RISPERDAL (RISPERIDONE) BY : FAITH PLETCHER 4/15/2014

GOALS AND OBJECTIVES Goal:  To convey information about Risperidone to the learner. Objectives:  The participant will be able to articulate three side effects of the drug. will

BRAND NAME: RISPERDAL GENERIC NAME: RISPERIDONE FUNCTIONAL CLASS: ANTIPSYCHOTIC

INDICATIONS:  MAIN USES:  Schizophrenia  Bipolar I disorder, acute manic/mixed  Irritability, autistic disorder- association (Children)  UNLABELED USES:  Acute psychosis  Agitation  ADHD  Dementia  Psychotic depression  Tourette’s syndrome

ACTION: Mechanism of action not fully understood: blocks dopamine (D2) and serotonin (5-HT2) receptors in the brain, depresses the RAS; anticholinergic, antihistaminic, and alpha-adrenergic blocking activity may contribute to some of its therapeutic and adverse actions

PHARMACOKINETICS  Absorption:  Risperidone is well absorbed. The absolute oral bioavailability of risperidone is 70% (CV=25%). The relative oral bioavailability of risperidone from a tablet is 94% (CV=10%) when compared to a solution.  Food Effect- Food does not affect either the rate or extent of absorption of risperidone. Thus, RISPERDAL® can be given with or without meals.  Distribution:  Risperidone is rapidly distributed. The volume of distribution is 1-2 L/kg. In plasma, risperidone is bound to albumin and α 1-acid glycoprotein. The plasma protein binding of risperidone is 90%, and that of its major metabolite, 9- hydroxyrisperidone, is 77%. Neither risperidone nor 9-hydroxyrisperidone displaces each other from plasma binding sites. High therapeutic concentrations of sulfamethazine (100 mcg/mL), warfarin (10 mcg/mL), and carbamazepine (10mcg/mL) caused only a slight increase in the free fraction of risperidone at 10 ng/mL and 9-hydroxyrisperidone at 50 ng/mL, changes of unknown clinical significance.

PHARMACOKINETICS  Metabolism:  Risperidone is extensively metabolized in the liver. The main metabolic pathway is through hydroxylation of risperidone to 9-hydroxyrisperidone by the enzyme, CYP 2D6. A minor metabolic pathway is through N-dealkylation. The main metabolite, 9-hydroxyrisperidone, has similar pharmacological activity as risperidone.  Excretion:  Risperidone and its metabolites are eliminated via the urine (90%) and, to a much lesser extent, via the feces.  Peak:  1-2 hr  Half life:  3-24 hrs

DOSAGE AND ROUTES  Schizophrenia  < 65 yo, first episode: 1-3 mg/ day PO divided qd-bid  Start: 1mg/day PO divided qd-bid then increase by 0.5 mg/day q6-7 days until target 2mg/day  <65 yo, maintenance: 1-4 mg/ day PO divided qd-bid  Start: 1-2 mg/day divided qd-bid then increase by 0.5 mg/day q3-7 days until target 4mg/day  >65 yo: 1-4 mg/day PO divided qd-bid  Start: 0.25 mg po qd then increase by mg/day q 6-7 days until target 2mg/day  Bipolar I disorder: acute manic/mixed:  1-6 mg/day PO divided qd-bid  Start: 2-3 mg PO qd, then may adjust dose by 1 mg/day no more frequently than q24h

SIDE EFFECTS:  CNS:  EPS, psuedoparkinsonisom, akathisia, dystonia, tardive dyskinesia, drowsiness, insomnia, agitation, anxiety, headaches, seizures, neuroleptic malignant syndrome, dizziness  CV:  Orthostatic hypotension, tachycardia, heart failure, sudden death( geriatric pts)  EENT:  Blurred vision  GI:  Nausea, vomiting, anorexia, constipation, jaundice, weight gain  GU:  Hyperprolactinemia, gynecomastia  MISC:  Renal artery occlusion, weight gain, hyperprolactinemia (child)  Respiratory:  Rhinitis, sinusitis, upper respiratory infection, cough

CONTRAINDICATIONS:  Contraindications:  hypersensitivity  Precautions:  Preganancy (C)  Children  Geriatric pts  Cardiac/renal/hepatic disease  CNS depression  Breast cancer  Parkinson’s disease  Brain tumor  Dehydration  Diabetes  Hematologic disease  Seizure disorders  Breast feeding

NURSING CONSIDERATIONS:  Mental status before initial administration  Swallowing of PO medication; check for hoarding or giving of medications to other pts  I&O ratio; palpate bladder if urinary output is low  Bilirubin, CBC, hepatic studies q month  Urinalysis before, during prolonged therapy  Affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances,  BP standing and lying; also pulse; respirations, take these q4h, during initial treatment

SUMMARY:  RISPERIDONE - ORAL  COMMON BRAND NAME: Risperdal  Risperidone is used to treat certain mental/mood disorders (such as schizophrenia, manic phase of bipolar disorder, irritability associated with autistic disorder). This medication can help you to think clearly and function in daily life. This is a psychiatric medication (antipsychotic-type) that works by helping to restore the balance of certain natural substances in the brain (D2 and 5-HT2). Dosages range from 1-6 mg po daily for the treatment of schizophrenia and Bipolar 1 disorder. This medication has several side effects including seizures, neuroleptic malignant syndrome, tachycardia, heart failure, sudden death( geriatric pts), and renal artery occlusion

REFERENCES Epocrates. (2014). Risperdal. [online] Retrieved from: Nursing Tutorial Online. (2014). Risperidone Drug Study. [online] Retrieved from: RxList. (2014). Risperdal (Risperidone) Drug Information: Clinical Pharmacology - Prescribing Information at RxList. [online] Retrieved from: Skidmore-Roth, L. (2011) Mosby's nursing drug reference. St. Louis, Mo.: Mosby.