Risperidone LAI
PERSERIS
Pronunciation: ris-PER-i-doen
“Purse heiress”
Spooky mascot → antipsychotic
Thick 18-gauge needle, subcutaneous to abdomen
PERSERIS was discontinued by the manufacturer
What it isLong-acting D2 and 5-HT2A antagonist with broad adrenergic and serotonergic blockade; schizophrenia.
Why this oneMonthly subcutaneous risperidone depot that forms an implant under the abdominal skin. No loading doses and no oral overlap.
What limits itSubcutaneous delivery brings injection-site lumps and soreness; prolactin elevation, EPS, weight gain, and orthostasis can limit use.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Schizophrenia | Adult | 90 mg or 120 mg SC once monthly | 90–120 mg once monthly | 120 mg per month |
Renal Titrate with oral risperidone up to at least 3 mg daily before initiating; then 90 mg once monthly based on response/tolerability
Hepatic Titrate with oral risperidone up to at least 3 mg daily before initiating; then 90 mg once monthly based on response/tolerability
One dose per month only; no loading dose.
Instructions
- Establish tolerability with oral risperidone before initiating
- Subcutaneous injection in the abdomen or back of the upper arm by a healthcare provider; do not give by any other route
- Do not give more than one dose (90 mg or 120 mg) per month; supplemental oral risperidone not recommended
- Fully mix the medication before administration
Available strengths
- inj 90, 120 mg (monthly)
Contraindications
- Known hypersensitivity to risperidone, paliperidone, or any components of PERSERIS (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
- increased weight
- sedation/somnolence
- musculoskeletal pain
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 | CostPlus | |
|---|---|---|---|---|
| 90 mg | inj | per unit | not offered | |
| 120 mg | inj | per unit | not offered |
Other forms: Risperidone (RISPERDAL) · Risperidone LAI (RISPERDAL CONSTA) · 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.