Private, confidential help is available

Call Now

Risperdal Withdrawal Symptoms, Risperidone Side Effects, Treatment Help

What Risperdal (risperidone) withdrawal feels like, how long it lasts, its side effects, and how to come off it safely with medical support.
  • Fact checked
  • Medically Reviewed
Mother comforting her upset son on the sofa

Table of Contents

Prefer to speak with someone?

Admissions can answer your questions privately.

Call admissions

1 (888) 907-7075

Alternative to Meds Editorial Team
Medically Reviewed by Dr John Motl MD

Risperdal withdrawal at a glance

Don’t stop Risperdal suddenly. The FDA recommends stopping gradually.

Common symptoms
Rebound psychosis, akathisia, anxiety, agitation, insomnia, nausea, headache, fatigue
In your system
Metabolites detectable 1–4 days, but brain receptors can take much longer to readjust
Approved uses
Schizophrenia, bipolar I mania, irritability in autism
Our approach
Individualized, never one-size-fits-all
Pace
As slow as you need, adjusted as you respond
Dosing
Each step planned and monitored by our medical team
Program length
About 60 days on average
Withdrawal symptomsHow long it lastsSide effectsGet help
Table of contents (11)

Risperdal (risperidone) withdrawal symptoms

Risperdal (risperidone) withdrawal is the set of physical and mental symptoms that can appear when this antipsychotic is lowered or stopped. They are most likely when it is stopped suddenly. The most common are a return or worsening of psychosis, inner restlessness (akathisia), anxiety and agitation, sleep problems, nausea, headache, and fatigue.

Risperidone withdrawal symptoms can include:

  • Rebound psychosis. Psychotic symptoms that come back stronger, called supersensitivity rebound psychosis.13
  • Hallucinations and catatonia. Seeing or hearing things, illusions, or becoming frozen and unresponsive.17
  • Anxiety, agitation, and restlessness.14,16
  • Akathisia. A relentless inner unease that drives pacing, rocking, or marching in place.11,12,16
  • Sleep changes. Insomnia, or sleeping unusually long or deeply.14,16
  • Nausea and vomiting.14
  • Headache17 and fatigue.16
  • Tingling or prickling skin (paresthesia).16
  • Cholinergic symptoms. Cramps, diarrhea, muscle weakness, blurred vision, excess saliva, and in severe cases paralysis.15
  • Movement problems. Dystonia (muscle spasms or twisted postures)16 and parkinsonism (stiff muscles, slow movement, shuffling walk).17

Coming off an atypical antipsychotic can go badly if it isn’t done carefully and slowly. Doctors are typically not trained in antipsychotic tapering, so if your prescriber is unsure how to guide you, it is reasonable to get a second opinion from someone with this expertise. Read more about Risperdal tapering.

Worried about Risperdal withdrawal? Talk to our team about an individualized, supervised taper and what a stay looks like.

Call (888) 907-7075Free, confidential consultation

How we help with antipsychotic withdrawal →Verify your insurance →

How long does risperidone withdrawal last?

There is no single timeline, and the drug leaving your body is only part of the story.

  • In your system: Risperdal metabolites can be detected for one to four days.9
  • In your brain: withdrawal is driven largely by dopamine receptors that adapted to the drug. Returning to their pre-medication state can take weeks, months, or even years.9
  • Delayed symptoms: akathisia and rebound psychosis have appeared some time after Risperdal was stopped,11,16 and some drug-induced reactions emerge long after an antipsychotic is discontinued.13-18

How long it takes depends on how long you took Risperdal, other medications, general health, genetics, metabolism, and even diet. This is why a good taper is paced to the person, not to a calendar.

Is it dangerous to stop risperidone suddenly?

