risperidone (Rx)

Brand and Other Names:Risperdal, Risperdal Consta, more...Risperdal M-Tab, Perseris
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet (Risperdal)

  • 0.25mg
  • 0.5mg
  • 1mg
  • 2mg
  • 3mg
  • 4mg

tablet, orally disintegrating (Risperdal M- Tabs)

  • 0.5mg
  • 1mg
  • 2mg
  • 3mg
  • 4mg

oral solution (Risperidal)

  • 1mg/mL

IM injection kit, long-acting injectable suspension (Risperdal Consta)

  • Kit contains prefilled 2-mL diluent syringe, vial containing risperidone microspheres, vial adapter, and needles for deltoid or gluteal IM administration
  • 12.5mg
  • 25mg
  • 37.5mg
  • 50mg

SC injection kit, extended-release injectable suspension (Perseris)

  • Kit includes a prefilled syringe containing risperidone powder, a syringe prefilled with the delivery system and desiccant, and needle for SC administration into the abdomen
  • 90mg
  • 120mg

Schizophrenia

PO (Risperdal or Risperidal M-Tabs)

  • 2 mg/day initially; may increase in increments of 1-2 mg/day at intervals ≥24 hr
  • Recommended target dosage: 2-8 mg/day once daily or divided q12hr (efficacy follows bell-shaped curve; 4-8 mg/day more effective than 12-16 mg/day)

IM (Risperdal Consta)

  • 12.5-50 mg injected into deltoid or gluteal muscle every 2 weeks; dosage should not be adjusted more frequently than every 4 weeks
  • Recommended to establish tolerability of PO risperidone before initiating treatment with IM risperidone

SC (Perseris)

  • 90 mg or 120 mg SC once monthly initially
  • Supplementation with oral risperidone is not recommended
  • Based on average plasma concentration of risperidone and total active moiety, 90-mg dose corresponds to 3 mg/day oral risperidone and 120-mg dose corresponds to 4 mg/day oral risperidone
  • Patients who are on stable oral risperidone doses <3 mg/day or >4 mg/day may not be candidates for risperidone ER suspension

Bipolar Mania

PO (Risperdal or Risperidal M-Tabs)

  • 2-3 mg/day initially; may be increased if necessary in increments of 1 mg/day at intervals of 24 hours to 6 mg/day; dosage recommendations not available for treatment duration >3 weeks

Bipolar Disorder

IM (Risperdal Consta)

  • Recommended dose for monotherapy or adjunctive therapy to lithium or valproate for the maintenance treatment of bipolar I disorder: 25 mg IM q2Weeks; some patients may benefit from a higher dose of 37.5 mg or 50 mg
  • Dosages above 50 mg have not been studied in this population
  • Periodically re-evaluate the long-term risks and benefits of the drug for the individual patient

Tourette Syndrome (Off-label)

0.5-1 mg/day PO; may be increased or decreased in increments of 0.5 mg q12hr at intervals >3 days; not to exceed 6 mg/day

Posttraumatic Stress Disorder (Off-label)

0.5-8 mg/day PO

Dosing Modifications

Renal impairment

  • SC
    • Not studied, use with caution
    • Prior to initiating treatment, it is recommended that patients be carefully titrated up to at least 3 mg/day or oral risperidone; if patients tolerate 3 mg oral and are psychiatrically stable, consider a 90-mg dose
  • CrCl <30 mL/min (PO)
    • 0.5 mg q12hr initially; consider longer titration intervals; may be increased by up to 0.5 mg/day PO divided q12hr; dosage increase >1.5 mg q12hr should occur no more frequently than once weekly
  • CrCl <30 mL/min (IM)
    • If 2-mg total daily dose of PO risperidone is well tolerated, may start with 12.5-25 mg IM every 2 weeks; continue PO supplementation for 3 weeks after first injection until main release of risperidone from injection has begun

Hepatic impairment

  • SC
    • Not studied, use with caution
    • Prior to initiating treatment, it is recommended that patients be carefully titrated up to at least 3 mg/day or oral risperidone; if patients tolerate 3 mg oral and are psychiatrically stable, consider a 90-mg dose
  • Child-Pugh 10-15 points (PO)
    • 0.5 mg q12hr initially; consider longer titration intervals; may be increased by up to 0.5 mg/day PO divided q12hr; dosage increase >1.5 mg q12hr should occur no more frequently than once weekly
  • Child-Pugh 10-15 points (IM)
    • If 2-mg total daily dose of PO risperidone is well tolerated, may start with 25 mg IM every 2 weeks; continue PO supplementation for 3 weeks after first injection until main release of risperidone from injection has begun

Coadministration with strong CYP2D6 inhibitors

  • SC, ER suspension
    • When initiation of a strong CYP2D6 inhibitor (eg, fluoxetine, paroxetine) is considered, patient may be placed on the lowest dose (90 mg) of risperidone ER suspension between 2-4 weeks before the planned start of the CYP2D6 inhibitor to adjust for the expected increase in plasma risperidone concentrations
    • When the CYP2D6 inhibitor is initiated in patients receiving risperidone ER suspension 90 mg, it is recommended to continue treatment with 90 mg unless clinical judgment necessitates interruption of risperidone treatment
  • IM, long-acting injectable suspension
    • When initiation of a strong CYP2D6 inhibitor (eg, fluoxetine, paroxetine) is considered, patient may be placed on a lower dose between 2-4 weeks before the planned start of the CYP2D6 inhibitor to adjust for the expected increase in plasma risperidone concentrations
    • When a CYP2D6 inhibitor initiated in patients receiving 25 mg IM of long-acting risperidone suspension, it is recommended to continue this dose unless clinical judgment necessitates lowering to 12.5 mg IM or interrupting treatment
    • If long-acting risperidone suspension is initiated in patients already receiving a strong CYP2D6 inhibitor, consider using a starting dose of 12.5 mg IM; efficacy of the 12.5 mg dose has not been investigated in clinical trials
  • PO
    • When a strong CYP2D6 inhibitor (eg, fluoxetine, or paroxetine) is coadministered with oral risperidone, reduce oral risperidone dose; dose should not exceed 8 mg/day in adults when coadministered with these drugs
    • When initiating therapy, titrate oral risperidone slowly If enzyme inhibitor is discontinued, assess risperidone dose and increase if necessary

Coadministration with strong CYP3A4 inducers

  • SC, ER injectable suspension
    • At initiation of therapy with CYP3A4 inducers (eg, carbamazepine, phenytoin, rifampin, phenobarbital), closely monitor during the first 4-8 weeks In patients receiving risperidone ER suspension 90 mg, consider increasing the dose to 120 mg
    • In patients receiving risperidone ER suspension 120 mg, consider additional oral risperidone therapy
    • On discontinuation of the strong CYP3A4 inducers, re-evaluated dosage of ER suspension or any additional oral risperidone therapy and if necessary, decreased to adjust for the expected increase in plasma concentration of risperidone
    • For patients treated with risperidone ER 90 mg and discontinuing from a strong CYP3A4 inducer, continue treatment with the 90-mg dose unless clinical judgment necessitates interruption of risperidone ER suspension treatment
  • IM, long-acting injectable suspension
    • Coadministration with strong CYP3A4 inducers (eg, carbamazepine, phenytoin, rifampin, phenobarbital) with risperidone would be expected to cause decreases in the plasma concentrations of the sum of risperidone and 9-hydroxyrisperidone combined, which could lead to decreased efficacy of IM risperidone; titrate accordingly for patients receiving these enzyme inducers, especially during initiation or discontinuation of therapy with these inducers
    • At the initiation of therapy with CYP3A4 inducers, patients should be closely monitored during the first 4-8 weeks, since the dose of IM risperidone may need to be adjusted; a dose increase, or additional oral risperidone, may need to be considered
    • If enzyme inducer is discontinued, assess risperidone dose and decrease if necessary
    • Patients may be placed on a lower dose of IM risperidone between 2-4 weeks before the planned discontinuation CYP3A4 inducers to adjust for the expected increase in plasma concentrations of risperidone plus 9-hydroxyrisperidone
    • For patients treated with the recommended dose of 25 mg and discontinuing from CYP3A4 inducers, continue treatment with the 25-mg dose unless clinical judgment necessitates lowering dose to 12.5 mg or necessitates interruption of IM risperidone treatment
    • The efficacy of the 12.5 mg dose has not been investigated in clinical trials
  • PO
    • Coadministered with enzyme inducers (eg, carbamazepine), the risperidone dose should be increased up to double the patient’s usual dose If enzyme inducer is discontinued, assess risperidone dose and decrease if necessary

Dosing Considerations

For patient who have never taken risperidone, establish tolerability with PO risperidone before initiating the IM or SC dosage forms

Switching from other antipsychotics to IM risperidone

  • There are no systematically collected data to specifically address switching patients from other antipsychotics to IM risperidone or concerning concomitant administration with other antipsychotics
  • Previous antipsychotics should be continued for 3 weeks after the first injection of IM risperidone to ensure that therapeutic concentrations are maintained until the main release phase of risperidone from the injection site has begun
  • As recommended with other antipsychotic medications, the need for continuing existing EPS medication should be re-evaluated periodically

