Risperidone (Risperdal) Nursing Considerations & Interventions

This drug is a second generation atypical antipsychotic medication, which is used to treat psychiatric conditions. This class of drug is preferred over typical antipsychotics, like haloperidol, because it is less likely to cause extrapyramidal motor control issues. Risperidone works by blocking dopaminergic and serotonergic receptors in the central nervous system.

Risperidone is indicated for managing schizophrenia and is effective in treating both the positive and negative symptoms of schizophrenia. This is because of the drug’s binding affinity for both dopaminergic and serotonergic receptors in the brain.

This med is used to control the manic episodes associated with bipolar disorder, otherwise known as bipolar mania. Furthermore, risperidone can be used to manage the inappropriate behavior and irritability associated with autistic disorder.

Risperidone is the only medication currently approved for irritability that is associated with autism. It is especially favorable due to the depot (long-acting) injectable form that is available.

This medication, like other antipsychotics, is associated with the possible development of extrapyramidal symptoms. These are drug-induced movement disorders that can include tardive dyskinesia (jerky, irregular movements), akathisia (motor restlessness), dystonia (continuous spasms and contractions), and Parkinson’s-like symptoms.

Inhibition of dopamine causes an increase of prolactin leading to possible gynecomastia (enlarged breasts) & galactorrhea.

Gynecomastia is the abnormal development of breast tissue in males and is related to the transient increase in prolactin that this medication causes.

Due to increased prolactin levels caused by this medication, some patients may experience spontaneous milk production or expulsion from the breast.

Due to hormone imbalances in the hypothalamic/pituitary axis, risperidone may cause patients to experience a lack of menstruation. Some patients may also experience fertility issues.

Prolongation of the QT interval in patients is commonly associated with almost all atypical antipsychotic medications. This prolongation may lead to serious cardiac manifestations, and should be used with caution in patients with underlying disorders. Overall, Risperidone has a lower risk of cardiac abnormalities relative to other neuroleptics.

There is a long-acting intramuscular form of the drug which is given every two weeks, known as the depot form. Patients who may have trouble with a regular oral routine may be given risperidone in this form. They should take the oral form for 3-4 weeks until the maximum effect is reached, and then they can be transitioned to the depot form.