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Risperidone Oral Solution Side Effects

Please note - some side effects for Risperidone Oral Solution may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Risperidone Oral Solution Side Effects - for the Professional

Risperidone Oral Solution


The following are discussed in more detail in other sections of the labeling:
 
  • Increased mortality in elderly patients with dementia-related psychosis [see Boxed Warning and Warnings and Precautions (5.1)]   
  • Cerebrovascular adverse events, including stroke, in elderly patients with dementia-related psychosis [see Warnings and Precautions (5.2)
  • Neuroleptic malignant syndrome [see Warnings and Precautions (5.3)]   
  • Tardive dyskinesia [see Warnings and Precautions (5.4)]
  • Metabolic changes [see Warnings and Precautions (5.5)]
  • Hyperprolactinemia [see Warnings and Precautions (5.6)]   
  • Orthostatic hypotension [see Warnings and Precautions (5.7)]   
  • Leukopenia, neutropenia, and agranulocytosis [see Warnings and Precautions (5.8)]
  • Potential for cognitive and motor impairment [see Warnings and Precautions (5.9)]   
  • Seizures [see Warnings and Precautions (5.10)]   
  • Dysphagia [see Warnings and Precautions (5.11)]   
  • Priapism [see Warnings and Precautions (5.12)]
  • Thrombotic Thrombocytopenic Purpura (TTP) [see Warnings and Precautions (5.13)]
  • Disruption of body temperature regulation [see Warnings and Precautions (5.14)]
  • Antiemetic effect [see Warnings and Precautions (5.15)]
  • Suicide [see Warnings and Precautions (5.16)]
  • Increased sensitivity in patients with Parkinson’s disease or those with dementia with Lewy bodies [see Warnings and Precautions (5.17)]
  • Diseases or conditions that could affect metabolism or hemodynamic responses [see Warnings and Precautions (5.17)]


The most common adverse reactions in clinical trials (≥ 10%) were somnolence, increased appetite, fatigue, insomnia, sedation, parkinsonism, akathisia, vomiting, cough, constipation, nasopharyngitis, drooling, rhinorrhea, dry mouth, abdominal pain upper, dizziness, nausea, anxiety, headache, nasal congestion, rhinitis, tremor, and rash.
 
The most common adverse reactions that were associated with discontinuation from clinical trials (causing discontinuation in >1% of adults and/or >2% of pediatrics) were nausea, somnolence, sedation, vomiting, dizziness, and akathisia [see Adverse Reactions (6.5)].
 
The data described in this section are derived from a clinical trial database consisting of 9712 adult and pediatric patients exposed to one or more doses of risperidone for the treatment of schizophrenia, bipolar mania, autistic disorder, and other psychiatric disorders in pediatrics and elderly patients with dementia. Of these 9712 patients, 2626 were patients who received risperidone while participating in double-blind, placebo-controlled trials. The conditions and duration of treatment with risperidone varied greatly and included (in overlapping categories) double-blind, fixed- and flexible-dose, placebo- or active-controlled studies and open-label phases of studies, inpatients and outpatients, and short-term (up to 12 weeks) and longer-term (up to 3 years) exposures. Safety was assessed by collecting adverse events and performing physical examinations, vital signs, body weights, laboratory analyses, and ECGs.
 
Adverse events during exposure to study treatment were obtained by general inquiry and recorded by clinical investigators using their own terminology. Consequently, to provide a meaningful estimate of the proportion of individuals experiencing adverse events, events were grouped in standardized categories using MedDRA terminology.
 
Throughout this section, adverse reactions are reported. Adverse reactions are adverse events that were considered to be reasonably associated with the use of risperidone (adverse drug reactions) based on the comprehensive assessment of the available adverse event information. A causal association for risperidone often cannot be reliably established in individual cases. Further, because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
 
The majority of all adverse reactions were mild to moderate in severity.