Dosage Forms & Strengths

tablet

  • 0.25mg
  • 0.5mg
  • 1mg
  • 2mg
  • 3mg
  • 4mg

tablet, orally disintegrating

  • 0.5mg
  • 1mg
  • 2mg
  • 3mg
  • 4mg

oral solution

  • 1mg/mL

Schizophrenia

<13 years: Safety and efficacy not established

>13 years: 0.5 mg/day PO in morning or evening initially; may be increased in increments of 0.5-1 mg/day at intervals ≥24 hr to recommended dosage of 3 mg/day; dosage range: 1-6 mg/day (dosages >3 mg/day have not been proved more effective and are associated with increased incidence of adverse effects)

If persistent somnolence occurs, daily dose may be divided q12hr

Bipolar Mania

<10 years: Safety and efficacy not established

>10 years: 0.5 mg/day PO in morning or evening initially; may be increased in increments of 0.5-1 mg/day at intervals ≥24 hr to recommended dosage of 2.5 mg/day; dosage range: 0.5-6 mg/day (dosages >2.5 mg/day have not been proved more effective and are associated with increased incidence of adverse effects)

If persistent somnolence occurs, daily dose may be divided q12hr

Autism

Irritability associated with autistic disorder in children aged 5-16 years

<5 years: Safety and efficacy not established

5-16 years (<20 kg): 0.25 mg/day PO initially; may be increased after ≥4 days to recommended dosage of 0.5 mg/day

5-16 years (≥20 kg): 0.5 mg/day PO initially; may be increased after ≥4 days to recommended dosage of 1 mg/day

Insufficient response to recommended dosage

  • If response to recommended dosage insufficient, dosage may be adjusted as follows after minimum of 14 days and at least every 2 weeks thereafter
  • <20 kg: Adjusted in increments of 0.25 mg/day; not to exceed 1 mg/day
  • ≥20 kg: Adjusted in increments of 0.5 mg/day; not to exceed 2.5 mg/day

Not approved for dementia-related psychosis, because of increased risk of cardiovascular or infectious related deaths (see Black Box Warnings)

Risk of orthostatic hypotension higher in elderly; monitoring of renal function and orthostatic blood pressure may be necessary; for titrating to target dose, twice-daily regimen should be used and dosage maintained for 2-3 days before change is made to once-daily dose regimen

Schizophrenia, Bipolar Mania

Use lower initial dose, and adjust more gradually

PO: 0.5 mg q12hr; may be increased in increments ≤0.5 mg q12hr; increases to dosages >1.5 mg q12hr should occur at intervals ≥1 week

IM: 12.5-25 mg injected into deltoid or gluteal muscle every 2 weeks; dosage should not be adjusted more frequently than every 4 weeks

Recommended to establish tolerability of PO risperidone before initiating treatment with IM risperidone

Psychosis, Agitation Related to Alzheimer Dementia (Off-label)

0.25-1 mg/day PO initially; may be increased gradually as tolerated; not to exceed 1.5-2 mg/day

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Interactions

Interaction Checker

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              Serious - Use Alternative (56)

              • amiodarone

                amiodarone will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. The concurrent administration of amiodarone and risperidone is not recommended due to the potential for inducing life-threatening arrhythmias. If concurrent use cannot be avoided, cautious dosing and telemetric monitoring is advised.

                amiodarone and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • apomorphine

                risperidone decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

              • artemether

                artemether and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • benzhydrocodone/acetaminophen

                benzhydrocodone/acetaminophen, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • bromocriptine

                risperidone decreases effects of bromocriptine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

              • cabergoline

                risperidone decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

              • calcium/magnesium/potassium/sodium oxybates

                risperidone, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • ceritinib

                ceritinib and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • citalopram

                citalopram and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • dacomitinib

                dacomitinib will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

              • degarelix

                degarelix and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • disopyramide

                disopyramide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • dopamine

                risperidone decreases effects of dopamine by pharmacodynamic antagonism. Contraindicated.

              • entrectinib

                risperidone and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

              • erdafitinib

                erdafitinib will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

              • fexinidazole

                fexinidazole and risperidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

              • fluoxetine

                fluoxetine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              • givosiran

                givosiran will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

              • glasdegib

                risperidone and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

              • hydrocodone

                hydrocodone, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • hydroxychloroquine sulfate

                hydroxychloroquine sulfate and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • ibutilide

                ibutilide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • indapamide

                indapamide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • ivosidenib

                ivosidenib and risperidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

              • lasmiditan

                lasmiditan increases levels of risperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • lefamulin

                lefamulin and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • levodopa

                risperidone decreases effects of levodopa by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

              • levodopa inhaled

                risperidone decreases effects of levodopa inhaled by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Atypical (2nd generation) antipsychotics inhibit dopamine D2 receptors in varying degrees (clozapine and quetiapine are lower risk). .

              • lisuride

                risperidone decreases effects of lisuride by pharmacodynamic antagonism. Contraindicated.

              • lonafarnib

                risperidone will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

              • macimorelin

                macimorelin and risperidone both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

              • mefloquine

                mefloquine increases toxicity of risperidone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

              • methyldopa

                risperidone decreases effects of methyldopa by pharmacodynamic antagonism. Contraindicated.

              • metoclopramide intranasal

                risperidone, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

                risperidone increases toxicity of metoclopramide intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive effects, including increased frequency and severity of tardive dyskinesia, other extrapyramidal symptoms, and neuroleptic malignant syndrome.

              • mobocertinib

                mobocertinib and risperidone both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

              • ondansetron

                ondansetron and risperidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

              • pentamidine

                pentamidine and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • pimozide

                pimozide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • pitolisant

                risperidone and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

              • pramipexole

                risperidone decreases effects of pramipexole by pharmacodynamic antagonism. Contraindicated.

              • procainamide

                procainamide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • propafenone

                propafenone will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. The concurrent administration of propafenone and risperidone is not recommended due to the potential for inducing life-threatening arrhythmias. If concurrent use cannot be avoided, cautious dosing and telemetric monitoring is advised.

              • quinidine

                quinidine will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

                quinidine and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

              • ribociclib

                ribociclib increases toxicity of risperidone by QTc interval. Avoid or Use Alternate Drug.

              • ropinirole

                risperidone decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

              • safinamide

                risperidone decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.

              • selinexor

                selinexor, risperidone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

              • sodium oxybate

                risperidone, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • sotalol

                risperidone and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

              • sotorasib

                sotorasib will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

              • sufentanil SL

                sufentanil SL, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • tepotinib

                tepotinib will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

              • umeclidinium bromide/vilanterol inhaled

                risperidone increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

              • vandetanib

                risperidone, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

              • vemurafenib

                vemurafenib and risperidone both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

              • vilanterol/fluticasone furoate inhaled

                risperidone increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

              Monitor Closely (394)

              • abiraterone

                abiraterone increases levels of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

              • abobotulinumtoxinA

                abobotulinumtoxinA increases effects of risperidone by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.

              • acarbose

                risperidone, acarbose. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • aclidinium

                aclidinium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • albiglutide

                risperidone, albiglutide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • albuterol

                risperidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                albuterol and risperidone both increase QTc interval. Use Caution/Monitor.

              • alfentanil

                alfentanil and risperidone both increase sedation. Use Caution/Monitor.

              • alfuzosin

                risperidone and alfuzosin both increase QTc interval. Use Caution/Monitor.

                alfuzosin and risperidone both increase QTc interval. Use Caution/Monitor.

              • almotriptan

                almotriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • alprazolam

                alprazolam and risperidone both increase sedation. Use Caution/Monitor.

              • amifostine

                amifostine, risperidone. Either increases effects of the other by anti-hypertensive channel blocking. Use Caution/Monitor. Due to its alpha adrenergic antagonism, atypical antipsychotic agents has the potential to enhance the effect of certain antihypertensive agents. Monitor blood pressure and adjust dose accordingly.

              • amiodarone

                amiodarone will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • amitriptyline

                amitriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and amitriptyline both increase sedation. Use Caution/Monitor.

              • amobarbital

                amobarbital and risperidone both increase sedation. Use Caution/Monitor.

              • amoxapine

                amoxapine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and amoxapine both increase sedation. Use Caution/Monitor.

              • anticholinergic/sedative combos

                anticholinergic/sedative combos decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                anticholinergic/sedative combos decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of anticholinergic/sedative combos by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • apomorphine

                risperidone and apomorphine both increase sedation. Use Caution/Monitor.

                apomorphine and risperidone both increase QTc interval. Use Caution/Monitor.

              • arformoterol

                risperidone increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                arformoterol and risperidone both increase QTc interval. Use Caution/Monitor.

              • aripiprazole

                aripiprazole and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                aripiprazole and risperidone both increase sedation. Use Caution/Monitor.

                aripiprazole and risperidone both increase QTc interval. Use Caution/Monitor.

              • armodafinil

                risperidone increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • arsenic trioxide

                arsenic trioxide and risperidone both increase QTc interval. Use Caution/Monitor.

              • artemether/lumefantrine

                artemether/lumefantrine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

                artemether/lumefantrine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • atomoxetine

                atomoxetine and risperidone both increase QTc interval. Use Caution/Monitor.

              • atorvastatin

                atorvastatin will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • atracurium

                atracurium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                atracurium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • atropine

                atropine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                atropine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of atropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • atropine IV/IM

                risperidone increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                atropine IV/IM decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                atropine IV/IM decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              • avapritinib

                risperidone will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • axitinib

                risperidone increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • azelastine

                azelastine and risperidone both increase sedation. Use Caution/Monitor.

              • baclofen

                baclofen and risperidone both increase sedation. Use Caution/Monitor.

