risperidone (Rx)

Brand and Other Names:Risperdal, Risperdal Consta, more...Risperdal M-Tab, Perseris
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet (Risperdal)

  • 0.25mg
  • 0.5mg
  • 1mg
  • 2mg
  • 3mg
  • 4mg

tablet, orally disintegrating (Risperdal M- Tabs)

  • 0.5mg
  • 1mg
  • 2mg
  • 3mg
  • 4mg

oral solution (Risperidal)

  • 1mg/mL

IM injection kit, long-acting injectable suspension (Risperdal Consta)

  • Kit contains prefilled 2-mL diluent syringe, vial containing risperidone microspheres, vial adapter, and needles for deltoid or gluteal IM administration
  • 12.5mg
  • 25mg
  • 37.5mg
  • 50mg

SC injection kit, extended-release injectable suspension (Perseris)

  • Kit includes a prefilled syringe containing risperidone powder, a syringe prefilled with the delivery system and desiccant, and needle for SC administration into the abdomen
  • 90mg
  • 120mg

Schizophrenia

PO (Risperdal or Risperidal M-Tabs)

  • 2 mg/day initially; may increase in increments of 1-2 mg/day at intervals ≥24 hr
  • Recommended target dosage: 2-8 mg/day once daily or divided q12hr (efficacy follows bell-shaped curve; 4-8 mg/day more effective than 12-16 mg/day)

IM (Risperdal Consta)

  • 12.5-50 mg injected into deltoid or gluteal muscle every 2 weeks; dosage should not be adjusted more frequently than every 4 weeks
  • Recommended to establish tolerability of PO risperidone before initiating treatment with IM risperidone

SC (Perseris)

  • 90 mg or 120 mg SC once monthly initially
  • Supplementation with oral risperidone is not recommended
  • Based on average plasma concentration of risperidone and total active moiety, 90-mg dose corresponds to 3 mg/day oral risperidone and 120-mg dose corresponds to 4 mg/day oral risperidone
  • Patients who are on stable oral risperidone doses <3 mg/day or >4 mg/day may not be candidates for risperidone ER suspension

Bipolar Mania

PO (Risperdal or Risperidal M-Tabs)

  • 2-3 mg/day initially; may be increased if necessary in increments of 1 mg/day at intervals of 24 hours to 6 mg/day; dosage recommendations not available for treatment duration >3 weeks

Bipolar Disorder

IM (Risperdal Consta)

  • Recommended dose for monotherapy or adjunctive therapy to lithium or valproate for the maintenance treatment of bipolar I disorder: 25 mg IM q2Weeks; some patients may benefit from a higher dose of 37.5 mg or 50 mg
  • Dosages above 50 mg have not been studied in this population
  • Periodically re-evaluate the long-term risks and benefits of the drug for the individual patient

Tourette Syndrome (Off-label)

0.5-1 mg/day PO; may be increased or decreased in increments of 0.5 mg q12hr at intervals >3 days; not to exceed 6 mg/day

Posttraumatic Stress Disorder (Off-label)

0.5-8 mg/day PO

Dosing Modifications

Renal impairment

  • SC
    • Not studied, use with caution
    • Prior to initiating treatment, it is recommended that patients be carefully titrated up to at least 3 mg/day or oral risperidone; if patients tolerate 3 mg oral and are psychiatrically stable, consider a 90-mg dose
  • CrCl <30 mL/min (PO)
    • 0.5 mg q12hr initially; consider longer titration intervals; may be increased by up to 0.5 mg/day PO divided q12hr; dosage increase >1.5 mg q12hr should occur no more frequently than once weekly
  • CrCl <30 mL/min (IM)
    • If 2-mg total daily dose of PO risperidone is well tolerated, may start with 12.5-25 mg IM every 2 weeks; continue PO supplementation for 3 weeks after first injection until main release of risperidone from injection has begun

Hepatic impairment

  • SC
    • Not studied, use with caution
    • Prior to initiating treatment, it is recommended that patients be carefully titrated up to at least 3 mg/day or oral risperidone; if patients tolerate 3 mg oral and are psychiatrically stable, consider a 90-mg dose
  • Child-Pugh 10-15 points (PO)
    • 0.5 mg q12hr initially; consider longer titration intervals; may be increased by up to 0.5 mg/day PO divided q12hr; dosage increase >1.5 mg q12hr should occur no more frequently than once weekly
  • Child-Pugh 10-15 points (IM)
    • If 2-mg total daily dose of PO risperidone is well tolerated, may start with 25 mg IM every 2 weeks; continue PO supplementation for 3 weeks after first injection until main release of risperidone from injection has begun

Coadministration with strong CYP2D6 inhibitors

  • SC, ER suspension
    • When initiation of a strong CYP2D6 inhibitor (eg, fluoxetine, paroxetine) is considered, patient may be placed on the lowest dose (90 mg) of risperidone ER suspension between 2-4 weeks before the planned start of the CYP2D6 inhibitor to adjust for the expected increase in plasma risperidone concentrations
    • When the CYP2D6 inhibitor is initiated in patients receiving risperidone ER suspension 90 mg, it is recommended to continue treatment with 90 mg unless clinical judgment necessitates interruption of risperidone treatment
  • IM, long-acting injectable suspension
    • When initiation of a strong CYP2D6 inhibitor (eg, fluoxetine, paroxetine) is considered, patient may be placed on a lower dose between 2-4 weeks before the planned start of the CYP2D6 inhibitor to adjust for the expected increase in plasma risperidone concentrations
    • When a CYP2D6 inhibitor initiated in patients receiving 25 mg IM of long-acting risperidone suspension, it is recommended to continue this dose unless clinical judgment necessitates lowering to 12.5 mg IM or interrupting treatment
    • If long-acting risperidone suspension is initiated in patients already receiving a strong CYP2D6 inhibitor, consider using a starting dose of 12.5 mg IM; efficacy of the 12.5 mg dose has not been investigated in clinical trials
  • PO
    • When a strong CYP2D6 inhibitor (eg, fluoxetine, or paroxetine) is coadministered with oral risperidone, reduce oral risperidone dose; dose should not exceed 8 mg/day in adults when coadministered with these drugs
    • When initiating therapy, titrate oral risperidone slowly If enzyme inhibitor is discontinued, assess risperidone dose and increase if necessary

Coadministration with strong CYP3A4 inducers

  • SC, ER injectable suspension
    • At initiation of therapy with CYP3A4 inducers (eg, carbamazepine, phenytoin, rifampin, phenobarbital), closely monitor during the first 4-8 weeks In patients receiving risperidone ER suspension 90 mg, consider increasing the dose to 120 mg
    • In patients receiving risperidone ER suspension 120 mg, consider additional oral risperidone therapy
    • On discontinuation of the strong CYP3A4 inducers, re-evaluated dosage of ER suspension or any additional oral risperidone therapy and if necessary, decreased to adjust for the expected increase in plasma concentration of risperidone
    • For patients treated with risperidone ER 90 mg and discontinuing from a strong CYP3A4 inducer, continue treatment with the 90-mg dose unless clinical judgment necessitates interruption of risperidone ER suspension treatment
  • IM, long-acting injectable suspension
    • Coadministration with strong CYP3A4 inducers (eg, carbamazepine, phenytoin, rifampin, phenobarbital) with risperidone would be expected to cause decreases in the plasma concentrations of the sum of risperidone and 9-hydroxyrisperidone combined, which could lead to decreased efficacy of IM risperidone; titrate accordingly for patients receiving these enzyme inducers, especially during initiation or discontinuation of therapy with these inducers
    • At the initiation of therapy with CYP3A4 inducers, patients should be closely monitored during the first 4-8 weeks, since the dose of IM risperidone may need to be adjusted; a dose increase, or additional oral risperidone, may need to be considered
    • If enzyme inducer is discontinued, assess risperidone dose and decrease if necessary
    • Patients may be placed on a lower dose of IM risperidone between 2-4 weeks before the planned discontinuation CYP3A4 inducers to adjust for the expected increase in plasma concentrations of risperidone plus 9-hydroxyrisperidone
    • For patients treated with the recommended dose of 25 mg and discontinuing from CYP3A4 inducers, continue treatment with the 25-mg dose unless clinical judgment necessitates lowering dose to 12.5 mg or necessitates interruption of IM risperidone treatment
    • The efficacy of the 12.5 mg dose has not been investigated in clinical trials
  • PO
    • Coadministered with enzyme inducers (eg, carbamazepine), the risperidone dose should be increased up to double the patient’s usual dose If enzyme inducer is discontinued, assess risperidone dose and decrease if necessary

Dosing Considerations

For patient who have never taken risperidone, establish tolerability with PO risperidone before initiating the IM or SC dosage forms

Switching from other antipsychotics to IM risperidone

  • There are no systematically collected data to specifically address switching patients from other antipsychotics to IM risperidone or concerning concomitant administration with other antipsychotics
  • Previous antipsychotics should be continued for 3 weeks after the first injection of IM risperidone to ensure that therapeutic concentrations are maintained until the main release phase of risperidone from the injection site has begun
  • As recommended with other antipsychotic medications, the need for continuing existing EPS medication should be re-evaluated periodically

