Risperidone
Risperdal
Second-Generation AntipsychoticGeneric availableTDM data
The mechanism of action of risperidone in schizophrenia is unclear. The drug's therapeutic activity in schizophrenia could be mediated through a combination of dopamine Type 2 (D 2 ) and serotonin Type 2 (5HT 2 ) receptor antagonism. The clinical effect from risperidone results from the combined concentrations of risperidone and its major metabolite, 9-hydroxyrisperidone (paliperidone) . Antagonism at receptors other than D 2 and 5HT 2 may explain some of the other effects of risperidone .
Compare Risperidone →FDA-Approved Indications
- Schizophrenia (adults; adolescents 13–17 years)
- Acute manic or mixed episodes in Bipolar I — mono or adjunct with lithium/valproate
- Irritability associated with autistic disorder (5–16 years)
Common Off-Label Uses
- PTSD
- OCD augmentation
- Agitation in dementia
- Tourette syndrome
- Disruptive behavior disorders
What Sets This Drug Apart
- Highest sustained prolactin elevation among commonly used SGAs (mean increase 37-48 ng/mL vs placebo in NMAs); screen for galactorrhea, amenorrhea, sexual dysfunction, and bone loss
- FDA-approved for irritability associated with autistic disorder in children and adolescents (ages 5-17) — one of only two SGAs with this indication
- Notable EPS among SGAs: akathisia RR 2.73 vs placebo; second-highest non-FGA for antiparkinson-medication use in Leucht 2026
- Active metabolite 9-OH-risperidone (paliperidone) carries most of the clinical effect; combined active moiety half-life ~21 hours
- Available as long-acting injectable (Risperdal Consta, biweekly) for adherence-limited patients; requires 3 weeks of oral overlap at initiation
- Sedation and weight gain may be more pronounced in pediatric populations than in adults
Boxed Warning
WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS Elderly patients with dementia-related psychosis treated wi