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What
is Risperdal?
Risperdal (risperidone), released in 1994, is one of the atypical
antipsychotic medications used to treat schizophrenia and
psychotic disorders. The drug helps manage schizophrenia's
positive symptoms (e.g., visual and auditory hallucinations,
delusions, and thought disturbances) and may also help treat
the illness’ negative symptoms (e.g., social withdrawal,
apathy, lack of motivation, and inability to experience pleasure).
It may also be useful in treating acute mania and severe depression
in combination with antidepressant medications. Risperdal’s
side effects are usually relatively minor, and blood monitoring
is not necessary.
How
is Risperdal different from other antipsychotic medications?
Conventional antipsychotics such as Haldol, Stelazine, and
Prolixin have treated positive symptoms in many patients for
several years. However, these drugs do not satisfactorily
affect the negative symptoms, and they often cause uncomfortable
or intolerable side effects. Risperdal is as effective as
the conventional medications in treating positive symptoms.
Risperdal also offers the advantages of helping treat negative
symptoms and causing fewer extrapyramidal side effects (EPS)
such as restlessness, muscle rigidity, and tremor when taken
at the manufacturer's recommended dose of 6 mg per day or
less.
How
does Risperdal work?
Risperdal, like some other atypical antipsychotics, is designed
as a serotonin/dopamine antagonist. While its exact mechanism
of action is not yet understood, Risperdal seems to block
the action of serotonin and dopamine, two neurotransmitter
chemicals in the brain. Conventional antipsychotics seem to
primarily affect only dopamine.
How
quickly does Risperdal relieve symptoms of schizophrenia?
Improvement of symptoms may be noticed in some patients relatively
quickly. Some adjustments may be necessary to reach the optimal
dose for each patient. It is normally advisable to give the
medication a trial period of at least four to six weeks at
the optimal dose before evaluating its effectiveness, although
experience with Clozaril suggests that improvements may take
months to fully emerge. When first released, the recommended
dose for Risperdal was 6 mg/day. It is now known that lower
doses (3 or 4 mg/day) are often effective with lower risk
for side effects.
What
are the side effects of Risperdal?
When taken at the manufacturer's recommended dose of 6 mg/day
or less. Risperdal has been observed to cause no higher rate
of significant side effects than the rate observed with placebo.
These side effects include extrapyramidal symptoms (muscle
stiffness, tremors, and body shakes). At higher doses, extrapyramidal
side effects often increase. Cogentin (benztropine) can be
prescribed to reduce or eliminate stiffness and tremors, but
its use beyond three months should be reevaluated.
More significant
possible side effects, affecting some patients but not all,
include low blood pressure; dizziness, especially when standing
up suddenly; heart palpitations; sleepiness; constipation;
weight gain; sexual dysfunction; and fatigue. Some of these
problems can be minimized by following recommended guidelines
for dosage at the beginning of treatment (gradual increase
of dose over a period of several weeks). Patients who already
have low blood pressure, have kidney or liver impairment,
are elderly, or are in a weakened condition may require close
monitoring and even more gradual dose adjustment.
Does
Risperdal cause tardive dyskinesia?
Tardive dyskinesia (TD), a disfiguring side effect that occurs
in some patients taking antipsychotic drugs, may not be a
major risk associated with Risperdal use, although it may
take years before researchers can fully assess the risk. It
is prudent to minimize the risk by using the lowest dose necessary
to relieve psychotic symptoms. Should symptoms of TD develop,
such as grimacing, sucking and smacking of lips, and other
spasmodic movements, discontinuation of Risperdal should be
considered.
What
else should be kept in mind when taking Risperdal?
Risperdal can be taken before, during, or after meals. Patients
should be cautious about operating hazardous machinery, including
driving, until they are certain they are not adversely affected.
Women should let their doctor know if they become pregnant
or intend to become pregnant. Breast feeding is not recommended
while taking Risperdal. Because some medications can affect
the effectiveness of Risperdal when taken at the same time,
patients should be sure their doctor is aware of all medications
they are taking.
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