Risperidone with Midodrine Interaction Details
Brand Names Associated with Risperidone
- Risperdal® M-TAB® Orally Disintegrating Tablets
- Risperdal® Oral Solution
- Risperdal® Tablets
- Risperidone
Brand Names Associated with Midodrine
- Midodrine
- Orvaten®
- Proamatine®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
An increased risk of acute dystonia
Interaction Summary
A case report described development of acute dystonia in a 33-year-old female following concomitant administration of midodrine and risperiDONE. Patients receiving this combination may need to be monitored for increased risperiDONE adverse events, including signs and symptoms of acute dystonia.
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Use caution if midodrine and risperiDONE are prescribed concurrently. Monitor for signs and symptoms of acute dystonia or other risperiDONE adverse events.
Mechanism Of Interaction
Unknown
Literature Reports
A) A 33-year-old female developed acute dystonia after addition of midodrine to treat orthostatic hypotension secondary to risperiDONE therapy. The patient had a 12-year history of catatonic schizophrenia, which was adequately controlled with a stable dose of risperiDONE 6 mg/day. Two days after addition of midodrine 4 mg/day to treat complaints of orthostatic hypotension, the patient exhibited manifestations of acute dystonia, including tongue protrusion, retrocollis, and oculogyric crisis. Intramuscular injection of anticholinergics immediately resolved all symptoms. Midodrine was discontinued and risperiDONE 6 mg/day monotherapy was continued. After two weeks without dystonic symptoms, midodrine 4 mg/day was added again to therapy to treat continuing complaints of orthostatic hypotension. A similar acute dystonic reaction recurred one day later and was successfully treated with one intramuscular injection of an anticholinergic. Again, midodrine was discontinued and the patient remained on risperiDONE 6 mg/day without dystonic symptoms. Two weeks later, the risperiDONE dose was decreased to 3 mg/day due to persistent orthostatic hypotension, and the patient was free of catatonic and dystonic symptoms at a 3-month follow-up. Increased risperiDONE-associated central noradrenergic activity due to the peripheral alpha-1 receptor activity of midodrine was a postulated mechanism for this interaction .
Risperidone Overview
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Risperidone is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used to treat episodes of mania (frenzied, abnormally excited, or irritated mood) or mixed episodes (symptoms of mania and depression that happen together) in adults and in teenagers and children 10 years of age and older with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Risperidone is also used to treat behavior problems such as aggression, self-injury, and sudden mood changes in teenagers and children 5 to 16 years of age who have autism (a condition that causes repetitive behavior, difficulty interacting with others, and problems with communication). Risperidone is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.
Midodrine Overview
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Midodrine is used to treat orthostatic hypotension (sudden fall in blood pressure that occurs when a person assumes a standing position). Midodrine is in a class of medications called alpha-adrenergic agonists. It works by causing blood vessels to tighten, which increases blood pressure.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
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Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
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