Risperidone
A second-generation antipsychotic used for schizophrenia, bipolar mania and irritability in autism; it raises prolactin markedly.
Drug card
- How it works
- Blocking dopamine D2 and serotonin 5-HT2A receptors
- Used for
- Schizophrenia
- Bipolar mania, alone or with lithium or valproate
- Irritability in autism
- Aggression in Alzheimer's dementia, short term (UK)
- Known for
- Parkinsonism, dystonia and tremor (extrapyramidal effects)
- Raised prolactin: breast swelling, milk, missed periods
- Its name
- -peridone means an atypical antipsychotic (risperidone type)
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does risperidone work?
Risperidone, a benzisoxazole, binds 5-HT2, D2, α1, α2 and H1 receptors with high affinity and has no affinity for muscarinic receptors. Its effect in schizophrenia is thought to come from combined D2 and 5-HT2 blockade, shared by its active metabolite 9-hydroxyrisperidone (paliperidone).
Like other second-generation antipsychotics: Most second-generation antipsychotics block dopamine D2 receptors together with serotonin 5-HT2A receptors, though exactly how they work is unclear; aripiprazole instead is a partial agonist at D2 receptors. As a group they cause fewer extrapyramidal effects than first-generation drugs, but many also block H1, α1 or muscarinic receptors, and weight gain with raised glucose and lipids is common.
Uses
What is risperidone used for?
- Schizophrenia
- Bipolar mania, alone or with lithium or valproate
- Irritability in autism
- Aggression in Alzheimer's dementia, short term (UK)
Side effects
Side effects of risperidone
- Parkinsonism, dystonia and tremor (extrapyramidal effects)Known for
- Raised prolactin: breast swelling, milk, missed periodsKnown for
- Akathisia (restlessness)
- Weight gain and increased appetite
- Raised blood sugar and lipids (metabolic changes)Serious
- Sedation
- Dizziness on standing (orthostatic hypotension)
- Tardive dyskinesiaSerious
- Neuroleptic malignant syndromeSerious
- Stroke in older people with dementiaSerious
- Higher death rate in older people with dementiaSerious
- Low white cell count, even agranulocytosisSerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Check weight, glucose and lipids regularly, and review breast changes, milk production or missed periods.
- Contraindicated in people allergic to paliperidone, its active metabolite.
- Start low and go slowly in people prone to orthostatic hypotension, such as older people or those with heart disease.
Good to know: Its label states it raises prolactin more than other antipsychotics, and its extrapyramidal effects are dose-related; paliperidone is its active metabolite.
Remember it
A way to remember it
Atypicals: fewer shakes, more cakes.
As a group they cause fewer extrapyramidal movement effects than first-generation antipsychotics, but more weight gain and raised glucose and lipids, so weight and blood tests are checked.
Written for biofideX
Its name
-peridone means atypical antipsychotic (risperidone type)
Risperidone and paliperidone, its active metabolite, share it. Domperidone ends in -peridone too but is an antiemetic that blocks dopamine D2 receptors outside the brain.
- Every drug name stem
Its class
Second-generation antipsychotics
Other second-generation antipsychotics with a card:
Easily mixed up with first-generation antipsychotics and lithium.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Psychosis, mood and ADHD
Risperidone is one of 9 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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