Management: Additive paliperidone exposure is expected with this combination. If combined, limit the dosages and duration of each drug. Monitor therapy, QT-prolonging Class IC Antiarrhythmics (Moderate Risk): May enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk). Patients with additional risk factors for QTc prolongation may be at even higher risk. Avoid combination, Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Avoid combination, Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Avoid combination, Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Hypotension may be seen with lorazepam at low levels. Consult drug interactions database for more detailed information. 2023 Medicine.com All rights reserved. Health care providers are encouraged to enroll women 18 to 45 years of age exposed to risperidone during pregnancy in the Atypical Antipsychotics Pregnancy Registry (1-866-961-2388 or http://www.womensmentalhealth.org/pregnancyregistry). Haloperidol alone does not appear to confer a significant risk of hypotension, but severe hypotension can occur with haloperidol in combination with antihypertensives, leading in rare cases to cardiac arrest. Falls: May increase the risk for falls due to somnolence, orthostatic hypotension, and motor or sensory instability. Online. Browse . Consider therapy modification, Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Monitor therapy, Revefenacin: Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. Talk with the doctor. SubQ: Two absorption peaks; first release occurs immediately after injection and second release occurs around 10 to 14 days; therapeutic levels maintained for 4 weeks after injection. Autism, associated irritability, including aggression, temper, tantrums, self-injurious behavior, and quickly changing moods: Children 5 years and Adolescents: Note: Individualize dose according to patient response and tolerability: 15 to 20 kg: Oral: Initial: 0.25 mg/day; after 4 days, may increase dose to 0.5 mg/day; maintain this dose for 14 days. Note: May administer 1/2 the daily dose twice daily if breakthrough symptoms occur in the afternoon or evening. However, if a woman is inadvertently exposed to an atypical antipsychotic while pregnant, continuing therapy may be preferable to switching to an agent that the fetus has not yet been exposed to; consider risk:benefit (ACOG 2008). Monitor therapy, Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Monitor therapy, Acetylcholinesterase Inhibitors (Central): May enhance the neurotoxic (central) effect of Antipsychotic Agents. Patients with additional risk factors for QTc prolongation may be at even higher risk. Abiraterone Acetate: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Monitor therapy, Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. If combined, limit the dosages and duration of each drug. Exceptions: Domperidone. Consider therapy modification, Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Rotate injection sites. Proper Use. Monitor therapy, CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk of dystonia (and possibly other EPS) may be greater with increased doses, use of conventional antipsychotics, males, and younger patients. Avoid combination, OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Maintenance treatment (monotherapy or as adjunct to antimanic therapy): Oral: Continue dose and combination regimen that was used to achieve control of the acute episode (CANMAT [Yatham 2018]). SubQ injection site reactions: Following each SubQ injection, a lump may develop and persist for several weeks; it will decrease in size over time. Doses up to 8 mg/day may be necessary in some patients (Freudenmann 2008; Kenchaiah 2010; Suh 2019). Mental status; vital signs (as clinically indicated); blood pressure (baseline; repeat 3 months after antipsychotic initiation, then yearly); weight, height, BMI, waist circumference (baseline; repeat at 4, 8, and 12 weeks after initiating or changing therapy, then quarterly; consider switching to a different antipsychotic for a weight gain 5% of initial weight); CBC (as clinically indicated; monitor frequently during the first few months of therapy in patients with pre-existing low WBC or history of drug-induced leukopenia/neutropenia); electrolytes, renal and liver function (annually and as clinically indicated); personal and family history of obesity, diabetes, dyslipidemia, hypertension, or cardiovascular disease (baseline; repeat annually); fasting plasma glucose level/HbA1c (baseline; repeat 3 months after starting antipsychotic, then yearly); fasting lipid panel (baseline; repeat 3 months after