Risperdal M-Tab (risperidone) Disease Interactions

There are 12 disease interactions with Risperdal M-Tab (risperidone):

Neuroleptics (Includes Risperdal M-Tab) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Alcoholism

The use of neuroleptic agents is contraindicated in patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of neuroleptic agents may be additive with those of alcohol. Severe respiratory depression and respiratory arrest may occur. Therapy with neuroleptic agents should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  2. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  3. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
View all 10 references

Neuroleptics (Includes Risperdal M-Tab) ↔ Cardiovascular Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Cerebrovascular Insufficiency, History - Cerebrovascular Disease, History - Myocardial Infarction, Hypotension, Heart Disease

Neuroleptic agents may cause hypotension (including orthostatic hypotension), reflex tachycardia, increased pulse rate, syncope and dizziness, particularly during initiation of therapy or rapid escalation of dosage. Tolerance to the hypotensive effects often develops after a few doses to a few weeks. Rarely, fatal cardiac arrest has occurred secondary to severe hypotension. Other reported adverse cardiovascular effects include hypertension, edema, arrhythmias, thrombophlebitis, myocarditis, angina, myocardial infarction, congestive heart failure, and ECG abnormalities such as PR and QT interval prolongation, diffuse T-wave flattening, and ST segment depression. Therapy with neuroleptic agents should be administered cautiously in patients with severe cardiovascular disease, pheochromocytoma, a predisposition to hypotension, or conditions that could be exacerbated by hypotension such as a history of myocardial infarction, angina, or ischemic stroke. Close monitoring of cardiovascular status, including ECG changes, is recommended at all dosages. If parenteral therapy is given, patients should be in a supine position during administration and for at least 30 to 60 minutes afterwards. Patients who experience orthostatic hypotension should be cautioned not to rise too abruptly. Occasionally, when severe, hypotension may require treatment with vasoconstrictive agents such as norepinephrine or phenylephrine. Epinephrine should not be used, however, since neuroleptic agents can reverse its vasopressor effects and cause a further lowering of blood pressure.

References

  1. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  2. Tueth M "Side effects of clozipine (Clozaril) requiring emergency treatment." Am J Emerg Med 11 (1993): 312-3
  3. Centorrino F, Baldessarini RJ, Kando JC, Frankenburg FR, Volpicelli SA, Flood JG "Clozapine and metabolites - concentrations in serum and clinical findings during treatment of chronically psychotic patients." J Clin Psychopharmacol 14 (1994): 119-25
View all 28 references

Neuroleptics (Includes Risperdal M-Tab) ↔ Cns Depression

Severe Potential Hazard, High plausibility

Applies to: Altered Consciousness, Respiratory Arrest

The use of neuroleptic agents is contraindicated in comatose patients and patients with severe central nervous system depression. Neuroleptic agents may potentiate the CNS and respiratory depression in these patients.

References

  1. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  2. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
View all 7 references

Neuroleptics (Includes Risperdal M-Tab) ↔ Nms

Severe Potential Hazard, High plausibility

Applies to: Neuroleptic Malignant Syndrome

The central dopaminergic blocking effects of neuroleptic agents may precipitate or aggravate a potentially fatal symptom complex known as neuroleptic malignant syndrome (NMS). NMS is observed most frequently when high-potency agents like haloperidol are administered intramuscularly, but may occur with any neuroleptic agent given for any length of time. Clinical manifestations of NMS include hyperpyrexia, muscle rigidity, altered mental status and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac arrhythmias). Additional signs may include elevated creatine phosphokinase, myoglobinuria, and acute renal failure. Neuroleptic agents should not be given to patients with active NMS and should be immediately discontinued if currently being administered in such patients. In patients with a history of NMS, introduction or reintroduction of neuroleptic agents should be carefully considered, since NMS may recur.

References

  1. Anderson ES, Powers PS "Neuroleptic malignant syndrome associated with clozapine use." J Clin Psychiatry 52 (1991): 102-4
  2. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  3. Sharma R, Trappler B, Ng YK, Leeman CP "Risperidone-induced neutroleptic malignant syndrome." Ann Pharmacother 30 (1996): 775-8
View all 40 references

