Second-Generation Antipsychotic Pregnancy: Not to be used during pregnancy unless clearly necessary; neonates exposed in the third trimester may develop extrapyramidal and/or withdrawal symptoms. Do not discontinue abruptly. (Rarely relevant in the elderly.)

Risperidone

Brand names: Risperdal

Risperidone is a second-generation (atypical) antipsychotic used in schizophrenia, bipolar mania, and short-term for persistent aggression in dementia or autism when other measures have failed.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Elderly: start 0.5 mg twice daily; titrate in 0.5 mg twice-daily increments to 1–2 mg twice daily (schizophrenia or bipolar mania)

Route: Oral

Frequency: Twice daily

Max: Persistent aggression in Alzheimer's dementia: up to 1 mg twice daily, for no more than 6 weeks

Same elderly starting dose (0.5 mg twice daily) applies to schizophrenia and bipolar mania; caution in bipolar mania as clinical experience in the elderly is limited. Persistent aggression in moderate-to-severe Alzheimer's dementia: start 0.25 mg twice daily; titrate by 0.25 mg twice daily no more often than every other day; optimum 0.5 mg twice daily for most patients (up to 1 mg twice daily); use no longer than 6 weeks. WARNING (§4.4): increased mortality and an approximately 3-fold increase in cerebrovascular adverse events in elderly patients with dementia treated with antipsychotics; higher mortality observed with concomitant furosemide; avoid dehydration. Full (non-elderly) adult schizophrenia dose for reference: start 2 mg/day, most benefit 4–6 mg/day, max 16 mg/day. Renal or hepatic impairment: halve starting and subsequent doses and titrate more slowly.

Dose adjustments

Renal

Renal or hepatic impairment: halve starting and subsequent doses and titrate more slowly (§4.2). Elderly are more likely to have reduced renal function — care in dose selection and consider monitoring renal function.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Table 1. Recommended Daily Dosage by Indication Initial Dose Titration (Increments) Target Dose Effective Dose Range Schizophrenia: adults ( 2.1 ) 2 mg 1 to 2 mg 4 to 8 mg 4 to 16 mg Schizophrenia: adolescents ( 2.2 ) 0.5 mg 0.5 to 1 mg 3 mg 1 to 6 mg Bipolar mania: adults ( 2.2 ) 2 to 3 mg 1 mg 1 to 6 mg 1 to 6 mg Bipolar mania: children and adolescents ( 2.2 ) 0.5 mg 0.5 to 1 mg 1 to 2.5 mg 1 to 6 mg Irritability in autistic disorder ( 2.3 ) 0.25 mg Can increase to 0.5 mg by Day 4: (body weight less than 20 kg) 0.5 mg Can increase to 1 mg by Day 4: (body weight greater than or equal to 20 kg) After Day 4, at intervals of > 2 weeks: 0.25 mg (body weight less than 20 kg) 0.5 mg (body weight …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2026-05-21. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to risperidone (or paliperidone) or to any excipient

Side effects

Parkinsonism
Sedation/somnolence
Orthostatic hypotension (and falls)
Headache
Insomnia

Interactions

Furosemide (elderly with dementia): higher mortality observed with risperidone plus furosemide — weigh risks and benefits; avoid dehydration (§4.4)
Carbamazepine and other enzyme inducers decrease plasma risperidone — may need up to double the usual dose; titrate slowly
Fluoxetine, paroxetine and other CYP2D6 inhibitors increase plasma risperidone — reduce the dose and do not exceed 8 mg/day

Clinical monograph

How it works

It antagonises dopamine D2 and serotonin 5-HT2 receptors.

Prescribing in practice

It raises prolactin more than some other atypicals (galactorrhoea, sexual and menstrual effects) and causes dose-related extrapyramidal effects.
In dementia it is one of the few licensed short-term options for persistent aggression, but antipsychotics increase stroke and mortality risk — use the lowest dose for the shortest time.
Metabolic effects, sedation, postural hypotension and QT prolongation can occur.

Monitoring

Monitor weight, glucose and lipids, blood pressure, prolactin-related symptoms and movement disorders; review the need to continue.

Counselling the patient

Rise slowly to avoid dizziness.
Report breast symptoms, abnormal movements or marked stiffness.
Do not stop it suddenly.

Evidence & guidelines

Used in schizophrenia and bipolar mania and, short-term, for persistent aggression in dementia (licensed and time-limited), with the antipsychotic stroke and mortality warning.

Reference: MHRA Drug Safety Update 2004 (risperidone BPSD); NICE NG97 (Dementia); AGS Beers Criteria 2023; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Olanzapine · Second-Generation Antipsychotic

Pathways