Risperidone Discontinuation Guidelines

Rationale for Tapering

The American Academy of Child and Adolescent Psychiatry recommends slow tapering of antipsychotics like risperidone to avoid rebound worsening of symptoms and withdrawal symptoms 1, 2
Gradual tapering is necessary to prevent rapid return or worsening of underlying psychiatric conditions, such as psychosis, mania, or tic disorders 1, 2

The Centers for Disease Control and Prevention, as reported in MMWR Recommendations and Reports, suggests reducing the dose gradually over several weeks, starting with a 25% decrease of the original dose, and maintaining this for 1-2 weeks 3
Continue reducing the dose by 25% increments every 1-2 weeks as tolerated, and slow the taper rate or temporarily return to the previous dose if withdrawal symptoms or psychiatric symptom recurrence occurs 3
Very slow tapers, with 10% reductions per month, may be necessary for patients on long-term treatment or those experiencing intolerable symptoms 3

The American Academy of Child and Adolescent Psychiatry recommends establishing a structured monitoring plan before starting the taper, including scheduling weekly follow-up visits to assess for symptom return and withdrawal effects 4
Monitor for return of original psychiatric symptoms, which may emerge weeks to months after the last dose, and watch for withdrawal symptoms including anxiety, insomnia, agitation, and physical discomfort 5, 2

The American Academy of Child and Adolescent Psychiatry advises against abrupt discontinuation of risperidone, except in medical emergencies, due to the risk of rapid clinical deterioration and psychotic exacerbations 1, 2
Patients who have been on risperidone for extended periods require especially gradual tapers to minimize the risk of symptom rebound 3
If severe psychiatric symptoms return during tapering, reinstate the previous effective dose and consult a psychiatrist before attempting further discontinuation 5, 1