Risperidone Kit
🆔 Identity & classification
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🏷️ RxNorm drug class
This medicine belongs to the Atypical Antipsychotic class.
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🏭 Manufacturer & labeler
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🩺 Clinical
Risperidone injection is used to treat schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) and bipolar I disorder (a disease that causes episodes of depression, episodes of severe mania, and other abnormal moods). Risperidone is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.
Read the full MedlinePlus article ↗- Risperidone is approved for three main uses: treating schizophrenia, managing acute manic or mixed episodes in Bipolar I Disorder, and reducing irritability — things like aggressio...
- What is risperidone actually used for — my doctor mentioned a few different things.
- Drowsiness and sedation are among the more common side effects, especially when you first start or when your dose increases. For most people, this tends to ease up as your body adj...
- Will I feel drowsy or like a 'zombie' on this medication?
Patient education
Supplement & herbal interactions
Some supplements/herbs that may interact with Risperidone — tap one for details:
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🧪 Inactive Ingredients / Excipients
Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.
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IACT rows and label-wide narrative are kept separate; availability and product-level specificity depend on the submitted label.Inactive ingredient FAQ
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💲 Pricing
A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.
| Price system | Per ea | Per package |
|---|---|---|
| Retail pharmacies payNADAC · weekly | $764.819 | — |
| Medicaid paysCMS SDUD · 12 mo | No recent Medicaid claims on file for this NDC — rare and low-volume NDCs are suppressed in the public data. | |
| Medicare drug plans payPart D · Q2 2026 | $484.62 | — |
| Medicare Part B allowsASP · J2794 | $11.105 / J2794 unit | — |
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🧾 Billing & reimbursement
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🔁 Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Risperidone 70121-2626-05 | Amneal | 1 kit | $353.489 | AB | Availability likely | save 54% |
| Risperidone 70121-2627-05 | Amneal | 1 kit | $556.699 | AB | Availability likely | save 27% |
| Risperidone 00480-1453-08 | Teva | 1 kit | $764.819 | AB | Availability likely | — |
| Risperidonethis 70121-2628-05 | Amneal | 1 kit | $764.819 | AB | Availability likely | — |
| risperidone 70748-0272-13 | Lupin | 1 kit | $764.819 | AB | Availability likely | — |
| Risperdal Consta 50458-0308-11 | Janssen | 1 kit | $1,273.770 | AB | Availability likely | +67% |
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⏳ Availability & generic status
This product is an FDA-approved generic. Other versions of the same drug are listed under Therapeutic equivalents, least expensive first.
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📊 Medicare Part D spend CMS · PART D · 2026 (Q1)
🔬 Reported adverse events (FAERS)
Top reported reactions
Reporter sex
Serious outcomes
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📦 Packaging — all sizes for this product
| Package NDC | Description | Marketing start | Status |
|---|---|---|---|
| 70121-2628-05 You're viewing this | 1 KIT in 1 CARTON (70121-2628-5) * 2 mL in 1 VIAL (70121-1353-1) * 2 mL in 1 SYRINGE (70121-2624-2) | 2025-09-08 | Active |
🧭 About this NDC listing & data coverage
Kit / multi-component package
This NDC identifies a kit — a package containing more than one component. Structured data (pricing, ingredients, equivalents) is often reported per component rather than for the kit NDC itself, which can make this page look thinner than the components' own pages.
What data is (and isn’t) available for this NDC — tap to expand
| NDC identity (package / product / labeler codes) | ✓ Available |
| Labeler | ✓ Available |
| Product & package description | ✓ Available |
| Marketing category & status | ✓ Available |
| Active ingredient / dosage form / route | ✓ Available |
| FDA label (SPL via DailyMed) | ✓ Available |
| Package photos | ✓ Available |
| Inactive ingredients (structured) | — Not published for this NDC The labeler did not submit a structured excipient list, or no SPL is available. |
| NADAC pharmacy acquisition price (CMS) | ✓ Available |
| Orange Book / therapeutic-equivalence data | ✓ Available |
| HCPCS J-code billing crosswalk | ✓ Available |
| Medicaid utilization (CMS SDUD) | — Not published for this NDC CMS reports utilization only for NDCs with Medicaid claims above its privacy threshold. |
Questions about this listing
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📄 Full prescribing information FDA SPL
🚨 Boxed Warning ▾
WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Risperidone for extended-release injectable suspension is not approved for the treatment of patients with dementia-related psychosis [see Warnings and Precautions (5.1) ]. WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS See full prescribing information for complete boxed warning.
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Risperidone for extended-release injectable suspension is not approved for use in patients with dementia-related psychosis. ( 5.1 )
🎯 Indications and Usage ▾
1 INDICATIONS AND USAGE Risperidone for extended-release injectable suspension is an atypical antipsychotic indicated: for the treatment of schizophrenia. ( 1.1 ) as monotherapy or as adjunctive therapy to lithium or valproate for the maintenance treatment of Bipolar I Disorder. ( 1.2 )
1.1Schizophrenia Risperidone for extended-release injectable suspension is indicated for the treatment of schizophrenia [see Clinical Studies (14.1) ].
1.2Bipolar Disorder Risperidone for extended-release injectable suspension is indicated as monotherapy or as adjunctive therapy to lithium or valproate for the maintenance treatment of Bipolar I Disorder [see Clinical Studies (14.2 , 14.3) ] .