initiation of antipsychotic; if LDL level is normal repeat at 2 to 5 year intervals or more frequently if clinical indicated); changes in menstruation, libido, development of galactorrhea, erectile and ejaculatory function (at each visit for the first 12 weeks after the antipsychotic is initiated or until the dose is stable, then yearly); abnormal involuntary movements or parkinsonian signs (baseline; repeat weekly until dose stabilized for at least 2 weeks after introduction and for 2 weeks after any significant dose increase); tardive dyskinesia (every 12 months; high-risk patients every 6 months); ocular examination (yearly in patients >40 years; every 2 years in younger patients) (ADA 2004; Lehman 2004; Marder 2004). Management: Consider alternatives to this drug combination. Monitor therapy, QT-prolonging Miscellaneous Agents (Moderate Risk): May enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk). Caffeine is addictive and can be hard to quit, but withdrawing caffeine from your daily routine can benefit your health and mental wellbeing. Acute manic or mixed episodes (labeled use) or acute hypomania (off-label use) (monotherapy or adjunctive therapy): Oral: Initial: 1 to 3 mg/day in 1 or 2 divided doses; may adjust dose based on response and tolerability in increments of 1 mg/day at intervals 24 hours to a usual dose of 4 to 6 mg/day; in general, assess full effect for 1 week before further advancing up to 8 mg/day (usual maximum) (CANMAT [Yatham 2018]; Moosavi 2014; Singh 2013). The relatively low incidence of extrapyramidal symptoms with risperidone may reflect a preferential action on mesolimbic rather than nigrostriatal dopaminergic pathways. Administer immediately after mixing. Doses ranging from 0.5 to 3 mg/day have been evaluated; however, therapeutic effect reached plateau at 2.5 mg/day (3 mg/day in pediatric patients >45 kg) in clinical trials. High blood sugar like confusion, feeling sleepy, more thirst, hunger, passing urine more often, flushing, fast breathing, or breath that smells like fruit. Altered cardiac conduction: May alter cardiac conduction and prolong the QT interval; life-threatening arrhythmias have occurred with therapeutic doses of antipsychotics (Haddad 2002; Ray 2009). Monitor therapy, Sodium Oxybate: May enhance the CNS depressant effect of CNS Depressants. The benefits or risks of interrupting risperidone prior to surgery have not been established; clinicians are advised to proceed with surgery cautiously. Consider therapy modification, Paliperidone: RisperiDONE may enhance the adverse/toxic effect of Paliperidone. Methods: In a double-blind, controlled clinical trial, 40 acute psychotic patients were randomly allocated in four groups and treated with each of the four antipsychotics: olanzapine, risperidone, haloperidol or thiothixene. Consider therapy modification, Iopamidol: Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iopamidol. Based on the US Veterans Affairs/Department of Defense clinical practice guideline for the management of MDD, second-generation antipsychotics, such as risperidone, should be considered as an antidepressant augmentation strategy only after other strategies have failed due to tolerability issues. Suicidal ideation: The possibility of a suicide attempt is inherent in psychotic illness or bipolar disorder; use with caution in high-risk patients during initiation of therapy. Drug information provided by: Merative, Micromedex Take this medicine only as directed by your doctor. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Here are 6 benefits of exercise for older adults and seniors. This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Obsessive-compulsive disorder, treatment resistant (augmentation to antidepressants) (off-label use): Oral: Initial: 0.25 to 0.5 mg/day; may increase dose based on response and tolerability in increments of 0.5 to 1 mg/day every 3 to 7 days; usual dose: 0.5 to 2 mg/day; doses up to 3 mg/day may be needed for optimal response (Erzegovesi 2005; McDougle 2000; Simpson 2013). Based on the European Society for the Study of Tourette Syndrome and the Tourette Syndrome Foundation of Canada guidelines, drug therapy, including risperidone, is effective and recommended for the management of Tourette syndrome to improve quality of life with tics that are painful or distressing, interfere with daily functioning, or cause sustained social or emotional problems. Severe extrapyramidal symptoms have occurred in some patients. Major depressive disorder (unipolar), treatment resistantbyes. