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
- Social phobia, other anxiety-related disorders
- Mental retardation
- Eating disorders
- Schizotypal personality disorder
- Borderline personality disorder
- Tourette syndrome
Please be advised that no bonafide studies have been completed that show 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 was 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
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:
- Blurred vision
- Respiratory infection
- Mood swings
- Difficulty swallowing
- Drowsiness, fatigue
- Weight gain
- Increased appetite
- Dry mouth
- Stomach pain
- Runny nose
- Sore throat
- Sensitivity to cold or heat
- Arthralgia, pain in joint or joints
- Nasal congestion
- Excess salivation (drooling)
- Increased irritability
- Ear pain
- Tinnitus, ringing in the ears
- Myalgia, pain in a grouping of muscles
- Neck pain
- Loss of libido
- Tongue spasm
Some less common but more severe effects include:
- Tardive dyskinesia, 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 a drop in blood pressure
- Risk of cerebrovascular adverse reactions, i.e., stroke, potentially fatal in elderly patients
- Cardiac disorders
- Anemia, low red blood cell count
- 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 lying 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
- Cognitive impairment
- Dysphagia, difficult or painful to swallow
- Priapism, 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 heartbeat
- 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 withdrawal is recommended to be done gradually rather than attempting sudden cessation unless the latter is needed to avert death due to allergic or other severe reactions.
The most commonly reported withdrawal symptoms include:
- Somnolence, sleeping for inordinately long periods or unusually deep sleep
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.
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 to 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.
Gradual Risperdal Withdrawal (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 dyskinesia, 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 receptor’s binding power to dopamine. (9)
This increased D2 dopamine binding and upregulation is a potential mechanism for the development of tardive dyskinesia. This receptor upregulation is most likely a central component in the manifestations of Risperdal 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 during Risperdal withdrawal, 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 Risperdal withdrawal, to make clear early in the process, that this is a possibility. And, furthermore, that the individual is 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 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 admitting 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 Risperdal withdrawal efforts may be safely resumed.
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 SNRIs may pose challenges during antipsychotic medication withdrawal, and having a conversation with your doctor about this potential would be advisable.