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION For patients who have never taken oral RISPERDAL, it is recommended to establish tolerability with oral RISPERDAL prior to initiating treatment with risperidone for extended-release injectable suspension. Risperidone for extended-release injectable suspension should be administered every 2 weeks by deep intramuscular (IM) deltoid or gluteal injection. Each injection should be administered by a health care professional using the appropriate enclosed safety needle [see Dosage and Administration (2.8) ] .
For deltoid administration, use the 1-inch needle alternating injections between the two arms. For gluteal administration, use the 2-inch needle alternating injections between the two buttocks. Do not administer intravenously.
For patients who have never taken oral RISPERDAL, tolerability should be established with oral RISPERDAL prior to initiating treatment with risperidone for extended-release injectable suspension. ( 2 ) Administer by deep intramuscular (IM) deltoid or gluteal injection. Each injection should be administered by a health care professional using the appropriate enclosed safety needle (1-inch for deltoid administration alternating injections between the two arms and 2-inch for gluteal administration alternating injections between the two buttocks).
Do not administer intravenously. ( 2 ) 25 mg intramuscular (IM) every 2 weeks. Patients not responding to 25 mg may benefit from a higher dose of 37.5 mg or 50 mg.
The maximum dose should not exceed 50 mg every 2 weeks. ( 2 ) Oral RISPERDAL (or another antipsychotic medication) should be given with the first injection of risperidone for extended-release injectable suspension and continued for 3 weeks (and then discontinued) to ensure adequate therapeutic plasma concentrations from risperidone for extended-release injectable suspension. ( 2 ) Upward dose adjustment of risperidone for extended-release injectable suspension should not be made more frequently than every 4 weeks.
Clinical effects of each upward dose adjustment should not be anticipated earlier than 3 weeks after injection. ( 2 ) Avoid inadvertent administration into a blood vessel. ( 5.16 ) See Full Prescribing Information Section 2.8 for instructions for use.
2.1Schizophrenia The recommended dose for the treatment of schizophrenia is 25 mg IM (intramuscular) every 2 weeks. Although dose response for effectiveness has not been established for risperidone for extended-release injectable suspension, some patients not responding to 25 mg may benefit from a higher dose of 37.5 mg or 50 mg. The maximum dose should not exceed 50 mg risperidone for extended-release injectable suspension every 2 weeks.
No additional benefit was observed with dosages greater than 50 mg risperidone for extended-release injectable suspension; however, a higher incidence of adverse effects was observed. The efficacy of risperidone for extended-release injectable suspension in the treatment of schizophrenia has not been evaluated in controlled clinical trials for longer than 12 weeks. Although controlled studies have not been conducted to answer the question of how long patients with schizophrenia should be treated with risperidone for extended-release injectable suspension, oral risperidone has been shown to be effective in delaying time to relapse in longer-term use.
It is recommended that responding patients be continued on treatment with risperidone for extended-release injectable suspension at the lowest dose needed. The physician who elects to use risperidone for extended-release injectable suspension for extended periods should periodically re-evaluate the long-term risks and benefits of the drug for the individual patient.
2.2Bipolar Disorder The recommended dose for monotherapy or adjunctive therapy to lithium or valproate for the maintenance treatment of Bipolar I Disorder is 25 mg IM (intramuscular) every 2 weeks. Some patients may benefit from a higher dose of 37.5 mg or 50 mg. Dosages above 5…
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS Risperidone for extended-release injectable suspension is available in dosage strengths of 12.5 mg, 25 mg, 37.5 mg and 50 mg risperidone, USP. It is provided as a single-dose pack, consisting of a vial containing the risperidone microspheres, a pre-filled syringe containing 2 mL of diluent for risperidone for extended-release injectable suspension, a vial adapter and two Terumo SurGuard 3 Needles for intramuscular injection (a 21 G TW 1-inch needle with needle protection device for deltoid administration and a 20 G TW 2-inch needle with needle protection device for gluteal administration).
Vial kits: 12.5 mg, 25 mg, 37.5 mg and 50 mg. ( 3 )
⛔ Contraindications ▾
4 CONTRAINDICATIONS Risperidone for extended-release injectable suspension is contraindicated in patients with a known hypersensitivity to either risperidone or paliperidone, or to any of the excipients in the risperidone for extended-release injectable suspension formulation. Hypersensitivity reactions, including anaphylactic reactions and angioedema, have been reported in patients treated with risperidone and in patients treated with paliperidone. Paliperidone is a metabolite of risperidone.
Known hypersensitivity to risperidone, paliperidone, or to any excipients in risperidone for extended-release injectable suspension. ( 4 )
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS Cerebrovascular events, including stroke, in elderly patients with dementia-related psychosis. Risperidone for extended-release injectable suspension is not approved for use in patients with dementia-related psychosis. ( 5.2 ) Neuroleptic Malignant Syndrome: Manage with immediate discontinuation and close monitoring.
( 5.3 ) Tardive Dyskinesia: Discontinue treatment if clinically appropriate. ( 5.4 ) Metabolic Changes: Atypical antipsychotic drugs have been associated with metabolic changes that may increase cardiovascular/cerebrovascular risk. These metabolic changes include hyperglycemia, dyslipidemia and weight gain.
( 5.5 ) Hyperglycemia and Diabetes Mellitus: Monitor patients for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia and weakness. Monitor glucose regularly in patients with diabetes or at risk for diabetes. ( 5.5 ) Dyslipidemia: Undesirable alterations have been observed in patients treated with atypical antipsychotics.
