College of Our Lady of Mt. Carmel (P)
NCM 106- Nursing Pharmacology
Godrey R. Pamintuan, S.N.
BSN 2 (A.Y. 2023-2024)
Drug Study: Antipsychotics
Drug Name
Classification
Mechanism of
Action
Indication and
Dosage
Side Effects
Adverse
Reaction
Contraindication
Nursing
Consideration
Generic Name:
Risperidone
Risperidone is
used to treat
certain
mental/mood
disorders such
as
schizophrenia,
BPD, and
irritability
associated with
autistic disorder.
Action:
Primary action is
to decrease
dopaminergic
and serotonergic
pathway activity
in the brain,
therefore
decreasing
symptoms of
schizoprenia and
mood disorders.
Feeling sleepy in
the day or
difficulty falling
asleep at night
CNS
Akathesia,
Sedation,
somnolence,
Dystonia,
Headache,
Insomnia,
Agitation,
Anxiety, Pain,
Parkinsonianism,
Abnormal gait,
Fever,
Hallucinations,
Mania, Tremor,
Fatigue,
Depression,
Nervousnes,
Vertigo, Syncope
Contraindicated
in palients
hypersensitive
to drug.
Alert: Obtain
baseline BP
measurements
before starting
therapy, and
monitor BP
regu-Tarly.
Watch for
orthostatic
hypotension,
especially during
first dosage
adjustment.
Pharmacokineti
cs:
Schizophrenia
Adults: Drug
may be given
once daily or
b.i.d. Initial
dosing is 2mg
PO daily
Increase dosage
intervals not less
than 24H in
increments of 1
to 2 mg/day, as
tolerated, to a
recommended
dose of 4 to 8
mg/day.
Maximum dose
is 16 mg/day.
Periodically
reassess to
determine the
need for
maintenance
treatment with
an appropriate
dose.
Action
Risperidone is
Adjust a dose
In older adults,
Stomach pain
Brand Name:
Risperdal
Pregnancy
Category:
Category C
The drug has
shown no direct
teratogenic
effects in animal
studies.
Increased risk of
spontaneous
abortions and
fetal
teratogenicity
could not be
identified with
pregnant women
administered
with Risperdal
Is a class of
atypical
antipsychotics.
It works by
helping to
restore the
balance of
certain natural
substances in
the brain.
Risperidone has
a high binding
affinity for
serotonergic
5-HT2A
receptors when
compared to
dopaminergic D2
receptors in the
brain.
Problems with
your movement
– difficulty
moving, stiff
muscles with
movements
which are
difficult to
control, a slow
shuffling walk,
shakes and
drooling – this is
known as
dyskinesia
Headaches
Putting on
weight or
changes in
appetite
CV
Tachycardia,
Bradycardia,
Bundle branch
block, ECG
changes, chest
pain,
hypotension,
edema,
palpitation, HTN
Opioids should
only be
prescribed with
benzodiazepines
or other CNS
depressants to
patients for
whom
alternative
treatment
options are
inadequate.
Boxed Warning
Older adults with
dementia-relate
d psychosis
treated with
antipsychotics
are at increased
risk for death.
Drug isn't
approved to
treat older
adults with
Monitor patient
for tardive
dyskinesia,
which may occur
after prolonged
use. It may not
appear until
months or years
later and may
disappear
spontaneously or
persist for life,
despite stopping
drug.
U Alert: Watch
1
College of Our Lady of Mt. Carmel (P)
NCM 106- Nursing Pharmacology
Godrey R. Pamintuan, S.N.
rapidly and
completely
absorbed after
oral
administration;
less than 1% is
excreted
unchanged in
feces.
Distribution
Risperidone is
rapidly
distributed. The
volume of
distribution is
1-2L/kg. In
plasma,
risperidone is
bound to
albumin and
a1-acid
glycoprotein.
The plasma
binding
risperidone i 90%
and of its major
metabolite,
9-hydroxyrisperi
done is 77%
Half Life
19 hours
patients woth
hypotension,
and CrCl of less
than 30mL/min
or severe
hepatic
impairment, use
lower starting
dosage of 0.5mg
PO, b.i.d., May
increase
increments of 0.5
mg or less b.i.d.,
Increase to
dosages above
1.5 mg b.i.d. At
intervals for at
least 1 week.
