Names and pronunciation
(ris-pehr′ih-dohn) Perseris, RisperDAL, RisperDAL Consta
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Individual generic drug information
Extracted information for risperiDONE only.
(ris-pehr′ih-dohn) Perseris, RisperDAL, RisperDAL Consta
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Func. class.: Antipsychotic
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Chem. class.: Benzisoxazole derivative
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Do not confuse: RisperDAL/reserpine
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ACTION: Unknown; may be mediated through both dopamine type 2 (D2) and serotonin type 2 (5-HT2) antagonism
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USES: Irritability associated with autism, bipolar disorder, mania, schizophrenia
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Unlabeled uses: Acute psychosis, agita- tion, ADHD, dementia, psychotic depres- sion, Tourette’s syndrome
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Extracted information for risperiDONE only.
CONTRAINDICATIONS: Hyper sensitivity, breastfeeding Precautions: Pregnancy, children, geri- atric patients, cardiac/renal/hepatic dis- ease, breast cancer, Parkinson’s disease, CNS depression, brain tumor, dehydra- tion, diabetes, hematologic disease, sei- zure disorders, abrupt discontinuation, suicidal ideation, phenylketonuria
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Black Box Warning: Increased mortality in elderly patients with dementia-related psychosis
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SIDE EFFECTS CNS: EPS, pseudoparkinsonism, aka thisia, dystonia, tardive dyskinesia; drowsiness, insomnia, agitation, anxi- ety, headache, seizures, neuroleptic malignant syndrome, dizziness, suicidal ideation, head titubation (shaking) CV: Orthostatic hypotension, tachycardia, heart failure, sudden death (geriatric patients), AV block EENT: Blurred vision, tinnitus GI: Nausea, vomiting, anorexia, consti- pation, jaundice, weight gain GU: Hyperprolactinemia, gynecomastia, dysuria HEMA: Neutropenia, granulocytopenia MISC: Renal artery occlusion; hyperpro- lactinemia (child) MS: Rhabdomyolysis RESP: Rhinitis, sinusitis, upper respira- tory infection, cough
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INTERACTIONS Increase: seizures—traMADol Increase: possible death in dementia- related psychosis: furosemide Increase: sedation—other CNS depres- sants, alcohol Increase: serotonin syndrome, neurolep- tic malignant syndrome—CYP2D6 inhibi- tors (SSRIs, SNRIs) Increase: EPS—other antipsychotics Increase: risperiDONE excretion— carBAMazepine Increase: QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β-agonists, local anesthetics, tricyclics, haloperidol, methadone, chloroquine, clarithromycin, droperidol, erythromycin, pentamidine, thioridazine, ziprasidone Increase: risperiDONE levels—acetyl- cholinesterase inhibitors, CYP2D6 inhibi- tors, SSRIs, valproic acid, verapamil Decrease: risperiDONE action—CYP2D6 inducers (carBAMazepine, barbiturates, phenytoins, rifAMPin) Decrease: levodopa effect—levodopa Drug/Herb Decrease: risperiDONE effect—echinacea Drug/Lab Test Increase: prolactin levels, blood, glu- cose, lipids
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TREATMENT OF OVERDOSE: Lavage if orally ingested; provide airway; do not induce vomiting
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Extracted information for risperiDONE only.
DOSAGE AND ROUTES • Adult: PO 2 mg/day as single dose or in 2 divided doses, adjust dose at inter- vals of ≥24 hr and 1-2 mg/day as toler- ated to 4-8 mg/day; IM establish dosing with PO before IM 25 mg q2wk, may increase to max 50 mg q2wk • Adolescent: PO 0.5 mg/day in AM or PM, adjust dose at intervals of ≥24 hr and 0.5-1 mg/day as tolerated to 3 mg/day • Geriatric: PO 0.5 mg daily-bid, in- crease by 1 mg/wk; IM 25 mg q2wk Hepatic/renal dose • Adult: PO 0.5 mg bid, increase by 0.5 mg bid, increase to 1.5 mg bid at intervals ≥1 wk
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Available forms: Tabs 0.25, 0.5, 1, 2, 3, 4 mg; oral sol 1 mg/mL; orally disinte- grating tabs 0.25, 0.5, 1, 2, 3, 4 mg; long-acting inj kit (Risperdal Consta) 12.5, 25, 37.5, 50 mg
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Administer: • Reduced dose in geriatric patients • Anticholinergic agent on order from prescriber, to be used for EPS • Avoid use with CNS depressants • Conventional tabs: give without regard to meals • Oral disintegrating tab: do not open blister pack until ready to use; tear at perfo- ration; bend; peel back foil; do not push tab through foil; remove from pack and place product on patient’s tongue; tab disinte- grates in seconds and can be swallowed with/without liquids, do not split or chew • Oral sol: May dilute 3-4 oz of beverage, measure dose using calibrated pipette; not compatible with tea, cola; compatible with water, coffee, orange juice, low-fat milk IM route R • Only use diluent and needle provided • Allow to come to room temperature for 30 min • Remove colored cap from the vial with- out removing the gray rubber stopper; wipe top of stopper with an alcohol wipe • Peel back the blister pouch and re- move the Vial Access Device by holding between the white Luer cap and the skirt; do not touch the spike tip at any time • Place the vial on a hard surface and hold the base; orient the Vial Access De- vice vertically over the vial so that the spike tip is at the center of the vial’s rub- ber stopper • While holding the white