( 5.5 ) Weight Gain: Significant weight gain has been reported. Monitor weight gain. ( 5.5 ) Hyperprolactinemia: Risperidone treatment may elevate prolactin levels.
Long-standing hyperprolactinemia, when associated with hypogonadism, can lead to decreased bone density in men and women. ( 5.6 ) Orthostatic hypotension: associated with dizziness, tachycardia, bradycardia and syncope can occur, especially during initial dose titration with oral risperidone. Use caution in patients with cardiovascular disease, cerebrovascular disease and conditions that could affect hemodynamic responses.
( 5.7 ) Leukopenia, Neutropenia and Agranulocytosis have been reported with antipsychotics, including risperidone for extended-release injectable suspension. Patients with history of a clinically significant low white blood cell count (WBC) or a drug-induced leukopenia/neutropenia should have their complete blood cell count (CBC) monitored frequently during the first few months of therapy and discontinuation of risperidone for extended-release injectable suspension should be considered at the first sign of a clinically significant decline in WBC in the absence of other causative factors.
( 5.9 ) Potential for cognitive and motor impairment: has potential to impair judgment, thinking and motor skills. Use caution when operating machinery, including automobiles. ( 5.10 ) Seizures: Use cautiously in patients with a history of seizures or with conditions that potentially lower the seizure threshold.
( 5.11 ) Dysphagia: Esophageal dysmotility and aspiration can occur. Use cautiously in patients at risk for aspiration pneumonia. ( 5.12 ) Priapism: has been reported.
Severe priapism may require surgical intervention. ( 5.13 ) Avoid inadvertent administration into a blood vessel. ( 5.15 )
5.1Increased Mortality in Elderly Patients with Dementia-Related Psychosis Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of 17 placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group.
Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear.
Risperidone for extended-release injectable suspension is not approved for the…
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS The following are discussed in more detail in other sections of the labeling: Increased mortality in elderly patients with dementia-related psychosis [see Boxed Warning and Warnings and Precautions (5.1) ]. Cerebrovascular adverse events, including stroke, in elderly patients with dementia-related psychosis [see Warnings and Precautions (5.2) ]. Neuroleptic malignant syndrome [see Warnings and Precautions (5.3) ].
Tardive dyskinesia [see Warnings and Precautions (5.4) ]. Metabolic changes [see Warnings and Precautions (5.5) ]. Hyperprolactinemia [see Warnings and Precautions (5.6) ].
Orthostatic hypotension [see Warnings and Precautions (5.7) ]. Falls [see Warnings and Precautions (5.8) ]. Leukopenia/Neutropenia and Agranulocytosis [see Warnings and Precautions (5.9) ].
Potential for cognitive and motor impairment [see Warnings and Precautions (5.10) ]. Seizures [see Warnings and Precautions (5.11) ]. Dysphagia [see Warnings and Precautions (5.12) ].
Priapism [see Warnings and Precautions (5.13) ]. Disruption of body temperature regulation [see Warnings and Precautions (5.14) ]. Avoidance of inadvertent injection into a blood vessel [see Warnings and Precautions (5.15) ].
Osteodystrophy and tumors in animals [see Warnings and Precautions (5.16) ]. The most common adverse reactions in clinical trials in patients with schizophrenia (≥ 5%) were: headache, parkinsonism, dizziness, akathisia, fatigue, constipation, dyspepsia, sedation, weight increased, pain in extremity and dry mouth. The most common adverse reactions in the double-blind, placebo-controlled periods of the bipolar disorder trials were weight increased (5% in the monotherapy trial) and tremor and parkinsonism (≥ 10% in the adjunctive treatment trial).
The most common adverse reactions that were associated with discontinuation from the 12-week double-blind, placebo-controlled trial in patients with schizophrenia (causing discontinuation in ≥ 1% of patients) were agitation, depression, anxiety and akathisia. Adverse reactions that were associated with discontinuation from the double-blind, placebo-controlled periods of the bipolar disorder trials were hyperglycemia (one patient in the monotherapy trial) and hypokinesia and tardive dyskinesia (one patient each in the adjunctive treatment trial).
The data described in this section are derived from a clinical trial database consisting of 2,392 patients exposed to one or more doses of risperidone for extended-release injectable suspension for the treatment of schizophrenia. Of these 2,392 patients, 332 were patients who received risperidone for extended-release injectable suspension while participating in a 12-week double-blind, placebo-controlled trial. Two hundred two (202) of the 332 were schizophrenia patients who received 25 mg or 50 mg risperidone for extended-release injectable suspension.
The conditions and duration of treatment with risperidone for extended-release injectable suspension in the other clinical trials varied greatly and included (in overlapping categories) double-blind, fixed- and flexible-dose, placebo- or active-controlled studies and open-label phases of studies, inpatients and outpatients and short-term (up to 12 weeks) and longer-term (up to 4 years) exposures. Safety was assessed by collecting adverse events and performing physical examinations, vital signs, body weights, laboratory analyses and ECGs.
In addition to the studies in patients with schizophrenia, safety data are presented from a trial assessing the efficacy and safety of risperidone for extended-release injectable suspension when administered as monotherapy for maintenance treatment in patients with bipolar I disorder. The subjects in this multi-center, double-blind, placebo-controlled study were adult patients who met DSM-IV criteria for Bipolar Disorder Type I and who were stable on risperidone (oral or long-acting injection), were stable on other antipsychotics or mood stabilizers, or were experiencing an ac…
🔄 Drug Interactions ▾
7 DRUG INTERACTIONS The interactions of risperidone for extended-release injectable suspension with co-administration of other drugs have not been systematically evaluated. The drug interaction data provided in this section is based on studies with oral RISPERDAL. Due to CNS effects, use caution when administering with other centrally-acting drugs.