              • bedaquiline

                risperidone and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

              • belladonna alkaloids

                belladonna alkaloids decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                belladonna alkaloids decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of belladonna alkaloids by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • belladonna and opium

                belladonna and opium and risperidone both increase sedation. Use Caution/Monitor.

                belladonna and opium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                belladonna and opium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • benazepril

                risperidone, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

              • benperidol

                benperidol and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                benperidol and risperidone both increase sedation. Use Caution/Monitor.

              • benzphetamine

                risperidone increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • benztropine

                risperidone increases effects of benztropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic adverse effects may be seen with concurrent use. .

              • berotralstat

                berotralstat will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

              • brexanolone

                brexanolone, risperidone. Either increases toxicity of the other by sedation. Use Caution/Monitor.

              • brompheniramine

                brompheniramine and risperidone both increase sedation. Use Caution/Monitor.

              • buprenorphine

                buprenorphine and risperidone both increase sedation. Use Caution/Monitor.

              • buprenorphine buccal

                buprenorphine buccal and risperidone both increase sedation. Use Caution/Monitor.

              • buprenorphine, long-acting injection

                risperidone increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

              • bupropion

                bupropion will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • butabarbital

                butabarbital and risperidone both increase sedation. Use Caution/Monitor.

              • butalbital

                butalbital and risperidone both increase sedation. Use Caution/Monitor.

              • butorphanol

                butorphanol and risperidone both increase sedation. Use Caution/Monitor.

              • caffeine

                risperidone increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • carbamazepine

                carbamazepine decreases levels of risperidone by increasing metabolism. Use Caution/Monitor.

              • carbinoxamine

                carbinoxamine and risperidone both increase sedation. Use Caution/Monitor.

              • carisoprodol

                carisoprodol and risperidone both increase sedation. Use Caution/Monitor.

              • cenobamate

                cenobamate, risperidone. Either increases effects of the other by sedation. Use Caution/Monitor.

              • chloral hydrate

                chloral hydrate and risperidone both increase sedation. Use Caution/Monitor.

              • chlordiazepoxide

                chlordiazepoxide and risperidone both increase sedation. Use Caution/Monitor.

              • chloroquine

                chloroquine increases toxicity of risperidone by QTc interval. Use Caution/Monitor.

              • chlorpheniramine

                chlorpheniramine and risperidone both increase sedation. Use Caution/Monitor.

              • chlorpromazine

                chlorpromazine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                chlorpromazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                chlorpromazine and risperidone both increase sedation. Use Caution/Monitor.

              • chlorpropamide

                risperidone, chlorpropamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • chlorzoxazone

                chlorzoxazone and risperidone both increase sedation. Use Caution/Monitor.

              • cinnarizine

                cinnarizine and risperidone both increase sedation. Use Caution/Monitor.

              • cisatracurium

                cisatracurium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cisatracurium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • citalopram

                citalopram will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

              • clarithromycin

                clarithromycin will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                clarithromycin and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • clemastine

                clemastine and risperidone both increase sedation. Use Caution/Monitor.

              • clobazam

                clobazam will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.

                risperidone, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

              • clomipramine

                clomipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and clomipramine both increase sedation. Use Caution/Monitor.

              • clonazepam

                clonazepam and risperidone both increase sedation. Use Caution/Monitor.

              • clonidine

                clonidine, risperidone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.

              • clorazepate

                clorazepate and risperidone both increase sedation. Use Caution/Monitor.

              • clotrimazole

                clotrimazole will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • clozapine

                clozapine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                clozapine and risperidone both increase sedation. Use Caution/Monitor.

                clozapine and risperidone both increase QTc interval. Use Caution/Monitor.

              • cobicistat

                cobicistat will increase the level or effect of risperidone by Other (see comment). Modify Therapy/Monitor Closely. A decrease in the dose of antipsychotics that are metabolized by CYP3A or CYP2D6 may be needed upon coadministration.

              • codeine

                codeine and risperidone both increase sedation. Use Caution/Monitor.

              • crizotinib

                crizotinib and risperidone both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

              • cyclizine

                cyclizine and risperidone both increase sedation. Use Caution/Monitor.

                cyclizine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cyclizine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of cyclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • cyclobenzaprine

                cyclobenzaprine and risperidone both increase sedation. Use Caution/Monitor.

                cyclobenzaprine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                cyclobenzaprine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • cyclosporine

                cyclosporine will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • cyproheptadine

                cyproheptadine and risperidone both increase sedation. Use Caution/Monitor.

              • dantrolene

                dantrolene and risperidone both increase sedation. Use Caution/Monitor.

              • darifenacin

                darifenacin decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                darifenacin decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of darifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • dasatinib

                dasatinib and risperidone both increase QTc interval. Use Caution/Monitor.

              • desflurane

                desflurane and risperidone both increase sedation. Use Caution/Monitor.

              • desipramine

                desipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and desipramine both increase sedation. Use Caution/Monitor.

              • desvenlafaxine

                desvenlafaxine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

              • deutetrabenazine

                risperidone and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.

                risperidone and deutetrabenazine both increase sedation. Use Caution/Monitor.

              • dexchlorpheniramine

                dexchlorpheniramine and risperidone both increase sedation. Use Caution/Monitor.

              • dexfenfluramine

                risperidone increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dexmedetomidine

                dexmedetomidine and risperidone both increase sedation. Use Caution/Monitor.

              • dexmethylphenidate

                risperidone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dextroamphetamine

                risperidone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dextromethorphan

                dextromethorphan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • dextromoramide

                dextromoramide and risperidone both increase sedation. Use Caution/Monitor.

              • diamorphine

                diamorphine and risperidone both increase sedation. Use Caution/Monitor.

              • diazepam

                diazepam and risperidone both increase sedation. Use Caution/Monitor.

              • dicyclomine

                dicyclomine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                dicyclomine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of dicyclomine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • diethylpropion

                risperidone increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • difenoxin hcl

                difenoxin hcl and risperidone both increase sedation. Use Caution/Monitor.

              • dihydroergotamine

                dihydroergotamine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • dimenhydrinate

                dimenhydrinate and risperidone both increase sedation. Use Caution/Monitor.

              • diphenhydramine

                diphenhydramine and risperidone both increase sedation. Use Caution/Monitor.

                diphenhydramine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                diphenhydramine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of diphenhydramine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • diphenoxylate hcl

                diphenoxylate hcl and risperidone both increase sedation. Use Caution/Monitor.

              • dipipanone

                dipipanone and risperidone both increase sedation. Use Caution/Monitor.

              • dobutamine

                risperidone increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dofetilide

                dofetilide and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • dolasetron

                dolasetron and risperidone both increase QTc interval. Use Caution/Monitor.

              • dopamine

                risperidone increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dopexamine

                risperidone increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dosulepin

                risperidone and dosulepin both increase sedation. Use Caution/Monitor.

              • doxepin

                doxepin and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and doxepin both increase sedation. Use Caution/Monitor.

              • doxylamine

                doxylamine and risperidone both increase sedation. Use Caution/Monitor.

              • dronedarone

                dronedarone will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                dronedarone and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • droperidol

                droperidol and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                droperidol and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                droperidol and risperidone both increase sedation. Use Caution/Monitor.

              • duloxetine

                duloxetine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • efavirenz

                efavirenz will decrease the level or effect of risperidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • elagolix

                elagolix will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • eletriptan

                eletriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • eliglustat

                eliglustat increases levels of risperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

                eliglustat increases levels of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; A decrease in dose of the neuroleptic may be needed when coadministered.

              • ephedrine

                risperidone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • epinephrine

                epinephrine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • epinephrine racemic

                epinephrine racemic and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ergoloid mesylates

                ergoloid mesylates, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • ergotamine

                ergotamine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • erythromycin base

                erythromycin base will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                erythromycin base and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                erythromycin ethylsuccinate and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • erythromycin lactobionate

                erythromycin lactobionate will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                erythromycin lactobionate and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • erythromycin stearate

                erythromycin stearate will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                erythromycin stearate and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • escitalopram

                escitalopram increases toxicity of risperidone by QTc interval. Use Caution/Monitor.

              • esketamine intranasal

                esketamine intranasal, risperidone. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

              • estazolam

                estazolam and risperidone both increase sedation. Use Caution/Monitor.

              • ethanol

                risperidone and ethanol both increase sedation. Use Caution/Monitor.

              • exenatide injectable solution

                risperidone, exenatide injectable solution. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • exenatide injectable suspension

                risperidone, exenatide injectable suspension. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • ezogabine

                ezogabine, risperidone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

              • fedratinib

                fedratinib will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

              • felodipine

                felodipine will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • fenfluramine

                risperidone increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                risperidone decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

              • fentanyl

                fentanyl, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • fesoterodine

                fesoterodine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                fesoterodine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of fesoterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • finerenone

                risperidone will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

              • flavoxate

                flavoxate decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                flavoxate decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of flavoxate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • flecainide

                flecainide and risperidone both increase QTc interval. Use Caution/Monitor.

              • flibanserin

                risperidone will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.

                flibanserin, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • fluconazole

                fluconazole and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • fluoxetine

                fluoxetine and risperidone both increase QTc interval. Use Caution/Monitor.

              • fluphenazine

                fluphenazine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                fluphenazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                fluphenazine and risperidone both increase sedation. Use Caution/Monitor.

              • flurazepam

                flurazepam and risperidone both increase sedation. Use Caution/Monitor.

