Risperidone LAI
RYKINDO
Pronunciation: ris-PER-i-doen
“Rye Kindle”
Spooky mascot → antipsychotic
Deltoid or gluteal injection site
What it isDepot D2 and 5-HT2A antagonist; schizophrenia and bipolar I maintenance.
Why this oneIts release profile shortens the oral-overlap requirement at initiation compared with CONSTA’s three weeks.
What limits itIt keeps the two-week injection frequency, so the visit burden is unchanged; prolactin elevation, parkinsonism, weight gain, and orthostasis can still end use.
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 titrate dose more frequently than every 4 weeks
Renal Titrate with oral risperidone up to at least 2 mg before initiating; reduced elimination expected in renal impairment
Hepatic Titrate with oral risperidone up to at least 2 mg before initiating
Administered every 2 weeks; overlap with 7 days of oral risperidone at initiation.
Instructions
- Establish tolerability with oral risperidone before initiating
- IM gluteal injection by a healthcare provider (alternate buttocks); do not give by any other route
- Administer the first dose with 7 days of oral risperidone
- Do not combine two different dose strengths in a single administration
Available strengths
- inj 25, 37.5, 50 mg
Contraindications
- Known hypersensitivity to risperidone, paliperidone, or any components of RYKINDO (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 | |
|---|---|---|---|---|---|
| 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 (RISPERDAL CONSTA) · Risperidone LAI (PERSERIS) · 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.