Avoid alcohol. ( 7.1 ) Due to hypotensive effects, hypotensive effects of other drugs with this potential may be enhanced. ( 7.2 ) Effects of levodopa and dopamine agonists may be antagonized.
( 7.3 ) Cimetidine and ranitidine increase the bioavailability of risperidone. ( 7.5 ) Clozapine may decrease clearance of risperidone. ( 7.7 ) Fluoxetine and paroxetine increase plasma concentrations of risperidone.
( 7.12 ) Carbamazepine and other enzyme inducers decrease plasma concentrations of risperidone. ( 7.13 )
7.1Centrally-Acting Drugs and Alcohol Given the primary CNS effects of risperidone, caution should be used when risperidone for extended-release injectable suspension is administered in combination with other centrally-acting drugs or alcohol.
7.2Drugs with Hypotensive Effects Because of its potential for inducing hypotension, risperidone for extended-release injectable suspension may enhance the hypotensive effects of other therapeutic agents with this potential.
7.3Levodopa and Dopamine Agonists Risperidone for extended-release injectable suspension may antagonize the effects of levodopa and dopamine agonists.
7.4Amitriptyline Amitriptyline did not affect the pharmacokinetics of risperidone or of risperidone and 9-hydroxyrisperidone combined following concomitant administration with oral RISPERDAL.
7.5Cimetidine and Ranitidine Cimetidine and ranitidine increased the bioavailability of oral risperidone by 64% and 26%, respectively. However, cimetidine did not affect the AUC of risperidone and 9-hydroxyrisperidone combined, whereas ranitidine increased the AUC of risperidone and 9-hydroxyrisperidone combined by 20%.
7.6Methylphenidate Concomitant use with methylphenidate, when there is change in dosage of either medication, may increase the risk of extrapyramidal symptoms (EPS). Monitor for symptoms of EPS with concomitant use of risperidone for extended-release injectable suspension and methylphenidate [see Adverse Reactions (6.2) ] .
7.7Clozapine Chronic administration of clozapine with risperidone may decrease the clearance of risperidone.
7.8Lithium Repeated doses of oral RISPERDAL (3 mg twice daily) did not affect the exposure (AUC) or peak plasma concentrations (C max ) of lithium (N=13).
7.9Valproate Repeated doses of oral RISPERDAL (4 mg once daily) did not affect the pre-dose or average plasma concentrations and exposure (AUC) of valproate (1,000 mg/day in three divided doses) compared to placebo (N=21). However, there was a 20% increase in valproate peak plasma concentration (C max ) after concomitant administration of oral RISPERDAL.
7.10Digoxin Oral RISPERDAL (0.25 mg twice daily) did not show a clinically relevant effect on the pharmacokinetics of digoxin.
7.11Topiramate Oral RISPERDAL administered at doses from 1 mg/day to 6 mg/day concomitantly with topiramate 400 mg/day resulted in a 23% decrease in risperidone C max and a 33% decrease in risperidone AUC 0-12 hour at steady state. Minimal reductions in the exposure to risperidone and 9-hydroxyrisperidone combined and no change for 9-hydroxyrisperidone were observed. This interaction is unlikely to be of clinical significance.
There was no clinically relevant effect of oral RISPERDAL on the pharmacokinetics of topiramate.
7.12Drugs That Inhibit CYP 2D6 and Other CYP Isozymes Risperidone is metabolized to 9-hydroxyrisperidone by CYP 2D6, an enzyme that is polymorphic in the population and that can be inhibited by a variety of psychotropic and other drugs [see Clinical Pharmacology (12.3) ] . Drug interactions that reduce the metabolism of risperidone to 9-hydroxyrisperidone would increase the plasma co…
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS Pregnancy: May cause extrapyramidal and/or withdrawal symptoms in neonates with third trimester exposure. ( 8.1 ) Renal or Hepatic Impairment: dose appropriately with oral RISPERDAL prior to initiating treatment with risperidone for extended-release injectable suspension. A lower starting dose of risperidone for extended-release injectable suspension of 12.5 mg may be appropriate in some patients.
( 2.4 ) Pediatric Use: safety and effectiveness not established in patients less than 18 years of age. ( 8.4 ) Elderly: dosing for otherwise healthy elderly patients is the same as for healthy nonelderly. Elderly may be more predisposed to orthostatic effects than nonelderly.
( 8.5 )
8.1Pregnancy Risk Summary Neonates exposed to antipsychotic drugs during the third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery (see Clinical Considerations) . Overall, available data from published epidemiologic studies of pregnant women exposed to risperidone have not established a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes (see Data). There are risks to the mother associated with untreated schizophrenia or bipolar I disorder and with exposure to antipsychotics, including risperidone for extended-release injectable suspension, during pregnancy (see Clinical Considerations) .
Risperidone has been detected in plasma in adult subjects up to 8 weeks after a single-dose administration of risperidone for extended-release injectable suspension [see Clinical Pharmacology (12.3) ] . The clinical significance of risperidone for extended-release injectable suspension administered before pregnancy or anytime during pregnancy is not known. Oral administration of risperidone to pregnant mice caused cleft palate at doses 3 to 4 times the maximum recommended human dose (MRHD) with maternal toxicity observed at 4-times the MRHD based on mg/m 2 body surface area.
