Table 9.
Risperidone Dosage and Monitoring
| Guideline | Dose | Patient monitoring parameters | Specific side effects | Specific drug interactions |
|---|---|---|---|---|
| APA | Up to 3mg/d | General AAP guidance only | General AAP guidance, plus prolactin related side effects | General AAP guidance only |
| BAP | 0.5-2mg/d.(Taylor et al., 2015) | General AAP guidance only | General AAP guidance only | – |
| CANMAT | 1-3mg/d | – | – | Moderate potential for drug-drug interactions (2D6, 3A4 substrate). Increases serum levels of CYP1A2 CYP substrates and CYP2D6. |
| CPG-S | – | – | – | – |
| ICSI | General AAP guidance only | – | – | – |
| MPG | General AAP guidance, plus 0.5-3mg/d, see guidelines for recommendations in cases of hepatic impairment | General AAP guidance only | Transient asymptomatic elevations in LFTs, cholestatic hepatitis, jaundice and rare cases of hepatic failure reported (Atasoy et al., 2007; Preskorn, 2012; Datapharm Communications Ltd, 2017; Truven Health Analytics, 2018). Low relative risk of sedation, akathisia, parkinsonism, and anticholinergic effects. Moderate relative risk of weight gain and hypotension, and high incidence of prolactin elevation (avoid in patients under 25/osteoporosis/history of hormone dependent breast cancer). Low relative risk of effect on QTc. Moderate propensity for increasing plasma lipids.(Perez-Iglesias et al., 2009) Moderately high reported incidence of ejaculatory problems (Dubé et al., 2007; Tohen et al., 2012). Priapism reported rarely (Baldwin and Mayers, 2003). Prevalence of sexual dysfunction reported to be 60–70% (Serretti and Chiesa, 2011). | General AAP guidance/see guidelines |
| NICE | – | – | – | – |
| RANZCP | General AAP guidance only | General AAP guidance only | General AAP guidance only | May be less effective in poor CYP2D6 metabolisers (de Leon et al., 2010). |
| TMAP | 0.25-0.5mg/d, target range 1-2mg/d | General AAP guidance only | General AAP guidance, plus EPS, glucose dysregulation, galactorrhoea, hyperlipidaemia, menstrual irregularity, orthostatic hypotension, prolactin elevation, sedation, sexual dysfunction, tardive dyskinesia, weight gain | Carbamazepine, cimetidine, fluoxetine, paroxetine, phenytoin, rifampin, tricyclic antidepressants. |
| WFSBP | Not recommended |
Abbreviations: –, not reported by guideline; AAPs, atypical antipsychotics; APA, American Psychiatric Association; BAP, British Association of Psychopharmacology; CANMAT, Canadian Network for Mood and Anxiety Disorders; CPG-S, Clinical Practice Guidelines in the Spanish NHS; ICSI, Institute for Clinical Systems Improvement; LFTs, liver function tests; NICE, National Institute for Health and Care Excellence; MPG, Maudsley Prescribing Guidelines; QTc, corrected Q-T interval; RANZCP, Royal Australian and New Zealand College of Psychiatrists; TMAP, Texas Medication Algorithm Project; WFSBP, World Federation of Societies of Biological Psychiatry.