Risperdal

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What is Risperdal?

Risperdal, or risperidone, is the newest medication for treating

schizophrenia and psychotic disorders. It helps manage schizophrenia's

" positive symptoms " such as visual and auditory hallucinations, delusions,

and thought disturbances. Risperdal may also help in treating so-called

" negative symptoms " such as social withdrawal, apathy, lack of motivation,

and inability to experience pleasure. Side effects are usually relatively

minor, and blood monitoring is not necessary. Risperdal is the first new

front-line treatment option in twenty years.

How is Risperdal different from other antipsychotic medications?

Conventional antipsychotics such as Haldol, Stelazine, and Prolixin have

treated positive symptoms in many patients for several years. However, they

do not satisfactorily affect the negative symptoms, and they often cause

uncomfortable or intolerable side effects. Risperdal is as effective as the

conventional medications in treating positive symptoms. It also offers the

advantages of helping to treat some of the negative symptoms somewhat and

causing fewer extrapyramidal side effects (EPS) such as restlessness, muscle

rigidity, and tremor when taken at the manufacturer's recommended dose of 6

mg per day.

Why is Risperdal called a new " front-line option? "

It means that Risperdal could be the first medication prescribed for a

person who is newly diagnosed with a psychotic disorder. Some medications,

such as clozapine, have side effects that may be inconvenient or difficult

to manage. Such medications may be reserved until after other medications

have been tried unsuccessfully. Because Risperdal is effective and has

relatively few side effects, doctors may consider it one of the first

medications to try for patients with schizophrenia. It's important to

remember that no medication will work for everyone, and some patients will

have greater success with Risperdal than others.

How does Risperdal work?

Risperdal, like other new antipsychotic drugs currently under development,

is designed as a serotonin/dopamine antagonist. While its exact mechanism of

action is not yet understood, Risperdal seems to block the action of

serotonin and dopamine, two neurotransmitter chemicals in the brain.

Conventional antipsychotics seem to primarily affect only dopamine.

How quickly does Risperdal relieve symptoms of schizophrenia?

The recommended dose is usually reached within three to four weeks, and

improvement of symptoms may be noticed in some patients relatively quickly.

Some adjustments may be necessary to reach the optimal dose for each

patient. It is normally advisable to give the medication a trial period of

at least four to six weeks at the optimal dose (6 mg/day) before evaluating

its effectiveness, although experience with clozapine suggests that

improvements may take months to fully emerge.

What are the side effects of Risperdal?

When taken at the manufacturer's recommended dose of 6 mg a day (3 mg twice

a day), the incidence of many side effects is not significantly greater than

for placebo. These side effects include extrapyramidal symptoms (muscle

stiffness, tremors, and body shakes). At higher doses, extrapyramidal side

effects often increase. Benztropine (Cogentin) can be prescribed to reduce

or eliminate stiffness and tremors, but its use beyond three months should

be re-evaluated.

More significant possible side effects, affecting some patients but not all,

include low blood pressure, dizziness, especially when standing up suddenly;

heart palpitations; sleepiness; constipation; weight gain; sexual

dysfunction; and fatigue. Some of these problems can be minimized by

following recommended guidelines for dosage at the beginning of treatment

(gradual increase of dose over a period of several weeks). Patients who

already have low blood pressure, who have kidney or liver impairment, are

elderly, or in a weakened condition may require close monitoring and even

more gradual dose adjustment.

Does Risperdal cause tardive dyskinesia?

Tardive dyskinesia (TD), a disfiguring side effect that occurs in some

patients taking antipsychotic drugs, may not be a major risk associated with

Risperdal use, although it may take years before researchers can fully

assess the risk. It is prudent to minimize the risk by using the lowest dose

necessary to relive psychotic symptoms. Should symptoms of TD develop, such

as grimacing, sucking and smacking of lips and other spasmodic movements,

discontinuation of Risperdal should be considered.

What else should be kept in mind when taking Risperdal?

Risperdal is usually taken twice a day. It can be take before, during, or

after meals. Because of its long half-life (similar to haloperidol),

however, once daily dosing should be considered. Patients should be cautious

about operating hazardous machinery, including driving, until they are

certain they are not adversely affected. Women should let their doctor know

if they become pregnant or intend to become pregnant. Breast feeding is not

recommended while taking Risperdal. Because some medications can affect the

effectiveness of Risperdal when taken at the same time, patients should be

sure their doctor is aware of all medications they are taking.

How much does Risperdal cost?

At the recommended dose of 4-6 mg a day, Risperdal is expected to cost the

patient less than $3,000 a year. Some insurance policies will cover the

cost. Uninsured outpatients who meet income eligibility standards may

qualify for low cost or free Risperdal through the manufacturer. Janssen

Pharmaceutica also answers questions about insurance coverage, and offers

assistance in filing claim forms and resolving claims that have been denied.

For information on the Risperdal Patient Assistance Program and the

Risperdal Reimbursement Support Program, call 1-800-652-6227.

Reviewed by Pickar, M.D., Chief, Experimental Therapeutics Branch,

National Institute of Health, (5/94) and Dale R. Grothe, Pharm.D., Mental

Health Clinical Pharmacy specialist, NIH/NIMH Pharmacy Dept. (12/95)

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