Risperidone was not teratogenic in rats or rabbits at doses up to 6-times the MRHD based on mg/m 2 body surface area. Increased stillbirths and decreased birth weight occurred after oral risperidone administration to pregnant rats at 1.5-times the MRHD based on mg/m 2 body surface area. Learning was impaired in offspring of rats when the dams were dosed at 0.6-times the MRHD and offspring mortality increased at doses 0.1 to 3 times the MRHD based on mg/m 2 body surface area.
The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.
Clinical Considerations Disease-associated Maternal and/or Embryo/Fetal Risk There is a risk to the mother from untreated schizophrenia or bipolar I disorder, including increased risk of relapse, hospitalization and suicide. Schizophrenia and bipolar I disorder are associated with increased adverse perinatal outcomes, including preterm birth. It is not known if this is a direct result of the illness or other comorbid factors.
Fetal/Neonatal Adverse Reactions Extrapyramidal and/or withdrawal symptoms, including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress and feeding disorder have been reported in neonates who were exposed to antipsychotic drugs, including risperidone for extended-release injectable suspension, during the third trimester of pregnancy. These symptoms have varied in severity. Monitor neonates for extrapyramidal and/or withdrawal symptoms and manage symptoms appropriately.
Some neonates recovered within hours or days without specific treatment; others required prolonged hospitalization. Data Human Data Published data from observational studies, birth registries and case reports on the use o…
🤰 Pregnancy ▾
8.1Pregnancy Risk Summary Neonates exposed to antipsychotic drugs during the third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery (see Clinical Considerations) . Overall, available data from published epidemiologic studies of pregnant women exposed to risperidone have not established a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes (see Data). There are risks to the mother associated with untreated schizophrenia or bipolar I disorder and with exposure to antipsychotics, including risperidone for extended-release injectable suspension, during pregnancy (see Clinical Considerations) .
Risperidone has been detected in plasma in adult subjects up to 8 weeks after a single-dose administration of risperidone for extended-release injectable suspension [see Clinical Pharmacology (12.3) ] . The clinical significance of risperidone for extended-release injectable suspension administered before pregnancy or anytime during pregnancy is not known. Oral administration of risperidone to pregnant mice caused cleft palate at doses 3 to 4 times the maximum recommended human dose (MRHD) with maternal toxicity observed at 4-times the MRHD based on mg/m 2 body surface area.
Risperidone was not teratogenic in rats or rabbits at doses up to 6-times the MRHD based on mg/m 2 body surface area. Increased stillbirths and decreased birth weight occurred after oral risperidone administration to pregnant rats at 1.5-times the MRHD based on mg/m 2 body surface area. Learning was impaired in offspring of rats when the dams were dosed at 0.6-times the MRHD and offspring mortality increased at doses 0.1 to 3 times the MRHD based on mg/m 2 body surface area.
The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.
Clinical Considerations Disease-associated Maternal and/or Embryo/Fetal Risk There is a risk to the mother from untreated schizophrenia or bipolar I disorder, including increased risk of relapse, hospitalization and suicide. Schizophrenia and bipolar I disorder are associated with increased adverse perinatal outcomes, including preterm birth. It is not known if this is a direct result of the illness or other comorbid factors.
Fetal/Neonatal Adverse Reactions Extrapyramidal and/or withdrawal symptoms, including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress and feeding disorder have been reported in neonates who were exposed to antipsychotic drugs, including risperidone for extended-release injectable suspension, during the third trimester of pregnancy. These symptoms have varied in severity. Monitor neonates for extrapyramidal and/or withdrawal symptoms and manage symptoms appropriately.
Some neonates recovered within hours or days without specific treatment; others required prolonged hospitalization. Data Human Data Published data from observational studies, birth registries and case reports on the use of atypical antipsychotics during pregnancy do not report a clear association with antipsychotics and major birth defects. A prospective observational study including 6 women treated with risperidone demonstrated placental passage of risperidone.
A retrospective cohort study from a Medicaid database of 9,258 women exposed to antipsychotics during pregnancy did not indicate an overall increased risk for major birth defects. There was a small increase in the risk major of birth defects (RR=1.26, 95% CI 1.02 to 1.56) and of cardiac malformations (RR=1.26, 95% CI 0.88 to 1.81) in a subgroup of 1,566 women exposed to risperidone during the first trimester of pregnancy; however, there is no mechanism of action to…
🧒 Pediatric Use ▾
8.4Pediatric Use Safety and effectiveness of risperidone for extended-release injectable suspension in pediatric patients have not been established. However, juvenile animal toxicology studies have been conducted with oral risperidone. Juvenile Animal Studies Juvenile dogs were treated with oral risperidone from weeks 10 to 50 of age (equivalent to the period of childhood through adolescence in humans), at doses of 0.31, 1.25, or 5 mg/kg/day, which are 1.2, 3.4 and 13.5 times the MRHD of 6 mg/day for children, based on mg/m 2 body surface area.
Bone length and density were decreased with a no-effect dose of 0.31 mg/kg/day; this dose produced plasma AUC of risperidone plus its active metabolite paliperidone (9-hydroxy-risperidone) that were similar to those in children and adolescents receiving the MRHD of 6 mg/day. In addition, sexual maturation was delayed at all doses in both males and females. The above effects showed little or no reversibility in females after a 12 week drug-free recovery period.