collar of the syringe, insert and press the syringe tip into the blue circle of the Vial Access Device and twist clockwise • Inject the entire contents of the syringe containing the diluent into the vial • Shake the vial vigorously • Invert completely and slowly withdraw the contents of the suspension from the vial into the syringe; tear the section of the vial label at the perforation and apply the detached label to the syringe • While holding the white collar of the syringe, unscrew the syringe from the Vial Access Device, then discard both the vial and the Vial Access Device appropriately • Select the appropriate color-coded needle provided with the kit; they are not interchangeable; do not use the needle intended for gluteal injection for deltoid injection, and vice versa • Peel the blister pouch of the Needle- Pro safety device open halfway; grasp the transparent needle using the pouch, at- tach the Luer connection of the orange Needle-Pro to the syringe with an easy clockwise twisting motion • While holding the white collar of the syringe, grasp the transparent needle sheath and seat the needle firmly on the orange Needle-Pro device with a push and a clockwise twist • Pull the transparent needle sheath straight away from the needle • Resuspension is necessary before ad- ministration • Only for IM; do not give IV • Remove air bubbles • Inject the entire contents of the syringe into the upper outer quadrant of the gluteal or deltoid muscle; gluteal injections should be alternated between the two buttocks • After the injection is complete, press the needle into the orange Needle-Pro safety device • Do not store the vial after reconstitu- tion or the suspension will settle • Do not combine 2 different dosage strengths of RisperDAL Consta in a single administration • The dose pack device is for single use only • Stability after reconstitution: Once in suspension, the product may remain at room temperature; use within 6 hr
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Extracted information for risperiDONE only.
Assess: • Suicidal thoughts/behaviors: often when depression is lessened; mental sta- tus before initial administration • Thyroid function test, blood glucose, serum electrolytes/prolactin/lipid pro- file, bilirubin, creatinine, weight, preg- nancy test, CBC, LFTs, AIMS assessment, baseline and periodically • Affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances • QT prolongation: B/P standing, lying; pulse, respirations; take these q4hr dur- ing initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg; watch for ECG changes • Dizziness, faintness, palpitations, tachycardia on rising • EPS: akathisia, tardive dyskinesia (bi- zarre movements of the jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait) • Serious reactions in geriatric pa- tient: fatal pneumonia, heart failure, sud- den death, dementia • Neuroleptic malignant syndrome: hyperthermia, increased CPK, altered mental status, muscle rigidity, seizures, change in B/P, fatigue, tachycardia • Constipation, urinary retention daily; if these occur, increase bulk, water in diet • Decreased stimuli by dimming lights, avoiding loud noises • Supervised ambulation until patient stabilized on medication; do not involve patient in strenuous exercise program because fainting is possible; patient should not stand still for a long time • Increased fluids to prevent constipation • Store in tight, light-resistant con- tainer (PO); unopened vials in refrig- erator, protect from light; do not freeze • Beers: avoid use in older adults except for schizophrenia, bipolar disorder, or as a short-term antiemetic in chemotherapy • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; EPS may oc- cur in neonate; enroll pregnant women in the National Pregnancy Registry for Atypi- cal Antipsychotics, 1-866-961-2388; do not breastfeed, excreted in breast milk
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Evaluate: • Therapeutic response: decrease in emotional excitement, hallucinations, de- lusions, paranoia; reorganization of pat- terns of thought, speech
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That orthostatic hypotension may occur; to rise from sitting or lying position gradually • To avoid abrupt withdrawal of product because EPS may result; product should be withdrawn slowly • To avoid OTC preparations (cough, hay fever, cold) unless approved by pre- scriber; that serious product interactions may occur; to avoid use of alcohol be- cause increased drowsiness may occur • To avoid hazardous activities if drowsy or dizzy • To comply with product regimen • To report impaired vision, tremors, muscle twitching R • Heat intolerance: That heat stroke may occur in hot weather; to take extra precau- tions to stay cool; to avoid hot tubs, hot showers, tub baths • To use contraception; to inform pre- scriber if pregnancy is planned or sus- pected; not to breastfeed • To notify provider of suicidal thoughts/ behaviors
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Extracted information for risperiDONE only.
PHARMACOKINETICS PO: Extensively metabolized by liver to major active metabolite, determined by poor metabolizer or average metabo- lizers; plasma protein binding 90%, peak 1-2 hr, excreted 90% in urine, terminal half-life 3-24 hr
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Filter the extracted dose blocks for this individual drug.
• Adolescent: PO 0.5 mg/day in AM or PM, adjust dose at intervals of ≥24 hr and 0.5-1 mg/day as tolerated to 3 mg/day
Candidate age grouping · source page 1165