Schizophrenia: Switching from other antipsychotics:
When medically appropriate, gradual discontinuation of the previous treatment while Risperidex Tablets therapy is initiated is recommended. Also, if medically appropriate, when switching patients from depot antipsychotics, initiate Risperidex therapy in place of the next scheduled injection. The need for continuing existing anti-Parkinson medications should be re-evaluated periodically.
Risperidex Tablets may be given once daily or twice daily.
Patients should start with 2 mg/day Risperidex Tablets. The dosage may be increased on the second day to 4 mg. From then on the dosage can be maintained unchanged, or further individualized, if needed. Most patients will benefit from daily doses between 4 and 6 mg. In some patients, a slower titration phase and a lower starting and maintenance dose may be appropriate. Doses above 10 mg/day have not been shown to be superior in efficacy to lower doses and may cause extrapyramidal symptoms. Since the safety of doses above 16 mg/day has not been evaluated, doses above this level should not be used.
A benzodiazepine may be added to Risperidex when additional sedation is required.
Special Populations: Elderly:
A starting dose of 0.5 mg twice daily is recommended. This dosage can be individually adjusted with 0.5 mg twice daily increments to 1 to 2 mg twice daily.
Experience in schizophrenia is lacking in children less than 15 years of age.
Renal and liver disease:
A starting dose of 0.5 mg twice daily is recommended. This dose can be individually adjusted with 0.5 mg twice daily increments to 1 to 2 mg twice daily.
Bipolar mania: Adults:
Risperidex Tablets should be administered on a once daily schedule, starting with 2 or 3 mg.
Dosage adjustments, if indicated, should occur at intervals of not less than 24 hours and in dosage increments of 1 mg per day. Efficacy was demonstrated in flexible doses over a range of 1 to 6 mg per day. A dosing range between 2-6 mg per day is recommended. The physician who elects to use Risperidex Tablets for periods extending beyond 12 weeks should periodically re-evaluate the long-term usefulness of the drug for the individual patient. As with all symptomatic treatments, the continued use or Risperidex Tablets must be evaluated and justified on an ongoing basis.
Experience is lacking in bipolar mania in children and adolescents less than 18 years of age.
Aggression in patients with Dementia of the Alzheimer type:
A starting dose of 0.25 mg b.i.d. is recommended. This dosage can be individually adjusted by increments of 0.25 mg b.i.d., not more frequently than every other day, if needed. The optimum dose is 0.5 mg b.i.d. for most patients. Some patients, however, may benefit from doses up to 1 mg b.i.d.
There is no data to support treatment beyond 12 weeks in patients with moderate to severe dementia of the Alzheimer type with agitation, aggression or psychotic symptoms.
Once patients have reached their target dose, a once daily dosing regimen can be considered. As with all symptomatic treatments, the continued use of Risperidex Tablets must be evaluated and justified on an ongoing basis.
Conduct and other disruptive behaviour disorders (5-18 years of age):
For patients ≥50 kg, a starting dose of 0.5 mg once daily is recommended. This dosage can be individually adjusted by increments of 0.5 mg once daily not more frequently than every other day, if needed. The optimum dose is 1 mg once daily for most patients. Some patients, however, may benefit from 0.5 mg once daily while others may require 1.5 mg once daily.
For patients <50 kg, a starting dose of 0.25 mg once daily is recommended. This dosage can be individually adjusted by increments of 0.25 mg once daily not more frequently than every other day, if needed. The optimum dose is 0.5 mg once daily for most patients. Some patients, however, may benefit from 0.25 mg once daily while others may require 0.75 mg once daily.
As with all symptomatic treatments, the continued use of Risperidex Tablets must be evaluated and justified on an ongoing basis.
Experience is lacking in children less than 5 years of age.
Autism: Pediatrics (5-17 years of age):
The dosage of Risperidex Tablets should be individualized according to the needs and response of the patient.
Dosing should be initiated at 0.25 mg per day for patients <20 kg and 0.5 mg per day for patients ≥20 kg.
On Day 4, the dose may be increased by 0.25 mg for patients <20 kg and 0.5 mg for patients ≥20 kg.
This dose should be maintained and response should be assessed at approximately Day 14.
Only in patients not achieving sufficient clinical response should additional dose increases be considered. Dose increases may proceed at ≥2-week intervals in increments of 0.25 mg for patients <20 kg or 0.5 mg for patient ≥20 kg.
In clinical studies, the maximum dose studied did not exceed a total daily dose of 1.5 mg in patients <20 kg, 2.5 mg in patients ≥20 kg, or 3.5 mg in patients >45 kg. Doses below 0.25 mg/day were not effective in clinical studies. (See Table 1.)
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For prescribers preferring to dose on a mg/kg/day basis the following guidance is provided. (See Table 2.)
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Risperidex Tablets can be administered once daily or twice daily.
Patients experiencing somnolence may benefit from a switch in dosing from once daily to either once daily at bedtime or twice daily.
Once sufficient clinical response has been achieved and maintained, consideration may be given to gradually lowering the dose to achieve the optimal balance of efficacy and safety.
Experience is lacking in children less than 5 years and limited in autistic adolescents.
Effectiveness for more than 8 weeks has not been systematically evaluated in double-blind, parallel-controlled clinical trials. Therefore, the physician who elects to use Risperidex Tablets for the treatment of behavioural disorders associated with autism (eg irritability, social withdrawal, stereotypic behaviour, hyperactivity and inappropriated speech) in children and adolescents for extended periods should periodically re-evaluate the long term risks and benefits of the drug for the individual patient.
Renal and Hepatic Impairment:
Patients with renal impairment have less ability to eliminate the active antipsychotic fraction than normal adults. Patients with impaired hepatic function have increases in plasma concentration of the free fraction of risperidone.
Irrespective of the indication, starting and consecutive dosing should be halved, and dose titration should be slower for patients with renal or hepatic impairment.
Risperidex Tablets should be used with caution in these groups of patients.
Risperidex tablets are given as oral tablets.