              • fluvoxamine

                fluvoxamine and risperidone both increase QTc interval. Use Caution/Monitor.

              • formoterol

                formoterol and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • foscarnet

                foscarnet and risperidone both increase QTc interval. Use Caution/Monitor.

              • fosphenytoin

                fosphenytoin will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • fostamatinib

                fostamatinib will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

              • fostemsavir

                risperidone and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

              • frovatriptan

                frovatriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • glecaprevir/pibrentasvir

                glecaprevir/pibrentasvir will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • glimepiride

                risperidone, glimepiride. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • glipizide

                risperidone, glipizide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • glyburide

                risperidone, glyburide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • glycopyrrolate

                risperidone increases effects of glycopyrrolate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • glycopyrrolate inhaled

                glycopyrrolate inhaled decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                glycopyrrolate inhaled decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • guanfacine

                guanfacine, risperidone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.

              • haloperidol

                haloperidol and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                haloperidol and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                haloperidol and risperidone both increase sedation. Use Caution/Monitor.

              • henbane

                henbane decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                henbane decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of henbane by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • homatropine

                homatropine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                homatropine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of homatropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • hydromorphone

                hydromorphone and risperidone both increase sedation. Use Caution/Monitor.

              • hydroxyzine

                hydroxyzine and risperidone both increase sedation. Use Caution/Monitor.

              • hyoscyamine

                hyoscyamine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • hyoscyamine spray

                risperidone increases effects of hyoscyamine spray by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

                hyoscyamine spray decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                hyoscyamine spray decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

              • iloperidone

                iloperidone and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                iloperidone and risperidone both increase QTc interval. Use Caution/Monitor.

                iloperidone and risperidone both increase sedation. Use Caution/Monitor.

              • imipramine

                imipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and imipramine both increase sedation. Use Caution/Monitor.

              • incobotulinumtoxinA

                risperidone, incobotulinumtoxinA. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.

              • indacaterol, inhaled

                indacaterol, inhaled, risperidone. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

              • indinavir

                indinavir will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • insulin aspart

                risperidone, insulin aspart. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • insulin degludec

                risperidone decreases effects of insulin degludec by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

              • insulin degludec/insulin aspart

                risperidone decreases effects of insulin degludec/insulin aspart by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

              • insulin detemir

                risperidone, insulin detemir. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • insulin glargine

                risperidone, insulin glargine. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • insulin glulisine

                risperidone, insulin glulisine. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • insulin inhaled

                risperidone decreases effects of insulin inhaled by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

              • insulin lispro

                risperidone, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • insulin NPH

                risperidone, insulin NPH. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • insulin regular human

                risperidone, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • ipratropium

                risperidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • isoproterenol

                risperidone increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • istradefylline

                istradefylline will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

              • itraconazole

                itraconazole will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                itraconazole and risperidone both increase QTc interval. Use Caution/Monitor.

              • ivacaftor

                ivacaftor increases levels of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

                risperidone increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

              • ketoconazole

                ketoconazole will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                ketoconazole and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • ketotifen, ophthalmic

                risperidone and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

              • lapatinib

                lapatinib and risperidone both increase QTc interval. Use Caution/Monitor.

              • lasmiditan

                lasmiditan, risperidone. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

              • lemborexant

                risperidone will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.

                lemborexant, risperidone. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

              • letermovir

                letermovir increases levels of risperidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • levalbuterol

                risperidone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • levofloxacin

                levofloxacin and risperidone both increase QTc interval. Use Caution/Monitor.

              • levomilnacipran

                levomilnacipran, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • levorphanol

                levorphanol and risperidone both increase sedation. Use Caution/Monitor.

              • linezolid

                linezolid, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • liraglutide

                risperidone, liraglutide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • lisdexamfetamine

                risperidone increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • lithium

                lithium, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • lofepramine

                lofepramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and lofepramine both increase sedation. Use Caution/Monitor.

              • lofexidine

                risperidone and lofexidine both increase sedation. Use Caution/Monitor.

              • lomitapide

                risperidone increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

              • lonafarnib

                lonafarnib will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.

              • loprazolam

                loprazolam and risperidone both increase sedation. Use Caution/Monitor.

              • loratadine

                loratadine will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • lorazepam

                lorazepam and risperidone both increase sedation. Use Caution/Monitor.

              • lorcaserin

                lorcaserin will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

                lorcaserin, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • lormetazepam

                lormetazepam and risperidone both increase sedation. Use Caution/Monitor.

              • loxapine

                loxapine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                loxapine and risperidone both increase sedation. Use Caution/Monitor.

              • loxapine inhaled

                loxapine inhaled and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                loxapine inhaled and risperidone both increase sedation. Use Caution/Monitor.

              • lumefantrine

                lumefantrine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

                lumefantrine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • lurasidone

                lurasidone, risperidone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

              • maprotiline

                maprotiline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and maprotiline both increase sedation. Use Caution/Monitor.

              • marijuana

                risperidone and marijuana both increase sedation. Use Caution/Monitor.

              • meclizine

                meclizine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                meclizine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of meclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • melatonin

                risperidone and melatonin both increase sedation. Use Caution/Monitor.

              • meperidine

                meperidine and risperidone both increase sedation. Use Caution/Monitor.

                meperidine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • meprobamate

                risperidone and meprobamate both increase sedation. Use Caution/Monitor.

              • metaproterenol

                risperidone increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • metaxalone

                metaxalone and risperidone both increase sedation. Use Caution/Monitor.

              • metformin

                risperidone, metformin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • methadone

                methadone and risperidone both increase QTc interval. Use Caution/Monitor.

                methadone and risperidone both increase sedation. Use Caution/Monitor.

                methadone, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • methamphetamine

                risperidone increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • methocarbamol

                methocarbamol and risperidone both increase sedation. Use Caution/Monitor.

              • methscopolamine

                methscopolamine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                methscopolamine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of methscopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • methylenedioxymethamphetamine

                risperidone increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • methylergonovine

                methylergonovine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • methylphenidate

                risperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

              • metoclopramide

                risperidone and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

              • midazolam

                midazolam and risperidone both increase sedation. Use Caution/Monitor.

              • midazolam intranasal

                risperidone will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.

                midazolam intranasal, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

              • midodrine

                risperidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • mifepristone

                mifepristone, risperidone. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

              • miglitol

                risperidone, miglitol. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • milnacipran

                milnacipran, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • mipomersen

                mipomersen, risperidone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

              • mirabegron

                mirabegron will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • mirtazapine

                risperidone and mirtazapine both increase sedation. Use Caution/Monitor.

              • modafinil

                risperidone increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • morphine

                morphine and risperidone both increase sedation. Use Caution/Monitor.

              • motherwort

                risperidone and motherwort both increase sedation. Use Caution/Monitor.

              • moxifloxacin

                moxifloxacin and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • moxonidine

                risperidone and moxonidine both increase sedation. Use Caution/Monitor.

              • nabilone

                risperidone and nabilone both increase sedation. Use Caution/Monitor.

              • nalbuphine

                nalbuphine and risperidone both increase sedation. Use Caution/Monitor.

              • naratriptan

                naratriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • nateglinide

                risperidone, nateglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • nefazodone

                nefazodone will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nevirapine

                nevirapine will decrease the level or effect of risperidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • nicardipine

                nicardipine will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nifedipine

                nifedipine will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nilotinib

                nilotinib and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • norepinephrine

                risperidone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nortriptyline

                nortriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and nortriptyline both increase sedation. Use Caution/Monitor.

              • octreotide

                octreotide and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • octreotide (Antidote)

                octreotide (Antidote) and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • ofloxacin

                ofloxacin and risperidone both increase QTc interval. Use Caution/Monitor.

              • olanzapine

                olanzapine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                olanzapine and risperidone both increase sedation. Use Caution/Monitor.

              • oliceridine

                oliceridine, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

              • olodaterol inhaled

                risperidone and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

              • onabotulinumtoxinA

                onabotulinumtoxinA decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                onabotulinumtoxinA decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • opium tincture

                opium tincture and risperidone both increase sedation. Use Caution/Monitor.

              • orphenadrine

                orphenadrine and risperidone both increase sedation. Use Caution/Monitor.

              • osilodrostat

                osilodrostat and risperidone both increase QTc interval. Use Caution/Monitor.

              • oxaliplatin

                oxaliplatin will increase the level or effect of risperidone by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

              • oxazepam

                oxazepam and risperidone both increase sedation. Use Caution/Monitor.

              • oxybutynin

                oxybutynin decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                oxybutynin decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of oxybutynin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • oxybutynin topical

                oxybutynin topical decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                oxybutynin topical decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of oxybutynin topical by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • oxybutynin transdermal

                oxybutynin transdermal decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                oxybutynin transdermal decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of oxybutynin transdermal by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • oxycodone

                oxycodone and risperidone both increase sedation. Use Caution/Monitor.

              • oxymorphone

                oxymorphone and risperidone both increase sedation. Use Caution/Monitor.

              • ozanimod

                ozanimod and risperidone both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

              • paliperidone

                paliperidone and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                paliperidone and risperidone both increase QTc interval. Use Caution/Monitor.

                paliperidone and risperidone both increase sedation. Use Caution/Monitor.

                paliperidone, risperidone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Paliperidone is the major active metabolite of risperidone, consideration should be given to the additive paliperidone exposure if any of these medications are coadministered.