Juvenile rats, treated with oral risperidone from days 12 to 50 of age (equivalent to the period of infancy through adolescence in humans) showed impaired learning and memory performance (reversible only in females), with a no-effect dose of 0.63 mg/kg/day which is 0.5 times the MRHD of 6 mg/day for children, based on mg/m 2 body surface area. This dose produced plasma AUC of risperidone plus paliperidone about half the exposure observed in humans at the MRHD. No other consistent effects on neurobehavioral or reproductive development were seen up to the highest tested dose of 1.25 mg/kg/day which is 1 time the MRHD and produced plasma AUC of risperidone plus paliperidone that were about two thirds of those observed in humans at the MRHD of 6 mg/day for children.
🧓 Geriatric Use ▾
8.5Geriatric Use In an open-label study, 57 clinically stable, elderly patients (≥ 65 years old) with schizophrenia or schizoaffective disorder received risperidone for extended-release injectable suspension every 2 weeks for up to 12 months. In general, no differences in the tolerability of risperidone for extended-release injectable suspension were observed between otherwise healthy elderly and nonelderly patients. Therefore, dosing recommendations for otherwise healthy elderly patients are the same as for nonelderly patients.
Because elderly patients exhibit a greater tendency to orthostatic hypotension than nonelderly patients, elderly patients should be instructed in nonpharmacologic interventions that help to reduce the occurrence of orthostatic hypotension (e.g., sitting on the edge of the bed for several minutes before attempting to stand in the morning and slowly rising from a seated position). In addition, monitoring of orthostatic vital signs should be considered in elderly patients for whom orthostatic hypotension is of concern [see Warnings and Precautions (5.7) ] .
Concomitant use with Furosemide in Elderly Patients with Dementia-Related Psychosis In two of four placebo-controlled trials in elderly patients with dementia-related psychosis, a higher incidence of mortality was observed in patients treated with furosemide plus oral risperidone when compared to patients treated with oral risperidone alone or with oral placebo plus furosemide. No pathological mechanism has been identified to explain this finding and no consistent pattern for cause of death was observed. An increase of mortality in elderly patients with dementia-related psychosis was seen with the use of oral risperidone regardless of concomitant use with furosemide.
Risperidone for extended-release injectable suspension is not approved for the treatment of patients with dementia-related psychosis [see Boxed Warning and Warnings and Precautions (5.1) ] .
🆘 Overdosage ▾
10 OVERDOSAGE
10.1Human Experience No cases of overdose were reported in pre-marketing studies with risperidone for extended-release injectable suspension. Because risperidone for extended-release injectable suspension is to be administered by health care professionals, the potential for overdosage by patients is low. In pre-marketing experience with oral RISPERDAL, there were eight reports of acute RISPERDAL overdosage, with estimated doses ranging from 20 mg to 300 mg and no fatalities.
In general, reported signs and symptoms were those resulting from an exaggeration of the drug’s known pharmacological effects, i.e., drowsiness and sedation, tachycardia and hypotension and extrapyramidal symptoms. One case, involving an estimated overdose of 240 mg, was associated with hyponatremia, hypokalemia, prolonged QT and widened QRS. Another case, involving an estimated overdose of 36 mg, was associated with a seizure.
Post-marketing experience with oral RISPERDAL includes reports of acute overdose, with estimated doses of up to 360 mg. In general, the most frequently reported signs and symptoms are those resulting from an exaggeration of the drug’s known pharmacological effects, i.e., drowsiness, sedation, tachycardia, hypotension and extrapyramidal symptoms. Other adverse reactions reported since market introduction related to oral RISPERDAL overdose include prolonged QT interval and convulsions.
Torsade de pointes has been reported in association with combined overdose of oral RISPERDAL and paroxetine.
10.2Management of Overdosage In case of acute overdosage, establish and maintain an airway and ensure adequate oxygenation and ventilation. Cardiovascular monitoring should commence immediately and should include continuous electrocardiographic monitoring to detect possible arrhythmias. If antiarrhythmic therapy is administered, disopyramide, procainamide and quinidine carry a theoretical hazard of QT prolonging effects that might be additive to those of risperidone.
Similarly, it is reasonable to expect that the alpha-blocking properties of bretylium might be additive to those of risperidone, resulting in problematic hypotension. There is no specific antidote to risperidone. Therefore, appropriate supportive measures should be instituted.
The possibility of multiple drug involvement should be considered. Hypotension and circulatory collapse should be treated with appropriate measures, such as intravenous fluids and/or sympathomimetic agents (epinephrine and dopamine should not be used, since beta stimulation may worsen hypotension in the setting of risperidone-induced alpha blockade). In cases of severe extrapyramidal symptoms, anticholinergic medication should be administered.
Close medical supervision and monitoring should continue until the patient recovers.
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action The mechanism of action of risperidone in schizophrenia is unclear. The drug’s therapeutic activity in schizophrenia could be mediated through a combination of dopamine Type 2 (D 2 ) and serotonin Type 2 (5HT 2 ) receptor antagonism. The clinical effect from risperidone results from the combined concentrations of risperidone and its major active metabolite, 9-hydroxyrisperidone (paliperidone) [see Clinical Pharmacology (12.3) ] .
Antagonism at receptors other than D 2 and 5HT 2 may explain some of the other effects of risperidone [see Clinical Pharmacology (12.1) ] .
