Recommended Dosage and Usage of Risperidone for Schizophrenia and Bipolar Disorder
For schizophrenia in adults, risperidone should be initiated at 2 mg/day, titrated by 1-2 mg increments to a target dose of 4-8 mg/day, with an effective dose range of 4-16 mg/day. 1
Schizophrenia Treatment
Adult Dosing
- Initial dose: 2 mg/day (can be administered once or twice daily) 1
- Titration: Increase at intervals of 24 hours or greater, in increments of 1-2 mg/day as tolerated 1
- Target dose: 4-8 mg/day (most patients respond well to this range) 1, 2
- Maximum dose: Although efficacy has been demonstrated up to 16 mg/day, doses above 6 mg/day generally don't provide additional benefit and are associated with more extrapyramidal symptoms 1, 3
- Current clinical practice recommendation: 4 mg/day is now considered the optimal target dose for most patients, based on naturalistic studies and clinical experience 2
Adolescent Dosing
- Initial dose: 0.5 mg once daily (morning or evening) 1
- Titration: Adjust at intervals of 24 hours or greater, in increments of 0.5-1 mg/day 1
- Target dose: 3 mg/day 1
- Effective dose range: 1-6 mg/day (no additional benefit observed above 3 mg/day) 1
- Note: Patients experiencing persistent somnolence may benefit from administering half the daily dose twice daily 1
Bipolar Disorder Treatment
Adult Dosing
- Initial dose: 2-3 mg/day 1
- Titration: Adjust at intervals of 24 hours or greater, in increments of 1 mg/day 1
- Effective dose range: 1-6 mg/day 1, 4
- Clinical benefits: Decreases in agitation, psychosis, sleep disturbance, and rapid cycling 4
Children and Adolescents with Bipolar Mania
- Initial dose: 0.5 mg/day 1
- Titration: Increase by 0.5-1 mg/day at intervals of 24 hours or greater 1
- Target dose: 1-2.5 mg/day 1
- Effective dose range: 1-6 mg/day 1
Special Populations
Elderly Patients
- Lower starting doses and slower titration are recommended 2
- Initial dose should be reduced to minimize side effects 2
First-Episode Patients
- Lower doses are often effective (1-4 mg/day) 5
- Only a small percentage of first-episode patients require doses over 6 mg/day 5
- Starting at 1 mg/day and increasing to 2 mg after 3 days has shown good efficacy and tolerability 5
Patients with Severe Renal or Hepatic Impairment
- Initial dose: 0.5 mg twice daily 1
- Titration: May increase to dosages above 1.5 mg twice daily at intervals of one week or longer 1
Maintenance Therapy
- Patients who respond acutely should generally be maintained on their effective dose beyond the acute episode 1
- Regular reassessment is needed to determine the continued need for maintenance treatment 1
- Effectiveness of maintenance therapy (2-8 mg/day) has been demonstrated in controlled trials for adults who had been clinically stable for at least 4 weeks 1
Important Considerations
- Extrapyramidal side effects should be avoided to encourage medication adherence, especially in first-episode patients 6
- For treatment-resistant schizophrenia (after failure of two adequate antipsychotic trials), clozapine should be considered rather than higher doses of risperidone 6
- When switching from other antipsychotics to risperidone, gradual cross-titration is recommended 6
- Risperidone has shown efficacy for both positive and negative symptoms of schizophrenia 3
- In early psychosis, appropriate initial target doses are risperidone 2 mg/day or olanzapine 7.5-10.0 mg/day 6