Dosage Forms & Strengths

tablet

  • 0.25mg
  • 0.5mg
  • 1mg
  • 2mg
  • 3mg
  • 4mg

tablet, orally disintegrating

  • 0.5mg
  • 1mg
  • 2mg
  • 3mg
  • 4mg

oral solution

  • 1mg/mL

Schizophrenia

<13 years: Safety and efficacy not established

>13 years: 0.5 mg/day PO in morning or evening initially; may be increased in increments of 0.5-1 mg/day at intervals ≥24 hr to recommended dosage of 3 mg/day; dosage range: 1-6 mg/day (dosages >3 mg/day have not been proved more effective and are associated with increased incidence of adverse effects)

If persistent somnolence occurs, daily dose may be divided q12hr

Bipolar Mania

<10 years: Safety and efficacy not established

>10 years: 0.5 mg/day PO in morning or evening initially; may be increased in increments of 0.5-1 mg/day at intervals ≥24 hr to recommended dosage of 2.5 mg/day; dosage range: 0.5-6 mg/day (dosages >2.5 mg/day have not been proved more effective and are associated with increased incidence of adverse effects)

If persistent somnolence occurs, daily dose may be divided q12hr

Autism

Irritability associated with autistic disorder in children aged 5-16 years

<5 years: Safety and efficacy not established

5-16 years (<20 kg): 0.25 mg/day PO initially; may be increased after ≥4 days to recommended dosage of 0.5 mg/day

5-16 years (≥20 kg): 0.5 mg/day PO initially; may be increased after ≥4 days to recommended dosage of 1 mg/day

Insufficient response to recommended dosage

  • If response to recommended dosage insufficient, dosage may be adjusted as follows after minimum of 14 days and at least every 2 weeks thereafter
  • <20 kg: Adjusted in increments of 0.25 mg/day; not to exceed 1 mg/day
  • ≥20 kg: Adjusted in increments of 0.5 mg/day; not to exceed 2.5 mg/day

Not approved for dementia-related psychosis, because of increased risk of cardiovascular or infectious related deaths (see Black Box Warnings)

Risk of orthostatic hypotension higher in elderly; monitoring of renal function and orthostatic blood pressure may be necessary; for titrating to target dose, twice-daily regimen should be used and dosage maintained for 2-3 days before change is made to once-daily dose regimen

Schizophrenia, Bipolar Mania

Use lower initial dose, and adjust more gradually

PO: 0.5 mg q12hr; may be increased in increments ≤0.5 mg q12hr; increases to dosages >1.5 mg q12hr should occur at intervals ≥1 week

IM: 12.5-25 mg injected into deltoid or gluteal muscle every 2 weeks; dosage should not be adjusted more frequently than every 4 weeks

Recommended to establish tolerability of PO risperidone before initiating treatment with IM risperidone

Psychosis, Agitation Related to Alzheimer Dementia (Off-label)

0.25-1 mg/day PO initially; may be increased gradually as tolerated; not to exceed 1.5-2 mg/day

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Interactions

Interaction Checker

and risperidone

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      Serious - Use Alternative

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            Contraindicated (1)

            • amisulpride

              amisulpride, risperidone. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndrome.

            Serious - Use Alternative (63)

            • amiodarone

              amiodarone will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. The concurrent administration of amiodarone and risperidone is not recommended due to the potential for inducing life-threatening arrhythmias. If concurrent use cannot be avoided, cautious dosing and telemetric monitoring is advised.

              amiodarone and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • amisulpride

              amisulpride and risperidone both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

            • apomorphine

              risperidone decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • artemether

              artemether and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • bromocriptine

              risperidone decreases effects of bromocriptine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • cabergoline

              risperidone decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

            • calcium/magnesium/potassium/sodium oxybates

              risperidone, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • ceritinib

              ceritinib and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • citalopram

              citalopram and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • dacomitinib

              dacomitinib will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

            • degarelix

              degarelix and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • desflurane

              desflurane and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • disopyramide

              disopyramide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • dopamine

              risperidone decreases effects of dopamine by pharmacodynamic antagonism. Contraindicated.

            • efavirenz

              efavirenz and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • encorafenib

              encorafenib and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • entrectinib

              risperidone and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

            • erdafitinib

              erdafitinib will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

            • fexinidazole

              fexinidazole and risperidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

            • fluoxetine

              fluoxetine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

            • givosiran

              givosiran will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

            • glasdegib

              risperidone and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

            • hydrocodone

              hydrocodone, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • ibutilide

              ibutilide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • indapamide

              indapamide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • isoflurane

              isoflurane and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • ivosidenib

              ivosidenib and risperidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

            • lasmiditan

              lasmiditan increases levels of risperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • lefamulin

              lefamulin and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • levodopa

              risperidone decreases effects of levodopa by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • levodopa inhaled

              risperidone decreases effects of levodopa inhaled by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Atypical (2nd generation) antipsychotics inhibit dopamine D2 receptors in varying degrees (clozapine and quetiapine are lower risk). .

            • lisuride

              risperidone decreases effects of lisuride by pharmacodynamic antagonism. Contraindicated.

            • lonafarnib

              risperidone will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

            • macimorelin

              macimorelin and risperidone both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

            • mefloquine

              mefloquine increases toxicity of risperidone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • methyldopa

              risperidone decreases effects of methyldopa by pharmacodynamic antagonism. Contraindicated.

            • metoclopramide intranasal

              risperidone, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

              risperidone increases toxicity of metoclopramide intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive effects, including increased frequency and severity of tardive dyskinesia, other extrapyramidal symptoms, and neuroleptic malignant syndrome.

            • mobocertinib

              mobocertinib and risperidone both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

            • ondansetron

              ondansetron and risperidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

            • pentamidine

              pentamidine and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • pimozide

              pimozide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • pitolisant

              risperidone and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

            • pramipexole

              risperidone decreases effects of pramipexole by pharmacodynamic antagonism. Contraindicated.

            • procainamide

              procainamide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • propafenone

              propafenone will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. The concurrent administration of propafenone and risperidone is not recommended due to the potential for inducing life-threatening arrhythmias. If concurrent use cannot be avoided, cautious dosing and telemetric monitoring is advised.

            • quinidine

              quinidine will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              quinidine and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • ribociclib

              ribociclib increases toxicity of risperidone by QTc interval. Avoid or Use Alternate Drug.

            • ropinirole

              risperidone decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

            • safinamide

              risperidone decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.

            • selinexor

              selinexor, risperidone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

            • sevoflurane

              sevoflurane and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • siponimod

              siponimod and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • sodium oxybate

              risperidone, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • sotalol

              risperidone and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • sotorasib

              sotorasib will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

            • sufentanil SL

              sufentanil SL, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • tepotinib

              tepotinib will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

            • umeclidinium bromide/vilanterol inhaled

              risperidone increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • vandetanib

              risperidone, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

            • vemurafenib

              vemurafenib and risperidone both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

            • vilanterol/fluticasone furoate inhaled

              risperidone increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            Monitor Closely (410)

            • abiraterone

              abiraterone increases levels of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

            • abobotulinumtoxinA

              abobotulinumtoxinA increases effects of risperidone by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.

            • acarbose

              risperidone, acarbose. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • aclidinium

              aclidinium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • albiglutide

              risperidone, albiglutide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • albuterol

              risperidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and risperidone both increase QTc interval. Use Caution/Monitor.

            • alfentanil

              alfentanil and risperidone both increase sedation. Use Caution/Monitor.

            • alfuzosin

              risperidone and alfuzosin both increase QTc interval. Use Caution/Monitor.

              alfuzosin and risperidone both increase QTc interval. Use Caution/Monitor.

            • almotriptan

              almotriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • alprazolam

              alprazolam and risperidone both increase sedation. Use Caution/Monitor.

            • amifostine

              amifostine, risperidone. Either increases effects of the other by anti-hypertensive channel blocking. Use Caution/Monitor. Due to its alpha adrenergic antagonism, atypical antipsychotic agents has the potential to enhance the effect of certain antihypertensive agents. Monitor blood pressure and adjust dose accordingly.

            • amiodarone

              amiodarone will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • amitriptyline

              amitriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and amitriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              amobarbital and risperidone both increase sedation. Use Caution/Monitor.

            • amoxapine

              amoxapine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and amoxapine both increase sedation. Use Caution/Monitor.

            • anticholinergic/sedative combos

              anticholinergic/sedative combos decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              anticholinergic/sedative combos decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of anticholinergic/sedative combos by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • apomorphine

              risperidone and apomorphine both increase sedation. Use Caution/Monitor.

              apomorphine and risperidone both increase QTc interval. Use Caution/Monitor.

            • arformoterol

              risperidone increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              arformoterol and risperidone both increase QTc interval. Use Caution/Monitor.

            • aripiprazole

              aripiprazole and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              aripiprazole and risperidone both increase sedation. Use Caution/Monitor.

              aripiprazole and risperidone both increase QTc interval. Use Caution/Monitor.

            • armodafinil

              risperidone increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • arsenic trioxide

              arsenic trioxide and risperidone both increase QTc interval. Use Caution/Monitor.

            • artemether/lumefantrine

              artemether/lumefantrine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              artemether/lumefantrine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • atogepant

              risperidone will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • atomoxetine

              atomoxetine and risperidone both increase QTc interval. Use Caution/Monitor.

