The atypical antipsychotic risperidone, often sold under the brand name Risperdal®, is generally used to treat the symptoms of schizophrenia in adults and adolescents, and is occasionally used off-label to treat irritability in children with autism or mania and depression in bipolar patients. Due to the dramatically increased risk of serious side-effects accompanying the use of higher or longer-term doses, the lowest possible effective risperidone dose should be given. Factors that can affect the efficacy of the standard risperidone dose and that necessitate adjustments include the patient's age, condition, concurrent drug regimen, liver health, and level of kidney function.
Adults using risperidone to control the symptoms of schizophrenia should be given an oral risperidone dose of 1 mg twice daily. If improvements are not seen after the third day of treatment, the dose may be increased by 2 mg per day, given in a divided dose. Further dosage increases should be evaluated seven days after each increase up to a maximum of 16 mg per day. Patients with lowered kidney or liver function should use half the recommended initial daily and maintenance doses, with dosage increases considered less than once per week. The same cautions should apply to debilitated patients as well as those at risk of developing low blood pressure or for whom low blood pressure would be dangerous.
The use of this medication in the treatment of schizophrenia in pediatric populations is recommended only for those between the ages of 13 and 17. Adolescents should be given a single daily risperidone dose of 0.5 mg administered orally. Dosage increases should be in increments of 0.5 to 1 mg per day, preferably in divided doses. A maintenance dose of 3 mg may be given. While doses of up to 6 mg have been used in the treatment of schizophrenia in adolescents, no statistically significant benefits have been found in the use of daily doses greater than 3 mg or for periods greater than eight weeks.
The recommended regimen for the treatment of schizophrenia in patients 65 years of age and older is much the same as that for the treatment of the condition in adolescents. Due to the risks of risperidone in geriatric patients, including extrapyramidal symptoms or sudden death, when a risperidone dose of 2 mg or more is given, this medication should be used with caution. Alternative medications should be considered if possible.
