaryngeal pain
- dyspepsia
- dyslipidemia
- rhinitis
- diarrhea
- URI
- rash
- extremity pain
- blurred vision
- back pain
- musculoskeletal pain
- tachycardia
- impaired body temperature regulation
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; fasting lipid panel at baseline, then periodically; weight; fasting glucose at baseline if diabetes risk factors, then periodically; CBC w/ diff frequently during initial tx if pre-existing or history of leukopenia/neutropenia; consider orthostatic vital signs if hypotension risk
Look/Sound-Alike Drug Names
risperiDONE confused with: busPIRone; repaglinide; Requip; reserpine; risedronate; RisperDAL; rOPINIRole; rosiglitazone
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, esp. in 3rd trimester; risk of teratogenicity not expected based on limited human data, though risk of neonatal extrapyramidal and withdrawal sx based on human data w/ antipsychotics
Pregnancy Registry
encourage patients to enroll in National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or www.womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; low risk of infant harm, incl. sedation and resp. depression, based on limited human data and drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver extensively; CYP450: 2D6 (primary), 3A4 substrate; Info: active metabolite (paliperidone)
Excretion: urine 70%, feces 14%; Half-life: 20h (PO form), 3-6 days (IM form), 9-22 days (SC form)
Subclass: Antipsychotics, 2nd generation
Mechanism of Action
exact mechanism of action unknown; antagonizes dopamine D2, serotonin 5-HT2, and other receptors
Formulary .
No Formulary Selected
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