            • atorvastatin

              atorvastatin will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • atracurium

              atracurium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              atracurium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • atropine

              atropine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              atropine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of atropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • atropine IV/IM

              risperidone increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              atropine IV/IM decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              atropine IV/IM decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

            • avapritinib

              risperidone will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • axitinib

              risperidone increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • azelastine

              azelastine and risperidone both increase sedation. Use Caution/Monitor.

            • baclofen

              baclofen and risperidone both increase sedation. Use Caution/Monitor.

            • bedaquiline

              risperidone and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

            • belladonna alkaloids

              belladonna alkaloids decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna alkaloids decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of belladonna alkaloids by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • belladonna and opium

              belladonna and opium and risperidone both increase sedation. Use Caution/Monitor.

              belladonna and opium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              belladonna and opium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • benazepril

              risperidone, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

            • benperidol

              benperidol and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              benperidol and risperidone both increase sedation. Use Caution/Monitor.

            • benzphetamine

              risperidone increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • benztropine

              risperidone increases effects of benztropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use. .

            • berotralstat

              berotralstat will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

            • brexanolone

              brexanolone, risperidone. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • brompheniramine

              brompheniramine and risperidone both increase sedation. Use Caution/Monitor.

            • buprenorphine

              buprenorphine and risperidone both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal and risperidone both increase sedation. Use Caution/Monitor.

            • buprenorphine, long-acting injection

              risperidone increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

            • bupropion

              bupropion will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • butabarbital

              butabarbital and risperidone both increase sedation. Use Caution/Monitor.

            • butalbital

              butalbital and risperidone both increase sedation. Use Caution/Monitor.

            • butorphanol

              butorphanol and risperidone both increase sedation. Use Caution/Monitor.

            • caffeine

              risperidone increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbamazepine

              carbamazepine decreases levels of risperidone by increasing metabolism. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine and risperidone both increase sedation. Use Caution/Monitor.

            • carisoprodol

              carisoprodol and risperidone both increase sedation. Use Caution/Monitor.

            • cenobamate

              cenobamate, risperidone. Either increases effects of the other by sedation. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate and risperidone both increase sedation. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide and risperidone both increase sedation. Use Caution/Monitor.

            • chloroquine

              chloroquine increases toxicity of risperidone by QTc interval. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine and risperidone both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              chlorpromazine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              chlorpromazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              chlorpromazine and risperidone both increase sedation. Use Caution/Monitor.

            • chlorpropamide

              risperidone, chlorpropamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • chlorzoxazone

              chlorzoxazone and risperidone both increase sedation. Use Caution/Monitor.

            • cinnarizine

              cinnarizine and risperidone both increase sedation. Use Caution/Monitor.

            • cisatracurium

              cisatracurium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cisatracurium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • citalopram

              citalopram will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • clarithromycin

              clarithromycin will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              clarithromycin and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • clemastine

              clemastine and risperidone both increase sedation. Use Caution/Monitor.

            • clobazam

              clobazam will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.

              risperidone, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clomipramine

              clomipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              clonazepam and risperidone both increase sedation. Use Caution/Monitor.

            • clonidine

              clonidine, risperidone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.

            • clorazepate

              clorazepate and risperidone both increase sedation. Use Caution/Monitor.

            • clotrimazole

              clotrimazole will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • clozapine

              clozapine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              clozapine and risperidone both increase sedation. Use Caution/Monitor.

              clozapine and risperidone both increase QTc interval. Use Caution/Monitor.

            • cobicistat

              cobicistat will increase the level or effect of risperidone by Other (see comment). Modify Therapy/Monitor Closely. A decrease in the dose of antipsychotics that are metabolized by CYP3A or CYP2D6 may be needed upon coadministration.

            • codeine

              codeine and risperidone both increase sedation. Use Caution/Monitor.

            • crizotinib

              crizotinib and risperidone both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • cyclizine

              cyclizine and risperidone both increase sedation. Use Caution/Monitor.

              cyclizine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclizine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of cyclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • cyclobenzaprine

              cyclobenzaprine and risperidone both increase sedation. Use Caution/Monitor.

              cyclobenzaprine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              cyclobenzaprine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • cyclosporine

              cyclosporine will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine and risperidone both increase sedation. Use Caution/Monitor.

            • dantrolene

              dantrolene and risperidone both increase sedation. Use Caution/Monitor.

            • daridorexant

              risperidone and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

            • darifenacin

              darifenacin decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              darifenacin decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of darifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • dasatinib

              dasatinib and risperidone both increase QTc interval. Use Caution/Monitor.

            • desflurane

              desflurane and risperidone both increase sedation. Use Caution/Monitor.

            • desipramine

              desipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and desipramine both increase sedation. Use Caution/Monitor.

            • desvenlafaxine

              desvenlafaxine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

            • deutetrabenazine

              risperidone and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.

              risperidone and deutetrabenazine both increase sedation. Use Caution/Monitor.

              deutetrabenazine and risperidone both increase QTc interval. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine and risperidone both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              risperidone increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine and risperidone both increase sedation. Use Caution/Monitor.

            • dexmethylphenidate

              risperidone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextroamphetamine

              risperidone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextromethorphan

              dextromethorphan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • dextromoramide

              dextromoramide and risperidone both increase sedation. Use Caution/Monitor.

            • diamorphine

              diamorphine and risperidone both increase sedation. Use Caution/Monitor.

            • diazepam

              diazepam and risperidone both increase sedation. Use Caution/Monitor.

            • dicyclomine

              dicyclomine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              dicyclomine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of dicyclomine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • diethylpropion

              risperidone increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • difelikefalin

              difelikefalin and risperidone both increase sedation. Use Caution/Monitor.

            • difenoxin hcl

              difenoxin hcl and risperidone both increase sedation. Use Caution/Monitor.

            • dihydroergotamine

              dihydroergotamine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • dimenhydrinate

              dimenhydrinate and risperidone both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine and risperidone both increase sedation. Use Caution/Monitor.

              diphenhydramine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              diphenhydramine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of diphenhydramine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • diphenoxylate hcl

              diphenoxylate hcl and risperidone both increase sedation. Use Caution/Monitor.

            • dipipanone

              dipipanone and risperidone both increase sedation. Use Caution/Monitor.

            • dobutamine

              risperidone increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dofetilide

              dofetilide and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • dolasetron

              dolasetron and risperidone both increase QTc interval. Use Caution/Monitor.

            • donepezil

              donepezil and risperidone both increase QTc interval. Use Caution/Monitor.

            • donepezil transdermal

              risperidone, donepezil transdermal. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor.

            • dopamine

              risperidone increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              risperidone increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              risperidone and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              doxepin and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              doxylamine and risperidone both increase sedation. Use Caution/Monitor.

            • dronedarone

              dronedarone will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              dronedarone and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • droperidol

              droperidol and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              droperidol and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              droperidol and risperidone both increase sedation. Use Caution/Monitor.

            • duloxetine

              duloxetine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • efavirenz

              efavirenz will decrease the level or effect of risperidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • elagolix

              elagolix will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • eletriptan

              eletriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • eliglustat

              eliglustat increases levels of risperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

              eliglustat increases levels of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; A decrease in dose of the neuroleptic may be needed when coadministered.

            • ephedrine

              risperidone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine

              epinephrine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine racemic

              epinephrine racemic and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ergoloid mesylates

              ergoloid mesylates, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • ergotamine

              ergotamine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • eribulin

              eribulin and risperidone both increase QTc interval. Use Caution/Monitor.

            • erythromycin base

              erythromycin base will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              erythromycin base and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin ethylsuccinate

              erythromycin ethylsuccinate will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              erythromycin ethylsuccinate and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin lactobionate

              erythromycin lactobionate will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              erythromycin lactobionate and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin stearate

              erythromycin stearate will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              erythromycin stearate and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • escitalopram

              escitalopram increases toxicity of risperidone by QTc interval. Use Caution/Monitor.

            • esketamine intranasal

              esketamine intranasal, risperidone. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

            • estazolam

              estazolam and risperidone both increase sedation. Use Caution/Monitor.

            • ethanol

              risperidone and ethanol both increase sedation. Use Caution/Monitor.

            • exenatide injectable solution

              risperidone, exenatide injectable solution. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • exenatide injectable suspension

              risperidone, exenatide injectable suspension. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • ezogabine

              ezogabine, risperidone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

            • fedratinib

              fedratinib will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

            • felodipine

              felodipine will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • fenfluramine

              risperidone increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              risperidone decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • fentanyl

              fentanyl, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • fesoterodine

              fesoterodine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              fesoterodine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of fesoterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • finerenone

              risperidone will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • fingolimod

              fingolimod and risperidone both increase QTc interval. Use Caution/Monitor.

            • flavoxate

              flavoxate decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              flavoxate decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of flavoxate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • flecainide

              flecainide and risperidone both increase QTc interval. Use Caution/Monitor.

            • flibanserin

              risperidone will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

              flibanserin, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • fluconazole

              fluconazole and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • fluoxetine

              fluoxetine and risperidone both increase QTc interval. Use Caution/Monitor.

            • fluphenazine

              fluphenazine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              fluphenazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              fluphenazine and risperidone both increase sedation. Use Caution/Monitor.

            • flurazepam

              flurazepam and risperidone both increase sedation. Use Caution/Monitor.

            • fluvoxamine

              fluvoxamine and risperidone both increase QTc interval. Use Caution/Monitor.