Parenteral
maintenance
therapy for
schizophrenia
or bipolar I
disorder (as
monotherapy or
as combination
therapy with
lithium or
valproate)
Adults: Establish
tolerance to oral
risperidone
before giving IM.
Give 25 mg deep
BSN 2 (A.Y. 2023-2024)
Feeling or being
sick (nausea or
vomiting)
Constipation
Diarrhoea
Swollen breasts,
pain in your
breast or leaking
breast milk –
these can be
signs of
hormone
changes
EENT
Abnormal vision,
Conjunctivitis,
Decreased visual
acuity, Ear
disorder,
rhinorrhea, nasal
congestion,
epistaxis,
rhinitis,
pharyngitis,
sinusitis
GI
Constipation,
Nausea,
Vomiting,
Dyspepsia,
Abdominal Pain,
Anorexia,
Increased
Appetite, Dry
mouth,
Increased
Saliva, Diarrhea.
GU
Urinary
Incontinence,
Increased
Urination,
Abnormal
Orgasm,
Decreased
dementia-relate
d psychosis. I
Use cautiously
in patients with
CV disease,
cerebrovascular
disease,
dehydration,
hypo-volemia,
history of
seizures, or
conditions that
could affect
metabolism or
hemodynamic
responses.
Use cautiously in
patients
exposed to
extreme heat.
Use caution in
patients at risk
for aspiration
pneumonia.
Use IM injection
cautiously in
those with
hepatic or renal
impairment.
for evidence of
NMS
(extra-pyramidal
effects,
hyperthermia,
autonomic
disturbance),
which is rare but
can be fatal.
Life-threatening
hyperglycemia
may °c-our in
patients taking
atypical
antipsychotics.
Monitor patients
with diabetes
regularly.
Alert: Monitor
patient for
symptoms of
metabolic
syndrome
(significant
weight gain and
increased BMI,
HTN,
hyperglycemia,
hypercholesterol
emia, and
hypertriglyc-erid
emia).
Somnolence,
2
College of Our Lady of Mt. Carmel (P)
NCM 106- Nursing Pharmacology
Godrey R. Pamintuan, S.N.
Route
PO and IM
Onset
3 hrs in extensive
metabolizers
17 hrs in poor
metabolizers
Peak
1 hour
Duration
Mean duration is
27.6 months.
IM into the
buttock every 2
weeks,
alternating
injections
between the two
buttocks.
Adjust dose no
sooner than
every 4 weeks.
Maximum, 50
mg IM every 2
weeks. Continue
oral
antipsychotic for
3 weeks after
first IM injection,
then stop oral
therapy.
Continue
therapy at
lowest dose
needed.
Periodically
reevaluate
long-term risks
and benefits of
drug for the
individual
patient.
For subcut
dosing, inject 90
or 120 mg once
monthly where
Perseris 90 mg
BSN 2 (A.Y. 2023-2024)
libido, Vaginal
dryness,
Amenorrhea,
Menstrual
Disorder,
Cystitis, Erectile
Dysfunction, UTI
Metabolic
Weight gain or
loss
Musculoskeletal
Arthralgia, Back
Pain, Leg Pain,
Myalgia, Muscle
Rigidity, Muscle
Spasm.
Respiratory
Cough, Dyspnea,
Bronchitis,
Pneumonia, URI
Skin
Rash, Eczema,
Pruritus, Dry
skin,
Photosensitivity
reactions, Acne,
Injection site
pain, reaction or
infection (IM
only)
orthostatic
hypotension,
and motor and
sensory
instability have
been reported,
which may lead
to falls and
fall-related
injuries.
Dialyzable drug:
Unknown.
Es Overdose
S&S: Drowsiness,
sedation,
tachycardia,
hypotension,
extrapyrami-dal
symptoms,
QT-interval
prolongation,
seizures,
torsades de
pointes.
Periodically
reevaluate
drug's risks and
ben-efits,
especially during
prolonged use.
Patients
experiencing
persistent
somnolence may
benefit from
administering
half the daily PO
dose b.i.d.
Monitor patient
for weight gain.
° Monitor CBC in
patients with
preexisting low
WBC count or
history of
drug-induced
leukopenia or
neutropenia.
Complete fall
risk assessments
when initiating
treatment and
recurrently for
patients on
long-term
therapy,
3
College of Our Lady of Mt. Carmel (P)
NCM 106- Nursing Pharmacology
Godrey R. Pamintuan, S.N.
corresponds to 3
mg/day oral
risperidone and
Perseris 120 mg
corresponds to 4
mg/day oral
risperidone.