12.2Pharmacodynamics Risperidone is a monoaminergic antagonist with high affinity (Ki of 0.12 nM to 7.3 nM) for the serotonin Type 2 (5HT 2 ), dopamine Type 2 (D 2 ), α1 and α2 adrenergic and H 1 histaminergic receptors. Risperidone showed low to moderate affinity (Ki of 47 nM to 253 nM) for the serotonin 5HT 1C , 5HT 1D and 5HT 1A receptors, weak affinity (Ki of 620 nM to 800 nM) for the dopamine D 1 and haloperidol-sensitive sigma site and no affinity (when tested at concentrations > 10 -5 M) for cholinergic muscarinic or β1 and β2 adrenergic receptors.
12.3Pharmacokinetics Absorption After a single intramuscular (gluteal) injection of risperidone for extended-release injectable suspension, there is a small initial release of the drug (< 1% of the dose), followed by a lag time of 3 weeks. The main release of the drug starts from 3 weeks onward, is maintained from 4 to 6 weeks and subsides by 7 weeks following the intramuscular (IM) injection. Therefore, oral antipsychotic supplementation should be given during the first 3 weeks of treatment with risperidone for extended-release injectable suspension to maintain therapeutic levels until the main release of risperidone from the injection site has begun [see Dosage and Administration (2) ] .
Following single-doses of risperidone for extended-release injectable suspension, the pharmacokinetics of risperidone, 9-hydroxyrisperidone (the major metabolite) and risperidone plus 9-hydroxyrisperidone were linear in the dosing range of 12.5 mg to 50 mg. The combination of the release profile and the dosage regimen [IM (intramuscular) injections every 2 weeks] of risperidone for extended-release injectable suspension results in sustained therapeutic concentrations. Steady-state plasma concentrations are reached after 4 injections and are maintained for 4 to 6 weeks after the last injection.
Following multiple doses of 25 mg and 50 mg risperidone for extended-release injectable suspension, plasma concentrations of risperidone, 9-hydroxyrisperidone and risperidone plus 9-hydroxyrisperidone were linear. Deltoid and gluteal intramuscular injections at the same doses are bioequivalent and, therefore, interchangeable. Distribution Once absorbed, risperidone is rapidly distributed.
The volume of distribution is 1 L/kg to 2 L/kg. In plasma, risperidone is bound to albumin and α1-acid glycoprotein. The plasma protein binding of risperidone is approximately 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 (10 mcg/mL) caused only a slight increase in the free fraction of risperidone at 10 ng/mL and of 9-hydroxyrisperidone at 50 ng/mL, changes of unknown clinical significance. Metabolism and Drug Interactions 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.
Consequently, the clinical effect of the drug results from the combined concentrations of risperidone plus 9-hydroxyrisperidone. CYP 2D6, also called debriso…
🧬 Mechanism of Action ▾
12.1Mechanism of Action The mechanism of action of risperidone in schizophrenia is unclear. The drug’s therapeutic activity in schizophrenia could be mediated through a combination of dopamine Type 2 (D 2 ) and serotonin Type 2 (5HT 2 ) receptor antagonism. The clinical effect from risperidone results from the combined concentrations of risperidone and its major active metabolite, 9-hydroxyrisperidone (paliperidone) [see Clinical Pharmacology (12.3) ] .
Antagonism at receptors other than D 2 and 5HT 2 may explain some of the other effects of risperidone [see Clinical Pharmacology (12.1) ] .
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED/STORAGE AND HANDLING Risperidone for Extended-Release Injectable Suspension is available in dosage strengths of 12.5 mg, 25 mg, 37.5 mg, or 50 mg risperidone, USP. It is provided as a single-dose pack, consisting of a vial containing the risperidone microspheres, a pre-filled syringe containing 2 mL of diluent for risperidone for extended-release injectable suspension, a vial adapter and two Terumo SurGuard ® 3 Needles for intramuscular injection (a 21 G TW 1-inch needle with needle protection device for deltoid administration and a 20 G TW 2-inch needle with needle protection device for gluteal administration).
They are available as below: 12.5 mg vial/kit: Contains 41 mg risperidone microspheres (equivalent to 12.5 mg of risperidone, USP) is a white to off-white powder provided in a clear glass vial with a purple flip-off seal cap. 12.5 mg Vial: NDC 70121-1350-1 12.5 mg Kit: NDC 70121-2625-5 25 mg vial/kit: Contains 78 mg risperidone microspheres (equivalent to 25 mg of risperidone, USP) is a white to off-white powder provided in a clear glass vial with a red flip-off seal cap. 25 mg Vial: NDC 70121-1351-1 25 mg Kit: NDC 70121-2626-5 37.5 mg vial/kit: Contains 116 mg risperidone microspheres (equivalent to 37.5 mg of risperidone, USP) is a white to off-white powder provided in a clear glass vial with a green flip-off seal cap.
37.5mg Vial: NDC 70121-1352-1 37.5 mg Kit: NDC 70121-2627-5 50 mg vial/kit: Contains 152 mg risperidone microspheres (equivalent to 50 mg of risperidone, USP) is a white to off-white powder provided in a clear glass vial with a blue flip-off seal cap. 50 mg Vial: NDC 70121-1353-1 50 mg Kit: NDC 70121-2628-5 Storage and Handling The entire single-dose pack should be stored in the refrigerator (36°F to 46°F; 2°C to 8°C) and protected from light. If refrigeration is unavailable, risperidone for extended-release injectable suspension can be stored at temperatures not exceeding 77°F (25°C) for no more than 7 days prior to administration.