            • formoterol

              formoterol and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • foscarnet

              foscarnet and risperidone both increase QTc interval. Use Caution/Monitor.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • fostamatinib

              fostamatinib will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

            • fostemsavir

              risperidone and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • frovatriptan

              frovatriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • gadobenate

              gadobenate and risperidone both increase QTc interval. Use Caution/Monitor.

            • ganaxolone

              risperidone and ganaxolone both increase sedation. Use Caution/Monitor.

            • gemifloxacin

              gemifloxacin and risperidone both increase QTc interval. Use Caution/Monitor.

            • gilteritinib

              gilteritinib and risperidone both increase QTc interval. Use Caution/Monitor.

            • glecaprevir/pibrentasvir

              glecaprevir/pibrentasvir will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • glimepiride

              risperidone, glimepiride. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • glipizide

              risperidone, glipizide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • glyburide

              risperidone, glyburide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • glycopyrrolate

              risperidone increases effects of glycopyrrolate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • glycopyrrolate inhaled

              glycopyrrolate inhaled decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              glycopyrrolate inhaled decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • granisetron

              granisetron and risperidone both increase QTc interval. Use Caution/Monitor.

            • guanfacine

              guanfacine, risperidone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.

            • haloperidol

              haloperidol and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              haloperidol and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              haloperidol and risperidone both increase sedation. Use Caution/Monitor.

            • henbane

              henbane decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              henbane decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of henbane by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • homatropine

              homatropine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              homatropine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of homatropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • hydromorphone

              hydromorphone and risperidone both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine and risperidone both increase sedation. Use Caution/Monitor.

              hydroxyzine and risperidone both increase QTc interval. Use Caution/Monitor.

            • hyoscyamine

              hyoscyamine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              hyoscyamine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • hyoscyamine spray

              risperidone increases effects of hyoscyamine spray by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              hyoscyamine spray decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              hyoscyamine spray decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

            • iloperidone

              iloperidone and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              iloperidone and risperidone both increase QTc interval. Use Caution/Monitor.

              iloperidone and risperidone both increase sedation. Use Caution/Monitor.

            • imipramine

              imipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and imipramine both increase sedation. Use Caution/Monitor.

            • incobotulinumtoxinA

              risperidone, incobotulinumtoxinA. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.

            • indacaterol, inhaled

              indacaterol, inhaled, risperidone. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

            • indinavir

              indinavir will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • insulin aspart

              risperidone, insulin aspart. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • insulin degludec

              risperidone decreases effects of insulin degludec by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

            • insulin degludec/insulin aspart

              risperidone decreases effects of insulin degludec/insulin aspart by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

            • insulin detemir

              risperidone, insulin detemir. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • insulin glargine

              risperidone, insulin glargine. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • insulin glulisine

              risperidone, insulin glulisine. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • insulin inhaled

              risperidone decreases effects of insulin inhaled by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

            • insulin lispro

              risperidone, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • insulin NPH

              risperidone, insulin NPH. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • insulin regular human

              risperidone, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • ipratropium

              risperidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • isavuconazonium sulfate

              risperidone will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • isoproterenol

              risperidone increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • istradefylline

              istradefylline will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

            • itraconazole

              itraconazole will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              itraconazole and risperidone both increase QTc interval. Use Caution/Monitor.

            • ivacaftor

              ivacaftor increases levels of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

              risperidone increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

            • ketoconazole

              ketoconazole will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              ketoconazole and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • ketotifen, ophthalmic

              risperidone and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • lapatinib

              lapatinib and risperidone both increase QTc interval. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, risperidone. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              risperidone will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

              lemborexant, risperidone. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • letermovir

              letermovir increases levels of risperidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • levalbuterol

              risperidone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • levofloxacin

              levofloxacin and risperidone both increase QTc interval. Use Caution/Monitor.

            • levoketoconazole

              levoketoconazole and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              levoketoconazole will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • levomilnacipran

              levomilnacipran, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • levorphanol

              levorphanol and risperidone both increase sedation. Use Caution/Monitor.

            • linezolid

              linezolid, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • liraglutide

              risperidone, liraglutide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • lisdexamfetamine

              risperidone increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lithium

              lithium, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              lithium and risperidone both increase QTc interval. Use Caution/Monitor.

            • lofepramine

              lofepramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and lofepramine both increase sedation. Use Caution/Monitor.

            • lofexidine

              risperidone and lofexidine both increase sedation. Use Caution/Monitor.

            • lomitapide

              risperidone increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

            • lonafarnib

              lonafarnib will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.

            • loprazolam

              loprazolam and risperidone both increase sedation. Use Caution/Monitor.

            • loratadine

              loratadine will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • lorazepam

              lorazepam and risperidone both increase sedation. Use Caution/Monitor.

            • lorcaserin

              lorcaserin will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              lorcaserin, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • lormetazepam

              lormetazepam and risperidone both increase sedation. Use Caution/Monitor.

            • loxapine

              loxapine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              loxapine and risperidone both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              loxapine inhaled and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              loxapine inhaled and risperidone both increase sedation. Use Caution/Monitor.

            • lumefantrine

              lumefantrine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              lumefantrine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • lurasidone

              lurasidone, risperidone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • maprotiline

              maprotiline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and maprotiline both increase sedation. Use Caution/Monitor.

            • marijuana

              risperidone and marijuana both increase sedation. Use Caution/Monitor.

            • meclizine

              meclizine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              meclizine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of meclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • melatonin

              risperidone and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              meperidine and risperidone both increase sedation. Use Caution/Monitor.

              meperidine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • meprobamate

              risperidone and meprobamate both increase sedation. Use Caution/Monitor.

            • metaproterenol

              risperidone increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaxalone

              metaxalone and risperidone both increase sedation. Use Caution/Monitor.

            • metformin

              risperidone, metformin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • methadone

              methadone and risperidone both increase QTc interval. Use Caution/Monitor.

              methadone and risperidone both increase sedation. Use Caution/Monitor.

              methadone, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • methamphetamine

              risperidone increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methocarbamol

              methocarbamol and risperidone both increase sedation. Use Caution/Monitor.

            • methscopolamine

              methscopolamine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              methscopolamine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of methscopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • methylenedioxymethamphetamine

              risperidone increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methylergonovine

              methylergonovine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • methylphenidate

              risperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

            • methylphenidate transdermal

              methylphenidate transdermal will increase the level or effect of risperidone by unspecified interaction mechanism. Use Caution/Monitor. When coadministered with methylphenidate, changes in dosage of either or both medications, may increase the risk of extrapyramidal symptoms (EPS). Monitor for signs of EPS.

            • metoclopramide

              risperidone and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

            • midazolam

              midazolam and risperidone both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              risperidone will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

              midazolam intranasal, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • midodrine

              risperidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mifepristone

              mifepristone, risperidone. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

            • miglitol

              risperidone, miglitol. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • milnacipran

              milnacipran, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • mipomersen

              mipomersen, risperidone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

            • mirabegron

              mirabegron will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • mirtazapine

              risperidone and mirtazapine both increase sedation. Use Caution/Monitor.

              mirtazapine and risperidone both increase QTc interval. Use Caution/Monitor.

            • modafinil

              risperidone increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • morphine

              morphine and risperidone both increase sedation. Use Caution/Monitor.

            • motherwort

              risperidone and motherwort both increase sedation. Use Caution/Monitor.

            • moxifloxacin

              moxifloxacin and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • moxonidine

              risperidone and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              risperidone and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              nalbuphine and risperidone both increase sedation. Use Caution/Monitor.

            • naratriptan

              naratriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • nateglinide

              risperidone, nateglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • nefazodone

              nefazodone will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • nevirapine

              nevirapine will decrease the level or effect of risperidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nicardipine

              nicardipine will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • nifedipine

              nifedipine will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • nilotinib

              nilotinib and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • norepinephrine

              risperidone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nortriptyline

              nortriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and nortriptyline both increase sedation. Use Caution/Monitor.

            • octreotide

              octreotide and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • octreotide (Antidote)

              octreotide (Antidote) and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • ofloxacin

              ofloxacin and risperidone both increase QTc interval. Use Caution/Monitor.

            • olanzapine

              olanzapine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              olanzapine and risperidone both increase sedation. Use Caution/Monitor.

              olanzapine and risperidone both increase QTc interval. Use Caution/Monitor.

            • oliceridine

              oliceridine, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • olodaterol inhaled

              risperidone and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

            • onabotulinumtoxinA

              onabotulinumtoxinA decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              onabotulinumtoxinA decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • opium tincture

              opium tincture and risperidone both increase sedation. Use Caution/Monitor.

            • orphenadrine

              orphenadrine and risperidone both increase sedation. Use Caution/Monitor.

            • osilodrostat

              osilodrostat and risperidone both increase QTc interval. Use Caution/Monitor.

            • oxaliplatin

              oxaliplatin will increase the level or effect of risperidone by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

            • oxazepam

              oxazepam and risperidone both increase sedation. Use Caution/Monitor.

            • oxybutynin

              oxybutynin decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              oxybutynin decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of oxybutynin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • oxybutynin topical

              oxybutynin topical decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              oxybutynin topical decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of oxybutynin topical by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • oxybutynin transdermal

              oxybutynin transdermal decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              oxybutynin transdermal decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of oxybutynin transdermal by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • oxycodone

              oxycodone and risperidone both increase sedation. Use Caution/Monitor.

