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Risperdal Withdrawal Help, Risperidone Side Effects, Symptoms, Treatment

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Last Updated on March 2, 2021 by Carol Gillette

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Alternative to Meds Editorial Team
Written by Diane Ridaeus Published Sep 13, 2018
Medically Reviewed by Dr John Motl MD

Risperdal (risperidone) withdrawal can be challenging. Professional guidance and help can be hard to find. And, you may feel it is the drug itself that is the major part of the problem.

These medications are generally prescribed in a crisis situation. A crisis may have multiple contributors that were overlooked. Drug use, toxic dietary habits, toxic exposure, poor sleep, genetic factors, are some issues that if never addressed, may have preceded an imperfect diagnosis and less than successful treatment.

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Risperdal (risperidone) Withdrawal Symptoms

Please Note: 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.1

Risperdal (risperidone) withdrawal symptoms include:

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

*Parkinsonism usually presents within a short time of starting antipsychotic medications according to Shin and Chung’s 2012 study on the subject.

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.

risperdal low dopamineIt 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.

risperdal withdrawal companionIt 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.

Risperdal (risperidone) is an antipsychotic medication used to treat autistic children age 5-16 diagnosed with irritability and is prescribed to patients age 13 and up for schizophrenia. This drug is also prescribed to treat acute mania of bipolar and similar conditions, for both adults and children from age of 10 up.

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 weeks to 12 weeks) 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 various age groups. More information can be found 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 with 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

Off-label uses for drugs can arise without clinical trials, or as a result of drug advertising claims that were not backed up by bonafide research.

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 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.

Even the sales of legal painkillers led to J&J lawsuits based on similar “sales over science” marketing techniques. It appears the practice is systemic in the pharmaceutical industry.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 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
  • 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 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
  • Seizures
  • 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) 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 highly recommended to thoroughly research a drug before starting or stopping it so your health questions can be fully addressed. Knowledge can increase your ability to reach the best solutions to mental health issues because such solutions are 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 shockingly common practice. Some Physicians and caregivers have raised concerns when non-drug-based treatments for behavioral issues in autistic or non-autistic children have not been explored before resorting to medication.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 for Prescribing Risperdal to Young Children

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 family or school stressors, etc.)

Particularly relevant to considering medicating children being diagnosed with Autism, the criteria for a correct diagnosis as well as a need for more studies on the effectiveness of nutritional therapies as part of treatment protocols should be well considered. 5, 10

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. A very short clinical trial was done comparing children already on stimulant medication for ADHD vs putting half the group on an additional daily dose of Risperdal. Parents reported a small to moderate reduction in symptoms of ODD but no reduction in symptoms of ADHD or “CD” (conduct disorder) or peer aggression. Another study found that parental training also had no effect on symptoms when added to the daily stimulant medication regimen of ADHD children. No studies could be found that actually compare drug-based therapy with non-drug therapy. However, nutritional therapy has been widely reported to be extremely successful in treating children as well as adults where deficiencies in vitamin D and omega-3 fatty acids, for example, were corrected and led to major improvements in cognitive function. 8, 10

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 a likelihood that receptors have upregulated themselves in response to the drug.9

The length of time that it may take for the receptors to return to premedicated 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. These are important things to consider when planning Risperdal withdrawal treatments.

Treatment for Risperdal (risperidone)

There are some studies that have found that chelation to remove heavy metals from the body has 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 Alternative to Meds Center, we offer a Risperdal withdrawal program that is individually designed, for 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, a clean, corrective diet, mild exercise, and various other adjunct therapies to improve overall health and well-being before, during, and post-withdrawal treatment.

Resolving Root Causes vs Masking Symptoms With Drugs

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 at Alternative to Meds Center for more information on Risperdal withdrawal and other treatments available at our comfortable, inpatient, retreat-styled treatment center.

1. Risperdal drug label FDA approval 1993 [cited 2020 Dec 7]

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 Dr “Autism” U.S. National Library of Medicine, 2010 Jan 7 PMID 21729335 [cited 2020 Dec 7]

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. Szalavitz M, “Johnson & Johnson Twisted the Truth – Here are the Facts” New York Times online, 2019 Aug 29 [cited 2020 Dec 7]

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]

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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Risperdal Withdrawal Help, Risperidone Side Effects, Symptoms, Treatment
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Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.

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