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Risperdal (Risperidone) Side Effects, Withdrawal and FAQs

Risperdal (risperidone) is an antipsychotic medication used to treat children age 5-16 diagnosed with autism with irritability, and is prescribed to patients age 13 and up for schizophrenia, and adults and children age 10 & up suffering acute manic or mixed episodes of Bipolar disorders.

This potent medication should not be used in elderly patients with signs of dementia as Risperdal has been shown to increase mortality rates in this population.

The FDA approval for use in children as young as 5 years of age was preceded by very short-term (4 week to 12 week) trials.  Again, caution is always prudent as stated in FDA Risperdal labeling information. (1)

There are a host of known side-effects and warnings concerning Risperdal (risperidone)  issued by the FDA that apply to every age group and these topics and other frequently requested information are further described below.

What Risperdal (Risperidone) is Used For

There are three FDA approved uses for Risperdal, and other uses that have become common in the off-label context.

  • Autistic children age 5 to 16 for irritability
  • Teens age 13-16 and adults for schizophrenia
  • Adults and children age 10 and older for manic or mixed episodes of Bipolar 1 disorder, excluding elderly dementia patients

Over time, off label uses have come to include:

  • OCD, obsessive compulsive personality disorder
  • ADHD
  • Social phobia, other anxiety related disorders
  • Depression
  • GAD
  • Mental retardation
  • Insomnia
  • Eating disorders
  • Schizotypal personality disorder
  • Borderline personality disorder
  • PTSD
  • Addiction
  • Tourette syndrome

Please be advised that no bonafide studies have been completed that show any efficacy using Risperdal for such disorders.

Quite to the contrary, in 2012 and again in 2013 the makers of Risperdal, Johnson & Johnson and a subsidiary, Janssen Pharmaceuticals, were sued across 36 states for misleading claims promoting that the drug was effective for the treatment of anger-management, and anxiety.

Other cases brought against the drug makers were settled after the company promoted Risperdal as effective in the treatment of dementia, a practice that is now banned by the FDA due to the patient’s risk of death.

Lawsuit claims resulted in fines of over $2.5 billion that J&J were forced to pay for their over-reaching claims attributed to Risperdal.

More can be learned about certain “sales over science” marketing techniques by researching published research articles on this topic. (7)

Risperdal (Risperidone) Alternative Names and Slang

Risperdal has not developed a reputation as a street drug, though because of its psychoactive effects, this can not be ruled out completely. No street names are known at this time.

There are several brand names for the generic drug, including:

  • Risperdal Consta (time release)
  • Risperdal M-Tab
  • Risperdal Quicklets
  • Risperlet


Risperdal (Risperidone) Side Effects

Long term use of Risperdal has not been studied, i.e. for longer than 4-8 weeks, which was the length of the pre-marketing trials for the drug.

Some of the most common side effects of Risperdal include:

  • Somnolence
  • Sedation
  • Blurred vision
  • Diarrhea
  • Respiratory infection
  • Mood swings
  • Difficulty swallowing
  • Drowsiness, fatigue
  • Dizziness
  • Fever
  • Nausea
  • Weight gain
  • Increased appetite
  • Restlessness
  • Headache
  • Dry mouth
  • Constipation
  • Stomach pain
  • Rash
  • Runny nose
  • Cough
  • Sore throat
  • Sensitivity to cold or heat
  • Anxiety
  • Arthralgia, pain in joint or joints
  • Nasal congestion
  • Excess salivation (drooling)
  • Lethargy
  • Increased irritability
  • Ear pain
  • Tinnitus, ringing in the ears
  • Myalgia, pain in a grouping of muscles
  • Neck pain
  • Loss of libido
  • Vertigo
  • Tongue spasm
  • Toothache
  • Abscesses

Some less common but more severe effects include:

  • Tardive dyskenisia, typically irreversible loss of motor control, characterized by distorted repeating muscle movements or fixed twisted postures, drooling, rolling tongue motions, facial spasms, grimaces, etc.
  • Loss of consciousness
  • Syncope, brief loss of consciousness due to drop in blood pressure
  • Convulsions
  • Risk of cerebrovascular adverse reactions, i.e., stroke, potentially fatal in elderly patients
  • Cardiac disorders
  • Anemia, low red blood cell count
  • Pneumonia
  • NMS, neuroleptic malignant syndrome: potentially fatal reaction to drugs characterized by sudden fever, rigid muscles, mental impairment, cardiac arrest, coma, etc.
  • Orthostatic hypotension, sudden lowered blood pressure especially after rising from sitting or laying position
  • Hyperglycemia, high blood sugar
  • Extrapyramidal effects, i.e., jerking or spasmodic muscle movements involving the eyes, limbs, hands, feet, facial muscles
  • Hyperprolactinemia, breast growth in male patients
  • Diabetes mellitus, a form of diabetes that prevents collecting energy from food ingested
  • Leucopenia, low white cell count
  • Seizures
  • Cognitive impairment
  • Dysphagia, difficult or painful to swallow
  • Priaprism, condition of persistent and painful penile erection
  • Parkinsonism, drug induced symptoms resembling Parkinson’s disease, i.e., shuffling walk, slowed motor control, rigid stiff muscles.
  • Akathisia, repetitive compulsive involuntary movements, accompanied by extreme internal unease, sometimes leads to suicide to get relief.
  • Dystonia, twisting and fixed abnormal postures in a muscle or group of muscles, or repetitive involuntary distorted and sometimes painful motions of certain muscles, caused by drugs or toxicity.
  • Tremors, shakiness
  • Tachycardia, racing heart beat
  • Asthenia, abnormal weakness in the muscles, over the entire body.

