Can you stop taking Risperidol (risperidone) suddenly?

Abrupt Discontinuation of Risperidone: Risks and Recommendations

Risperidone should not be stopped suddenly due to significant risks of withdrawal symptoms, relapse of psychiatric symptoms, and potential development of tardive dyskinesia. 1

Risks of Abrupt Discontinuation

Neurological Complications

• Tardive dyskinesia: Case reports document tardive dyskinesia occurring within days of sudden risperidone discontinuation, presenting as unsteady gait, axial dystonia, finger movements, shoulder shrugging, and tongue protrusion 1
• Withdrawal symptoms: Abrupt discontinuation of psychotropic drugs like risperidone can cause significant withdrawal symptoms 2
• Rebound psychosis: Sudden stopping increases risk of symptom relapse and psychiatric decompensation

Cardiovascular Risks

• Risperidone is associated with QT prolongation and increased risk of ventricular arrhythmias 3, 4
• Abrupt discontinuation could potentially cause autonomic instability in patients whose systems have adapted to the medication

Evidence for Gradual Tapering

A placebo discontinuation study in children with autism spectrum disorders demonstrated that even with a 3-week taper period (rather than abrupt discontinuation), 8 of 12 patients who switched to placebo experienced relapse of symptoms, compared to only 3 of 12 who continued risperidone 5. This suggests that:

1. Discontinuation effects are significant even with tapering
2. Gradual discontinuation is preferable to sudden stopping

Recommended Discontinuation Protocol

Based on the evidence, here is the recommended approach:

1. Consult with prescribing physician before making any changes to risperidone regimen

2. Implement gradual tapering:

   • Reduce dose by no more than 25% every 2-4 weeks
   • For patients on higher doses, initial reductions can be larger, with smaller reductions as the dose gets lower
   • Final stages of discontinuation should be especially slow and gradual

3. Monitor closely for:

   • Emergence of withdrawal symptoms
   • Return of original psychiatric symptoms
   • Development of tardive dyskinesia or other movement disorders
   • Cardiovascular changes (particularly in patients with risk factors)

4. Consider adjunctive treatment during tapering:

   • Benzodiazepines may help manage withdrawal symptoms if they emerge 1
   • Other supportive therapies based on specific symptoms

Special Considerations

High-Risk Situations

• Patients with history of relapse: More gradual tapering required
• Patients on multiple medications: Be aware of potential drug interactions during discontinuation 2
• Patients with cardiac risk factors: Monitor cardiac function more closely, as risperidone affects QT interval 3, 4

When Abrupt Discontinuation May Be Necessary

In rare emergency situations (e.g., neuroleptic malignant syndrome, severe allergic reaction), the risks of continuing risperidone may outweigh the risks of abrupt discontinuation. In such cases:

• Immediate medical supervision is essential
• Replacement therapy may be needed
• Close monitoring for withdrawal symptoms is critical

Conclusion

The evidence strongly indicates that risperidone should be discontinued gradually rather than abruptly to minimize risks of withdrawal symptoms, symptom relapse, and neurological complications like tardive dyskinesia. Any discontinuation should be supervised by a healthcare provider with appropriate monitoring.