From the Guidelines
When monitoring patients on risperidone, healthcare providers should regularly assess for extrapyramidal symptoms, weight changes, metabolic alterations, and other potential side effects to minimize morbidity and mortality. The monitoring of patients on risperidone should include regular checks for:
- Extrapyramidal symptoms (EPS) such as tremor, rigidity, and akathisia, which are common side effects 1
- Weight, blood glucose, and lipid levels at baseline and periodically thereafter, as risperidone can cause significant metabolic changes including weight gain, hyperglycemia, and dyslipidemia 1
- Blood pressure and heart rate, particularly during dose adjustments, as orthostatic hypotension can occur 1
- Prolactin levels if symptoms of hyperprolactinemia develop, such as gynecomastia, galactorrhea, sexual dysfunction, or menstrual irregularities 1
- Sedation, especially when initiating therapy or increasing doses 1
- ECG monitoring may be necessary in patients with cardiac risk factors or those on high doses due to potential QT prolongation 1
- Regular assessment of therapeutic response and mental status is essential to ensure the medication is effectively treating the underlying condition 1
- Patients should also be monitored for rare but serious adverse effects like neuroleptic malignant syndrome (fever, muscle rigidity, altered mental status) and tardive dyskinesia (involuntary movements of the face and extremities) 1
- Liver function tests, as risperidone may produce elevations in hepatic transaminase levels, although these elevations are often transient and generally resolve with cessation of the drug 1
It is crucial to prioritize the patient's quality of life and adjust the treatment plan accordingly, taking into account the potential side effects and benefits of risperidone therapy 1.
From the FDA Drug Label
Patients with an established diagnosis of diabetes mellitus who are started on atypical antipsychotics, including RISPERIDONE, should be monitored regularly for worsening of glucose control. Patients with risk factors for diabetes mellitus (e.g., obesity, family history of diabetes) who are starting treatment with atypical antipsychotics, including RISPERIDONE, should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment Any patient treated with atypical antipsychotics, including RISPERIDONE, should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Monitoring of orthostatic vital signs should be considered in patients for whom this is of concern. Patients with a history of a clinically significant low WBC or a drug-induced leukopenia/neutropenia should have their complete blood count (CBC) monitored frequently during the first few months of therapy Patients with clinically significant neutropenia should be carefully monitored for fever or other symptoms or signs of infection and treated promptly if such symptoms or signs occur.
Key Monitoring Parameters:
- Glucose control
- Fasting blood glucose
- Symptoms of hyperglycemia (polydipsia, polyuria, polyphagia, and weakness)
- Orthostatic vital signs
- Complete blood count (CBC)
- Fever or other symptoms or signs of infection in patients with clinically significant neutropenia 2 2
From the Research
Monitoring Parameters for Patients on Risperidone
The following parameters are monitored for patients on risperidone:
- Weight 3, 4
- Physical examination 3
- Fasting blood sugar (FBS) 3
- Serum lipid (S.L.) 3
- Pulse 3
- Blood pressure 3
- ECG 3
- Liver function tests (LFT) 3
- Urea and electrolytes (U&E) 3
- Triglycerides 3, 4
- Total cholesterol 4
- LDL cholesterol 4
Therapeutic Drug Monitoring
Therapeutic drug monitoring of risperidone may be beneficial in certain circumstances, including:
- Assessing potential noncompliance and supporting compliance 5
- Ruling out therapeutic failure as a result of low drug concentrations 5
- Identifying and managing drug interactions, adverse effects, and use in special populations 5
- Preventing concentration-related adverse drug reactions in children and adolescents 6
Special Considerations
- Particular attention should be given to the decision of increasing the drug dose, and minimum effective dosages should be preferred 4
- Promotion of healthy living and eating, exercise, and monitoring weight should be recommended 3
- Therapeutic drug monitoring is recommended in children and adolescents with schizophrenic disorders treated with risperidone 6