It can be. As with other psychoactive drugs, the FDA recommends stopping Risperdal gradually.1 In most cases, antipsychotics need to be tapered very slowly and under careful medical observation. Case reports, including one published in Psychopharmacology Bulletin in 2019, describe akathisia and rebound psychosis appearing some time after Risperdal was stopped abruptly.11,16

There is one important exception. If a severe or life-threatening reaction develops, such as tardive dyskinesia, neuroleptic malignant syndrome (NMS), Stevens-Johnson syndrome, organ failure, or a dangerous drug interaction, the drug must be withdrawn immediately, in a clinical setting.18

Why Risperdal withdrawal happens

Risperdal is believed to block dopamine at the brain’s D2 receptors, which reduces manic symptoms. A PET study by Silvestri and colleagues found the brain pushes back: in response to the blocked dopamine, it increases D2 receptor binding.9

This “upregulation” is thought to be linked to tardive dyskinesia and other drug-induced reactions, both when starting and when stopping antipsychotics. It is likely a central part of Risperdal withdrawal. For some people, antipsychotic withdrawal is harder than withdrawal from any other drug class, including benzodiazepines and even opiates such as heroin.13-18

Coming off Risperdal safely

As the dose comes down, dopamine starts flowing again into receptors that have become extra sensitive. This can show up as a sudden onset of manic or psychotic symptoms.13 Some people feel an intense rush of reward, which can make them resist slowing the taper or restabilizing, even when they need to.

That is why a safe taper is planned ahead of time and supervised, never improvised. At ATMC that means:

  • Built around you. Your plan reflects your dose, how long you’ve taken Risperdal, your other medications, and your history.
  • Adjusted as you respond. We watch closely and adjust the pace. Slower is always an option.
  • Precise doses. Our medical team plans each dose step, using half tablets or liquid preparations as needed, so each step is the right size.
  • Brain chemistry support. Nutrient therapy and neurotransmitter support help each step feel more tolerable.
  • Clinical team on site. If rebound symptoms appear, help is right there, not a phone call away.

Stimulants matter too. Caffeine should be restricted during Risperdal withdrawal, and stimulating drugs such as Wellbutrin, Effexor, and other SNRIs may pose challenges. If you are working with an outpatient doctor, review every medication you take with them.

Looking for alternatives to Risperdal? Learn about natural, non-drug options and what to discuss with your doctor.

Explore risperidone alternatives

Helping a loved one come off Risperdal

Antipsychotics are often taken by a son, daughter, or partner, and family is usually the first to notice when withdrawal goes wrong. A few things help:

  • Plan before the first reduction. Talk openly with the care team about the possibility that your loved one may resist guidance if mania or rebound symptoms appear.
  • Consider a “Ulysses contract.” This is a signed agreement, made while well, to follow one trusted person’s direction if their own judgment slips.19 It doesn’t work in every case, but with a strong family alliance it can be real protection.
  • Have a safety net. Work with a doctor or center that has hospital admitting privileges, so restabilization, if needed, can happen humanely and the taper can resume safely later.
  • Know the warning signs. Pacing or inner restlessness, sleep changes, and returning psychotic symptoms are reasons to call the prescriber.

Calling for a family member? We’ll explain how a supervised Risperdal taper works and how families are involved.

Call (888) 907-7075Free, confidential consultation

Our antipsychotic withdrawal program →

Tapering Risperdal at home vs. at ATMC

At home At ATMC
Taper plan Often a fixed schedule Individualized and adjusted as you respond
Dosing You work out each dose change yourself Precise doses, such as liquid preparations
Rebound psychosis or mania Family manages it alone Clinical team on site adjusts the plan
Akathisia and restlessness Hard to tell from relapse Watched closely and the pace adjusted
Brain chemistry Not addressed Nutrient therapy and neurotransmitter support
Underlying causes Not addressed Diet, toxins, and counseling addressed
See where you’d stayTour our Sedona residence →Hear from clientsReal recovery stories →

Risperdal side effects

Risperdal carries a “black box” warning against use in elderly patients with dementia because of the risk of death, stroke, and other cerebrovascular reactions. NAMI lists loss of periods in women and loss of sexual function in men among its side effects.23 Many thousands of lawsuits are pending over Risperdal causing breast enlargement in males.23

