Normal Dose of Risperidone
For adults with schizophrenia, start with 2 mg/day and target 4-6 mg/day; for first-episode psychosis, start with 2 mg/day as the target dose; for children and adolescents, start with 0.5 mg/day and target 1-3 mg/day depending on indication. 1
Adult Dosing by Indication
Schizophrenia - Adults
- Starting dose: 2 mg/day (once or twice daily) 1
- Titration: Increase by 1-2 mg/day at intervals of ≥24 hours 1
- Target dose: 4-8 mg/day 1
- Effective range: 4-16 mg/day, though doses above 6 mg/day show no additional efficacy and increase extrapyramidal symptoms 1, 2
- Optimal dose for most patients: 4-6 mg/day provides the best balance of efficacy and tolerability 3, 4, 2, 5
First-Episode Psychosis - Adults
- Target dose: 2 mg/day 3
- Maximum recommended: 4-6 mg/day (equivalent to 4-6 mg haloperidol) 3
- Lower doses and slower titration are appropriate for treatment-naive patients 4
Bipolar Mania - Adults
- Starting dose: 2-3 mg/day 1
- Titration: Increase by 1 mg/day at intervals of ≥24 hours 1
- Effective range: 1-6 mg/day 1
Delirium in Cancer Patients - Adults
- Starting dose: 0.5 mg PO or SC stat 3
- PRN dosing: 0.5-1 mg q1h PRN (or q8h-q12h if scheduled) 3
- Use lower doses (0.25-0.5 mg) in older or frail patients 3
PTSD-Related Nightmares - Adults
- Dose range: 0.5-3 mg/day 3
- Most common: 1-3 mg/day showed efficacy in case series 3
- Average effective dose: 1 mg/day in burn patients 3
Pediatric Dosing by Indication
Schizophrenia - Adolescents (13-17 years)
- Starting dose: 0.5 mg once daily 1
- Titration: Increase by 0.5-1 mg/day at intervals of ≥24 hours 1
- Target dose: 3 mg/day 1
- Effective range: 1-6 mg/day, though no additional benefit above 3 mg/day 1
Bipolar Mania - Children and Adolescents (10-17 years)
- Starting dose: 0.5 mg once daily 1
- Titration: Increase by 0.5-1 mg/day at intervals of ≥24 hours 1
- Target dose: 1-2.5 mg/day 1
- Effective range: 1-6 mg/day 1
Irritability in Autism - Children and Adolescents (5+ years)
- Starting dose (weight <20 kg): 0.25 mg/day, can increase to 0.5 mg by Day 4 1
- Starting dose (weight ≥20 kg): 0.5 mg/day, can increase to 1 mg by Day 4 1
- Further titration: After Day 4, increase at intervals >2 weeks by 0.25 mg (<20 kg) or 0.5 mg (≥20 kg) 1
- Target dose: 0.5 mg (<20 kg) or 1 mg (≥20 kg) 1
- Effective range: 0.5-3 mg/day 1
Disruptive Behaviors in Intellectual Disability - Children
- Mean effective dose: 1.16 mg/day for conduct problems 3
- Dose range studied: Up to 2.9 mg/day 3
- Most studies show efficacy starting within 2 weeks 3
Special Populations
Severe Renal or Hepatic Impairment - Adults
- Starting dose: 0.5 mg twice daily 1
- Titration: May increase above 1.5 mg twice daily at intervals of ≥1 week 1
Elderly Patients
- Use lower starting doses (0.25-0.5 mg) and titrate gradually 3, 4
- Reduce dose in hepatic impairment 3
Key Clinical Considerations
Avoid high doses (≥10 mg/day): These provide no additional efficacy over 4-6 mg/day and significantly increase extrapyramidal symptoms 1, 2, 6. Ultra-low doses (<2 mg/day) are insufficient for most patients and lead to early discontinuation due to inadequate response 2.
Titration speed matters: Slower titration may be appropriate for first-episode patients, elderly patients, and young patients to minimize side effects and improve adherence 3, 1, 4.
Common pitfall: The original trials suggested 6 mg/day as the target, but subsequent evidence and clinical experience support 4 mg/day as optimal for most patients, with less-rapid titration than initially recommended 4, 2.
Monitor for extrapyramidal symptoms: Risk increases significantly above 6 mg/day 3, 1, 2. In children with intellectual disability, extrapyramidal symptom profiles at therapeutic doses are comparable to placebo 3.
Weight-based considerations in children: Dosing for autism-related irritability is stratified by 20 kg body weight threshold 1.