Commonly-Observed Adverse Reactions in Double-Blind, Placebo-Controlled Clinical Trials - Schizophrenia


Adult Patients with Schizophrenia
 
Table 4 lists the adverse reactions reported in 1% or more of risperidone-treated adult patients with schizophrenia in three 4- to 8-week, double-blind, placebo-controlled trials.
Table 4. Adverse Reactions in ≥1% of Risperidone-Treated Adult Patients with Schizophrenia in Double-Blind, Placebo-Controlled Trials
System/Organ Class
Adverse Reaction
Percentage of Patients
Reporting Event
Risperidone
2 to 8 mg
per day
(N=366)
>8 to 16 mg
per day
(N=198)
Placebo
(N=225)
* Parkinsonism includes extrapyramidal disorder, musculoskeletal stiffness, parkinsonism, cogwheel rigidity, akinesia, bradykinesia, hypokinesia, masked facies, muscle rigidity, and Parkinson’s disease. Akathisia includes akathisia and restlessness. Dystonia includes dystonia, muscle spasms, muscle contractions involuntary, muscle contracture, oculogyration, tongue paralysis. Tremor includes tremor and parkinsonian rest tremor. Dyskinesia includes dyskinesia, muscle twitching, chorea, and choreoathetosis.
 Blood and Lymphatic System Disorders
 
 
 
     Anemia
<1
1
0
 Cardiac Disorders
     Tachycardia
1
3
0
 Ear and Labyrinth Disorders
     Ear pain
<1
1
0
 Eye Disorders
     Vision blurred
3
1
1
 Gastrointestinal Disorders
     Nausea
9
4
4
     Constipation
8
9
6
     Dyspepsia
8
6
5
     Vomiting
7
5
7
     Dry mouth
4
0
1
     Abdominal discomfort
3
1
1
     Salivary hypersecretion
2
1
<1
     Diarrhea
2
1
1
     Abdominal pain
1
1
0
     Abdominal pain upper
1
1
0
     Stomach discomfort
1
1
1
 General Disorders
     Fatigue
3
1
0
     Chest pain
2
2
1
     Asthenia
2
1
<1
 Immune System Disorders
     Hypersensitivity
<1
1
0
 Infections and Infestations
     Nasopharyngitis
3
4
3
     Upper respiratory tract infection
2
3
1
     Sinusitis
1
2
1
     Urinary tract infection
1
3
0
 Investigations
     Weight increased
1
1
0
     Blood creatine phosphokinase increased
1
2
<1
     Heart rate increased
<1
2
0
 Metabolism and Nutrition Disorders
     Decreased appetite
1
0
<1
 Musculoskeletal and Connective Tissue Disorders
     Back pain
4
1
1
     Arthralgia
2
3
<1
     Pain in extremity
2
1
1
     Joint stiffness
1
1
0
 Nervous System Disorders
     Parkinsonism*
14
17
8
     Akathisia*
10
10
3
     Dizziness
7
4
2
     Somnolence
7
2
1
     Dystonia*
3
4
2
     Sedation
3
3
1
     Tremor*
2
3
1
     Dizziness postural
2
0
0
     Dyskinesia*
1
2
2
     Syncope
1
1
0
 Psychiatric Disorders
     Insomnia
32
25
27
     Anxiety
16
11
11
     Nervousness
1
1
<1
 Renal and Urinary Disorders
     Urinary incontinence
1
1
0
 Reproductive System and Breast Disorders
     Ejaculation failure
<1
1
0
 Respiratory, Thoracic and Mediastinal Disorders
     Nasal congestion
4
6
2
     Dyspnea
1
2
0
     Epistaxis
<1
2
0
 Skin and Subcutaneous Tissue Disorders
     Rash
1
4
1
     Dry skin
1
3
0
     Dandruff
1
1
0
     Seborrheic dermatitis
<1
1
0
     Hyperkeratosis
0
1
1
 Vascular Disorders
     Orthostatic hypotension
2
1
0
     Hypotension
1
1
0