Common risperidone side effects include:1,22,23

  • Energy and mood: drowsiness, sedation, fatigue, mood swings, irritability, anxiety, restlessness, insomnia.
  • Body and metabolism: weight gain, increased appetite, fever, sensitivity to heat or cold.
  • Digestion: nausea, vomiting, constipation, diarrhea, stomach and upper abdominal pain, dry mouth, drooling, difficulty swallowing.
  • Pain: headache, back, joint, neck, and muscle pain, toothache.
  • Respiratory: respiratory infection, runny or stuffy nose, cough, sore throat.
  • Other: dizziness, vertigo, blurred vision, ringing in the ears, rash, abscesses, urinary incontinence, tongue spasm, loss of libido, loss of periods.

Serious FDA warnings include: tardive dyskinesia (often irreversible repetitive movements of the face, tongue, and body), neuroleptic malignant syndrome (a potentially fatal reaction with fever and rigid muscles), seizures, fainting, sudden drops in blood pressure on standing, heart problems and racing heartbeat, high blood sugar and diabetes, high prolactin with male breast growth, low white and red blood cell counts, pneumonia, cognitive impairment, painful swallowing, priapism, parkinsonism, dystonia, and akathisia, which has sometimes led to suicide.

This is not a complete list. If you notice side effects, see your doctor without delay.

What Risperdal is used for

The FDA approves Risperdal for three uses:1

  • Irritability in autistic children aged 5 to 16
  • Schizophrenia in teens aged 13 to 16 and adults
  • Manic or mixed episodes of bipolar I disorder in adults and children 10 and older (not elderly dementia patients)

A September 2011 government review of off-label uses of atypical antipsychotics, including anxiety, ADHD, insomnia, PTSD, eating disorders, and addiction, concluded that none of these uses were justified or effective.21 Johnson & Johnson and its subsidiary Janssen were sued across 36 states for promoting Risperdal for anger and anxiety, and paid over $2.5 billion in fines over marketing claims, including promotion for dementia.7 Pre-approval trials of Risperdal tablets lasted only 4 to 8 weeks.1


Other names: risperidone is sold as Risperdal, Risperdal Consta (long-acting), Risperdal M-Tab, Risperdal Quicklets, and Risperlet. It has no known street names.

Risperdal withdrawal treatment at Alternative to Meds Center

Antipsychotics are usually prescribed in a crisis. That crisis may have had overlooked contributors, such as drug use, poor diet, toxic exposure, poor sleep, or genetics. If these are never addressed, the diagnosis and treatment may not fit. Our program looks for and treats these root causes while you taper.

Alternative to Meds Center has specialized in antipsychotic withdrawal for nearly 20 years, and our results are documented in published evidence.

ATMC client outcomes after Risperdal withdrawal


What a stay in Sedona includes:

  • An individualized taper with precise dosing, paced as you respond, and our clinical team on site.
  • Nutrient therapy and neurotransmitter support, including orthomolecular diet correction.
  • Gentle neurotoxin testing and removal with nebulized glutathione, sauna, bentonite clay, food-grade supplements, and a clean diet. Removing toxic heavy metals has been documented as helpful for many conditions in adults.6 Some studies have found chelation beneficial in some cases of childhood autism.5
  • Counseling and comfort therapies, including CBT, equine-assisted therapy, and Qi Gong, in our residential facility among Sedona’s red rocks.

Our program lasts about 60 days on average. Learn more about our antipsychotic program and how we treat medication withdrawal.


A client’s story: this young man was in and out of psychiatric wards and diagnosed with schizophrenia. His problems turned out to be largely food allergies, nutrient depletion, and recreational drug-induced psychosis. After our program he became medication-free and is now an author and international speaker.

Talk to our admissions team. Ask about an individualized Risperdal taper, what a stay looks like, and insurance.

Call (888) 907-7075Free, confidential consultation

Prefer to write? Contact admissions online →

Watch: do your symptoms require Risperdal?