Adjust-a-dose:
In patients with
hepatic or renal
impairment,
titrate slowly to
2 mg PO daily
for 1 week. If
tolerated, give
25 mg IM every
2 weeks, or may
consider initial
dose of 12.5 mg
IM. Continue
oral form of
risperi-done (or
another
antipsychotic)
with the first
injection and for
3 subsequent
weeks to
maintain
therapeutic drug
levels.
BSN 2 (A.Y. 2023-2024)
especially for
older adults and
patients with
diseases,
conditions, or
who are taking
other drugs that
could increase
fall Look
allke-sound
alike: Don't
confuse
risperidone with
reserpine or
ropinirole.
Don't confuse
Risperdal with
Restoril.
Monotherapy or
combination
4
College of Our Lady of Mt. Carmel (P)
NCM 106- Nursing Pharmacology
Godrey R. Pamintuan, S.N.
BSN 2 (A.Y. 2023-2024)
therapy with
lithium or
valproate for
3-week
treatment of
acute manic or
mixed episodes
Adults: Initially,
2 to 3 mg PO
once daily.
Adjust dose by 1
mg daily.
Dosage range is
1 to 6 mg daily.
Or, 25 mg IM
every 2 weeks.
Some patients
may benefit
from a higher
dose of 37.5 or
50 mg.
Adjust-a-dose:
In older adults,
patients with
hypotension,
and those with
severe renal or
hepatic
impairment,
start with 0.5 mg
PO b.i.d.
Increase dosage
by 0.5 mg b.i.d.
5
College of Our Lady of Mt. Carmel (P)
NCM 106- Nursing Pharmacology
Godrey R. Pamintuan, S.N.
BSN 2 (A.Y. 2023-2024)
Increase in
dosages above
1.5 mg b.i.d.
should occur at
least 1 week
apart.
Subsequent
switches to
once-daily
dosing may be
made after
patient is on a
twice-daily
regimen for 2 to
3 days at the
target dose.
Children and
adolescents
ages 10 to 17:
0.5 mg PO as a
single daily dose
in either the
morning or
evening. Adjust
dose, if
indicated, at
intervals not less
than 24 hours, in
increments of 0.5
or 1 mg/day, as
tolerated, to a
recommended
dose of 2.5
mg/day.
6
College of Our Lady of Mt. Carmel (P)
NCM 106- Nursing Pharmacology
Godrey R. Pamintuan, S.N.
BSN 2 (A.Y. 2023-2024)
Irritability,
including
aggression,
self-injury, and
temper
tantrums,
associated with
an autistic
disorder
Adolescents and
children ages 5
to 17 weighing
20 kg or more:
Initially, 0.5 mg
PO once daily or
in two divided
doses. After 4
days, increase
dose to 1 mg.
Increase dosage
further in 0.5-mg
increments at
intervals of at
least
2 weeks.
Children ages 5
to 17 weighing
more than 15
and less than 20
kg: Initially, 0.25
mg
PO once daily or
7
College of Our Lady of Mt. Carmel (P)
NCM 106- Nursing Pharmacology
Godrey R. Pamintuan, S.N.
BSN 2 (A.Y. 2023-2024)
in two divided
doses. After 4
days, increase
dose to 0.5 mg.
Increase dosage
further in
0.25-mg
increments at
intervals of at
least 2 weeks.
References used:
Cunha, J. P. (2021, August 10). Risperidone (Risperdal, Risperdal Consta): Side effects, dosages, treatment, interactions, warnings. RxList.
https://www.rxlist.com/risperidone/generic-drug.htm
Gentile, S. (2010, May). Antipsychotic therapy during early and late pregnancy. A systematic review. Schizophrenia bulletin.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879689/
Gupta, S., Al-Samarrai, S., Masand, P. S., Lentz, B. J., Keller, P. J., & Droney, T. M. (2000, April). Real-world outcomes of once-daily risperidone dosing.
Primary care companion to the Journal of clinical psychiatry.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181206/#:~:text=The%20mean%20duration%20of%20treatment,%2C%208%E2%80%9336%20months).
Hendler, B. C. (2023). Nursing 2023 drug handbook. Wolters Kluwer.
Risperidone. Uses, Interactions, Mechanism of Action | DrugBank Online. (n.d.). https://go.drugbank.com/drugs/DB00734
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