Pediatric Patients with Schizophrenia 
 
Table 5 lists the adverse reactions reported in 5% or more of risperidone-treated pediatric patients with schizophrenia in a 6-week double-blind, placebo-controlled trial.
Table 5. Adverse Reactions in ≥5% of Risperidone-Treated Pediatric Patients with Schizophrenia in a Double-Blind Trial
System/Organ Class
Adverse Reaction
Percentage of Patients
Reporting Event
Risperidone  
1 to 3 mg
per day
(N=55)
4 to 6 mg
per day
(N=51)
Placebo
(N=54)
* Parkinsonism includes extrapyramidal disorder, muscle rigidity, musculoskeletal stiffness, and hypokinesia. Akathisia includes akathisia and restlessness. Dystonia includes dystonia and oculogyration.
 Gastrointestinal Disorders
     Salivary hypersecretion
0
10
2
 Nervous System Disorders
     Parkinsonism*
16
28
11
     Sedation
13
8
2
     Somnolence
11
4
2
     Tremor
11
10
6
     Akathisia*
9
10
4
     Dizziness
7
14
2
     Dystonia*
2
6
0
 Psychiatric Disorders
     Anxiety
7
6
0

Commonly-Observed Adverse Reactions in Double-Blind, Placebo-Controlled Clinical Trials – Bipolar Mania


Adult Patients with Bipolar Mania
 
Table 6 lists the adverse reactions reported in 1% or more of risperidone-treated adult patients with bipolar mania in four 3-week, double-blind, placebo-controlled monotherapy trials.
Table 6. Adverse Reactions in ≥1% of Risperidone-Treated Adult Patients with Bipolar Mania in Double-Blind, Placebo-Controlled Monotherapy Trials
System/Organ Class
Adverse Reaction
Percentage of Patients
Reporting Event
Risperidone
1 to 6 mg per day
(N=448)
Placebo
(N=424)
* Parkinsonism includes extrapyramidal disorder, parkinsonism, musculoskeletal stiffness, hypokinesia, muscle rigidity, muscle tightness, bradykinesia, cogwheel rigidity. Akathisia includes akathisia and restlessness. Tremor includes tremor and parkinsonian rest tremor. Dystonia includes dystonia, muscle spasms, oculogyration, torticollis. Dyskinesia includes muscle twitching and dyskinesia.
 Cardiac Disorders
 
 
     Tachycardia
1
<1
 Eye Disorders
     Vision blurred
2
1
 Gastrointestinal Disorders
     Nausea
5
2
     Diarrhea
3
2
     Salivary hypersecretion
3
1
     Dyspepsia
2
2
     Stomach discomfort
2
<1
 General Disorders
     Fatigue
2
1
     Asthenia
1
1
     Pyrexia
1
1
 Infections and Infestations
     Nasopharyngitis
1
1
 Investigations
     Aspartate aminotransferase increased
1
<1
 Nervous System Disorders
     Parkinsonism*
25
9
     Akathisia*
9
3
     Tremor*
6
3
     Dizziness
6
5
     Sedation
6
2
     Somnolence
5
2
     Dystonia*
5
1
     Lethargy
2
1
     Dyskinesia*
1
<1
 Reproductive System and Breast Disorders
     Galactorrhea
1
0
 Skin and Subcutaneous Tissue Disorders
     Acne
1
0
Table 7 lists the adverse reactions reported in 2% or more of risperidone-treated adult patients with bipolar mania in two 3-week, double-blind, placebo-controlled adjuvant therapy trials.
Table 7. Adverse Reactions in ≥2% of Risperidone-Treated Adult Patients with Bipolar Mania in Double-Blind, Placebo-Controlled Adjuvant Therapy Trials
System/Organ Class
Adverse Reaction
Percentage of Patients
Reporting Event
Risperidone +
Mood Stabilizer
(N=127)
Placebo +
Mood Stabilizer
(N=126)
* Parkinsonism includes extrapyramidal disorder, hypokinesia and bradykinesia. Akathisia includes hyperkinesia and akathisia.
 Cardiac Disorders
     Palpitations
2
0
 Gastrointestinal Disorders
     Dyspepsia
9
8
     Nausea
6
4
     Diarrhea
6
4
     Dry mouth
4
4
     Vomiting
4
6
     Constipation
3
3
     Salivary hypersecretion
2
0
 General Disorders
     Chest pain
2
1
     Fatigue
2
2
 Infections and Infestations
     Nasopharyngitis
2
3
     Urinary tract infection
2
1
 Investigations
     Weight increased
2
2
 Nervous System Disorders
     Parkinsonism*
14
4
     Headache
14
15
     Akathisia*
8
0
     Dizziness
7
2
     Sedation
6
3
     Tremor
6
2
     Somnolence
3
1
     Lethargy
2
1
 Psychiatric Disorders
     Insomnia
4
8
     Anxiety
3
2
 Respiratory, Thoracic and Mediastinal Disorders
     Pharyngolaryngeal pain
5
2
     Cough
2
0