Risperdal (risperidone) FAQs

Can I stop Risperdal on my own?
Stopping Risperdal on your own, especially suddenly, is not recommended. The FDA advises a gradual taper,1 and abrupt stops have been followed by akathisia and rebound psychosis.11,16 Withdrawal can also bring mania that makes it hard to judge your own progress. Work with a prescriber experienced in antipsychotic tapering, or call us to talk through a supervised, individualized plan.
What happens if you stop taking risperidone?
(A common question in Spanish too: “¿Qué pasa si dejo de tomar risperidona?”) Stopping can cause rebound psychosis, akathisia, anxiety and agitation, insomnia, nausea, headache, and movement problems.13,14,16,17 These are most likely after a sudden stop, and some can appear a while after the last dose.11,16 A slow, supervised taper lowers the risk.
How long does Risperdal stay in your system?
Risperdal metabolites can be detected for one to four days. But withdrawal has more to do with dopamine receptors that adapted to the drug, and those can take weeks, months, or longer to readjust.9
What does Risperdal do to the brain?
Exactly how antipsychotics work is not fully known. Risperdal is thought to restrict dopamine and other brain chemicals, which dampens emotions, energy, and the ability to feel reward or pleasure. People taking it often become quieter, less active, sleep more, and show cognitive impairment. That may help in a crisis but may not be tenable for life.
Does Risperdal make you sleepy?
Yes. In clinical trials a significant percentage of patients of all ages had marked drowsiness. The FDA warns against driving or operating machinery while taking Risperdal.1
Can Risperdal be used to treat anxiety?
Treating anxiety with Risperdal is not FDA-approved. One pharmaceutical company-funded review found atypical antipsychotics only slightly more effective than placebo for anxiety and mood disorders.24 Most other studies reported more adverse effects and questionable results, and called for caution.25-27 About 16,900 lawsuits have been pending against Risperdal’s makers over adverse effects.28
Can Risperdal cause aggression?
In a trial of adults with aggression after brain injury, people given placebo did better than those given risperidone.29 A Cochrane review by Ostinelli and colleagues found aggressive or irritable behavior worsened after a short time on Risperdal.30 The trials behind its approval for irritability in autistic children lasted only 4 to 8 weeks,1 and some physicians worry that nutrition, education, and counseling aren’t tried first.2 As child psychiatrist Dr. Laura Prager put it, “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
Does Risperdal help with ADHD?
Using Risperdal for ADHD is off-label. No studies were found comparing it with non-drug therapy. Correcting deficiencies such as vitamin D and omega-3 fatty acids has been reported to improve mood and cognition.8,10 A review by Auclair and colleagues found CBT significantly reduced adult ADHD symptoms without drug side effects.31

Sources:

1. Risperdal Oral Tablets drug label FDA approval 1993 [cited 2021 May 10]

2. Miller C “What Parents Should Know About Risperdal” Child Mind Institute [N.D.] [cited 2020 Dec 7]

3. Institute authors, “Disruptive Behavior: Why It’s Often Misdiagnosed” Child Mind Institute online N.D. [cited 2020 Dec 7]

4. APA authors Supplement to Diagnostic and Statistical Manual of Mental Disorders, Fifth ed., 2017 Oct [cited 2020 Dec 7]

5. Parr J. Autism. BMJ Clin Evid. 2010 Jan 7;2010:0322. PMID: 21729335; PMCID: PMC2907623.[cited 2022 Sept 14]

6. Singh R, Gautam N, Mishra A, Gupta R “Heavy metals and living systems: An overview” Indian Journal of Pharmacology, 2011 May-Jun PMID 21713081 [cited 2020 Dec 7]

7. Hodkinson A, Heneghan C, Mahtani KR, Kontopantelis E, Panagioti M. Benefits and harms of Risperidone and Paliperidone for treatment of patients with schizophrenia or bipolar disorder: a meta-analysis involving individual participant data and clinical study reports. BMC Med. 2021 Aug 25;19(1):195. doi: 10.1186/s12916-021-02062-w. PMID: 34429113; PMCID: PMC8386072. [cited 2022 Sept 14]