              • pancuronium

                pancuronium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pancuronium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of pancuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • papaveretum

                papaveretum and risperidone both increase sedation. Use Caution/Monitor.

              • papaverine

                risperidone and papaverine both increase sedation. Use Caution/Monitor.

              • paroxetine

                paroxetine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

                paroxetine and risperidone both increase QTc interval. Use Caution/Monitor.

                paroxetine increases levels of risperidone by decreasing metabolism. Use Caution/Monitor.

                paroxetine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • pasireotide

                risperidone and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

              • peginterferon alfa 2b

                peginterferon alfa 2b, risperidone. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

              • pentazocine

                pentazocine and risperidone both increase sedation. Use Caution/Monitor.

              • pentobarbital

                pentobarbital and risperidone both increase sedation. Use Caution/Monitor.

              • perphenazine

                perphenazine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                perphenazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                perphenazine and risperidone both increase sedation. Use Caution/Monitor.

              • phendimetrazine

                risperidone increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenelzine

                phenelzine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • phenobarbital

                phenobarbital will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                phenobarbital and risperidone both increase sedation. Use Caution/Monitor.

              • phentermine

                risperidone increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenylephrine

                risperidone increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenylephrine PO

                risperidone increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • phenytoin

                phenytoin will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • pholcodine

                risperidone and pholcodine both increase sedation. Use Caution/Monitor.

              • pimozide

                pimozide and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                pimozide and risperidone both increase sedation. Use Caution/Monitor.

              • pioglitazone

                risperidone, pioglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • pirbuterol

                risperidone increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ponatinib

                ponatinib increases levels of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • posaconazole

                posaconazole and risperidone both increase QTc interval. Use Caution/Monitor.

              • pralidoxime

                pralidoxime decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                pralidoxime decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • pramlintide

                risperidone, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • primidone

                primidone and risperidone both increase sedation. Use Caution/Monitor.

              • procarbazine

                procarbazine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • prochlorperazine

                prochlorperazine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                prochlorperazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                prochlorperazine and risperidone both increase sedation. Use Caution/Monitor.

              • promazine

                promazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              • promethazine

                promethazine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                promethazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                promethazine and risperidone both increase sedation. Use Caution/Monitor.

                promethazine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • propantheline

                propantheline decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                propantheline decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of propantheline by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • propofol

                propofol and risperidone both increase sedation. Use Caution/Monitor.

              • propylhexedrine

                risperidone increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • protriptyline

                protriptyline and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and protriptyline both increase sedation. Use Caution/Monitor.

              • quazepam

                quazepam and risperidone both increase sedation. Use Caution/Monitor.

              • quercetin

                quercetin will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • quetiapine

                quetiapine and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                quetiapine and risperidone both increase sedation. Use Caution/Monitor.

                quetiapine, risperidone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

              • quinidine

                quinidine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • quinine

                risperidone and quinine both increase QTc interval. Use Caution/Monitor.

              • ramelteon

                risperidone and ramelteon both increase sedation. Use Caution/Monitor.

              • ranolazine

                ranolazine will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                ranolazine and risperidone both increase QTc interval. Use Caution/Monitor.

              • rapacuronium

                rapacuronium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                rapacuronium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of rapacuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • remimazolam

                remimazolam, risperidone. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

              • repaglinide

                risperidone, repaglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • rifampin

                rifampin will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • rilpivirine

                rilpivirine increases toxicity of risperidone by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

              • rimabotulinumtoxinB

                risperidone, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Anticholinergics may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • ritonavir

                ritonavir will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • rocuronium

                rocuronium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                rocuronium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of rocuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • rolapitant

                rolapitant will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

              • romidepsin

                risperidone and romidepsin both increase QTc interval. Use Caution/Monitor.

              • rosiglitazone

                risperidone, rosiglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • salmeterol

                risperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • sarecycline

                sarecycline will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

              • saxagliptin

                risperidone, saxagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • scopolamine

                scopolamine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                scopolamine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • scullcap

                risperidone and scullcap both increase sedation. Use Caution/Monitor.

              • secobarbital

                secobarbital and risperidone both increase sedation. Use Caution/Monitor.

              • selegiline

                selegiline, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • selpercatinib

                selpercatinib increases toxicity of risperidone by QTc interval. Use Caution/Monitor.

              • sertraline

                sertraline will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • shepherd's purse

                risperidone and shepherd's purse both increase sedation. Use Caution/Monitor.

              • simvastatin

                simvastatin will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • sirolimus

                sirolimus will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • sitagliptin

                risperidone, sitagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • sodium sulfate/?magnesium sulfate/potassium chloride

                sodium sulfate/?magnesium sulfate/potassium chloride increases effects of risperidone by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

              • sodium sulfate/potassium sulfate/magnesium sulfate

                sodium sulfate/potassium sulfate/magnesium sulfate increases effects of risperidone by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

              • solifenacin

                solifenacin decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                solifenacin decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • sorafenib

                sorafenib and risperidone both increase QTc interval. Use Caution/Monitor.

              • St John's Wort

                St John's Wort will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • stiripentol

                stiripentol will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

                stiripentol, risperidone. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

              • sufentanil

                sufentanil and risperidone both increase sedation. Use Caution/Monitor.

              • sulfamethoxazole

                sulfamethoxazole and risperidone both increase QTc interval. Use Caution/Monitor.

              • sumatriptan

                sumatriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • sumatriptan intranasal

                sumatriptan intranasal, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • tacrolimus

                tacrolimus will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • tapentadol

                tapentadol and risperidone both increase sedation. Use Caution/Monitor.

              • tazemetostat

                risperidone will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • telavancin

                risperidone and telavancin both increase QTc interval. Use Caution/Monitor.

              • temazepam

                temazepam and risperidone both increase sedation. Use Caution/Monitor.

              • terbinafine

                terbinafine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

              • terbutaline

                risperidone increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • tetrabenazine

                risperidone and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

              • thioridazine

                risperidone and thioridazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                thioridazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and thioridazine both increase sedation. Use Caution/Monitor.

              • thiothixene

                risperidone and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                risperidone and thiothixene both increase sedation. Use Caution/Monitor.

              • tinidazole

                risperidone will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • tiotropium

                tiotropium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                tiotropium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • tolazamide

                risperidone, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • tolbutamide

                risperidone, tolbutamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • tolterodine

                tolterodine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                tolterodine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • tolvaptan

                tolvaptan will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • topiramate

                risperidone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

              • tramadol

                tramadol and risperidone both increase sedation. Use Caution/Monitor.

              • tranylcypromine

                tranylcypromine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • trazodone

                trazodone will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                trazodone and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and trazodone both increase sedation. Use Caution/Monitor.

              • triazolam

                triazolam and risperidone both increase sedation. Use Caution/Monitor.

              • triclabendazole

                triclabendazole and risperidone both increase QTc interval. Use Caution/Monitor.

              • triclofos

                triclofos and risperidone both increase sedation. Use Caution/Monitor.

              • trifluoperazine

                risperidone and trifluoperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                trifluoperazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and trifluoperazine both increase sedation. Use Caution/Monitor.

              • trihexyphenidyl

                risperidone increases effects of trihexyphenidyl by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive anticholinergic effects.

              • trimethoprim

                risperidone and trimethoprim both increase QTc interval. Use Caution/Monitor.

              • trimipramine

                trimipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and trimipramine both increase sedation. Use Caution/Monitor.

              • triprolidine

                triprolidine and risperidone both increase sedation. Use Caution/Monitor.

              • tropisetron

                risperidone and tropisetron both increase QTc interval. Use Caution/Monitor.

              • trospium chloride

                trospium chloride decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                trospium chloride decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • tucatinib

                tucatinib will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

              • vecuronium

                vecuronium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

                vecuronium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor.

                risperidone increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

              • venlafaxine

                venlafaxine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

                risperidone and venlafaxine both increase QTc interval. Use Caution/Monitor.

                venlafaxine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • verapamil

                verapamil will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • vilazodone

                vilazodone, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • voclosporin

                voclosporin, risperidone. Either increases effects of the other by QTc interval. Use Caution/Monitor.

              • voriconazole

                risperidone and voriconazole both increase QTc interval. Use Caution/Monitor.

              • xylometazoline

                risperidone increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • yohimbine

                risperidone increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ziconotide

                risperidone and ziconotide both increase sedation. Use Caution/Monitor.

              • ziprasidone

                risperidone and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                risperidone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

                risperidone and ziprasidone both increase sedation. Use Caution/Monitor.

              • zolmitriptan

                zolmitriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

              • zotepine

                risperidone and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

                risperidone and zotepine both increase sedation. Use Caution/Monitor.

              Minor (28)

              • amoxapine

                risperidone and amoxapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Minor/Significance Unknown.

              • asenapine

                asenapine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • azithromycin

                azithromycin and risperidone both increase QTc interval. Minor/Significance Unknown.

              • brimonidine

                brimonidine increases effects of risperidone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

              • celecoxib

                celecoxib will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • chasteberry

                chasteberry decreases effects of risperidone by pharmacodynamic antagonism. Minor/Significance Unknown. (Theoretical interaction).

              • chloroquine

                chloroquine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • cimetidine

                cimetidine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • darifenacin

                darifenacin will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • diphenhydramine

                diphenhydramine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • dronedarone

                dronedarone will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • ethanol

                ethanol, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

              • eucalyptus

                risperidone and eucalyptus both increase sedation. Minor/Significance Unknown.