Pediatric Patients with Bipolar Mania
 
Table 8 lists the adverse reactions reported in 5% or more of risperidone-treated pediatric patients with bipolar mania in a 3-week double-blind, placebo-controlled trial.
Table 8. Adverse Reactions in ≥5% of Risperidone-Treated Pediatric Patients with Bipolar Mania in Double-Blind, Placebo-Controlled Trials
System/Organ Class
Adverse Reaction
Percentage of Patients
Reporting Event
Risperidone  
0.5 to 2.5 mg
per day
(N=50)
3 to 6 mg
per day
(N=61)
Placebo
(N=58)
* Parkinsonism includes musculoskeletal stiffness, extrapyramidal disorder, bradykinesia, and nuchal rigidity. Dystonia includes dystonia, laryngospasm, and muscle spasms. Akathisia includes restlessness and akathisia.
 Eye Disorders
     Vision blurred
4
7
0
 Gastrointestinal Disorders
     Abdominal pain upper
16
13
5
     Nausea
16
13
7
     Vomiting
10
10
5
     Diarrhea
8
7
2
     Dyspepsia
10
3
2
     Stomach discomfort
6
0
2
 General Disorders
     Fatigue
18
30
3
 Metabolism and Nutrition Disorders
     Increased appetite
4
7
2
 Nervous System Disorders
     Somnolence
22
30
12
     Sedation
20
23
7
     Dizziness
16
13
5
     Parkinsonism*
6
12
3
     Dystonia*
6
5
0
     Akathisia*
0
8
2
 Psychiatric Disorders
     Anxiety
0
8
3
 Respiratory, Thoracic and Mediastinal Disorders
     Pharyngolaryngeal pain
10
3
5
 Skin and Subcutaneous Tissue Disorders
     Rash
0
7
2

Commonly-Observed Adverse Reactions in Double-Blind, Placebo-Controlled Clinical Trials - Autistic Disorder


Table 9 lists the adverse reactions reported in 5% or more of risperidone-treated pediatric patients treated for irritability associated with autistic disorder in two 8-week, double-blind, placebo-controlled trials.
Table 9. Adverse Reactions in ≥5% of Risperidone-Treated Pediatric Patients Treated for Irritability Associated with Autistic Disorder in Double-Blind, Placebo-Controlled Trials
System/Organ Class
Adverse Reaction
Percentage of Patients Reporting Event
Risperidone
0.5 to 4 mg per day
(N=76)
 
Placebo
(N=80)
* Parkinsonism includes musculoskeletal stiffness, extrapyramidal disorder, muscle rigidity, cogwheel rigidity, and muscle tightness.
 Cardiac Disorders
     Tachycardia
5
0
 Gastrointestinal Disorders
     Vomiting
25
21
     Constipation
21
8
     Dry mouth
15
6
     Salivary hypersecretion
9
0
     Nausea
8
6
 General Disorders
     Fatigue
42
13
     Feeling abnormal
5
0
 Infections and Infestations
     Nasopharyngitis
21
10
     Rhinitis
13
10
     Upper respiratory tract infection
8
3
 Investigations
     Weight increased
5
0
 Metabolism and Nutrition Disorders
     Increased appetite
47
19
 Nervous System Disorders
     Somnolence
49
18
     Sedation
29
3
     Drooling
16
5
     Tremor
12
1
     Parkinsonism*
11
1
     Dizziness
9
3
     Dyskinesia
7
3
     Lethargy
5
3
 Respiratory, Thoracic and Mediastinal Disorders
     Cough
24
18
     Rhinorrhea
16
13
     Nasal congestion
13
5
 Skin and Subcutaneous Tissue Disorders
     Rash
11
8
In another study with patients treated for irritability associated with autistic disorder, headache (6%), epistaxis (6%) and pyrexia (6%) were also observed in risperidone-treated pediatric subjects.