8. Gadow KD, Arnold LE, Molina BS, Findling RL, Bukstein OG, Brown NV, McNamara NK, Rundberg-Rivera EV, Li X, Kipp HL, Schneider J, Farmer CA, Baker JL, Sprafkin J, Rice RR Jr, Bangalore SS, Butter EM, Buchan-Page KA, Hurt EA, Austin AB, Grondhuis SN, Aman MG. Risperidone added to parent training and stimulant medication: effects on attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and peer aggression. J Am Acad Child Adolesc Psychiatry. 2014 Sep;53(9):948-959.e1. doi: 10.1016/j.jaac.2014.05.008. Epub 2014 Jun 12. PMID: 25151418; PMCID: PMC4145805. [cited 2021 Jan 10]

9. Silvestri S, Seeman MV, Negrete JC, Houle S, Shammi CM, Remington GJ, Kapur S, Zipursky RB, Wilson AA, Christensen BK, Seeman P. ” Increased dopamine D2 receptor binding after long-term treatment with antipsychotics in humans: a clinical PET study.” Psychopharmacology (Berl). 2000 Oct;152(2):174-80. doi: 10.1007/s002130000532. PMID: 11057521.[cited 2020 Dec 7]

10. Young G, Conquer J. Omega-3 fatty acids and neuropsychiatric disorders. Reprod Nutr Dev. 2005 Jan-Feb;45(1):1-28. doi: 10.1051/rnd:2005001. PMID: 15865053. [cited 2021 Jan 10]

11. Soundarrajan G, Chogtu B, Krishna V, Kamath G A, Murugesan M. Akathisia Induced by Abrupt Withdrawal of Risperidone: A Case Report. Psychopharmacol Bull. 2019 Feb 15;49(1):80-83. PMID: 30858641; PMCID: PMC6386429. [cited 2023 July 27]

12. Bertolín Guillén JM, Martínez Franco L, Juni Anahuja J. Acatisia por retirada de risperidona: dos observaciones clínicas [Akathisia due to risperidone withdrawal: two clinical cases]. Actas Esp Psiquiatr. 2002 May-Jun;30(3):195-7. Spanish. PMID: 12106521. [cited 2021 May 6]

13. Chouinard G, Chouinard VA. Atypical antipsychotics: CATIE study, drug-induced movement disorder and resulting iatrogenic psychiatric-like symptoms, supersensitivity rebound psychosis and withdrawal discontinuation syndromes. Psychother Psychosom. 2008;77(2):69-77. doi: 10.1159/000112883. Epub 2008 Jan 25. PMID: 18230939. [cited 2021 May 6]

14. Borison RL. Changing antipsychotic medication: guidelines on the transition to treatment with risperidone. The Consensus Study Group on Risperidone Dosing. Clin Ther. 1996 Jul-Aug;18(4):592-607; discussion 591. doi: 10.1016/s0149-2918(96)80211-6. PMID: 8879889.[cited 2021 May 6]

15. Adeyinka A, Kondamudi NP. Cholinergic Crisis. [Updated 2021 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK482433/ [cited 2021 May 6]

16. Keks N, Schwartz D, Hope J. Stopping and switching antipsychotic drugs. Aust Prescr. 2019;42(5):152-157. doi:10.18773/austprescr.2019.052 [cited 2021 May 6]

17. Shin HW, Chung SJ. Drug-induced parkinsonism. J Clin Neurol. 2012;8(1):15-21. doi:10.3988/jcn.2012.8.1.15 [cited 2021 May 10]

18. Desarkar P, Nizamie SH. Risperidone-induced erythema multiforme minor. Br J Clin Pharmacol. 2006;62(4):504-505. doi:10.1111/j.1365-2125.2006.02708.x [cited 2021 May 10]