              • haloperidol

                haloperidol will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • imatinib

                imatinib will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • maraviroc

                maraviroc will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • marijuana

                marijuana will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • nilotinib

                nilotinib will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • parecoxib

                parecoxib will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • pazopanib

                pazopanib and risperidone both increase QTc interval. Minor/Significance Unknown.

              • perphenazine

                perphenazine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • quinacrine

                quinacrine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • ranolazine

                ranolazine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • ritonavir

                ritonavir will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • ruxolitinib

                risperidone will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

              • sage

                risperidone and sage both increase sedation. Minor/Significance Unknown.

              • thioridazine

                thioridazine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              • tipranavir

                tipranavir will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.

              Previous
              Next:

              Adverse Effects

              >10%

              Somnolence (40-45%)

              Insomnia (26-30%)

              Agitation (20-25%)

              Anxiety (10-15%)

              Headache (10-15%)

              Rhinitis (10-15%)

              Fatigue (18-31%)

              Parkinsonism (28-62%)

              Akathisia (5-11%)

              Increased appetite (4-44%)

              Vomiting (10-20%)

              Drooling (<12%)

              Urinary incontinence (5-22%)

              Tremor (11-24%)

              Nasopharyngitis (4-19%)

              Rhinorrhea (4-12%)

              Enuresis (1-16%)

              ER suspension

              • Increased weight (12.8-13%)

              1-10%

              Constipation (5-10%)

              Dyspepsia (5-10%)

              Nausea (5-10%)

              Abdominal pain (1-5%)

              Aggressive reaction (1-5%)

              Facial edema (<4%)

              QT prolongation (<4%)

              Dizziness (1-5%)

              Extrapyramidal symptoms (EPS; 1-5%)

              Gynecomastia in children (1-5%)

              Rash (1-5%)

              Tachycardia (1-5%)

              Syncope (1-2%)

              Bradycardia (<4%)

              Palpitation (<4%)

              Chest pain (<4%)

              Agitation (<4%)

              Postural dizziness (<4%)

              Pruritus (<4%)

              Acne (1-2%)

              Hyperprolactinemia (<4%)

              Sexual dysfunction (<4%)

              Xerostomia (7-10%)

              ER suspension

              • Sedation (7-7.7%)
              • Pain in extremity (0.9-7.7%)
              • Constipation (7-7/7%)
              • Anxiety (2.6-6.8%)
              • Akathisia (2.6-6.8%)
              • Back pain (3.5-6.8%)
              • Musculoskeletal pain (5.2%)
              • Extrapyramidal disorder (1.7-4.3%)
              • Increased appetite (1.7-3.4%)
              • Musculoskeletal stiffness (0.9-2.6%)
              • Abdominal discomfort (2.6%)
              • Muscle spasms (0-2.6%)
              • Dry mouth (1.7-2.6%)

              <1%

              Agranulocytosis

              Cholesterol increased

              Delirium

              Ketoacidosis

              Orthostatic hypotension

              Seizures

              Frequency Not Defined

              Diabetes mellitus

              Hyperthermia

              Hypoglycemia

              Hypothermia

              Myelosuppression

              Neuroleptic malignant syndrome (NMS)

              Priapism

              Prolonged QT interval

              Tardive dyskinesia

              Thrombotic thrombocytopenic purpura (TTP)

              Sleep apnea syndrome

              Urinary retention

              Blood and lymphatic system disorders: Anemia, granulocytopenia

              Cardiac disorders: Tachycardia, sinus bradycardia, sinus tachycardia, atrioventricular block first degree, bundle branch block left, bundle branch block right, atrioventricular block

              Ear and labyrinth disorders: Ear pain, tinnitus

              Eye Disorders: Vision blurred, oculogyration, ocular hyperemia, eye discharge, conjunctivitis, eye rolling, eyelid edema, eye swelling, eyelid margin crusting, dry eye, lacrimation increased, photophobia, glaucoma, visual acuity reduced

              Gastrointestinal disorders: Dysphagia, fecaloma, fecal incontinence, gastritis, lip swelling, cheilitis, aptyalism

              General disorders: Thirst, gait disturbance, chest pain, influenza-like illness, pitting edema, edema, chills, sluggishness, malaise, face edema, discomfort, generalized edema, drug withdrawal syndrome, peripheral coldness, feeling abnormal

              Immune system disorders: Drug hypersensitivity

              Infections and infestations: Nasopharyngitis, upper respiratory tract infection, sinusitis, urinary tract infection, pneumonia, influenza, ear infection, viral infection, pharyngitis, tonsillitis, bronchitis, eye infection, localized infection, cystitis, cellulitis, otitis media, onychomycosis, acarodermatitis, bronchopneumonia, respiratory tract infection, tracheobronchitis, otitis media chronic

              Investigations: Body temperature increased, alanine aminotransferase increased, heart rate increased, eosinophil count increased, white blood cell count decreased, hemoglobin decreased, blood creatine phosphokinase increased, hematocrit decreased, body temperature decreased, blood pressure decreased, transaminases increased

              Metabolism and nutrition disorders: Polydipsia, anorexia

              Musculoskeletal, connective tissue, and bone disorders: Joint swelling, musculoskeletal chest pain, posture abnormal, myalgia, neck pain, muscular weakness, muscle rigidity, muscle contracture, rhabdomyolysis

              Nervous system disorders: Dizziness postural, disturbance in attention, unresponsive to stimuli, depressed level of consciousness, movement disorder, hypokinesia, bradykinesia, transient ischemic attack, coordination abnormal, cerebrovascular accident, masked facies, speech disorder, syncope, loss of consciousness, muscle contractions involuntary, Parkinson disease, tongue paralysis, akinesia, cerebral ischemia, cerebrovascular disorder, neuroleptic malignant syndrome, diabetic coma, head titubation

              Psychiatric disorders: Agitation, blunted affect, confusional state, middle insomnia, nervousness, sleep disorder, listlessness

              Renal and urinary disorders: Enuresis, dysuria, pollakiuria, urinary incontinence Reproductive system and breast disorders: Vaginal discharge, menstrual disorder, retrograde ejaculation, sexual dysfunction

              Postmarketing Reports

              Falls

              Alopecia, anaphylactic reaction, angioedema, atrial fibrillation, cardiopulmonary arrest, diabetic ketoacidosis in patients with impaired glucose metabolism, dysgeusia, hypoglycemia, hypothermia, ileus, inappropriate antidiuretic hormone secretion, intestinal obstruction, jaundice, mania, pancreatitis, pituitary adenoma, precocious puberty, pulmonary embolism, QT prolongation, sleep apnea syndrome, sudden death, thrombocytopenia, thrombotic thrombocytopenic purpura, urinary retention, Stevens-Johnson syndrome, toxic epidermal necrolysis (SJS/TEN), and water intoxication

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              Warnings

              Black Box Warnings

              Elderly patients with dementia-related psychosis

              • Not approved for dementia-related psychosis
              • Elderly patients with dementia-related psychosis who are treated with antipsychotic drugs are at increased risk of death, as shown in short-term controlled trials; deaths in these trials appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature

              Contraindications

              Documented hypersensitivity

              Cautions

              Increased incidence of cerebrovascular disease reported; may alter cardiac conduction; life threatening arrhythmias reported with therapeutic doses of antipsychotics

              May cause anticholinergic effects including blurred vision, urinary retention, agitation, confusion, blurred vision, and xerostomia

              Use with caution in patients with history of seizures, Parkinson disease, Lewy body dementia, cardiovascular disease, hypovolemia, dehydration

              Leukopenia/neutropenia and agranulocytosis reported; possible risk factors for leukopenia/neutropenia include preexisting low white blood cell (WBC) count and history of drug-induced leukopenia/neutropenia

              If patient has history of clinically significant low WBC count or drug-induced leukopenia/neutropenia, monitor complete blood count (CBC) frequently during first few months of therapy; discontinue drug at first sign of clinically significant WBC decline <1000/μL in absence of other causative factors, and continue monitoring WBC count until recovery

              May cause somnolence, postural hypotension, motor and sensory instability, which may lead to falls and, consequently, fractures or other injuries; perform complete fall risk assessments when initiating antipsychotic treatment and recurrently for patients on long-term antipsychotic therapy

              Use caution in patients at risk of pneumonia; esophageal dysmotility and aspiration reported with antipsychotic use

              May cause extrapyramidal symptoms including acute dystonic reactions, akathisia, pseudoparkinsonism, and tardive dyskinesia

              Intraoperative floppy iris syndrome reported in patients receiving risperidone therapy

              Monitor for fever, mental status changes, muscle rigidity and or autonomic instability; neuroleptic malignant syndrome (NMS) associated with risperidone use; if NMS suspected, discontinue therapy immediately and provide symptomatic treatment and monitoring

              Use with caution in children <15 kg

              Cases of priapism reported with therapy

              Prolactin elevations occur and persist during chronic administration; risperidone is associated with higher levels of prolactin elevation than other antipsychotic agents

              Use caution when operating heavy machinery

              FDA warning regarding off-label use for dementia in elderly

              Seizures observed during premarketing studies of risperidone in adult patients with schizophrenia

              Esophageal dysmotility and aspiration have been associated with antipsychotic use

              Disruption of body temperature regulation has been attributed to antipsychotic agents

