Can someone take Risperdal (risperidone) and aripiprazole together?

From the Guidelines

Taking risperidone (Risperdal) and aripiprazole together is not recommended without careful medical supervision due to the potential for increased side effects and limited additional therapeutic benefit. These medications are both antipsychotics that work on similar brain receptors, particularly dopamine receptors. Combining them could potentially increase the risk of side effects such as sedation, weight gain, metabolic changes, and movement disorders like tardive dyskinesia or extrapyramidal symptoms 1.

Key Considerations

• Antipsychotic polypharmacy, which involves taking two or more antipsychotic medications concurrently, has been associated with detrimental effects on cognition, although the evidence is somewhat conflicting 1.
• The use of antipsychotic polypharmacy is generally not recommended by treatment guidelines, which instead endorse monotherapy as the preferred approach 1.
• However, in certain specific clinical situations, such as treatment-resistant schizophrenia, antipsychotic polypharmacy may be considered under close medical supervision 1.
• It is essential to consult with a psychiatrist before making any changes to your medication regimen, as they can evaluate your specific situation, medical history, and treatment needs to determine the best course of action 1.

Potential Risks and Benefits

• The combination of risperidone and aripiprazole may increase the risk of side effects such as hyperprolactinemia, sexual dysfunction, and weight gain 1.
• However, some studies have noted beneficial effects of combining aripiprazole with an antipsychotic with a greater side-effect burden, such as reduced weight gain and dyslipidemia 1.
• The decision to use antipsychotic polypharmacy should be made on a case-by-case basis, taking into account the individual patient's needs and medical history 1.

Clinical Implications

• If antipsychotic polypharmacy is used, it is essential to closely monitor side effects, medication levels, and therapeutic response 1.
• The selection of antipsychotics with differing side-effect profiles may help minimize the risk of adverse effects 1.
• Knowledge of cytochrome P450 (CYP) metabolizer status, especially for CYP2D6, may help predict potential drug-drug interactions and guide treatment decisions 1.

From the Research

Combination Therapy with Risperdal and Aripiprazole

• The combination of Risperdal (risperidone) and aripiprazole has been studied in various contexts, including the treatment of psychotic symptoms and tic disorders.
• A study published in the International Journal of Psychiatry in Clinical Practice 2 reported a case of severe psychotic exacerbation in a patient who was switched from risperidone to a combination of aripiprazole and haloperidol, suggesting that clinicians should be cautious when switching or combining these medications.

Efficacy and Safety of Combination Therapy

• A study published in Therapeutic Drug Monitoring 3 found that coadministration of duloxetine with risperidone or aripiprazole did not significantly increase the concentration of the parent drug or the parent drug/metabolite ratio, indicating that duloxetine may be safely used concomitantly with these medications.
• Another study published in Palliative & Supportive Care 4 compared the efficacy and side-effect profile of haloperidol, risperidone, olanzapine, and aripiprazole in the management of delirium, finding that all medications were equally effective, but differed in terms of their side-effect profile.

Specific Patient Populations

• A study published in the Journal of Substance Abuse Treatment 5 evaluated the tolerability and efficacy of aripiprazole and risperidone for treatment of methamphetamine-associated psychosis in Chinese patients, finding that both medications were effective in reducing psychotic symptoms, but risperidone-treated patients reported greater reductions in methamphetamine craving.
• A randomized double-blind clinical trial published in Child Psychiatry and Human Development 6 compared the safety and efficacy of aripiprazole and risperidone for treating children and adolescents with tic disorder, finding that both medications decreased tic severity and improved health-related quality of life, with comparable adverse effects.