Risperidone Discontinuation: Taper Required
You should taper risperidone gradually rather than discontinue it abruptly to avoid withdrawal symptoms and rebound worsening of psychotic symptoms. 1
Rationale for Tapering
Antipsychotics like risperidone require gradual tapering to prevent two key problems:
- Rebound worsening of symptoms: Abrupt discontinuation can cause a rapid return or worsening of the underlying psychiatric condition (tics, psychosis, mania) that was being treated 1
- Withdrawal symptoms: Sudden cessation of psychotropic medications acting on the central nervous system can produce distressing physical and psychological withdrawal effects 2
The American Academy of Child and Adolescent Psychiatry explicitly recommends slow tapering for antipsychotics to avoid these complications 1
Recommended Tapering Approach
Reduce the dose gradually over several weeks, monitoring closely for symptom recurrence:
- Start by decreasing the dose by 25% of the original dose and maintain this for 1-2 weeks 1
- Continue reducing by 25% increments every 1-2 weeks as tolerated 1
- If withdrawal symptoms or psychiatric symptom recurrence occurs, slow the taper rate or temporarily return to the previous dose 1
- Very slow tapers (10% reductions per month) may be necessary for patients on long-term treatment or those experiencing intolerable symptoms 1
Monitoring During Discontinuation
Establish a structured monitoring plan before starting the taper:
- Schedule weekly follow-up visits during the tapering period to assess for symptom return and withdrawal effects 3
- Monitor for return of the original psychiatric symptoms (psychosis, agitation, behavioral disturbances) which may emerge weeks to months after the last dose 1
- Watch for withdrawal symptoms including anxiety, insomnia, agitation, and physical discomfort 4
Critical Cautions
Do not abruptly discontinue risperidone except in medical emergencies (such as severe adverse reactions requiring immediate cessation) 5
- Abrupt discontinuation has been associated with rapid clinical deterioration and psychotic exacerbations in some patients 5
- The risk of symptom rebound is particularly high with antipsychotics used for conditions like mania or tic disorders 1
- Patients who have been on risperidone for extended periods (months to years) require especially gradual tapers 1
If severe psychiatric symptoms return during tapering, reinstate the previous effective dose and consult a psychiatrist before attempting further discontinuation 1