Risperdal Warning Signs and Precautions

Neurological Warning Signs

Risperidone causes more extrapyramidal symptoms (EPS) than other atypical antipsychotics, making it the most likely among this class to produce movement disorders 1, 2, 3
Acute dystonia: Involuntary motor tics or spasms involving the face, extraocular muscles (oculogyric crisis), neck, back, and limb muscles—typically occurs after first few doses or dose increases 4
Parkinsonism: Muscle rigidity, bradykinesia, cogwheel rigidity, masked facies, and akinesia 1
Akathisia: Restlessness and inability to sit still 1
Tremor: Parkinsonian rest tremor 1
Risk of EPS increases with doses >6 mg/24 hours 5, 6
Neuroleptic malignant syndrome: Case reports documented in both adults and teenagers taking risperidone 1, 2, 3
Tardive dyskinesia: Reported in adults and teenagers, potentially irreversible 1, 2, 3
Laryngeal dystonia: Rare but life-threatening, presents as choking sensation and difficulty breathing 4

Extreme weight gain is the most common significant problem with atypical antipsychotics including risperidone 1, 2, 7, 8
Monitor weight at baseline and regularly during treatment 9
Associated with increased appetite 9

Orthostatic hypotension: Common problem requiring monitoring, particularly in elderly and frail patients 1, 2, 7, 3
Can cause dizziness and falls 5, 6
Use lower starting doses in older patients (0.25-0.5 mg) 5, 6, 10
QTc prolongation: Risperidone causes 0-5 ms mean QT prolongation, less than many other antipsychotics 4
Monitor ECG in patients with cardiac risk factors 1, 7, 3

Leukocytopenia: One case report of leukocytopenia in a teenage boy receiving risperidone 1, 7, 8, 3
Agranulocytosis can occur with any antipsychotic agent, though primarily associated with clozapine 1, 7, 8, 3
Consider baseline and periodic monitoring in high-risk patients 1, 8

Elevated hepatic transaminase levels: Often transient and resolve with drug cessation 1, 2, 7, 8, 3
Two reported cases of liver enzyme abnormalities and fatty infiltrates associated with obesity in adolescent males during risperidone therapy 1, 2, 7, 8, 3
Check baseline liver functions prior to initiating treatment with periodic monitoring during ongoing therapy 1, 2, 7, 8, 3

Pediatric patients: Higher rates of sedation, drooling, and weight gain compared to adults 9
Pediatric patients: Extrapyramidal symptoms occur but may present differently than in adults 1, 4
Elderly patients with dementia: Use lowest effective doses (start 0.25-0.5 mg) and monitor closely 5, 6, 10

The American Academy of Child and Adolescent Psychiatry reports that somnolence/drowsiness occurs in 51-63% of pediatric patients, and headache affects 12-29% of patients 11
The American Academy of Child and Adolescent Psychiatry also reports that nausea, vomiting, and dyspepsia occur in 15-20% of patients 11