Neuroleptics (Includes Risperdal M-Tab) ↔ Tardive Dyskinesia

Severe Potential Hazard, Moderate plausibility

Applies to: Tardive Dyskinesia

Neuroleptic agents may precipitate symptoms of tardive dyskinesia (TD), a syndrome consisting of rhythmic involuntary movements variously involving the tongue, face, mouth, lips, jaw, and/or trunk and extremities, following chronic use of at least several months but often years. Elderly patients, particularly women, are most susceptible. Both the risk of developing the syndrome and the likelihood that it will become irreversible increase with the duration and total cumulative dose of neuroleptic therapy administered. However, patients may infrequently develop symptoms after relatively brief treatment periods at low dosages. If TD occurs during neuroleptic therapy, prompt withdrawal of the offending agent or at least a lowering of the dosage should be considered. TD symptoms may become more severe after drug discontinuation or a dosage reduction, but may gradually improve over months to years. In patients with preexisting drug-induced TD, initiating or increasing the dosage of neuroleptic therapy may temporarily mask the symptoms of TD but could eventually worsen the condition. The newer, atypical neuroleptic agents (e.g., risperidone, quetiapine, olanzapine) tend to be associated with a substantially reduced risk of inducing TD and are considered the drugs of choice in patients being treated for psychosis.

References

  1. Pinder RM, Brogden RN, Swayer R, Speight TM, Spencer R, Avery GS "Pimozide: a review of its pharmacological properties and therapeutic uses in psychiatry." Drugs 12 (1976): 1-40
  2. Ghelber D, Belmaker RH "Tardive dyskinesia with quetiapine." Am J Psychiat 156 (1999): 796-7
  3. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
View all 42 references

Risperidone (Includes Risperdal M-Tab) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Risperidone is metabolized by the liver to the principal active metabolite, 9-hydroxyrisperidone. Although the pharmacokinetics of risperidone do not seem to be significantly altered in patients with liver disease, the mean free fraction of risperidone in plasma has been shown to increase by about 35% because of the diminished concentration of both albumin and alpha1-acid glycoprotein. Therapy with risperidone should be administered cautiously in patients with severe hepatic impairment. Lower initial dosages and slower titration are recommended.

References

  1. Mannens G, Huang ML, Meuldermans W, Hendrickx J, Woestenborghs R, Heykants J "Absorption, metabolism, and excretion of risperidone in humans." Drug Metab Dispos 21 (1993): 1134-41
  2. Heykants J, Huang ML, Mannens G, Meuldermans W, Snoeck E, Vanbeijsterveldt L, Vanpeer A, Woestenborghs R "The pharmacokinetics of risperidone in humans - a summary." J Clin Psychiatry 55 Suppl (1994): 13-7
  3. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.

Risperidone (Includes Risperdal M-Tab) ↔ Qt Interval Prolongation

Severe Potential Hazard, High plausibility

Applies to: Hypokalemia, Diarrhea, Magnesium Imbalance, Abnormal Electrocardiogram, Electrolyte Abnormalities

Risperidone and its active metabolite, 9-hydroxyrisperidone, can prolong the QT interval of the electrocardiogram in some patients. The risk of torsade de pointes is progressively increased as the degree of prolongation becomes greater. Therapy with risperidone should be administered cautiously, if at all, in patients with congenital or acquired QT interval prolongation syndromes. Electrolyte disturbances such as hypokalemia and hypomagnesemia may augment the prolongation effect of risperidone on the QT interval and should be corrected prior to institution of risperidone therapy. In addition, patients who experience frequent, severe, or prolonged diarrhea may be subject to electrolyte losses and should be followed closely and managed accordingly during therapy with risperidone.

References

  1. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  2. Huang CL, Su KP, Hsu HB, Pariante CM "A pilot observational crossover study of QTc interval changes associated with switching between olanzapine and risperidone." J Clin Psychiatry 68 (2007): 803-5
  3. Glassman AH, Bigger JT Jr "Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death." Am J Psychiatry 158 (2001): 1774-82

Risperidone (Includes Risperdal M-Tab) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Risperidone and its primary active metabolite, 9-hydroxyrisperidone, are eliminated by the kidney. In patients with moderate to severe renal disease, clearance of the sum of parent drug and metabolite has been shown to decrease by 60% compared to that in young, healthy subjects. Therapy with risperidone should be administered cautiously in patients with impaired renal function. Lower initial dosages and slower titration are recommended.