              Tardive dyskinesia

              • A syndrome consisting of potentially irreversible, involuntary, dyskinetic movements, may develop in patients treated with antipsychotic drugs; although prevalence appears to be highest among elderly, especially elderly women, it is impossible to predict which patients will develop the syndrome; whether antipsychotic drug products differ in their potential to cause tardive dyskinesia is unknown
              • Risk of developing tardive dyskinesia and likelihood that it will become irreversible increase with the duration of treatment and the cumulative dose. The syndrome can develop after relatively brief treatment periods, even at low doses. It may also occur after discontinuation of treatment
              • Tardive dyskinesia may remit, partially or completely, if antipsychotic treatment is discontinued; antipsychotic treatment, itself, however, may suppress (or partially suppress) signs and symptoms of the syndrome, possibly masking the underlying process
              • Therapy should be prescribed in a manner that is most likely to minimize occurrence of tardive dyskinesia; chronic antipsychotic treatment should generally be reserved for patients who suffer from a chronic illness known to respond to antipsychotic drugs, and for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate
              • In patients who do require chronic treatment, use lowest dose and shortest duration of treatment producing a satisfactory clinical response; periodically reassess need for continued treatment;
              • If signs and symptoms of tardive dyskinesia appear in a patient receiving therapy, consider discontinuing drug; however, some patients may require treatment with the drug despite the presence of the syndrome

              Orthostatic hypotension

              • May induce orthostatic hypotension associated with dizziness, tachycardia, and in some patients, syncope, especially during initial dose-titration period, probably reflecting its alpha-adrenergic antagonistic properties
              • risk of orthostatic hypotension and syncope may be minimized by limiting the initial dose to 2 mg total (either once daily or 1 mg twice daily) in normal adults and 0.5 mg twice daily in the elderly and patients with renal or hepatic impairment
              • Risk of orthostatic hypotension and syncope may be minimized by limiting initial dose to 2 mg total (either once daily or 1 mg twice daily) in normal adults and 0.5 mg twice daily in the elderly and patients with renal or hepatic impairment
              • Consider monitoring orthostatic vital signs in patients at risk; consider dose reduction if hypotension occurs
              • Use caution in patients with known cardiovascular disease (history of myocardial infarction or ischemia, heart failure, or conduction abnormalities), cerebrovascular disease, and conditions that would predispose patients to hypotension, eg, dehydration and hypovolemia, and in the elderly and patients with renal or hepatic impairment
              • Consider monitoring for orthostatic vital signs if hypotension occurs; clinically significant hypotension observed with concomitant use of drug and antihypertensive medication

              Metabolic changes

              • Atypical antipsychotic drugs have been associated with metabolic changes that may increase cardiovascular or cerebrovascular risk (eg, hyperglycemia, dyslipidemia, and body weight gain)
              • In some cases, hyperglycemia concomitant with use of atypical antipsychotics has been associated with ketoacidosis, hyperosmolar coma, or death
              • In some cases, hyperglycemia has resolved when the atypical antipsychotic, including risperidone, was discontinued; however, some patients required continuation of antidiabetic treatment despite discontinuation of risperidone
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              Pregnancy & Lactation

              Pregnancy

              There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to atypical antipsychotics, including risperidone, during pregnancy

              Healthcare professionals are encouraged to register patients by contacting the National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or online at http://womensmentalhealth.org/clinical-and-research programs/ pregnancyregistry/

              Infertility

              • Based on the pharmacologic action of risperidone, treatment may result in an increase in serum prolactin levels, which may lead to reversible reduction in fertility in females of reproductive potential

              Disease-associated maternal and/or embryo/fetal risk

              • There is a risk to the mother from untreated schizophrenia, including increased risk of relapse, hospitalization, and suicide
              • Schizophrenia is associated with increased adverse perinatal outcomes, including preterm birth It is not known if this is a direct result of the illness or other comorbid factors

              Fetal/neonatal adverse reactions

              • Extrapyramidal and/or withdrawal symptoms, including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorder reported in neonates who were exposed to antipsychotic drugs, including risperidone, during the third trimester of pregnancy; symptoms varied
              • Monitor neonates for extrapyramidal and/or withdrawal symptoms and manage symptoms appropriately

              Lactation

              Limited data from published literature reports the presence of risperidone and its metabolite, 9- hydroxyrisperidone, in human breast milk at relative infant dose ranging between 2.3 and 4.7% of the maternal weight-adjusted dosage

              Reports of sedation, failure to thrive, jitteriness, and extrapyramidal symptoms (tremors and abnormal muscle movements) in breastfed infants exposed to risperidone

              Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Has high affinity for serotonin type 2 (5-HT2) receptors; binds to dopamine D2 receptors with 20 times lower affinity than that for 5-HT2 receptors; antagonizes alpha1-adrenergic, alpha2-adrenergic, and histaminergic receptors; has moderate affinity for serotonin type 1 (5-HT1C, 5-HT1D, 5-HT1A) receptors; has weak affinity for dopamine D1 receptors; has no affinity for muscarinic, beta1-adrenergic, and beta2-adrenergic receptors

              Absorption

              Peak plasma time, steady-state: 4-6 hr (SC)

              Peak plasma concentration: 6.33-10.9 ng/mL (risperidone, 9-hydroxyrisperidone)

              AUC: 2262-3891 ng·hr/mL

              Bioavailability: 70%

              Peak plasma time: Extensive metabolizers, 3 hr; poor metabolizers, 17 hr

              Distribution

              Protein bound: Risperidone, 90%; metabolite, 77%

              Vd: 1-2 L/kg

              Metabolism

              Metabolized in liver by CYP2D6

              Metabolite: 9-hydroxyrisperidone (paliperidone)

              Elimination

              Half-life: Extensive metabolizers, 3 hr (parent and metabolite combined); poor metabolizers, 20 hr (parent and metabolite combined); prolonged in renal impairment; free fraction increase in hepatic disease

              Half-life: 8-9 days (9-hydroxyrisperidone and total active moiety)

              Excretion: Urine (70%), feces (14%)

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              Administration

              Oral Administration

              Oral solution

              • Administer directly from the calibrated pipette, or can be mixed with a beverage prior to administration
              • Compatible in the following beverages: Water, coffee, orange juice, and low-fat milk; it is NOT compatible with either cola or tea

              Orally disintegrating tablets

              • Do not open the blister until ready to administer
              • For single tablet removal, separate one of the four blister units by tearing apart at the perforations
              • Bend the corner where indicated
              • Peel back foil to expose the tablet
              • DO NOT push the tablet through the foil because this could damage the tablet
              • The child-resistant pouch should be torn open at the notch to access the blister; do not open the blister until ready to administer
              • Peel back foil from the side to expose the tablet
              • DO NOT push the tablet through the foil, because this could damage the tablet
              • Using dry hands, remove the tablet from the blister unit and immediately place the entire oral disintegration on the tongue; consumed immediately, as the tablet cannot be stored once removed from the blister unit
              • Disintegrate in the mouth within seconds and can be swallowed subsequently with or without liquid; patients should not attempt to split or to chew the tablet

              SC Preparation

              Visually inspect for particulate matter and discoloration prior to administration

              Hold powder syringe upright tap the barrel of the syringe to unpack the powder

              Remove caps from both powder syringe and diluent syringe

              Connect both syringes; do not over tighten

              Keep your fingers off the plunger to avoid drug spillage

              Mix product

              • Failure to fully mix the product could result in incorrect dosage
              • Premixing
                • Transfer contents of the liquid syringe into the powder syringe
                • Gently push the powder syringe plunger until you feel resistance (to wet powder and avoid compacting)
                • Repeat this gentle back-and-forth process for 5 cycles
              • Complete mixing
                • Continue mixing the syringes for an additional 55 cycles; mixing can be more vigorous than when premixing
                • When fully mixed, the product should be a cloudy suspension that is uniform in color; varies between white to yellow-green in color
                • If mixed drug appears any clear areas in the mixture, continue to mix until the distribution of the color is uniform

              SC Administration

              For abdominal SC injection, only

              Do not administer by any other route

              To be administered by a healthcare professional only

              Choose an injection site on the abdomen with adequate SC tissue that has no skin conditions (eg, nodules, lesions, excessive pigment); recommended patient be in the supine position; rotate injection sites (refer to prescribing information)

              Allow package to come to room temperature for at least 15 minutes prior to preparation

              Only prepare medication when you are ready to administer the dose

              As a universal precaution, always wear gloves

              IM preparation

              Remove dose pack from refrigerator; allow to sit at room temperature at least 30 minutes before reconstituting; do not warm any other way

              Remove vial cap; connect vial adapter

              Keep vial vertical to prevent leakage

              Hold base of vial and pull up on the sterile blister to remove; do not shake; do not touch exposed luer opening on vial adapter; this will result in contamination

              Remove cap from liquid cap; connect liquid syringe to the vial adapter

              Do not hold glass syringe barrel; may cause the white collar to loose or detach Inject diluent, suspend microspheres in diluent

              Continuing to hold down the plunger rod, shake vigorously for at least 10 seconds, as shown; check the suspension

              Microspheres will be visible in the liquid; immediately proceed to the next step so suspension does not settle

              IM Administration

              Immediately inject entire contents of syringe IM into the gluteal or deltoid muscle of the patient

              Gluteal injection should be made into the upper-outer quadrant of the gluteal area

              Do not IV administer

              Storage

              Tablets and oral disintegrating tablets

              • Store at room temperature 15-25°C (59-77°F); protect from light and moisture

              Oral solution

              • Store at controlled room temperature 15- 25°C (59-77°F); protect from light and freezing

