risperidone

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Antipsychotics: avoid concomitant use of depot formulations with clozapine (cannot be withdrawn quickly if neutropenia occurs)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.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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