This is not an all-inclusive list. If you notice discomforts see your doctor without delay, so that medical attention can be given in time to avert any potential health crisis.

Risperdal (Risperidone) Withdrawal Symptoms

Risperdal (risperidone) is recommended to be tapered down gradually over sudden cessation, unless the latter is needed to avert death due to allergic or other severe reaction.

The most commonly reported withdrawal symptoms include:

  • Nausea
  • Dizziness
  • Sedation
  • Somnolence, sleeping for inordinately long periods or unusually deep sleep
  • Vomiting

Other withdrawal symptoms included these more severe ones:

  • Akathisia, a motor movement disorder that causes relentless internal unease, characterized by repetitive marching, rocking, pacing, or other compulsive motions
  • Dystonia, spasms or distorted muscle postures caused by drug therapy
  • Abdominal pain
  • Parkinsonism, looks like Parkinson’s disease, but is drug induced, rigid muscles, slow movements, shuffling walk, etc.
  • Lethargy
  • Agitation

Coming off an atypical antipsychotic drug can be difficult. Seek medical guidance and consult with your prescribing physician to help navigate through the process.

If your prescribing physician is unwilling to help or simply unable guide you because of unfamiliarity with the problem, it is always a good idea to seek a second opinion. It is not at all unusual to meet with such resistance, because physicians are typically not trained during their schooling in drug tapering. Realize the problem needs expertise for your best way forward.

Discontinuing/Quitting Risperdal (Risperidone)

As with all other psychoactive medications, the gradual cessation of this medication is the safer approach. There are a few exceptions to this general standard rule, however.

When a patient develops a life-threatening adverse reaction such as tardive dyskenisia, NMS, Stevens – Johnson syndrome, organ failure, interactions with other drugs or substances, or other high risk events, the drug must be withdrawn immediately in a clinical setting, to save the life of the patient.

It is believed that Risperdal has the ability to block dopamine at the D2 dopamine receptor and by reducing dopamine availability, reduce manic symptoms. Most psychiatric medications are limited due to the neuroadaptation of the synapse. The synapse, in response to a perceived dopamine deficiency, can then increase the receptors binding power to dopamine. (9)

This increased D2 dopamine binding and upregulation is a potential mechanism for the development of tardive dyskenisia. This receptor upregulation is most likely a central component in the manifestations of antipsychotic medication withdrawal. For some, antipsychotic withdrawal can be extremely challenging, more so than any of the drug classes including benzodiazepines and even opiates such as heroin.

As the antipsychotic medication is lowered, dopamine flow will begin to return. This previously restricted dopamine coming into contact with upregulated receptors may clinically present as an abrupt onset of manic or psychotic symptomatology. It is common for the patient to become enamored with what they are feeling. The sense of reward they may experience could be likened to winning the lottery, In other words, it can be extreme. This newfound reward could leave them resistant to either increasing the medication to assist in regaining stability, or slowing down the medication taper. This aversion to proper guidance can make this situation very hard to manage.

It is advised that when attempting an antipsychotic medication withdrawal, that it is made clear early in the process, that this is a possibility; and, furthermore, that the individual be encouraged to make a pact that they will listen to at least one person without question. If they sign something saying that they will take this trusted person’s direction in the event that their own judgment cannot be trusted, it can be something that can be presented to them if things start to run awry. Obviously this will not work for everyone in this situation, but for some, especially those with a strong family alliance, this can be a successful agreement.

Another form of preemptive strategy is to enlist a doctor or center that has hospital admission privileges. Should things get to the point where restabilization is necessary, a doctor that has the ability to admit the patient to the hospital can help things go in a humanistic way so that future reduction efforts may be entertained.

It should also be noted that there should be a strictly adhered to restriction of stimulants such as coffee and other forms of caffeine, etc., during this time. Even medications like Wellbutrin, Effexor, and SNRI’s may pose challenges during an antipsychotic medication withdrawal, and having a conversation with your doctor about this potential would be advisable.

Risperdal (Risperidone) FAQs

Below is a collection of information about Risperdal and how it works, what it is and is not FDA approved for, and many other topics of interest on this atypical antipsychotic medication.

It is high recommended to thoroughly research a drug before starting or stopping it so your health questions can be fully addressed, and your ability to reach the best solutions to mental health issues is supported by science rather than perhaps overzealous advertising claims that may conflict with documented evidence.

What Does Risperdal (Risperidone) Do to the Brain?

An individual with a lessened capacity to find reward may be attracted to stimulants, and those with an excessive flood of reward neurochemicals may present as manic.