            • oxymorphone

              oxymorphone and risperidone both increase sedation. Use Caution/Monitor.

            • ozanimod

              ozanimod and risperidone both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

            • paliperidone

              paliperidone and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              paliperidone and risperidone both increase QTc interval. Use Caution/Monitor.

              paliperidone and risperidone both increase sedation. Use Caution/Monitor.

              paliperidone, risperidone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Paliperidone is the major active metabolite of risperidone, consideration should be given to the additive paliperidone exposure if any of these medications are coadministered.

            • pancuronium

              pancuronium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              pancuronium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of pancuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • papaveretum

              papaveretum and risperidone both increase sedation. Use Caution/Monitor.

            • papaverine

              risperidone and papaverine both increase sedation. Use Caution/Monitor.

            • paroxetine

              paroxetine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              paroxetine and risperidone both increase QTc interval. Use Caution/Monitor.

              paroxetine increases levels of risperidone by decreasing metabolism. Use Caution/Monitor.

              paroxetine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • pasireotide

              risperidone and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • peginterferon alfa 2b

              peginterferon alfa 2b, risperidone. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

            • pentazocine

              pentazocine and risperidone both increase sedation. Use Caution/Monitor.

            • pentobarbital

              pentobarbital and risperidone both increase sedation. Use Caution/Monitor.

            • perphenazine

              perphenazine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              perphenazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              perphenazine and risperidone both increase sedation. Use Caution/Monitor.

            • phendimetrazine

              risperidone increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenelzine

              phenelzine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • phenobarbital

              phenobarbital will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              phenobarbital and risperidone both increase sedation. Use Caution/Monitor.

            • phentermine

              risperidone increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine

              risperidone increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine PO

              risperidone increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • phenytoin

              phenytoin will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • pholcodine

              risperidone and pholcodine both increase sedation. Use Caution/Monitor.

            • pimozide

              pimozide and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              pimozide and risperidone both increase sedation. Use Caution/Monitor.

            • pioglitazone

              risperidone, pioglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • pirbuterol

              risperidone increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ponatinib

              ponatinib increases levels of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • posaconazole

              posaconazole and risperidone both increase QTc interval. Use Caution/Monitor.

            • pralidoxime

              pralidoxime decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              pralidoxime decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • pramlintide

              risperidone, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • primaquine

              primaquine and risperidone both increase QTc interval. Use Caution/Monitor.

            • primidone

              primidone and risperidone both increase sedation. Use Caution/Monitor.

            • procarbazine

              procarbazine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • prochlorperazine

              prochlorperazine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              prochlorperazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              prochlorperazine and risperidone both increase sedation. Use Caution/Monitor.

            • promazine

              promazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

            • promethazine

              promethazine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              promethazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              promethazine and risperidone both increase sedation. Use Caution/Monitor.

              promethazine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • propantheline

              propantheline decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              propantheline decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of propantheline by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • propofol

              propofol and risperidone both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              risperidone increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              protriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and protriptyline both increase sedation. Use Caution/Monitor.

            • quazepam

              quazepam and risperidone both increase sedation. Use Caution/Monitor.

            • quercetin

              quercetin will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • quetiapine

              quetiapine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              quetiapine and risperidone both increase sedation. Use Caution/Monitor.

              quetiapine, risperidone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

            • quinidine

              quinidine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • quinine

              risperidone and quinine both increase QTc interval. Use Caution/Monitor.

            • ramelteon

              risperidone and ramelteon both increase sedation. Use Caution/Monitor.

            • ranolazine

              ranolazine will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              ranolazine and risperidone both increase QTc interval. Use Caution/Monitor.

            • rapacuronium

              rapacuronium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              rapacuronium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of rapacuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • remimazolam

              remimazolam, risperidone. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • repaglinide

              risperidone, repaglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • rifampin

              rifampin will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • rilpivirine

              rilpivirine increases toxicity of risperidone by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

            • rimabotulinumtoxinB

              risperidone, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Anticholinergics may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

            • ritonavir

              ritonavir will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • rocuronium

              rocuronium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              rocuronium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of rocuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • rolapitant

              rolapitant will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

            • romidepsin

              risperidone and romidepsin both increase QTc interval. Use Caution/Monitor.

            • rosiglitazone

              risperidone, rosiglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • salmeterol

              risperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sarecycline

              sarecycline will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

            • saxagliptin

              risperidone, saxagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • scopolamine

              scopolamine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              scopolamine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • scullcap

              risperidone and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              secobarbital and risperidone both increase sedation. Use Caution/Monitor.

            • selegiline

              selegiline, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • selpercatinib

              selpercatinib increases toxicity of risperidone by QTc interval. Use Caution/Monitor.

            • sertraline

              sertraline will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              sertraline and risperidone both increase QTc interval. Use Caution/Monitor.

            • shepherd's purse

              risperidone and shepherd's purse both increase sedation. Use Caution/Monitor.

            • simvastatin

              simvastatin will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • sirolimus

              sirolimus will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • sitagliptin

              risperidone, sitagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases effects of risperidone by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases effects of risperidone by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

            • solifenacin

              solifenacin decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              solifenacin decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              solifenacin and risperidone both increase QTc interval. Use Caution/Monitor.

            • sorafenib

              sorafenib and risperidone both increase QTc interval. Use Caution/Monitor.

            • St John's Wort

              St John's Wort will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • stiripentol

              stiripentol will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

              stiripentol, risperidone. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            • sufentanil

              sufentanil and risperidone both increase sedation. Use Caution/Monitor.

            • sulfamethoxazole

              sulfamethoxazole and risperidone both increase QTc interval. Use Caution/Monitor.

            • sumatriptan

              sumatriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • sumatriptan intranasal

              sumatriptan intranasal, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • tacrolimus

              tacrolimus will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • tapentadol

              tapentadol and risperidone both increase sedation. Use Caution/Monitor.

            • tazemetostat

              risperidone will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • telavancin

              risperidone and telavancin both increase QTc interval. Use Caution/Monitor.

            • temazepam

              temazepam and risperidone both increase sedation. Use Caution/Monitor.

            • terbinafine

              terbinafine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

            • terbutaline

              risperidone increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tetrabenazine

              risperidone and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

            • thioridazine

              risperidone and thioridazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              thioridazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              risperidone and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              risperidone and thiothixene both increase sedation. Use Caution/Monitor.

            • tinidazole

              risperidone will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tiotropium

              tiotropium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              tiotropium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • tolazamide

              risperidone, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • tolbutamide

              risperidone, tolbutamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

            • tolterodine

              tolterodine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              tolterodine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • tolvaptan

              tolvaptan will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • topiramate

              risperidone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              tramadol and risperidone both increase sedation. Use Caution/Monitor.

            • tranylcypromine

              tranylcypromine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • trazodone

              trazodone will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              trazodone and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              triazolam and risperidone both increase sedation. Use Caution/Monitor.

            • triclabendazole

              triclabendazole and risperidone both increase QTc interval. Use Caution/Monitor.

            • triclofos

              triclofos and risperidone both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              risperidone and trifluoperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              trifluoperazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and trifluoperazine both increase sedation. Use Caution/Monitor.

            • trihexyphenidyl

              risperidone increases effects of trihexyphenidyl by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive anticholinergic effects.

            • trimethoprim

              risperidone and trimethoprim both increase QTc interval. Use Caution/Monitor.

            • trimipramine

              trimipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and trimipramine both increase sedation. Use Caution/Monitor.

            • triprolidine

              triprolidine and risperidone both increase sedation. Use Caution/Monitor.

            • tropisetron

              risperidone and tropisetron both increase QTc interval. Use Caution/Monitor.

            • trospium chloride

              trospium chloride decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              trospium chloride decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • tucatinib

              tucatinib will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

            • vecuronium

              vecuronium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              vecuronium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              risperidone increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

            • venlafaxine

              venlafaxine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              risperidone and venlafaxine both increase QTc interval. Use Caution/Monitor.

              venlafaxine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • verapamil

              verapamil will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • vilazodone

              vilazodone, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • voclosporin

              voclosporin, risperidone. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • voriconazole

              risperidone and voriconazole both increase QTc interval. Use Caution/Monitor.

            • xylometazoline

              risperidone increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • yohimbine

              risperidone increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziconotide

              risperidone and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              risperidone and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              risperidone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone and ziprasidone both increase sedation. Use Caution/Monitor.

            • zolmitriptan

              zolmitriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

            • zotepine

              risperidone and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              risperidone and zotepine both increase sedation. Use Caution/Monitor.

            Minor (29)

            • amoxapine

              risperidone and amoxapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Minor/Significance Unknown.

            • asenapine

              asenapine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • azithromycin

              azithromycin and risperidone both increase QTc interval. Minor/Significance Unknown.

            • brimonidine

              brimonidine increases effects of risperidone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • celecoxib

              celecoxib will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • chasteberry

              chasteberry decreases effects of risperidone by pharmacodynamic antagonism. Minor/Significance Unknown. (Theoretical interaction).

            • chloroquine

              chloroquine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • cimetidine

              cimetidine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • darifenacin

              darifenacin will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • diphenhydramine

              diphenhydramine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • dronedarone

              dronedarone will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • ethanol

              ethanol, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

            • eucalyptus

              risperidone and eucalyptus both increase sedation. Minor/Significance Unknown.

