Tapering Off Risperidone 0.25mg BID
To safely taper off risperidone 0.25mg twice daily, implement a gradual hyperbolic taper over 4-6 weeks, reducing by 25% every 7-10 days to minimize withdrawal symptoms. 1
Recommended Tapering Schedule
Step 1: Initial Reduction (Week 1-2)
- Reduce to 0.25mg in the morning and 0.125mg at night for 7-10 days
- Monitor for withdrawal symptoms using validated assessment tools 2
Step 2: Second Reduction (Week 2-3)
- Reduce to 0.125mg twice daily for 7-10 days
- Continue monitoring for withdrawal symptoms
Step 3: Third Reduction (Week 3-4)
- Reduce to 0.125mg once daily for 7-10 days
- Administer at night to minimize daytime side effects
Step 4: Final Reduction (Week 4-6)
- Reduce to 0.125mg every other day for 7-10 days
- Then discontinue completely
Monitoring During Tapering
Withdrawal Symptoms to Monitor
- Insomnia
- Anxiety
- Agitation
- Nausea
- Dizziness
- Tremor
- Return of original symptoms
Assessment Frequency
- Reassess for withdrawal symptoms after each dose reduction 2
- Schedule follow-up within 1-2 weeks after starting the taper 3
- Evaluate need to slow the taper if significant withdrawal symptoms occur
Important Considerations
Rationale for Gradual Tapering
- Hyperbolic tapering (reducing by percentage rather than fixed amounts) minimizes withdrawal symptoms 1
- Slow titration is particularly important when discontinuing antipsychotics 3
- Rapid discontinuation increases risk of rebound symptoms and withdrawal effects
Adjustments to Tapering Schedule
- If withdrawal symptoms emerge, return to previous dose and slow the taper
- For severe withdrawal symptoms, consider extending each step to 14 days
- If patient has been on risperidone long-term (>6 months), consider an even slower taper
Practical Administration Tips
- For 0.125mg doses, use liquid formulation if available
- If only tablets are available, consider alternate-day dosing or tablet splitting with a pill cutter
- Administer with food to minimize gastrointestinal side effects
Non-Pharmacological Support During Tapering
- Create a calm, structured environment during the tapering process 3
- Implement regular sleep hygiene practices
- Consider stress reduction techniques (deep breathing, mindfulness)
- Provide education to patient and caregivers about the tapering process and potential withdrawal symptoms
This tapering approach prioritizes patient safety while minimizing withdrawal symptoms through a gradual, systematic reduction in risperidone dosage.