risperidone

Adult Dosing .

Dosage forms:  TAB: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg; ODT: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg; SOL: 1 mg per mL; INJ: 12.5 mg per 2 mL, 25 mg per 2 mL, 37.5 mg per 2 mL, 50 mg per 2 mL

schizophrenia

[PO route]

Dose: 2-8 mg/day PO divided qd-bid; Start: 2 mg/day PO divided qd-bid, then incr. by 1-2 mg/day no more frequently than q24h; Max: 8 mg/day; Info: doses >6 mg/day rarely more effective, may incr. ADR risk; start 0.5 mg PO bid, titrate slowly in elderly pts; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; do not cut/chew ODT form

[IM route]

Dose: 25-50 mg IM q2wk; Start: 25 mg IM q2wk after establishing tolerability w/ PO risperidone, may incr. dose no more frequently than q4wk; Max: 50 mg IM q2wk; Info: overlap w/ PO risperidone or other PO antipsychotic x3wk; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

bipolar I disorder

[acute manic/mixed]

Dose: 1-6 mg/day PO divided qd-bid; Start: 2-3 mg PO qd, then may adjust dose by 1 mg/day no more frequently than q24h; Max: 6 mg/day; Info: for monotherapy or valproate or lithium adjunct; start 0.5 mg PO bid, titrate slowly in elderly pts; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; do not cut/chew ODT form

[maintenance tx]

Dose: 25-50 mg IM q2wk; Start: 25 mg IM q2wk after establishing tolerability w/ PO risperidone, may incr. dose no more frequently than q4wk; Max: 50 mg IM q2wk; Info: for monotherapy or valproate or lithium adjunct; overlap w/ PO risperidone or other PO antipsychotic x3wk; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

Tourette syndrome (off-label)

[0.25-3 mg/day PO divided qd-bid]

Start: 0.25-0.5 mg PO qd, then may incr. by up to 0.5 mg/day q4-5 days; Max: 6 mg/day; Info: periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; do not cut/chew ODT form

renal dosing

[PO route, Tourette syndrome]

renal impairment: not defined

HD/PD: not defined

[PO route, all other indications]

CrCl <30: start 0.5 mg PO bid, may incr. by up to 0.5 mg PO bid until 1.5 mg bid, then may incr. dose no more frequently than qwk

HD/PD: not defined

[IM route]

renal impairment: use PO form to titrate; start 0.5 mg PO bid x1wk, then may incr. to 2 mg/day PO divided qd-bid x1wk, if tolerating then may add 12.5-25 mg IM q2wk; Info: D/C PO form 3wk after 1st IM dose

HD/PD: not defined

hepatic dosing

[PO route, Tourette syndrome]

hepatic impairment: not defined

[PO route, all other indications]

Child-Pugh Class C: start 0.5 mg PO bid, may incr. by up to 0.5 mg PO bid until 1.5 mg bid, then may incr. dose no more frequently than qwk

[IM route]

hepatic impairment: use PO form to titrate; start 0.5 mg PO bid x1wk, then may incr. to 2 mg/day PO divided qd-bid x1wk, if tolerating then may add 12.5-25 mg IM q2wk; Info: D/C PO form 3wk after 1st IM dose

Peds Dosing .

Dosage forms:  TAB: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg; ODT: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg; SOL: 1 mg per mL; INJ: 12.5 mg per 2 mL, 25 mg per 2 mL, 37.5 mg per 2 mL, 50 mg per 2 mL

schizophrenia

[PO route, 13-17 yo]

Dose: 1-6 mg/day PO divided qd-bid; Start: 0.5 mg PO qd, then incr. by 0.5-1 mg/day no more frequently than q24h; Max: 6 mg/day; Info: doses >3 mg/day rarely more effective, may incr. ADR risk; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; do not cut/chew ODT form

[IM route, 13 yo and older (off-label)]

Dose: 25-37.5 mg IM q2wk; Start: after establishing tolerability w/ PO risperidone, may incr. dose by 12.5 mg no more frequently than q4wk; Max: 50 mg IM q2wk; Info: for maintenance tx; overlap w/ PO risperidone x3wk; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

bipolar I disorder

[acute manic/mixed, 10-17 yo]

Dose: 0.5-6 mg/day PO divided qd-bid; Start: 0.5 mg PO qd, then incr. by 0.5-1 mg/day no more frequently than q24h; Max: 6 mg/day; Info: doses >2.5 mg/day rarely more effective, may incr. ADR risk; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; do not cut/chew ODT form

[maintenance tx, 12 yo and older (off-label)]

Dose: 25-37.5 mg IM q2wk; Start: 25 mg IM q2wk after establishing tolerability w/ PO risperidone, may incr. dose no more frequently than q4wk; Max: 50 mg IM q2wk; Info: overlap w/ PO risperidone x3wk; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC

irritability, autistic disorder-associated

[5-17 yo, 15-20 kg]

Dose: 0.5-3 mg/day PO divided qd-bid; Start: 0.25 mg PO qd for at least 4 days, then incr. to 0.5 mg/day, then may adjust dose by 0.25 mg/day no more frequently than q2wk; Max: 3 mg/day; Info: periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; do not cut/chew ODT form

[5-17 yo, >20 kg]

Dose: 0.5-3 mg/day PO divided qd-bid; Start: 0.5 mg/day PO divided qd-bid for at least 4 days, then incr. to 1 mg/day, then may adjust dose by 0.5 mg/day no more frequently than q2wk; Max: 3 mg/day; Info: periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; do not cut/chew ODT form

Tourette syndrome (off-label)

[6 yo and older]

Dose: 0.25-3 mg/day PO divided qd-bid; Start: 0.25-0.5 mg PO qd, then may incr. by up to 0.5 mg/day q4-5 days; Max: 6 mg/day; Info: periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC; do not cut/chew ODT form

renal dosing

[PO route]

renal impairment: decr. usual dose, amount not defined

HD/PD: not defined

[IM route]

renal impairment: consider adult renal dosing for guidance

HD/PD: not defined

hepatic dosing

[not defined]

hepatic impairment: consider adult hepatic dosing for guidance