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Agitation/Aggression and psychosis associated with dementia, severe or refractorybyes. Following clinical response, consider gradually decreasing dose to lowest effective dose. SubQ: Administer SubQ into the abdomen only. Wait at least 24 hours after the procedure to resume such agents. Monitor therapy, Domperidone: QT-prolonging Agents (Moderate Risk) may enhance the QTc-prolonging effect of Domperidone. SubQ: Usual dose: 90 or 120 mg once monthly. Refer to the manufacturer's labeling for reconstitution instructions. Management: Consider increasing the dose of oral risperidone (to no more than double the original dose) if a strong CYP3A4 inducer is initiated. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. In this article, we report a case of risperidone-induced ALD presenting with acute onset shortness of breath, initially misdiagnosed as a panic attack, leading to a delay in management. Monitor therapy, Loop Diuretics: May enhance the adverse/toxic effect of RisperiDONE. Oxcarbazepine is an anti-epileptic medication used in the treatment of partial onset seizures that was first approved for use in the United States in 2000. Risperidone and its metabolite cross the placenta (Newport 2007). Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat. Bipolar Mania . It is also used to treat episodes of mania (frenzied, abnormally excited, or irritated mood) or mixed episodes . Monitor therapy, QT-prolonging Quinolone Antibiotics (Moderate Risk): May enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk). Avoid combination, Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Monitor therapy, OLANZapine: QT-prolonging Antipsychotics (Moderate Risk) may enhance the QTc-prolonging effect of OLANZapine. Specifically, the risk for akathisia, parkinsonism, or neuroleptic malignant syndrome may be increased. A few minutes of physical activity a day can have a positive impact on your mood. In general, assess full effect for 1 week before further advancing, if needed, to 6 to 8 mg/day (usual maximum). Management: Avoid concomitant use of anticholinergic agents and secretin. Risperidone has no affinity for . Risperidone is an atypical antipsychotic medication, first approved for use in the USA by the Food and Drug Administration (FDA) in 1993. Strategies include cross-titration (gradually discontinuing the first antipsychotic while gradually increasing the new antipsychotic) and abrupt change (abruptly discontinuing the first antipsychotic and either increasing the new antipsychotic gradually or starting it at a treatment dose). It is used to treat irritation that happens with autistic disorder. Tends to wax and wane: may have periods of lucidity in between periods of confusion. In patients with schizophrenia at high risk of relapse, the current medication may be maintained at full dose as the new medication is increased (ie, overlap); once the new medication is at therapeutic dose, the first medication is gradually decreased and discontinued over 1 to 2 weeks (Cerovecki 2013; Remington 2005; Takeuchi 2017). Exceptions: Amisulpride; CloZAPine; Droperidol; Flupentixol; OLANZapine; Pimozide; QUEtiapine; RisperiDONE. Consider therapy modification, Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Cardiovascular disease: Use with caution in patients with severe cardiac disease, hemodynamic instability, prior myocardial infarction or ischemic heart disease. May be low to moderately sedating in comparison with other antipsychotics (Richelson 1999); dose-related effects have been observed. Cannabidiol, a constituent of the Cannabis sativa plant, has potential both as an antipsychotic and as a cannabis . Monitor therapy, Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Other agents are used preferentially in some intoxications (eg, stimulants) or alcohol withdrawal (Moore 2019; WFSBP [Garriga 2016]; Wilson 2012b). Evidence supporting ideal switch strategies and taper rates is limited and results are conflicting (Cerovecki 2013; Remington 2005). Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risperidone has low to moderate affinity for 5-HT1C, 5-HT1D, and 5-HT1A receptors, weak affinity for D1 and no affinity for muscarinics or beta1 and beta2 receptors. