Risperidone LAI
RISPERDAL CONSTA
Pronunciation: ris-PER-i-doen
“Risperdal Constantly (q 2 wk)”
Spooky mascot → antipsychotic
Deltoid or gluteal injection site
What it isLong-acting injectable D2 and serotonin-receptor antagonist; maintenance treatment of schizophrenia and bipolar disorder.
Why this oneThe microspheres release almost nothing for the first three weeks, so it needs three weeks of oral risperidone overlap, unlike newer depots.
What limits itEvery-two-week injections require refrigeration; prolactin elevation, weight gain, and EPS persist.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Schizophrenia | Adult | 25 mg IM every 2 weeks | 25–50 mg IM every 2 weeks | 50 mg every 2 weeks |
| Bipolar I disorder, maintenance (monotherapy or adjunct to lithium/valproate) | Adult | 25 mg IM every 2 weeks | 25–50 mg IM every 2 weeks | 50 mg every 2 weeks |
Titration Do not adjust dose upward more frequently than every 4 weeks
Renal Titrate carefully with oral risperidone before initiating; reduced elimination in renal impairment (a lower Consta starting dose of 12.5 mg may be appropriate)
Hepatic Titrate carefully with oral risperidone before initiating; a lower Consta starting dose of 12.5 mg may be appropriate
Administered every 2 weeks; upward dose adjustments no more often than every 4 weeks.
Instructions
- Establish tolerability with oral risperidone before initiating
- Deep IM deltoid (1-inch needle, alternate arms) or gluteal (2-inch needle, alternate buttocks) injection by a healthcare professional; do not give IV
- Give oral risperidone (or another antipsychotic) with the first injection and continue for 3 weeks, then discontinue
Available strengths
- inj 12.5, 25, 37.5, 50 mg (q2wk)
Contraindications
- Known hypersensitivity to risperidone or paliperidone, or to any excipients in the formulation (anaphylactic reactions and angioedema reported).
Cautions
- Increased mortality in elderly patients with dementia-related psychosis (boxed; not approved for this use)
- Cerebrovascular adverse events, including stroke, in elderly dementia patients
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- Metabolic changes (hyperglycemia/diabetes, dyslipidemia, weight gain)
- Hyperprolactinemia
- Orthostatic hypotension and syncope
- Falls
- Leukopenia/neutropenia; seizures; potential for cognitive/motor impairment; dysphagia; priapism; disruption of body temperature regulation
Adverse reactions
- headache
- parkinsonism
- dizziness
- akathisia
- fatigue
- constipation
- dyspepsia
- sedation
- weight increased
- pain in extremity
- dry mouth
Pregnancy Neonates exposed to antipsychotics in the third trimester are at risk for extrapyramidal and/or withdrawal symptoms after delivery. Pregnancy registry available.
Lactation Risperidone and 9-hydroxyrisperidone present in human milk (relative infant dose 2.3–4.7% of maternal); reports of sedation, failure to thrive, jitteriness, and extrapyramidal symptoms in breastfed infants.
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 12.5 mg | inj | per unit | — | not offered | |
| 25 mg | inj | per unit | — | not offered | |
| 37.5 mg | inj | per unit | — | not offered | |
| 50 mg | inj | per unit | — | $9451.01/mL | not offered |
Other forms: Risperidone (RISPERDAL) · Risperidone LAI (PERSERIS) · Risperidone LAI (RYKINDO) · Risperidone LAI (UZEDY)
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.