General Dosing Recommendations: Risperidone may be given with or without meals.
Gradual withdrawal is advised upon discontinuation of therapy. Acute withdrawal symptoms, including nausea, vomiting, sweating, and insomnia have very rarely been described after abrupt cessation of high doses of antipsychotic drugs. Recurrence of psychotic symptoms may also occur, and the emergence of involuntary movement disorders (e.g., akathisia, dystonia, and dyskinesia) has been reported.
Switching from other antipsychotics: It is recommended that gradual discontinuation of the previous treatment should be done when risperidone therapy is initiated. The period of overlapping antipsychotic administration should be minimized. If necessary, when switching patients from depot antipsychotics, initiate risperidone therapy in place of the next scheduled injection. The need for continuing existing anti-Parkinson drugs should be reevaluated periodically.
Recommended Oral Risperidone Dose: See table.
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Irritability Associated with Autistic Disorder in Children and Adolescents 5 to 16 years old: The dosage of risperidone should be individualized according to response and tolerability of the patient.
The total daily dose of risperidone can be administered once a day, or half the total daily dose can be administered twice a day.
Initial Dose: Patient Weight: < 20 kg: 0.25 mg per day; ≥ 20 kg: 0.5 mg per day.
After a minimum of four days from treatment initiation, the dose may be increased to a recommended dose of 0.5 mg per day for patients < 20 kg and 1 mg per day for patients ≥ 20 kg. This dose should be maintained for a minimum of 14 days.
In patients not achieving sufficient clinical response, dose increases may be considered at ≥ 2-week intervals in increments of 0.25 mg per day for patients <20 kg or 0.5 mg per day for patients ≥ 20 kg.
Patients experiencing persistent somnolence may benefit from a once a day dose administered at bedtime or administering half the daily dose twice a day, or a reduction of the dose.
Exercise caution with dosage for smaller children who weigh less than 15 kg.
Once sufficient response has been achieved and maintained, consider gradually lowering the dose to achieve optimum balance of effectiveness and tolerance.
As with all symptomatic treatments, the continued use of risperidone in children and adolescents with autism must be evaluated and justified on an ongoing basis.
Dosage in Special Population (elderly or debilitated patients, patients with severe renal or hepatic impairment, and patients either predisposed to hypotension or for whom hypotension would pose a risk): Initial Dose: 0.5 mg twice a day.
Dosage may be increased in increments of not more than 0.5 mg twice a day.
Increases to dosages above 1.5 mg twice a day should occur at intervals of at least one week. In some patients, slower titration may be medically appropriate.
If a once a day dosing regimen in the elderly or debilitated patient is being considered, it is recommended that the patient be titrated on a twice a day regimen for 2 to 3 days at the target dose. Subsequent switches to a once a day dosing regimen can be done thereafter.
Or, as prescribed by a physician.