            • haloperidol

              haloperidol will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • imatinib

              imatinib will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • maraviroc

              maraviroc will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • marijuana

              marijuana will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • nilotinib

              nilotinib will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • parecoxib

              parecoxib will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • pazopanib

              pazopanib and risperidone both increase QTc interval. Minor/Significance Unknown.

            • perphenazine

              perphenazine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • quinacrine

              quinacrine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • ranolazine

              ranolazine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • ritonavir

              ritonavir will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • ruxolitinib

              risperidone will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • ruxolitinib topical

              risperidone will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • sage

              risperidone and sage both increase sedation. Minor/Significance Unknown.

            • thioridazine

              thioridazine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

            • tipranavir

              tipranavir will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Somnolence (40-45%)

            Insomnia (26-30%)

            Agitation (20-25%)

            Anxiety (10-15%)

            Headache (10-15%)

            Rhinitis (10-15%)

            Fatigue (18-31%)

            Parkinsonism (28-62%)

            Akathisia (5-11%)

            Increased appetite (4-44%)

            Vomiting (10-20%)

            Drooling (<12%)

            Urinary incontinence (5-22%)

            Tremor (11-24%)

            Nasopharyngitis (4-19%)

            Rhinorrhea (4-12%)

            Enuresis (1-16%)

            ER suspension

            • Increased weight (12.8-13%)

            1-10%

            Constipation (5-10%)

            Dyspepsia (5-10%)

            Nausea (5-10%)

            Abdominal pain (1-5%)

            Aggressive reaction (1-5%)

            Facial edema (<4%)

            QT prolongation (<4%)

            Dizziness (1-5%)

            Extrapyramidal symptoms (EPS; 1-5%)

            Gynecomastia in children (1-5%)

            Rash (1-5%)

            Tachycardia (1-5%)

            Syncope (1-2%)

            Bradycardia (<4%)

            Palpitation (<4%)

            Chest pain (<4%)

            Agitation (<4%)

            Postural dizziness (<4%)

            Pruritus (<4%)

            Acne (1-2%)

            Hyperprolactinemia (<4%)

            Sexual dysfunction (<4%)

            Xerostomia (7-10%)

            ER suspension

            • Sedation (7-7.7%)
            • Pain in extremity (0.9-7.7%)
            • Constipation (7-7/7%)
            • Anxiety (2.6-6.8%)
            • Akathisia (2.6-6.8%)
            • Back pain (3.5-6.8%)
            • Musculoskeletal pain (5.2%)
            • Extrapyramidal disorder (1.7-4.3%)
            • Increased appetite (1.7-3.4%)
            • Musculoskeletal stiffness (0.9-2.6%)
            • Abdominal discomfort (2.6%)
            • Muscle spasms (0-2.6%)
            • Dry mouth (1.7-2.6%)

            <1%

            Agranulocytosis

            Cholesterol increased

            Delirium

            Ketoacidosis

            Orthostatic hypotension

            Seizures

            Frequency Not Defined

            Diabetes mellitus

            Hyperthermia

            Hypoglycemia

            Hypothermia

            Myelosuppression

            Neuroleptic malignant syndrome (NMS)

            Priapism

            Prolonged QT interval

            Tardive dyskinesia

            Thrombotic thrombocytopenic purpura (TTP)

            Sleep apnea syndrome

            Urinary retention

            Blood and lymphatic system disorders: Anemia, granulocytopenia

            Cardiac disorders: Tachycardia, sinus bradycardia, sinus tachycardia, atrioventricular block first degree, bundle branch block left, bundle branch block right, atrioventricular block

            Ear and labyrinth disorders: Ear pain, tinnitus

            Eye Disorders: Vision blurred, oculogyration, ocular hyperemia, eye discharge, conjunctivitis, eye rolling, eyelid edema, eye swelling, eyelid margin crusting, dry eye, lacrimation increased, photophobia, glaucoma, visual acuity reduced

            Gastrointestinal disorders: Dysphagia, fecaloma, fecal incontinence, gastritis, lip swelling, cheilitis, aptyalism

            General disorders: Thirst, gait disturbance, chest pain, influenza-like illness, pitting edema, edema, chills, sluggishness, malaise, face edema, discomfort, generalized edema, drug withdrawal syndrome, peripheral coldness, feeling abnormal

            Immune system disorders: Drug hypersensitivity

            Infections and infestations: Nasopharyngitis, upper respiratory tract infection, sinusitis, urinary tract infection, pneumonia, influenza, ear infection, viral infection, pharyngitis, tonsillitis, bronchitis, eye infection, localized infection, cystitis, cellulitis, otitis media, onychomycosis, acarodermatitis, bronchopneumonia, respiratory tract infection, tracheobronchitis, otitis media chronic

            Investigations: Body temperature increased, alanine aminotransferase increased, heart rate increased, eosinophil count increased, white blood cell count decreased, hemoglobin decreased, blood creatine phosphokinase increased, hematocrit decreased, body temperature decreased, blood pressure decreased, transaminases increased

            Metabolism and nutrition disorders: Polydipsia, anorexia

            Musculoskeletal, connective tissue, and bone disorders: Joint swelling, musculoskeletal chest pain, posture abnormal, myalgia, neck pain, muscular weakness, muscle rigidity, muscle contracture, rhabdomyolysis

            Nervous system disorders: Dizziness postural, disturbance in attention, unresponsive to stimuli, depressed level of consciousness, movement disorder, hypokinesia, bradykinesia, transient ischemic attack, coordination abnormal, cerebrovascular accident, masked facies, speech disorder, syncope, loss of consciousness, muscle contractions involuntary, Parkinson disease, tongue paralysis, akinesia, cerebral ischemia, cerebrovascular disorder, neuroleptic malignant syndrome, diabetic coma, head titubation

            Psychiatric disorders: Agitation, blunted affect, confusional state, middle insomnia, nervousness, sleep disorder, listlessness

            Renal and urinary disorders: Enuresis, dysuria, pollakiuria, urinary incontinence Reproductive system and breast disorders: Vaginal discharge, menstrual disorder, retrograde ejaculation, sexual dysfunction

            Postmarketing Reports

            Falls

            Alopecia, anaphylactic reaction, angioedema, atrial fibrillation, cardiopulmonary arrest, diabetic ketoacidosis in patients with impaired glucose metabolism, dysgeusia, hypoglycemia, hypothermia, ileus, inappropriate antidiuretic hormone secretion, intestinal obstruction, jaundice, mania, pancreatitis, pituitary adenoma, precocious puberty, pulmonary embolism, QT prolongation, sleep apnea syndrome, sudden death, thrombocytopenia, thrombotic thrombocytopenic purpura, urinary retention, Stevens-Johnson syndrome, toxic epidermal necrolysis (SJS/TEN), and water intoxication

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            Warnings

            Black Box Warnings

            Elderly patients with dementia-related psychosis

            • Not approved for dementia-related psychosis
            • Elderly patients with dementia-related psychosis who are treated with antipsychotic drugs are at increased risk of death, as shown in short-term controlled trials; deaths in these trials appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature

            Contraindications

            Documented hypersensitivity

            Cautions

            Increased incidence of cerebrovascular disease reported; may alter cardiac conduction; life threatening arrhythmias reported with therapeutic doses of antipsychotics

            May cause anticholinergic effects including blurred vision, urinary retention, agitation, confusion, blurred vision, and xerostomia

            Use with caution in patients with history of seizures, Parkinson disease, Lewy body dementia, cardiovascular disease, hypovolemia, dehydration

            Leukopenia/neutropenia and agranulocytosis reported; possible risk factors for leukopenia/neutropenia include preexisting low white blood cell (WBC) count and history of drug-induced leukopenia/neutropenia

            If patient has history of clinically significant low WBC count or drug-induced leukopenia/neutropenia, monitor complete blood count (CBC) frequently during first few months of therapy; discontinue drug at first sign of clinically significant WBC decline <1000/μL in absence of other causative factors, and continue monitoring WBC count until recovery

            May cause somnolence, postural hypotension, motor and sensory instability, which may lead to falls and, consequently, fractures or other injuries; perform complete fall risk assessments when initiating antipsychotic treatment and recurrently for patients on long-term antipsychotic therapy

            Use caution in patients at risk of pneumonia; esophageal dysmotility and aspiration reported with antipsychotic use

            May cause extrapyramidal symptoms including acute dystonic reactions, akathisia, pseudoparkinsonism, and tardive dyskinesia

            Intraoperative floppy iris syndrome reported in patients receiving risperidone therapy

            Monitor for fever, mental status changes, muscle rigidity and or autonomic instability; neuroleptic malignant syndrome (NMS) associated with risperidone use; if NMS suspected, discontinue therapy immediately and provide symptomatic treatment and monitoring

            Use with caution in children <15 kg

            Cases of priapism reported with therapy

            Prolactin elevations occur and persist during chronic administration; risperidone is associated with higher levels of prolactin elevation than other antipsychotic agents

            Use caution when operating heavy machinery

            FDA warning regarding off-label use for dementia in elderly

            Seizures observed during premarketing studies of risperidone in adult patients with schizophrenia

            Esophageal dysmotility and aspiration have been associated with antipsychotic use

            Disruption of body temperature regulation has been attributed to antipsychotic agents

