Internal Medicine News - Risperdal
(risperidone, Janssen)
An atypical antipsychotic for short-term treatment of acute manic or mixed episodes associated with bipolar I disorder, as monotherapy, or in combination with lithium or valproate. Approved in 1994 for schizophrenia.
* Recommended Dosage: Starting at 2-3 mg once daily, reducing or increasing dose by 1 mg/day, no less than 24 hours apart. In short-term trials, from 1- to 6-mg daily doses were effective.
* Special Considerations: The most common side effects in trials included extrapyramidal symptoms, sleepiness, dyspepsia, nausea, abnormal vision, dizziness, and parkinsonism. Coadministration with carbamazepine and other enzyme inducers such as rifampin can reduce Risperdal plasma levels, and may reduce efficacy.
Related Results
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* Comment: Approval was based on three 3-week studies of adults with bipolar I disorder, with manic or mixed episodes, with or without psychotic features. Two were monotherapy trials, and one used Risperdal with lithium or valproate. Treatment with Risperdal, alone or in combination, was significantly more effective than placebo in treating manic or mixed episodes. Risperdal “is a medication that works fast, is safe, and can be used very nicely in combination” with other drugs to treat bipolar patients, said Dr. Robert Hirschfeld, who was not an investigator but was involved in the analysis of the data. Last summer, the FDA approved the antiepileptic Lamictal (lamotrigine) and the atypical antipsychotic Zyprexa (olanzapine) for bipolar indications. These recent approvals are “very exciting,” considering that the only treatments available for bipolar disorder for many years were lithium and traditional antipsychotics, said Dr. Hirschfeld, professor and chair of the department of psychiatry and behavioral sciences at the University of Texas, Galveston. He is a consultant to and has received speaking honoraria from Janssen.
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