              SC and IM kits

              • Unopened: Refrigerate 2-8°C (36-46°F); may store at room temperature in its original packaging at 20-25°C (68-77°F) for up to 7 days
              • After removal from the refrigerator, discard after 7 days
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Risperdal oral
              -
              2 mg tablet
              Risperdal oral
              -
              0.5 mg tablet
              Risperdal oral
              -
              3 mg tablet
              Risperdal oral
              -
              4 mg tablet
              Risperdal oral
              -
              1 mg tablet
              Risperdal oral
              -
              0.25 mg tablet
              Risperdal oral
              -
              1 mg/mL solution
              risperidone oral
              -
              1 mg/mL solution
              risperidone oral
              -
              4 mg tablet
              risperidone oral
              -
              3 mg tablet
              risperidone oral
              -
              2 mg tablet
              risperidone oral
              -
              1 mg tablet
              risperidone oral
              -
              0.5 mg tablet
              risperidone oral
              -
              0.25 mg tablet
              risperidone oral
              -
              1 mg tablet
              risperidone oral
              -
              0.25 mg tablet
              risperidone oral
              -
              3 mg tablet
              risperidone oral
              -
              2 mg tablet
              risperidone oral
              -
              1 mg tablet
              risperidone oral
              -
              0.5 mg tablet
              risperidone oral
              -
              0.25 mg tablet
              risperidone oral
              -
              1 mg/mL solution
              risperidone oral
              -
              4 mg tablet
              risperidone oral
              -
              0.25 mg tablet
              risperidone oral
              -
              2 mg tablet
              risperidone oral
              -
              4 mg tablet
              risperidone oral
              -
              0.25 mg tablet
              risperidone oral
              -
              0.5 mg tablet
              risperidone oral
              -
              1 mg tablet
              risperidone oral
              -
              2 mg tablet
              risperidone oral
              -
              3 mg tablet
              risperidone oral
              -
              0.25 mg tablet
              risperidone oral
              -
              4 mg tablet
              risperidone oral
              -
              0.5 mg tablet
              risperidone oral
              -
              3 mg tablet
              risperidone oral
              -
              1 mg tablet
              risperidone oral
              -
              0.5 mg tablet
              risperidone oral
              -
              0.25 mg tablet
              risperidone oral
              -
              0.25 mg tablet
              risperidone oral
              -
              1 mg tablet
              risperidone oral
              -
              2 mg tablet
              risperidone oral
              -
              3 mg tablet
              risperidone oral
              -
              0.5 mg tablet
              risperidone oral
              -
              4 mg tablet
              risperidone oral
              -
              4 mg tablet
              risperidone oral
              -
              3 mg tablet
              risperidone oral
              -
              2 mg tablet
              risperidone oral
              -
              1 mg tablet
              risperidone oral
              -
              0.5 mg tablet
              risperidone oral
              -
              2 mg tablet
              risperidone oral
              -
              1 mg tablet
              risperidone oral
              -
              4 mg tablet
              risperidone oral
              -
              3 mg tablet
              risperidone oral
              -
              2 mg tablet
              risperidone oral
              -
              1 mg tablet
              risperidone oral
              -
              0.5 mg tablet
              risperidone oral
              -
              0.25 mg tablet
              risperidone oral
              -
              3 mg tablet
              risperidone oral
              -
              2 mg tablet
              risperidone oral
              -
              1 mg/mL solution
              risperidone oral
              -
              4 mg tablet
              risperidone oral
              -
              0.5 mg tablet
              risperidone oral
              -
              1 mg/mL solution
              risperidone oral
              -
              4 mg tablet
              risperidone oral
              -
              3 mg tablet
              risperidone oral
              -
              1 mg/mL solution
              risperidone oral
              -
              4 mg tablet
              risperidone oral
              -
              3 mg tablet
              risperidone oral
              -
              2 mg tablet
              risperidone oral
              -
              1 mg tablet
              risperidone oral
              -
              0.5 mg tablet
              risperidone oral
              -
              0.5 mg tablet
              risperidone oral
              -
              1 mg/mL solution
              risperidone oral
              -
              1 mg tablet
              risperidone oral
              -
              4 mg tablet
              risperidone oral
              -
              3 mg tablet
              risperidone oral
              -
              2 mg tablet
              Perseris abdominal subcutaneous
              -
              120 mg syringe
              Perseris abdominal subcutaneous
              -
              90 mg syringe

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              risperidone oral

              RISPERIDONE DISINTEGRATING TABLET - ORAL

              (riss-PAIR-ih-doan)

              COMMON BRAND NAME(S): Risperdal M

              WARNING: There may be a slightly increased risk of serious, possibly fatal side effects (such as stroke, heart failure, fast/irregular heartbeat, pneumonia) when this medication is used by older adults with dementia. This medication is not approved for the treatment of dementia-related behavior problems. Discuss the risks and benefits of this medication, as well as other effective and possibly safer treatments for dementia-related behavior problems, with the doctor.If you are using risperidone in combination with other medication to treat depression, also carefully read the drug information for the other medication.

              USES: Risperidone is used to treat certain mental/mood disorders (such as schizophrenia, bipolar disorder, irritability associated with autistic disorder). This medication can help you to think clearly and take part in everyday life.Risperidone belongs to a class of drugs called atypical antipsychotics. It works by helping to restore the balance of certain natural substances in the brain.

              HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually once or twice daily.This medication comes in a blister pack. Do not remove the tablet from the packaging until you are ready to take it. With dry hands, peel back the foil on the blister pack to carefully remove the tablet. Do not try to push the tablet through the foil because doing so can damage the tablet. Place the tablet on your tongue right away and allow it to dissolve on your tongue. Do not split or chew the tablet. After the tablet has melted on the tongue, it can be swallowed with or without water.The dosage is based on your age, medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day. Keep taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor.Tell your doctor if your condition persists or worsens.

              SIDE EFFECTS: Drowsiness, dizziness, lightheadedness, drooling, nausea, weight gain, or tiredness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Dizziness and lightheadedness can increase the risk of falling. Get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: difficulty swallowing, muscle spasms, shaking (tremor), mental/mood changes (such as anxiety, restlessness), interrupted breathing during sleep.This medication may rarely make your blood sugar rise, which can cause or worsen diabetes. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. If you already have diabetes, check your blood sugar regularly as directed and share the results with your doctor. Your doctor may need to adjust your diabetes medication, exercise program, or diet.This drug may also cause significant weight gain and a rise in your blood cholesterol (or triglyceride) levels. These effects, along with diabetes, may increase your risk for developing heart disease. Discuss the risks and benefits of treatment with your doctor. (See also Notes section.)Risperidone may rarely cause a condition known as tardive dyskinesia. In some cases, this condition may be permanent. Tell your doctor right away if you develop any unusual/uncontrolled movements (especially of the face, lips, mouth, tongue, arms or legs).This medication may increase a certain natural substance (prolactin) made by your body. For females, this increase in prolactin may result in unwanted breast milk, missed/stopped periods, or difficulty becoming pregnant. For males, it may result in decreased sexual ability, inability to produce sperm, or enlarged breasts. If you develop any of these symptoms, tell your doctor right away.Get medical help right away if you have any very serious side effects, including: severe dizziness, fainting, seizures.This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you have any of the following symptoms: fever, muscle stiffness/pain/tenderness/weakness, severe tiredness, severe confusion, sweating, fast/irregular heartbeat, dark urine, signs of kidney problems (such as change in the amount of urine).Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking risperidone, tell your doctor or pharmacist if you are allergic to it; or to paliperidone; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, seizures, difficulty swallowing, low white blood cell count, Parkinson's disease, dementia, certain eye problems (cataracts, glaucoma), personal or family history of diabetes, heart disease, high cholesterol/triglyceride levels, breathing trouble during sleep (sleep apnea).Risperidone may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using risperidone, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using risperidone safely.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery (including cataract/glaucoma eye surgery), tell your doctor or dentist if you are taking or have ever taken this medication, and about all the other products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication may contain aspartame. If you have phenylketonuria (PKU) or any other condition that requires you to limit/avoid aspartame (or phenylalanine) in your diet, ask your doctor or pharmacist about using this medication safely.This medication may make you sweat less, making you more likely to get heat stroke. Avoid doing things that may cause you to overheat, such as hard work or exercise in hot weather, or using hot tubs. When the weather is hot, drink a lot of fluids and dress lightly. If you overheat, quickly look for a place to cool down and rest. Get medical help right away if you have a fever that does not go away, mental/mood changes, headache, or dizziness.Older adults may be more sensitive to the side effects of this drug, especially drowsiness, dizziness, lightheadedness, and QT prolongation (see above). Drowsiness, dizziness, and lightheadedness can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. Babies born to mothers who have used this drug during the last 3 months of pregnancy may rarely develop symptoms including muscle stiffness or shakiness, drowsiness, feeding/breathing difficulties, or constant crying. If you notice any of these symptoms in your newborn especially during their first month, tell the doctor right away.Since untreated mental/mood problems (such as schizophrenia, bipolar disorder, depression) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.This medication passes into breast milk and may have undesirable effects on a nursing infant. Tell the doctor right away if your baby develops symptoms such as muscle stiffness or shakiness, unusual sleepiness, or difficulty feeding. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: metoclopramide.Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness/dizziness, fast/irregular heartbeat, unusual/uncontrolled movements, seizures.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as blood sugar, weight, blood pressure, blood cholesterol/triglyceride levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
              Additional Offers
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.