Do not expose unrefrigerated product to temperatures above 77°F (25°C). Keep out of reach of children.
📋 Description ▾
11 DESCRIPTION Risperidone for extended-release injectable suspension contains risperidone, USP an atypical antipsychotic belonging to the chemical class of benzisoxazole derivatives. The chemical designation is 3-[2-[4-(6-fluoro-1,2-benzisoxazol-3-yl)piperidino]ethyl]-6,7,8,9-tetrahydro-2-methyl-4H-pyrido[1,2-a]pyrimidin-4-one. Its molecular formula is C 23 H 27 FN 4 O 2 and its molecular weight is 410.48 g/mol.
The structural formula is: Risperidone, USP is soluble in methylene chloride, sparingly soluble in alcohol and practically insoluble in water. Risperidone for Extended-Release Injectable Suspension is a combination of extended-release microspheres for injection and diluent for parenteral use. The extended-release microspheres formulation is a sterile, white to off white, free-flowing powder that is available in dosage strengths of 12.5 mg, 25 mg, 37.5 mg, or 50 mg risperidone, USP per vial.
Risperidone, USP is micro-encapsulated in 7525 polylactide-co-glycolide (PLG) at a concentration of 381 mg risperidone per gram of microspheres. The diluent for parenteral use is a clear, colorless solution. Composition of the diluent includes 1 mg/mL citric acid anhydrous; 1.25 mg/mL disodium hydrogen phosphate dihydrate; 1 mg/mL polysorbate 20; 23 mg/mL sodium carboxymethyl cellulose; 6 mg/mL sodium chloride; 0.55 mg/mL sodium hydroxide and water for injection.
The microspheres are suspended in the diluent prior to injection. Risperidone for extended-release injectable suspension is provided as a single-dose pack, consisting of a vial containing the microspheres, a pre-filled syringe containing the diluent, a vial adapter and two Terumo SurGuard 3 Needles (a 21 G TW 1-inch needle with needle protection device for deltoid administration and a 20 G TW 2-inch needle with needle protection device for gluteal administration). 051
💬 Information for Patients ▾
17 PATIENT COUNSELING INFORMATION Physicians are advised to discuss the following issues with patients for whom they prescribe risperidone for extended-release injectable suspension. Neuroleptic Malignant Syndrome (NMS) Counsel patients about a potentially fatal adverse reaction, Neuroleptic Malignant Syndrome (NMS), that has been reported in association with administration of antipsychotic drugs. Advise patients, family members, or caregivers to contact the healthcare provider or report to the emergency room if they experience signs and symptoms of NMS, including hyperpyrexia, muscle rigidity, altered mental status including delirium and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmia) [see Warnings and Precautions (5.3) ] .
Tardive Dyskinesia Counsel patients on the signs and symptoms of tardive dyskinesia and to contact their healthcare provider if these abnormal movements occur [see Warnings and Precautions (5.4) ] . Metabolic Changes Educate patients about the risk of metabolic changes, how to recognize symptoms of hyperglycemia and diabetes mellitus and the need for specific monitoring, including blood glucose, lipids and weight [see Warnings and Precautions (5.5) ] . Orthostatic Hypotension Educate patients about the risk of orthostatic hypotension and syncope, particularly at the time of initiating treatment, re-initiating treatment, or increasing the dose [see Warnings and Precautions (5.7) ] .
Leukopenia/Neutropenia Advise patients with a pre-existing low WBC or a history of drug induced leukopenia/neutropenia that they should have their CBC monitored while being treated with risperidone for extended-release injectable suspension [see Warnings and Precautions (5.9) ] . Hyperprolactinemia Counsel patients on signs and symptoms of hyperprolactinemia that may be associated with chronic use of risperidone for extended-release injectable suspension. Advise them to seek medical attention if they experience any of the following: amenorrhea or galactorrhea in females, erectile dysfunction or gynecomastia in males [see Warnings and Precautions (5.6) ] .
Interference with Cognitive and Motor Performance Caution patients about performing activities requiring mental alertness, such as operating hazardous machinery, or operating a motor vehicle, until they are reasonably certain that risperidone for extended-release injectable suspension therapy does not affect them adversely [see Warnings and Precautions (5.10) ] . Priapism Advise patients of the possibility of painful or prolonged penile erections (priapism). Instruct the patient to seek immediate medical attention in the event of priapism [see Warnings and Precautions (5.13) ] .
Heat Exposure and Dehydration Counsel patients regarding appropriate care in avoiding overheating and dehydration [see Warnings and Precautions (5.14) ] . Concomitant Medication Advise patients to inform their healthcare providers if they are taking, or plan to take any prescription or over-the-counter drugs, as there is a potential for interactions [see Drug Interactions (7) ] . Alcohol Advise patients to avoid alcohol during treatment with risperidone for extended-release injectable suspension [see Drug Interactions (7.1) ] .
Pregnancy Advise patients to notify their healthcare provider if they become pregnant or intend to become pregnant during treatment with risperidone for extended-release injectable suspension. Advise patients that risperidone for extended-release injectable suspension may cause extrapyramidal and/or withdrawal symptoms in a neonate [see Use in Specific Populations (8.1) ] . Lactation Advise breastfeeding women using risperidone for extended-release injectable suspension to monitor infants for somnolence, failure to thrive, jitteriness and extrapyramidal symptoms (tremors and abnormal muscle movements) and to seek medical care if they notice these signs [see Use in Specific Populations (8.2) ] .
Infertility Ad…