References

  1. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  2. Mannens G, Huang ML, Meuldermans W, Hendrickx J, Woestenborghs R, Heykants J "Absorption, metabolism, and excretion of risperidone in humans." Drug Metab Dispos 21 (1993): 1134-41
  3. Heykants J, Huang ML, Mannens G, Meuldermans W, Snoeck E, Vanbeijsterveldt L, Vanpeer A, Woestenborghs R "The pharmacokinetics of risperidone in humans - a summary." J Clin Psychiatry 55 Suppl (1994): 13-7

Neuroleptics (Includes Risperdal M-Tab) ↔ Breast Cancer

Moderate Potential Hazard, Moderate plausibility

Applies to: Breast Cancer

The chronic use of neuroleptic agents can cause persistent elevations in prolactin levels. Based on in vitro data, approximately one-third of human breast cancers are thought to be prolactin-dependent. The clinical significance of this observation with respect to long-term neuroleptic therapy is unknown. Chronic administration of neuroleptic drugs has been associated with mammary tumorigenesis in rodent studies but not in human clinical or epidemiologic studies. Until further data are available, therapy with neuroleptic agents should be administered cautiously in patients with a previously detected breast cancer.

References

  1. Dickson RA, Dalby JT, Williams R, Edwards AL "Risperidone-induced prolactin elevations in premenopausal women with schizophrenia." Am J Psychiatry 152 (1995): 1102-3
  2. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  3. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
View all 16 references

Neuroleptics (Includes Risperdal M-Tab) ↔ Dehydration

Moderate Potential Hazard, Moderate plausibility

Applies to: Dehydration, Diarrhea, Vomiting

Neuroleptic agents may cause hypotension (including orthostatic hypotension) and associated reflex tachycardia, syncope or dizziness, particularly during initiation of therapy or rapid escalation of dosage. Tolerance to the hypotensive effects often develops after a few doses to a few months. Rarely, fatal cardiac arrest has occurred secondary to severe hypotension. Therapy with neuroleptic agents should be administered cautiously in patients with conditions that would predispose them to hypotension, such as hypovolemia or dehydration (e.g., due to severe diarrhea or vomiting). In addition, neuroleptic agents can interfere with the body's ability to regulate core body temperature, occasionally producing hyperthermia during strenuous exercise, exposure to hot weather, and concomitant treatment with anticholinergic medications. Patients who are dehydrated may be particularly susceptible.

References

  1. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  2. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  3. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.

Neuroleptics (Includes Risperdal M-Tab) ↔ Parkinsonism

Moderate Potential Hazard, Moderate plausibility

Applies to: Parkinsonism

The use of neuroleptic agents is associated with pseudo-parkinsonian symptoms such as akinesia, bradykinesia, tremors, pill-rolling motion, cogwheel rigidity, and postural abnormalities including stooped posture and shuffling gait. The onset is usually 1 to 2 weeks following initiation of therapy or an increase in dosage. Older neuroleptic agents such as haloperidol are more likely to induce these effects, and their use may be contraindicated in patients with Parkinson's disease or parkinsonian symptoms.

References

  1. Pinder RM, Brogden RN, Swayer R, Speight TM, Spencer R, Avery GS "Pimozide: a review of its pharmacological properties and therapeutic uses in psychiatry." Drugs 12 (1976): 1-40
  2. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  3. Moleman P, Janzen G, von Bargen BA, et al "Relationship between age and incidence of parkinsonism in psychiatric patients treated with haloperidol." Am J Psychiatry 143 (1986): 232-4
View all 14 references

Neuroleptics (Includes Risperdal M-Tab) ↔ Seizure Disorders

Moderate Potential Hazard, Moderate plausibility

Applies to: CNS Disorder, Alcoholism

Neuroleptic agents can lower the seizure threshold and induce seizures, particularly when dosages are high or increased rapidly and during the initiation of therapy. Clozapine appears to have the greatest epileptogenic potential, while most of the other newer, atypical neuroleptic agents (e.g., risperidone, quetiapine, olanzapine), as well as haloperidol and molindone, have the least. Therapy with neuroleptic agents should be administered cautiously in patients with a history of seizures or other factors predisposing to seizures such as abnormal EEG, preexisting CNS pathology, or head trauma. Adequate anticonvulsant therapy should be maintained during administration of neuroleptic agents. Clozapine should not be used in patients with uncontrolled epilepsy.

References

  1. Mahr GC, Berchou R, Balon R "A grand mal seizure associated with desipramine and haloperidol." Can J Psychiatry 32 (1987): 463-4
  2. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  3. Welch J, Manschreck T, Redmond D "Clozapine-induced seizures and EEG changes." J Neuropsychiatry Clin Neurosci 6 (1994): 250-6
View all 29 references

You should also know about...

Risperdal M-Tab (risperidone) drug Interactions

There are 1001 drug interactions with Risperdal M-Tab (risperidone)

Risperdal M-Tab (risperidone) alcohol/food Interactions

There are 2 alcohol/food interactions with Risperdal M-Tab (risperidone)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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