Other Adverse Reactions Observed During the Clinical Trial Evaluation of Risperidone


The following adverse reactions occurred in < 1%  of the adult patients and in < 5% of the pediatric patients treated with risperidone in the above double-blind, placebo-controlled clinical trial data sets. In addition, the following also includes adverse reactions reported in risperidone-treated patients who participated in other studies, including double-blind, active-controlled and open-label studies in schizophrenia and bipolar mania studies in pediatric patients with psychiatric disorders other than schizophrenia, bipolar mania, or autistic disorder, and studies in elderly patients with dementia.

Blood and Lymphatic System Disorders: granulocytopenia, neutropenia
 
Cardiac Disorders: sinus bradycardia, sinus tachycardia, atrioventricular block first degree, bundle branch block left, bundle branch block right, atrioventricular block
 
Ear and Labyrinth Disorders: tinnitus
 
Endocrine Disorders: hyperprolactinemia
 
Eye Disorders: ocular hyperemia, eye discharge, conjunctivitis, eye rolling, eyelid edema, eye swelling, eyelid margin crusting, dry eye, lacrimation increased, photophobia, glaucoma, visual acuity reduced
 
Gastrointestinal Disorders: dysphagia, fecaloma, fecal incontinence, gastritis, lip swelling, cheilitis, aptyalism
 
General Disorders: edema peripheral, thirst, gait disturbance, influenza-like illness, pitting edema, edema, chills, sluggishness, malaise, chest discomfort, face edema, discomfort, generalized edema, drug withdrawal syndrome, peripheral coldness
 
Immune System Disorders: drug hypersensitivity
 
Infections and Infestations: pneumonia, influenza, ear infection, viral infection, pharyngitis, tonsillitis, bronchitis, eye infection, localized infection, cystitis, cellulitis, otitis media, onychomycosis, acarodermatitis, bronchopneumonia, respiratory tract infection, tracheobronchitis, otitis media chronic
 
Investigations: body temperature increased, blood prolactin increased, alanine aminotransferase increased, electrocardiogram abnormal, eosinophil count increased, white blood cell count decreased, blood glucose increased, hemoglobin decreased, hematocrit decreased, body temperature decreased, blood pressure decreased, transaminases increased 
 
Metabolism and Nutrition Disorders: polydipsia, anorexia
 
Musculoskeletal and Connective Tissue Disorders: joint swelling, musculoskeletal chest pain, posture abnormal, myalgia, neck pain, muscular weakness, rhabdomyolysis
 
Nervous System Disorders: balance disorder, disturbance in attention, dysarthria, unresponsive to stimuli, depressed level of consciousness, movement disorder, hypersomnia, transient ischemic attack, coordination abnormal, cerebrovascular accident, speech disorder, loss of consciousness, hypoesthesia, tardive dyskinesia, cerebral ischemia, cerebrovascular disorder, neuroleptic malignant syndrome, diabetic coma, head titubation
 
Psychiatric Disorders: agitation, blunted affect, confusional state, middle insomnia, sleep disorder, listlessness, libido decreased, anorgasmia
 
Renal and Urinary Disorders: enuresis, dysuria, pollakiuria
 
Reproductive System and Breast Disorders: menstruation irregular, amenorrhea, gynecomastia, vaginal discharge, menstrual disorder, erectile dysfunction, retrograde ejaculation, ejaculation disorder, sexual dysfunction, breast enlargement
 