19. Standing H, Lawlor R. Ulysses Contracts in psychiatric care: helping patients to protect themselves from spiralling. J Med Ethics. 2019 Nov;45(11):693-699. doi: 10.1136/medethics-2019-105511. Epub 2019 Sep 4. PMID: 31484783. [cited 2021 May 10]

20. Maher AR, Theodore G. Summary of the comparative effectiveness review on off-label use of atypical antipsychotics. J Manag Care Pharm. 2012 Jun;18(5 Suppl B):S1-20. doi: 10.18553/jmcp.2012.18.s5-b.1. PMID: 22784311. [cited 2021 May 10]

21. Effective Healthcare Bulletin “Off-Label Use of Atypical Antipsychotics : An Update.” [online] Sept 2011 [cited 2021 May 10]

22. Alladi CG, Mohan A, Shewade DG, Rajkumar RP, Adithan S, Subramanian K. Risperidone-Induced Adverse Drug Reactions and Role of DRD2 (-141 C Ins/Del) and 5HTR2C (-759 C>T) Genetic Polymorphisms in Patients with Schizophrenia. J Pharmacol Pharmacother. 2017;8(1):28-32. doi:10.4103/jpp.JPP_197_16 [cited 2021 May 10]

23. NAMI, “Risperidone (Risperdal) fact sheet” [cited 2021 May 10]

24. Gao K, Sheehan DV, Calabrese JR. Atypical antipsychotics in primary generalized anxiety disorder or comorbid with mood disorders. Expert Rev Neurother. 2009;9(8):1147-1158. doi:10.1586/ern.09.37 [cited 2021 May 11]

25. Lorenz RA, Jackson CW, Saitz M. Adjunctive use of atypical antipsychotics for treatment-resistant generalized anxiety disorder. Pharmacotherapy. 2010 Sep;30(9):942-51. doi: 10.1592/phco.30.9.942. PMID: 20795849. [cited 2021 May 11]

26. Maglione M, Maher AR, Hu J, Wang Z, Shanman R, Shekelle PG, Roth B, Hilton L, Suttorp MJ, Ewing BA, Motala A, Perry T. Off-Label Use of Atypical Antipsychotics: An Update [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Sep. Report No.: 11-EHC087-EF. PMID: 22132426. [cited 2021 May 11]

27. McDonagh M, Peterson K, Carson S, Fu R, Thakurta S. Drug Class Review: Atypical Antipsychotic Drugs: Final Update 3 Report [Internet]. Portland (OR): Oregon Health & Science University; 2010 Jul. PMID: 21348048. [cited 2021 May 11]

28. Drugwatch, “Risperdal lawsuit 2021 update.” [May 2017} [cited 2021 May 11]

29. Deb S, Aimola L, Leeson V, et al. Risperidone versus placebo for aggression following traumatic brain injury: a feasibility randomised controlled trial. BMJ Open 2020;10:e036300. doi:10.1136/bmjopen-2019-036300 [cited 2021 May 11]

30. Ostinelli EG, Hussein M, Ahmed U, Rehman F, Miramontes K, Adams CE. Risperidone for psychosis-induced aggression or agitation (rapid tranquillisation). Cochrane Database of Systematic Reviews 2018, Issue 4. Art. No.:CD009412.DOI:10.1002/14651858.CD009412.pub2 [cited 2021 May 11]

31. Auclair V, Harvey PO, Lepage M. La thérapie cognitive-comportementale dans le traitement du TDAH chez l’adulte [Cognitive Behavioral Therapy and the Treatment of ADHD in Adults]. Sante Ment Que. 2016 Spring;41(1):291-311. French. PMID: 27570962. [cited 2021 May 11]

Originally Published Sep 13, 2018 by Diane Ridaeus


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.

Social Profile: LinkedIn

View Bio

Medical disclaimer

This article is for educational purposes only and does not provide medical advice, diagnosis, or treatment. Never start, stop, or change a prescription medication without consulting a qualified healthcare professional who understands your medical history. If you are experiencing an immediate medical or safety emergency, call 911.