CLINICAL USE

Schizophrenia Psychoses Mania

DOSE IN NORMAL RENAL FUNCTION

Oral: 2–16 mg daily in divided dosesIM: 25–50 mg every 2 weeks

PHARMACOKINETICS

  • Molecular weight                           :410.5
  • %Protein binding                           :90
  • %Excreted unchanged in urine     : 70
  • Volume of distribution (L/kg)       :1–2
  • half-life – normal/ESRD (hrs)      :19.5/Increased

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Initially 0.5 mg twice daily, increasing by 0.5 mg BD to 1–2 mg twice daily. Use with caution. for IM dosing
  • 10 to 20     : Initially 0.5 mg twice daily, increasing by 0.5 mg BD to 1–2 mg twice daily. Use with caution. for IM dosing
  • <10           : Initially 0.5 mg twice daily, increasing by 0.5 mg BD to 1–2 mg twice daily. Use with caution. for IM dosing

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Unlikely to be dialysed. Dose as in GFR <10 mL/min
  • HD                     :Dialysed. Dose as in GFR
  • <10           : mL/min
  • HDF/high flux   :Dialysed. Dose as in GFR
  • <10           : mL/min
  • CAV/VVHD      :Unlikely to be dialysed. Dose as in GFR 10 to 20 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Anaesthetics: enhanced hypotensive effect
  • Analgesics: increased risk of convulsions with tramadol; enhanced hypotensive and sedative effects with opioids
  • Antidepressants: concentration increased by fluoxetine and possibly paroxetine; concentration of tricyclics possibly increased
  • Anti-epileptics: antagonism, convulsive threshold may be lowered; metabolism accelerated by carbamazepine
  • Antimalarials: avoid concomitant use with artemether with lumefantrine
  • Antipsychotics: avoid concomitant use of depot formulations with clozapine (cannot be withdrawn quickly if neutropenia occurs)
  • Antivirals: ritonavir may increase concentration of risperidoneAnxiolytics and hypnotics: enhanced sedative effects
  • Sibutramine: increased risk of CNS toxicity – avoid concomitant use)

    ADMINISTRATION

    Reconstition

    With solvent provided

    Route

    Oral, deep IM

    Rate of Administration

    –

    Comments

    –

    OTHER INFORMATION

    At a dose of 3 mg twice daily, 1.5 mg (i.e. 25%) of risperidone is removed after a 5 hour dialysis session with a dialysate flow of 500 mL/minIn overdose, rare cases of QT prolongation have been reportedClearance of risperidone and active metabolites decreased by 60% in severe renal impairmentIf a dose of 2 mg daily orally is tolerated then a dose of 25 mg (IM) every 2 weeks can be used initially in renal impairment.

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