Warnings

Risperidone

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Oct 20, 2022

Warnings

Risperidone Risks, Warnings, and Complications

Risperidone can cause serious problems in some people. Talk to your doctor or pharmacist about other treatment options if you are at increased risk of complications from risperidone use.

INCREASED RISK OF STROKE AND DEATH: Antipsychotic medications like risperidone can put elderly patients with dementia-related psychosis at a higher risk of stroke and death. Risperidone is not used to treat mental health conditions like dementia-related psychosis.
NEUROLEPTIC MALIGNANT SYNDROME: Very rarely, risperidone can lead to a serious brain disorder called neuroleptic malignant syndrome. Signs and symptoms of this condition include high fever, muscle stiffness, excessive sweating, confusion, and changes in heart rate and blood pressure. Get medical help right away if you experience these symptoms as they can be life-threatening.
TARDIVE DYSKINESIA: Risperidone can lead to a movement disorder called tardive dyskinesia in which there are extrapyramidal symptoms (uncontrolled movements of the face, tongue, and other parts of the body). Other symptoms may include fidgeting, restlessness, shakiness, and muscle stiffness. Tell your doctor right away if you notice any restlessness or unusual movements. The risk is higher with larger doses of risperidone and long-term use of this medicine.
HIGH BLOOD GLUCOSE, HIGH CHOLESTEROL, AND WEIGHT GAIN: Risperidone can cause an increase in your blood sugar and cholesterol levels. It can also lead to an increase in appetite and weight gain. Your doctor may order blood tests to make sure you don’t have high blood sugar or high cholesterol before starting you on risperidone. The risk of these complications is higher in people who are obese, those with a personal or family history of diabetes, and those who already have high cholesterol.
DECREASE IN WHITE BLOOD CELL COUNT: Risperidone can lead to a drop in the number of white blood cells in your blood. These cells help the body fight infections. Tell your doctor right away if you develop a fever or find that you are falling sick or catching infections more easily. Your healthcare professional may order a blood test before starting you on this medicine and during the first few months of treatment to keep an eye on your white blood cell count.
SEIZURES: Risperidone can increase the likelihood of having seizures. People with a history or seizures or other health conditions that can cause seizures are at higher risk. Tell your doctor about any history of seizures before starting risperidone.
DECREASED THINKING ABILITY: This medicine affects your ability to concentrate, focus, think, and react. Avoid doing activities that require you to be fully alert, such as driving a car or operating machinery, until you know how risperidone affects you.
LOW BLOOD PRESSURE: Risperidone can lead to a sudden fall in blood pressure, which can cause dizziness and increase your risk of falls and injuries. Be sure to go slowly from a sitting or lying position to standing until your body gets used to the medicine. Risk factors include a history of stroke or heart disease, taking medications for high blood pressure, and dehydration.
DIFFICULTY SWALLOWING: Taking risperidone can make it harder to swallow foods and drinks. This can potentially cause these substances to enter your lungs and cause problems with breathing. Be sure to chew food completely and swallow drinks carefully. Tell your healthcare provider if you notice any problems with swallowing or tightening in the throat area. Older adults with Alzheimer’s dementia are at particularly high risk.
DIFFICULTY WITH REGULATING BODY TEMPERATURE: Risperidone can make it harder for the body to regulate its temperature. As a result, you may not be able to cool down in hot weather or warm up in cold weather. Monitor your body temperature carefully when you’re exposed to extreme outside temperatures while on risperidone.
PAINFUL OR PROLONGED ERECTION: Risperidone can cause a painful erection that lasts for several hours. This is an emergency. You should seek immediate medical care if you have an erection that is painful or does not go away. In severe cases, doctors may need to perform surgery to prevent permanent damage to the penis.
RISK TO PEOPLE WITH PHENYLKETONURIA: The orally disintegrating tablets of risperidone contain an amino acid called phenylalanine. Some people with a rare but serious condition called phenylketonuria are unable to break down this amino acid. High levels of phenylalanine can cause symptoms like shaking, seizures, behavioral problems, and musty-smelling urine, skin, and breath. Tell your healthcare provider if you have phenylketonuria before starting risperidone.
INCREASED PROLACTIN LEVELS: Risperidone can lead to an increase in prolactin levels. High levels of this hormone can cause fertility problems, enlargement of male breasts, absent or irregular menstrual periods in females, sexual dysfunction, and weakening of the bones. Your healthcare provider may order blood tests on a regular basis to keep an eye on your prolactin levels.
POTENTIAL HARM TO NEWBORN BABIES: Taking risperidone during the third trimester of pregnancy can increase the risk of withdrawal symptoms in a newborn baby after delivery. Talk to your doctor about the risk of taking risperidone if you are pregnant or planning a pregnancy.