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Dose related QTc prolongation and risk of cardiac arrhythmias. It is recommended that the patient is in the supine position. Talk to your doctor if you have questions. Compared to other antipsychotics, the risk of weight gain with risperidone is moderate (Solmi 2017). Mechanism of action. Hepatic impairment: Use with caution in patients with hepatic disease or impairment; dosage reduction is recommended. Exercise has many benefits for older adults and can help you to live a longer and healthier life. Note: May administer 1/2 the daily dose twice daily in patients who experience persistent somnolence. not dementia). Monitor therapy, Deutetrabenazine: May enhance the adverse/toxic effect of Antipsychotic Agents. It is also known as a second-generation antipsychotic (SGA) or atypical antipsychotic. Monitor therapy, Pimozide: May enhance the QTc-prolonging effect of QT-prolonging Agents (Moderate Risk). Priapism: Rare cases of priapism have been reported. Management: Monitor closely for evidence of excessive CNS depression. Monitor therapy, QT-prolonging Antipsychotics (Moderate Risk): May enhance the QTc-prolonging effect of RisperiDONE. Monitor therapy, Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Tablet will dissolve within seconds and may be swallowed with or without liquid. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Avoid combination, Clarithromycin: QT-prolonging Antipsychotics (Moderate Risk) may enhance the QTc-prolonging effect of Clarithromycin. QuiNIDine may increase the serum concentration of RisperiDONE. Bipolar disorder: As monotherapy or as adjunctive therapy to lithium or valproate for the maintenance treatment of bipolar I disorder. Switching antipsychotics: An optimal universal strategy for switching antipsychotic agents has not been established. Consider therapy modification, Perhexiline: CYP2D6 Substrates (High risk with Inhibitors) may increase the serum concentration of Perhexiline. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. The onset of action of each drug was assessed by the Positive and Negative Symptoms Scale. Data from 2 meta-analyses of 4 randomized, double-blind, placebo-controlled trials support the use of adjunctive risperidone (in combination with antidepressants) in the treatment of treatment-resistant major depressive disorder (MDD) Komossa 2010, Nelson 2009. Hypersensitivity: Hypersensitivity reactions including anaphylactic reactions and angioedema have been reported. Data from a limited number of patients studied in randomized, double-blind trials suggest that risperidone may be beneficial for the treatment of obsessive-compulsive disorder (OCD) as an adjunct treatment in patients with a partial response to antidepressants Erzegovesi 2005, Li 2005, McDougle 2000. Monitor therapy, Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Based on the American Academy of Neurology practice guideline recommendations summary for the treatment of tics in people with Tourette syndrome and chronic tic disorders, antipsychotics such as risperidone are recommended for the management of tics when the benefit outweighs the risks of treatment. Not due to severely reduced level of arousal (i.e., coma). Background Cannabis use is an important risk factor for development of psychosis and further transition to schizophrenia. Discontinuation of therapy: Children and Adolescents: American Academy of Child and Adolescent Psychiatry (AACAP), American Psychiatric Association (APA), Canadian Psychiatric Association (CPA), National Institute for Health and Care Excellence (NICE), and World Federation of Societies of Biological Psychiatry (WFSBP) guidelines recommend gradually tapering antipsychotics to avoid withdrawal symptoms and minimize the risk of relapse (AACAP [McClellan 2007]; APA [Lehman 2004]; Cerovecki 2013; CPA 2005; NICE 2013; WFSBP [Hasan 2012]); risk for withdrawal symptoms may be highest with highly anticholinergic or dopaminergic antipsychotics (Cerovecki 2013). This could result in serotonin syndrome. Monitor therapy, Nabilone: May enhance the CNS depressant effect of CNS Depressants. Factors associated with greater vulnerability to tardive dyskinesia include older in age, female gender combined with postmenopausal status, Parkinson disease, pseudoparkinsonism symptoms, affective disorders (particularly major depressive disorder), concurrent medical diseases such as diabetes, previous brain damage, alcoholism, poor treatment response, and use of high doses of antipsychotics (APA [Lehman 2004]; Soares-Weiser 2007). Also known as a second-generation antipsychotic ( SGA ) or atypical antipsychotic day can have positive... Action on mesolimbic rather than nigrostriatal dopaminergic pathways plant, has Potential as... With lorazepam at low levels of antipsychotic Agents, treatment resistantbyes and can help you to live longer... Is in the supine position known as a second-generation antipsychotic ( SGA ) or atypical antipsychotic QT-prolonging Antipsychotics ( risk. 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