Respiratory, Thoracic, and Mediastinal Disorders: wheezing, pneumonia aspiration, sinus congestion, dysphonia, productive cough, pulmonary congestion, respiratory tract congestion, rales, respiratory disorder, hyperventilation, nasal edema
 
Skin and Subcutaneous Tissue Disorders: erythema, skin discoloration, skin lesion, pruritus, skin disorder, rash erythematous, rash papular, rash generalized, rash maculopapular 

Vascular Disorders: flushing

Discontinuations Due to Adverse Reactions


Schizophrenia – Adults
 
Approximately 7% (39/564) of risperidone-treated patients in double-blind, placebo-controlled trials discontinued treatment due to an adverse event, compared with 4% (10/225) who were receiving placebo. The adverse reactions associated with discontinuation in 2 or more risperidone-treated patients were:
Table 10. Adverse Reactions Associated With Discontinuation in 2 or More Risperidone-Treated Adult Patients in Schizophrenia Trials
Adverse Reaction Risperidone
2 to 8 mg/day
(N=366)
>8 to 16 mg/day
(N=198)
Placebo
(N=225)
 Dizziness
1.4%
1%
0%
 Nausea
1.4%
0%
0%
 Vomiting
0.8%
0%
0%
 Parkinsonism
0.8%
0%
0%
 Somnolence
0.8%
0%
0%
 Dystonia
0.5%
0%
0%
 Agitation
0.5%
0%
0%
 Abdominal pain
0.5%
0%
0%
 Orthostatic hypotension
0.3%
0.5%
0%
 Akathisia
0.3%
2%
0%
Discontinuation for extrapyramidal symptoms (including Parkinsonism, akathisia, dystonia, and tardive dyskinesia) was 1% in placebo-treated patients, and 3.4% in active control-treated patients in a double-blind, placebo- and active-controlled trial.
 
Schizophrenia – Pediatrics
 
Approximately 7% (7/106), of risperidone-treated patients discontinued treatment due to an adverse event in a double-blind, placebo-controlled trial, compared with 4% (2/54) placebo-treated patients. The adverse reactions associated with discontinuation for at least one risperidone-treated patient were dizziness (2%), somnolence (1%), sedation (1%), lethargy (1%), anxiety (1%), balance disorder (1%), hypotension (1%), and palpitation (1%).
 
Bipolar Mania – Adults 
 
In double-blind, placebo-controlled trials with risperidone as monotherapy, approximately 6% (25/448) of risperidone-treated patients discontinued treatment due to an adverse event, compared with approximately 5% (19/424) of placebo-treated patients. The adverse reactions associated with discontinuation in risperidone-treated patients were: 
Table 11. Adverse Reactions Associated With Discontinuation in 2 or More Risperidone-Treated Adult Patients in Bipolar Mania Clinical Trials
Adverse Reaction Risperidone
1 to 6 mg/day
(N=448)
Placebo
(N=424)
 Parkinsonism
0.4%
0%
 Lethargy
0.2%
0%
 Dizziness
0.2%
0%
 Alanine aminotransferase increased
0.2%
0.2%
 Aspartate aminotransferase increased
0.2%
0.2%
Bipolar Mania – Pediatrics
 
In a double-blind, placebo-controlled trial 12% (13/111) of risperidone-treated patients discontinued due to an adverse event, compared with 7% (4/58) of placebo-treated patients. The adverse reactions associated with discontinuation in more than one risperidone-treated pediatric patient were nausea (3%), somnolence (2%), sedation (2%), and vomiting (2%).
 
Autistic Disorder – Pediatrics
 
In the two 8-week, placebo-controlled trials in pediatric patients treated for irritability associated with autistic disorder (n = 156), one risperidone-treated patient discontinued due to an adverse reaction (Parkinsonism), and one placebo-treated patient discontinued due to an adverse event.

Dose Dependency of Adverse Reactions in Clinical Trials


Extrapyramidal Symptoms
 
Data from two fixed-dose trials in adults with schizophrenia provided evidence of dose-relatedness for extrapyramidal symptoms associated with risperidone treatment.
 