            Tardive dyskinesia

            • A syndrome consisting of potentially irreversible, involuntary, dyskinetic movements, may develop in patients treated with antipsychotic drugs; although prevalence appears to be highest among elderly, especially elderly women, it is impossible to predict which patients will develop the syndrome; whether antipsychotic drug products differ in their potential to cause tardive dyskinesia is unknown
            • Risk of developing tardive dyskinesia and likelihood that it will become irreversible increase with the duration of treatment and the cumulative dose. The syndrome can develop after relatively brief treatment periods, even at low doses. It may also occur after discontinuation of treatment
            • Tardive dyskinesia may remit, partially or completely, if antipsychotic treatment is discontinued; antipsychotic treatment, itself, however, may suppress (or partially suppress) signs and symptoms of the syndrome, possibly masking the underlying process
            • Therapy should be prescribed in a manner that is most likely to minimize occurrence of tardive dyskinesia; chronic antipsychotic treatment should generally be reserved for patients who suffer from a chronic illness known to respond to antipsychotic drugs, and for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate
            • In patients who do require chronic treatment, use lowest dose and shortest duration of treatment producing a satisfactory clinical response; periodically reassess need for continued treatment;
            • If signs and symptoms of tardive dyskinesia appear in a patient receiving therapy, consider discontinuing drug; however, some patients may require treatment with the drug despite the presence of the syndrome

            Orthostatic hypotension

            • May induce orthostatic hypotension associated with dizziness, tachycardia, and in some patients, syncope, especially during initial dose-titration period, probably reflecting its alpha-adrenergic antagonistic properties
            • risk of orthostatic hypotension and syncope may be minimized by limiting the initial dose to 2 mg total (either once daily or 1 mg twice daily) in normal adults and 0.5 mg twice daily in the elderly and patients with renal or hepatic impairment
            • Risk of orthostatic hypotension and syncope may be minimized by limiting initial dose to 2 mg total (either once daily or 1 mg twice daily) in normal adults and 0.5 mg twice daily in the elderly and patients with renal or hepatic impairment
            • Consider monitoring orthostatic vital signs in patients at risk; consider dose reduction if hypotension occurs
            • Use caution in patients with known cardiovascular disease (history of myocardial infarction or ischemia, heart failure, or conduction abnormalities), cerebrovascular disease, and conditions that would predispose patients to hypotension, eg, dehydration and hypovolemia, and in the elderly and patients with renal or hepatic impairment
            • Consider monitoring for orthostatic vital signs if hypotension occurs; clinically significant hypotension observed with concomitant use of drug and antihypertensive medication

            Metabolic changes

            • Atypical antipsychotic drugs have been associated with metabolic changes that may increase cardiovascular or cerebrovascular risk (eg, hyperglycemia, dyslipidemia, and body weight gain)
            • In some cases, hyperglycemia concomitant with use of atypical antipsychotics has been associated with ketoacidosis, hyperosmolar coma, or death
            • In some cases, hyperglycemia has resolved when the atypical antipsychotic, including risperidone, was discontinued; however, some patients required continuation of antidiabetic treatment despite discontinuation of risperidone
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            Pregnancy & Lactation

            Pregnancy

            There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to atypical antipsychotics, including risperidone, during pregnancy

            Healthcare professionals are encouraged to register patients by contacting the National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or online at http://womensmentalhealth.org/clinical-and-research programs/ pregnancyregistry/

            Infertility

            • Based on the pharmacologic action of risperidone, treatment may result in an increase in serum prolactin levels, which may lead to reversible reduction in fertility in females of reproductive potential

            Disease-associated maternal and/or embryo/fetal risk

            • There is a risk to the mother from untreated schizophrenia, including increased risk of relapse, hospitalization, and suicide
            • Schizophrenia is associated with increased adverse perinatal outcomes, including preterm birth It is not known if this is a direct result of the illness or other comorbid factors

            Fetal/neonatal adverse reactions

            • Extrapyramidal and/or withdrawal symptoms, including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorder reported in neonates who were exposed to antipsychotic drugs, including risperidone, during the third trimester of pregnancy; symptoms varied
            • Monitor neonates for extrapyramidal and/or withdrawal symptoms and manage symptoms appropriately

            Lactation

            Limited data from published literature reports the presence of risperidone and its metabolite, 9- hydroxyrisperidone, in human breast milk at relative infant dose ranging between 2.3 and 4.7% of the maternal weight-adjusted dosage

            Reports of sedation, failure to thrive, jitteriness, and extrapyramidal symptoms (tremors and abnormal muscle movements) in breastfed infants exposed to risperidone

            Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Has high affinity for serotonin type 2 (5-HT2) receptors; binds to dopamine D2 receptors with 20 times lower affinity than that for 5-HT2 receptors; antagonizes alpha1-adrenergic, alpha2-adrenergic, and histaminergic receptors; has moderate affinity for serotonin type 1 (5-HT1C, 5-HT1D, 5-HT1A) receptors; has weak affinity for dopamine D1 receptors; has no affinity for muscarinic, beta1-adrenergic, and beta2-adrenergic receptors

            Absorption

            Peak plasma time, steady-state: 4-6 hr (SC)

            Peak plasma concentration: 6.33-10.9 ng/mL (risperidone, 9-hydroxyrisperidone)

            AUC: 2262-3891 ng·hr/mL

            Bioavailability: 70%

            Peak plasma time: Extensive metabolizers, 3 hr; poor metabolizers, 17 hr

            Distribution

            Protein bound: Risperidone, 90%; metabolite, 77%

            Vd: 1-2 L/kg

            Metabolism

            Metabolized in liver by CYP2D6

            Metabolite: 9-hydroxyrisperidone (paliperidone)

            Elimination

            Half-life: Extensive metabolizers, 3 hr (parent and metabolite combined); poor metabolizers, 20 hr (parent and metabolite combined); prolonged in renal impairment; free fraction increase in hepatic disease

            Half-life: 8-9 days (9-hydroxyrisperidone and total active moiety)

            Excretion: Urine (70%), feces (14%)

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            Administration

            Oral Administration

            Oral solution

            • Administer directly from the calibrated pipette, or can be mixed with a beverage prior to administration
            • Compatible in the following beverages: Water, coffee, orange juice, and low-fat milk; it is NOT compatible with either cola or tea

            Orally disintegrating tablets

            • Do not open the blister until ready to administer
            • For single tablet removal, separate one of the four blister units by tearing apart at the perforations
            • Bend the corner where indicated
            • Peel back foil to expose the tablet
            • DO NOT push the tablet through the foil because this could damage the tablet
            • The child-resistant pouch should be torn open at the notch to access the blister; do not open the blister until ready to administer
            • Peel back foil from the side to expose the tablet
            • DO NOT push the tablet through the foil, because this could damage the tablet
            • Using dry hands, remove the tablet from the blister unit and immediately place the entire oral disintegration on the tongue; consumed immediately, as the tablet cannot be stored once removed from the blister unit
            • Disintegrate in the mouth within seconds and can be swallowed subsequently with or without liquid; patients should not attempt to split or to chew the tablet

            SC Preparation

            Visually inspect for particulate matter and discoloration prior to administration

            Hold powder syringe upright tap the barrel of the syringe to unpack the powder

            Remove caps from both powder syringe and diluent syringe

            Connect both syringes; do not over tighten

            Keep your fingers off the plunger to avoid drug spillage

            Mix product

            • Failure to fully mix the product could result in incorrect dosage
            • Premixing
              • Transfer contents of the liquid syringe into the powder syringe
              • Gently push the powder syringe plunger until you feel resistance (to wet powder and avoid compacting)
              • Repeat this gentle back-and-forth process for 5 cycles
            • Complete mixing
              • Continue mixing the syringes for an additional 55 cycles; mixing can be more vigorous than when premixing
              • When fully mixed, the product should be a cloudy suspension that is uniform in color; varies between white to yellow-green in color
              • If mixed drug appears any clear areas in the mixture, continue to mix until the distribution of the color is uniform

            SC Administration

            For abdominal SC injection, only

            Do not administer by any other route

            To be administered by a healthcare professional only

            Choose an injection site on the abdomen with adequate SC tissue that has no skin conditions (eg, nodules, lesions, excessive pigment); recommended patient be in the supine position; rotate injection sites (refer to prescribing information)

            Allow package to come to room temperature for at least 15 minutes prior to preparation

            Only prepare medication when you are ready to administer the dose

            As a universal precaution, always wear gloves

            IM preparation

            Remove dose pack from refrigerator; allow to sit at room temperature at least 30 minutes before reconstituting; do not warm any other way

            Remove vial cap; connect vial adapter

            Keep vial vertical to prevent leakage

            Hold base of vial and pull up on the sterile blister to remove; do not shake; do not touch exposed luer opening on vial adapter; this will result in contamination

            Remove cap from liquid cap; connect liquid syringe to the vial adapter

            Do not hold glass syringe barrel; may cause the white collar to loose or detach Inject diluent, suspend microspheres in diluent

            Continuing to hold down the plunger rod, shake vigorously for at least 10 seconds, as shown; check the suspension

            Microspheres will be visible in the liquid; immediately proceed to the next step so suspension does not settle

            IM Administration

            Immediately inject entire contents of syringe IM into the gluteal or deltoid muscle of the patient

            Gluteal injection should be made into the upper-outer quadrant of the gluteal area

