Risperidone

Key facts

• Risperidone is an atypical antipsychotic used to treat schizophrenia, the manic phase of bipolar disorder, and irritability associated with autism spectrum disorder in children.
• It is taken as tablets, a liquid, or a dissolving wafer, usually once or twice daily; a long-acting injection given every two to four weeks is available for people who need more consistent dosing.
• Risperidone raises prolactin, a hormone, more than most other antipsychotics. This can cause missed periods, breast enlargement or discharge, reduced sex drive, and, over time, bone thinning.
• Seek urgent care for high fever with muscle stiffness and confusion, or for uncontrollable movements of the face or body.

What risperidone treats

Risperidone treats schizophrenia, reducing hallucinations, delusions, and disorganized thinking. It treats manic episodes in bipolar disorder, and it is used in children and adolescents for irritability, aggression, and severe mood swings linked to autism spectrum disorder. It is not intended for occasional use for anxiety or sleep.

How risperidone works

Risperidone blocks dopamine and serotonin receptors in the brain, reducing the overactive signaling linked to hallucinations, delusions, and severe mood swings. Its strong effect on dopamine receptors in a separate pathway that controls hormone release is why it raises prolactin more than many related medicines.

Before you take it

• Tell your prescriber about heart disease, low white blood cell counts, diabetes, or a personal or family history of breast cancer, since prolactin-related effects can matter more with that history.
• Ask about the long-acting injection if daily tablets are hard to keep up with; it maintains steady levels between doses given every two to four weeks.
• It can lower blood pressure on standing and adds to the effect of alcohol and other sedating medicines.
• It is not approved for older adults with dementia-related psychosis, where it raises the risk of stroke and death.

Side effects

Common effects: drowsiness, dizziness on standing, dry mouth, weight gain, and, in some people, missed periods, breast changes, or reduced sex drive from raised prolactin.

Stop and seek urgent medical care for any of these:

• High fever, muscle rigidity, and confusion, possible neuroleptic malignant syndrome.
• Uncontrollable muscle stiffness or repetitive movements of the face or tongue.
• Fast or irregular heartbeat.
• New or worsening breast discharge or swelling.

Safety essentials

• Risperidone raises prolactin more than most other antipsychotics. Report menstrual changes, breast symptoms, or reduced sex drive so your prescriber can check your prolactin level and consider a dose change.
• A long-acting injectable form is available and can help you stay on treatment consistently if remembering daily tablets is difficult; ask your prescriber if it suits you.
• Do not stop risperidone abruptly. Neuroleptic malignant syndrome, a rare but serious reaction causing high fever and severe muscle rigidity, is a medical emergency, and sudden stopping can cause withdrawal or rebound symptoms.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.