Gradual Risperdal Withdrawal (risperidone)
As with all other psychoactive medications, gradual cessation of this medication is the FDA-recommended approach.1 In most cases, it has been found necessary for the safety of the patient to taper antipsychotic medications very slowly and always under careful medical observation. In addition, a number of research papers including a case study published in the Pharmacological Bulletin in 2019 reported the latent onset of akathisia and rebound psychosis some time after abrupt Risperdal cessation. 11,16
Medications can be tricky and can cause unpredictable reactions. So it is important to note that there are a few exceptions to this general standard rule, however.
When a patient on antipsychotic medication develops a severe or 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syndrome, organ failure, interactions with other drugs or substances, or other high-risk events, the drug must be withdrawn immediately which must be carried out in a clinical setting.18
Risperdal and Dopamine
According to Silvestri et al in their study published in the Berlin Journal of Psychopharmacology, it is believed that Risperdal has the ability to block or bind dopamine at the D2 dopamine receptors. The authors suggest that reducing dopamine availability reduces 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 subsequent upregulation is thought linked to the development of tardive dyskinesia and other drug-induced reactions. Such responses can occur on initiating or discontinuing neuroleptic medications, and sometimes these can emerge long after an antipsychotic medication was stopped. 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.13-18
Managing Risperdal Withdrawal Challenges
As the antipsychotic medication is lowered during Risperdal withdrawal, dopamine flow will begin to return. This previously restricted dopamine coming into contact with upregulated (super-sensitive) receptors may clinically present as an abrupt onset of manic or psychotic symptoms.13 As a result, the patient may become enamored with what they are now feeling. The sense of reward they may experience could be compared 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 medical guidance can make this situation very hard to manage.
It is advised that when attempting Risperdal withdrawal, one should understand early in the process, that aversion to medical guidance is a very real possibility. Have a discussion with your medical caregivers and your support team about this. And, furthermore, one is encouraged to make a pact, sometimes called a “Ulysses Contract” that they will listen to at least one person without question should they become resistant to medical guidance.19 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 go awry. While this may not work in every case, for some, especially those with a strong family alliance, this can be successful protection for the patient and can be put in place early in the process.
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.
What Risperdal (risperidone) Is Used For
There are three uses for Risperdal.1
- Autistic children age 5 to 16 for irritability
- Teens aged 13-16 and adults with schizophrenia
- Adults and children aged 10 and older for manic or mixed episodes of Bipolar 1 disorder, excluding elderly dementia patients.
In September 2011 the government issued a review on what had become known as off-label uses for atypical antipsychotic medications, including OCD, ADHD, social phobias, anxiety disorders, mental retardation, insomnia, eating disorders, PTSD, addiction, Tourette syndrome, and others. The board concluded that none of these off-label uses were justified nor were they effective.21
Off-label uses for drugs can arise without clinical trials, or as a result of drug advertising claims to popularize uses that were not backed up by bonafide research or safety trials. As one example, 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 Risperdal 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 dementia patient’s risk of death. Lawsuit claims resulted in fines of over $2.5 billion that J&J was forced to pay for their overreaching claims attributed to Risperdal. Even the sales of legal painkillers led to J&J lawsuits based on similar “sales over science” marketing techniques. Despite government advisory board disapproval, it appears the practice has remained systemic in the pharmaceutical industry.7
Risperdal Side Effects (risperidone)
Pre-sales trials for Risperdal oral tablets were 4 to 8 weeks long. Long-term (1-2 year) follow-ups are mentioned on the label, but no details are provided beyond a statement that schizophrenic participants experienced longer times between relapses compared to the participants who received a “comparative activator,” which is not identified.1
A “black box” warning is placed on Risperdal packaging against prescribing to elderly patients with dementia due to the risk of death, stroke, and other cerebrovascular adverse reactions. NAMI reports side effects for women to include loss of period, and for males, loss of sexual function.23
Many thousands of lawsuits are pending for Risperdal causing male breast enlargement.23
Additional FDA-issued warnings include these:
- Tardive dyskinesia, typically an irreversible loss of motor control, is characterized by distorted repeating muscle movements or fixed twisted postures, drooling, rolling tongue motions, facial spasms, grimaces, etc.
- Loss of consciousness
- Syncope – a brief loss of consciousness due to a drop in blood pressure
- Convulsions
- Tremors, shakiness, stiffness
- 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 a 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 energy collection from food ingested
- Leucopenia, low white cell count
- Seizures
- Cognitive impairment
- Dysphagia, difficult or painful to swallow
- Priapism, a 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
- Tachycardia, racing heartbeat
- Asthenia, abnormal weakness in the muscles, over the entire body
The following are more common side effects of Risperdal: 1,22,23
- Respiratory infection
- Back pain, pain in joints and extremities, neck pain, myalgia (pain in groups of muscles)
- Upper abdominal pain
- Mood swings
- Drooling, difficulty swallowing;
- Sedation
- Drowsiness, fatigue, lethargy
- Dizziness, vertigo
- Urinary incontinence
- Fever
- Nausea, vomiting
- Insomnia
- Weight gain
- Increased appetite
- Restlessness
- Headache
- Dry mouth
- Constipation
- Stomach pain
- Rash
- Runny nose
- Cough
- Sore throat
- Sensitivity to cold or heat
- Anxiety
- Nasal congestion
- Excess salivation (drooling)
- Increased irritability
- Tinnitus, ringing in the ears, ear pain
- Loss of libido, loss of menstrual periods
- Tongue spasm
- Toothache
- Abscesses
- Blurred vision
- Diarrhea
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) 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©