Risperdal may restrict the flood of reward chemicals, and in this way, dampen the manic symptoms.

How does Risperdal (Risperidone) Work?

How antipsychotics and atypical antipsychotic medications work is as yet unknown. What is theorized is that Risperdal affects certain neurotransmitters in the CNS and this influence is thought to have a corrective effect.

What can be observed clearly however, is that patients who are prescribed Risperdal become quieter, less active, sleep more, and show cognitive impairments.

Can Risperdal (Risperidone) Be Used to Treat Anxiety?

Treating anxiety with Risperdal was the cause of many legal suits against the makers of the drug for promoting the drug for anxiety. Anxiety is not an FDA approved use for Risperdal.

Can Risperdal (Risperidone) Cause Aggression or Aggressive Behaviors?

The studies that were done on Risperdal before it was approved for the treatment of very young children with autism showing irritable behavior were extremely short, i.e., 4 week and 8 week trials.

Equally concerning is the fact that no trials were found that showed safety or efficacy results for off-label use of Risperdal on non-autistic young children for ADHD or other behavioral reasons, yet this has become a common practice. There has been concern that other treatments for behavioral issues in young autistic and off-label use on non-autistic children have not been explored before resorting to a medication-as-treatment approach. (2)

Emotional dysregulation is a term used to describe the behavior of children that goes into the “red zone”, i.e., fighting, breaking things, tantrums, etc. While it can be a source of great anguish for parents and families to have a child presenting these kinds of reactions, Dr. Laura Prager, director of the CPE (child psychiatry emergency services) at Mass general hospital, says “Kids who may not have words to express their feelings or because no-one is listening to them, might manifest their anxiety with behavioral dysregulation.” (3)

Simply medicating a young child with limited vocabulary and articulation skills may not be the best first choice. There is also evidence that such aggressive or irritable behaviors have actually worsened while the child was put on risperidone treatment.

Best practices would follow the revised 2017 recommendations given in the DSM which clearly indicate that specific criteria need to be met to properly diagnose and treat mental disorders including ruling out psycho-social stressors, such as unemployment, or school stressors, etc.)

Particularly relevant to medicating children being diagnosed with Autism, the criteria for a correct diagnosis has been significantly limited in most recent updates. (4)

Does Risperdal (Risperidone) Make you Feel Sleepy?

Yes. According to clinical trials, a significant percentage of patients no matter their age group being given Risperdal experienced drowsiness and somnolence to a marked degree. The FDA warns against driving or operating machinery or other tasks requiring alertness while taking Risperdal.

Does Risperdal (Risperidone) Help with ADHD?

Risperdal use for ADHD would be considered an off-label (not FDA approved) use. One study was done by 2 physicians that compared 2 groups of aggressive ADHD children. The first group was given parental coaching and a stimulant or placebo, and the second group was given the same protocols, but after 2 weeks, one third of these children were also put on Risperdal.

The study showed that the kids taking both the stimulant drug and Risperdal showed less aggression, not unexpectedly, as the drug causes fatigue, lethargy and slowed motor response, as in Parkinsonism.

Parents in the trials were mostly enthusiastic about the parental coaching they received. (8)

How Long Does Risperdal (Risperidone) Stay in Your System?

After taking Risperdal, the metabolites can be detected for a period of time that ranges between one and four days. This metabolite clearance time may have very little to do with withdrawal manifestations. There is likelihood that receptors have upregulated themselves in response to the drug. (10)

The length of time that it may take for the receptors to return to pre-medicated states may be indefinite, lasting for weeks to months and even to years. The time span for this upregulated dopamine transport system to then downregulate will largely depend on the duration of Risperdal or other antipsychotic use, genetics, the effect of any other medications that may be in use, and even certain dietary considerations.

Treatment for Risperdal (Risperidone) Abuse and Addiction?

There are some studies which have found that chelation to remove heavy metals from the body have been beneficial in some cases of childhood autism, though published comprehensive studies on this subject are not easy to access. (5)

However, the chelation (removal) of toxic levels of heavy metals has been documented as helpful for many conditions in the adult population. (6)

At the Alternative to Meds Center, we offer a program designed individually to help a person taper off medications safely, with a minimum amount of discomfort, and maximum health improvements.

A thorough program has been designed to address numerous health issues that may have been overlooked, and certainly not investigated much if at all before a prescription of medication such as Risperdal. One highly effective protocol used in the program is heavy metal toxicity, which is tested for and analyzed. The offending contaminants once found are then systematically and gently removed as part of a comprehensive series of steps that aim to provide a pathway to natural mental health. Some of these steps include nebulized glutathione treatments, low-temperature sauna, bentonite clay treatments, food-grade supplements, clean diet, mild exercise, and various other adjunct therapies to improve overall health and well-being before, during and post-taper.

These are important and useful treatments for anyone who wishes to not only taper from medications safely, but to address the symptoms that led to the prescription in the first place.

Please contact us for more information on these and other treatments available at our comfortable, inpatient, retreat-styled treatment center.

This content has been reviewed and approved by a licensed physician.

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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