Precautions Before Starting Risperidone

Tell your doctor if you have ever had an allergic reaction to risperidone, any of the active or inactive ingredients in risperidone dosage forms, or any other medications. Your pharmacy can give you a list of ingredients. Also tell your doctor if you have ever had to stop taking a medication for mental illness due to severe side effects.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Risperidone may not be right for people with certain medical conditions such as substance abuse (alcohol, street drugs, or prescription medications), phenylketonuria, Parkinson’s disease, high cholesterol, low white blood cells, balance problems, swallowing difficulties, chest pain, irregular heartbeat, high or low blood pressure, heart disease, heart failure, heart attack, stroke, seizures, kidney disease, liver disease, or breast cancer.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding. Taking risperidone, especially in the last few months of your pregnancy, can cause problems in your baby after delivery. Also, this medication can pass into breast milk and may harm a breastfeeding infant.

Precautions During Use of Risperidone

Keep all your doctors’ appointments while taking risperidone. Your doctor may want to order certain laboratory tests on a regular basis during your treatment with this medicine.

Risperidone can make you drowsy and dizzy. Do not drive a car or operate machinery until you know how it affects you. Avoid drinking alcohol while on this medicine because it can make these side effects worse.

You may experience lightheadedness, dizziness, or fainting if you get up too quickly from a sitting or lying position while on risperidone. This is especially true when you first start the medicine. To reduce your risk of falls, arise slowly, rest your feet on the ground for a few minutes, and then stand up.

It can be harder for your body to regulate temperature on risperidone. Before starting this medicine, tell your doctor if you do vigorous physical activity or are likely to be exposed to extreme high or low temperatures.

Taking risperidone can increase your risk of experiencing hyperglycemia (high blood sugar) even if you do not have diabetes. People who have schizophrenia are at higher risk of developing diabetes while on risperidone. Contact your doctor without delay if you experience signs and symptoms of high blood glucose, such as extreme thirst, extreme hunger, frequent urination, weakness, or blurred vision. If left untreated, high blood sugar can lead to a serious and potentially life-threatening complication called ketoacidosis. Watch out for symptoms of ketoacidosis such as dry mouth, vomiting, upset stomach, difficulty breathing, fruity smelling breath, and reduced consciousness.

Call your doctor if you develop vomiting, diarrhea, or dehydration while on risperidone.

Tell your doctor if you become pregnant while on risperidone.

Be sure to tell all your doctors you are on risperidone before any surgery, including dental procedures.

Risperidone Drug Interactions

Certain other drugs can affect how risperidone works. Possible interactions between risperidone and other medicines can increase the risk of severe adverse effects. The following medications can have possible interactions with risperidone:

Antidepressants like paroxetine (Paxil)
Medications used to treat anxiety
Anti-seizure medications like carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), phenytoin (Dilantin), and valproic acid (Depakote, Depakene)
Other atypical antipsychotics like clozapine (Clozaril)
Medications used to treat mental illnesses
Medications used to treat Parkinson’s disease (dopamine agonists) like bromocriptine (Parlodel), levodopa (Dopar, Larodopa), cabergoline (Dostinex), ropinirole (Requip), and pergolide (Permax)
Antihistamines like cimetidine (Tagamet)
Medications used to treat high blood pressure
Medications used to treat irregular heart rhythms such as quinidine (Quinaglute, Quinidex)
Antibiotics like rifampin (Rifadin, Rimactane)
Sleeping pills, sedatives, tranquilizers, and muscle relaxants

The above list may not describe all possible interactions of risperidone. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, OTC medications, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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