            Do not IV administer

            Storage

            Tablets and oral disintegrating tablets

            • Store at room temperature 15-25°C (59-77°F); protect from light and moisture

            Oral solution

            • Store at controlled room temperature 15- 25°C (59-77°F); protect from light and freezing

            SC and IM kits

            • Unopened: Refrigerate 2-8°C (36-46°F); may store at room temperature in its original packaging at 20-25°C (68-77°F) for up to 7 days
            • After removal from the refrigerator, discard after 7 days
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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Risperdal oral
            -
            4 mg tablet
            Risperdal oral
            -
            1 mg tablet
            Risperdal oral
            -
            2 mg tablet
            Risperdal oral
            -
            0.5 mg tablet
            Risperdal oral
            -
            1 mg/mL solution
            Risperdal oral
            -
            3 mg tablet
            Risperdal oral
            -
            0.25 mg tablet
            risperidone oral
            -
            4 mg tablet
            risperidone oral
            -
            4 mg tablet
            risperidone oral
            -
            3 mg tablet
            risperidone oral
            -
            2 mg tablet
            risperidone oral
            -
            1 mg tablet
            risperidone oral
            -
            3 mg tablet
            risperidone oral
            -
            0.5 mg tablet
            risperidone oral
            -
            3 mg tablet
            risperidone oral
            -
            2 mg tablet
            risperidone oral
            -
            0.25 mg tablet
            risperidone oral
            -
            1 mg tablet
            risperidone oral
            -
            2 mg tablet
            risperidone oral
            -
            0.5 mg tablet
            risperidone oral
            -
            0.25 mg tablet
            risperidone oral
            -
            1 mg/mL solution
            risperidone oral
            -
            4 mg tablet
            risperidone oral
            -
            1 mg tablet
            risperidone oral
            -
            2 mg tablet
            risperidone oral
            -
            4 mg tablet
            risperidone oral
            -
            4 mg tablet
            risperidone oral
            -
            3 mg tablet
            risperidone oral
            -
            3 mg tablet
            risperidone oral
            -
            0.5 mg tablet
            risperidone oral
            -
            4 mg tablet
            risperidone oral
            -
            2 mg tablet
            risperidone oral
            -
            1 mg tablet
            risperidone oral
            -
            4 mg tablet
            risperidone oral
            -
            0.25 mg tablet
            risperidone oral
            -
            0.25 mg tablet
            risperidone oral
            -
            2 mg tablet
            risperidone oral
            -
            1 mg tablet
            risperidone oral
            -
            0.5 mg tablet
            risperidone oral
            -
            1 mg tablet
            risperidone oral
            -
            1 mg tablet
            risperidone oral
            -
            3 mg tablet
            risperidone oral
            -
            2 mg tablet
            risperidone oral
            -
            0.5 mg tablet
            risperidone oral
            -
            3 mg tablet
            risperidone oral
            -
            1 mg tablet
            risperidone oral
            -
            1 mg/mL solution
            risperidone oral
            -
            0.5 mg tablet
            risperidone oral
            -
            4 mg tablet
            risperidone oral
            -
            3 mg tablet
            risperidone oral
            -
            2 mg tablet
            risperidone oral
            -
            1 mg tablet
            risperidone oral
            -
            2 mg tablet
            risperidone oral
            -
            1 mg/mL solution
            risperidone oral
            -
            0.25 mg tablet
            risperidone oral
            -
            3 mg tablet
            risperidone oral
            -
            4 mg tablet
            risperidone oral
            -
            0.25 mg tablet
            risperidone oral
            -
            0.5 mg tablet
            risperidone oral
            -
            0.25 mg tablet
            risperidone oral
            -
            0.5 mg tablet
            risperidone oral
            -
            4 mg tablet
            risperidone oral
            -
            3 mg tablet
            risperidone oral
            -
            1 mg tablet
            risperidone oral
            -
            0.5 mg tablet
            risperidone oral
            -
            0.25 mg tablet
            risperidone oral
            -
            2 mg tablet
            risperidone oral
            -
            4 mg tablet
            risperidone oral
            -
            1 mg tablet
            risperidone oral
            -
            1 mg/mL solution
            risperidone oral
            -
            1 mg/mL solution
            Perseris abdominal subcutaneous
            -
            120 mg syringe
            Perseris abdominal subcutaneous
            -
            90 mg syringe

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            risperidone oral

            RISPERIDONE - ORAL

            (riss-PAIR-ih-doan)

            COMMON BRAND NAME(S): Risperdal

            WARNING: There may be a slightly increased risk of serious, possibly fatal side effects (such as stroke, heart failure, fast/irregular heartbeat, pneumonia) when this medication is used by older adults with dementia. This medication is not approved for the treatment of dementia-related behavior problems. Discuss the risks and benefits of this medication, as well as other effective and possibly safer treatments for dementia-related behavior problems, with the doctor.If you are using risperidone in combination with other medication to treat depression, also carefully read the drug information for the other medication.

            USES: Risperidone is used to treat certain mental/mood disorders (such as schizophrenia, bipolar disorder, irritability associated with autistic disorder). This medication can help you to think clearly and take part in everyday life.Risperidone belongs to a class of drugs called atypical antipsychotics. It works by helping to restore the balance of certain natural substances in the brain.

            HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually once or twice daily.If you are using the liquid form of this medication, read the Instructions for Use if available from your pharmacist before you start using risperidone and each time you get a refill. Carefully measure the dose using the special measuring device that is provided. Do not use a household spoon because you may not get the correct dose. If directed, you may mix the measured dose with a small amount of liquid (3 to 4 ounces/about 100 milliliters) such as water, coffee, orange juice, or low-fat milk. Do not mix with cola or tea. Take all of the mixture right away. Do not prepare a supply in advance. Consult your pharmacist if you have any questions.The dosage is based on your age, medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day. Keep taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor.Tell your doctor if your condition lasts or gets worse.

            SIDE EFFECTS: Drowsiness, dizziness, lightheadedness, drooling, nausea, weight gain, or tiredness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Dizziness and lightheadedness can increase the risk of falling. Get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: difficulty swallowing, muscle spasms, shaking (tremor), mental/mood changes (such as anxiety, restlessness), interrupted breathing during sleep.This medication may rarely make your blood sugar rise, which can cause or worsen diabetes. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. If you already have diabetes, check your blood sugar regularly as directed and share the results with your doctor. Your doctor may need to adjust your diabetes medication, exercise program, or diet.This drug may also cause significant weight gain and a rise in your blood cholesterol (or triglyceride) levels. These effects, along with diabetes, may increase your risk for developing heart disease. Discuss the risks and benefits of treatment with your doctor. (See also Notes section.)Risperidone may rarely cause a condition known as tardive dyskinesia. In some cases, this condition may be permanent. Tell your doctor right away if you develop any unusual/uncontrolled movements (especially of the face, lips, mouth, tongue, arms or legs).This medication may increase a certain natural substance (prolactin) made by your body. For females, this increase in prolactin may result in unwanted breast milk, missed/stopped periods, or difficulty becoming pregnant. For males, it may result in decreased sexual ability, inability to produce sperm, or enlarged breasts. If you develop any of these symptoms, tell your doctor right away.Get medical help right away if you have any very serious side effects, including: severe dizziness, fainting, seizures.This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you have any of the following symptoms: fever, muscle stiffness/pain/tenderness/weakness, severe tiredness, severe confusion, sweating, fast/irregular heartbeat, dark urine, signs of kidney problems (such as change in the amount of urine).Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking risperidone, tell your doctor or pharmacist if you are allergic to it; or to paliperidone; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, seizures, difficulty swallowing, low white blood cell count, Parkinson's disease, dementia, certain eye problems (cataracts, glaucoma), personal or family history of diabetes, heart disease, high cholesterol/triglyceride levels, breathing trouble during sleep (sleep apnea).Risperidone may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using risperidone, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using risperidone safely.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery (including cataract/glaucoma eye surgery), tell your doctor or dentist if you are taking or have ever taken this medication, and about all the other products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication may make you sweat less, making you more likely to get heat stroke. Avoid doing things that may cause you to overheat, such as hard work or exercise in hot weather, or using hot tubs. When the weather is hot, drink a lot of fluids and dress lightly. If you overheat, quickly look for a place to cool down and rest. Get medical help right away if you have a fever that does not go away, mental/mood changes, headache, or dizziness.Older adults may be more sensitive to the side effects of this drug, especially drowsiness, dizziness, lightheadedness, and QT prolongation (see above). Drowsiness, dizziness, and lightheadedness can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. Babies born to mothers who have used this drug during the last 3 months of pregnancy may rarely develop symptoms including muscle stiffness or shakiness, drowsiness, feeding/breathing difficulties, or constant crying. If you notice any of these symptoms in your newborn especially during their first month, tell the doctor right away.Since untreated mental/mood problems (such as schizophrenia, bipolar disorder, depression) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.This medication passes into breast milk and may have undesirable effects on a nursing infant. Tell the doctor right away if your baby develops symptoms such as muscle stiffness or shakiness, unusual sleepiness, or difficulty feeding. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: metoclopramide.Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness/dizziness, fast/irregular heartbeat, unusual/uncontrolled movements, seizures.

            NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as blood sugar, weight, blood pressure, blood cholesterol/triglyceride levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not freeze the liquid form of this medication. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised May 2022. Copyright(c) 2022 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

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            • View the formulary and any restrictions for each plan.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.