Is a taper necessary to discontinue risperidone (antipsychotic medication) after 2 days of treatment at 2 mg?

No Taper Needed After 2 Days of Risperidone

After only 2 days of risperidone 2 mg, you can discontinue immediately without tapering—no gradual dose reduction is necessary.

Rationale for Direct Discontinuation

• Tapering is recommended to prevent withdrawal symptoms and rebound worsening when medications have been used long enough to cause physiological adaptation 1, 2
• After just 2 days of treatment, insufficient time has elapsed for the development of physiological dependence or receptor adaptation that would necessitate gradual withdrawal 1
• The primary concerns with antipsychotic discontinuation—dyskinesias, parkinsonian symptoms, dystonias, and neuroleptic malignant syndrome—occur with abrupt cessation after prolonged use (typically weeks to months), not after 2 days 1

What the Evidence Shows About Tapering Duration

• Gradual withdrawal extending over a period greater than 1 month is recommended for patients who have been on antipsychotics chronically 1
• Monitoring plans for medication discontinuation may require "weeks to months after the last dose" to identify return of symptoms in patients with mood and anxiety disorders, but this applies to established treatment courses 1
• The 2 mg dose used here is actually the recommended initial target dose for risperidone in early psychosis, indicating it represents a starting rather than maintenance dose 1

Clinical Context

• Risperidone can be rapidly titrated to therapeutic doses within 16-24 hours in acute settings, with patients tolerating dose increases of 1 mg every 6-8 hours 3
• This rapid dosing tolerance demonstrates that brief exposure (2 days) does not create significant physiological dependence requiring taper 3
• The medication discontinuation guidance emphasizing gradual tapering specifically addresses situations where medications have been used "for more than 9 weeks" or in cases of "long-term" use 1

Important Caveat

• If the patient was taking risperidone to manage acute psychosis, agitation, or other psychiatric symptoms, simply stopping the medication does not address the underlying condition 1, 4
• You should have an alternative treatment plan in place or ensure the indication for starting risperidone has resolved 1
• Document the reason for discontinuation and monitor for return of the original symptoms that prompted the brief trial 1, 2