Two methods were used to measure extrapyramidal symptoms (EPS) in an 8-week trial comparing 4 fixed doses of risperidone (2, 6, 10, and 16 mg/day), including (1) a Parkinsonism score (mean change from baseline) from the Extrapyramidal Symptom Rating Scale, and (2) incidence of spontaneous complaints of EPS: 
Dose Groups Placebo Risperidone
2 mg
Risperidone
 6 mg
Risperidone
 10 mg
Risperidone
16 mg
 Parkinsonism
1.2
0.9
1.8
2.4
2.6
 EPS Incidence
13%
17%
21%
21%
35%

Similar methods were used to measure extrapyramidal symptoms (EPS) in an 8-week trial comparing 5 fixed doses of risperidone (1, 4, 8, 12, and 16 mg/day): 

Dose Groups
Risperidone
1 mg
Risperidone
4 mg
Risperidone
8 mg
Risperidone
 12 mg
Risperidone
16 mg
 Parkinsonism
0.6
1.7
2.4
2.9
4.1
 EPS Incidence
7%
12%
17%
18%
20%

Dystonia
 
Class Effect: Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue. While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs. An elevated risk of acute dystonia is observed in males and younger age groups.
 
Other Adverse Reactions
 
Adverse event data elicited by a checklist for side effects from a large study comparing 5 fixed doses of risperidone (1, 4, 8, 12, and 16 mg/day) were explored for dose-relatedness of adverse events. A Cochran-Armitage Test for trend in these data revealed a positive trend (p<0.05) for the following adverse reactions: somnolence, vision abnormal, dizziness, palpitations, weight increase, erectile dysfunction, ejaculation disorder, sexual function abnormal, fatigue, and skin discoloration.

Changes in ECG


Between-group comparisons for pooled placebo-controlled trials in adults revealed no statistically significant differences between risperidone and placebo in mean changes from baseline in ECG parameters, including QT, QTc, and PR intervals, and heart rate. When all risperidone doses were pooled from randomized controlled trials in several indications, there was a mean increase in heart rate of 1 beat per minute compared to no change for placebo patients. In short-term schizophrenia trials, higher doses of risperidone (8 to 16 mg/day) were associated with a higher mean increase in heart rate compared to placebo (4 to 6 beats per minute). In pooled placebo-controlled acute mania trials in adults, there were small decreases in mean heart rate, similar among all treatment groups.
 
In the two placebo-controlled trials in children and adolescents with autistic disorder (aged 5 to 16 years) mean changes in heart rate were an increase of 8.4 beats per minute in the risperidone groups and 6.5 beats per minute in the placebo group. There were no other notable ECG changes.

In a placebo-controlled acute mania trial in children and adolescents (aged 10 to 17 years), there were no significant changes in ECG parameters, other than the effect of risperidone to transiently increase pulse rate (< 6 beats per minute). In two controlled schizophrenia trials in adolescents (aged 13 to 17 years), there were no clinically meaningful changes in ECG parameters including corrected QT intervals between treatment groups or within treatment groups over time.

Postmarketing Experience


The following adverse reactions have been identified during postapproval use of risperidone; because these reactions are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency: agranulocytosis, alopecia, anaphylactic reaction, angioedema, atrial fibrillation, blood cholesterol increased, blood triglycerides increased, diabetes mellitus, diabetic ketoacidosis in patients with impaired glucose metabolism, drug withdrawal syndrome neonatal, dysgeusia, hypoglycemia, hypothermia, inappropriate antidiuretic hormone secretion, intestinal obstruction, jaundice, mania, pancreatitis, priapism, QT prolongation, sleep apnea syndrome, thrombocytopenia, urinary retention, and water intoxication.
 
Other adverse events reported since market introduction, which were temporally related to risperidone but not necessarily causally related, include the following: pituitary adenoma, pulmonary embolism, precocious puberty, cardiopulmonary arrest, and sudden death. Top

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