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Risperdal M-Tab (risperidone) Disease Interactions

There are 20 disease interactions with Risperdal M-Tab (risperidone):

Major

Atypical Antipsychotic Agents (Includes Risperdal M-Tab) ↔ Dementia

Severe Potential Hazard, High plausibility

Applies to: Dementia

Elderly patients with dementia- related psychosis treated with antipsychotic drugs are at an increased risk of death, mostly from cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) causes. A causal relationship with antipsychotic use has not been established. In controlled trials, treatment with some atypical antipsychotic drugs was also associated with an increased risk of cerebrovascular adverse events (e.g., stroke, transient ischemic attack), including fatalities, in elderly patients with dementia- related psychosis. These agents are not approved for the treatment of patients with dementia- related psychosis.

Major

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. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  3. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  4. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  5. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  6. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  7. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  8. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  9. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  10. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
View all 10 references
Major

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.
  4. Vetter PH, Proppe DG "Clozapine-induced coma." J Nerv Ment Dis 180 (1992): 58-9
  5. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  6. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  7. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
View all 7 references
Major

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. Sharma R, Trappler B, Ng YK, Leeman CP "Risperidone-induced neutroleptic malignant syndrome." Ann Pharmacother 30 (1996): 775-8
  3. Campellone JV, Mccluskey LF, Greenspan D "Fatal outcome from neuroleptic malignant syndrome associated with clozapine." Neuropsychiatry Neuropsychol Behav Neurol 8 (1995): 70-3
  4. Johnson V, Bruxner G "Neuroleptic malignant syndrome associated with olanzapine." Aust N Z J Psychiat 32 (1998): 884-6
  5. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  6. Margolese HC, Chouinard G "Olanzapine-induced neuroleptic malignant syndrome with mental retardation." Am J Psychiat 156 (1999): 1115-6
  7. SierraBiddle D, Herran A, DiezAja S, GonzalezMata JM, Vidal E, DiezManrique F, VazquezBarquero JL "Neuroleptic malignant syndrome and olanzapine." J Clin Psychopharmacol 20 (2000): 704-5
  8. Tarsy D "Risperidone and neuroleptic malignant syndrome." JAMA 275 (1996): 446
  9. Miller DD, Sharafuddin MJ, Kathol RG "A case of clozapine-induced neuroleptic malignant syndrome." J Clin Psychiatry 52 (1991): 99-101
  10. Hermesh H, Sirota P, Eviatar J "Recurrent neuroleptic malignant syndrome due to haloperidol and amantadine." Biol Psychiatry 25 (1989): 962-5
  11. Levenson JL "Neuroleptic malignant syndrome after the initiation of olanzapine." J Clin Psychopharmacol 19 (1999): 477-8
  12. Najara JE, Enikeev ID "Risperidone and neuroleptic malignant syndrome: a case report." J Clin Psychiatry 56 (1995): 534-5
  13. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  14. Dave M "Two cases of risperidone-induced neuroleptic malignant syndrome." Am J Psychiatry 152 (1995): 1233-4
  15. Chong LS, Abbott PM "Neuroleptic malignant syndrome secondary to loxapine." Br J Psychiatry 159 (1991): 572-3
  16. Burkhard PR, Vingerhoets FJG "Olanzapine induced neuroleptic malignant syndrome." Arch Gen Psychiat 56 (1999): 101-2
  17. Nemecek D "Atropism may precipitate neuroleptic malignant syndrome during treatment with clozapine." Am J Psychiatry 150 (1993): 1561
  18. Aisen PS, Lawlor BA "Neuroleptic malignant syndrome induced by low-dose haloperidol." Am J Psychiatry 149 (1992): 844
  19. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  20. Singer S, Richards C, Boland RJ "Two cases of risperidone-induced neuroleptic malignant syndrome." Am J Psychiatry 152 (1995): 1234
  21. Nyfort-Hansen K, Alderman CP "Possible neuroleptic malignant syndrome associated with olanzapine." Ann Pharmacother 34 (2000): 667
  22. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  23. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  24. "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb, Princeton, NJ.
  25. Padgett R, Lipman E "Use of neuroleptics after an episode of neuroleptic malignant syndrome" Can J Psychiatry 34 (1989): 323-5
  26. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  27. Caroff SN "The neuroleptic malignant syndrome." J Clin Psychiatry 41 (1980): 79-83
  28. Raitasuo V, Vataja R, Elomaa E "Risperidone-induced neuroleptic malignant syndrome in young patient." Lancet 344 (1994): 1705
  29. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  30. Ryken TC, Merrell AN "Haloperidol-induced neuroleptic malignant syndrome in a 67-year-old woman with parkinsonism." West J Med 151 (1989): 326-8
  31. Moltz DA, Coeytaux RR "Case report: Possible neuroleptic malignant syndrome associated with olanzapine." J Clin Psychopharmacol 18 (1998): 485-6
  32. Kern JL, Cernek PK "Delayed risperidone-induced malignant syndrome." Ann Pharmacother 30 (1996): 300
  33. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  34. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  35. Levitt AJ, Midha R, Craven JL "Neuroleptic malignant syndrome with intravenous haloperidol." Can J Psychiatry 35 (1990): 789
  36. Ewert AL, Kloek J, Wells B, Phelps S "Neuroleptic malignant syndrome associated with loxapine" J Clin Psychiatry 44 (1983): 37-8
  37. Webster P, Wijeratne C "Risperidone-induced neuroleptic malignant syndrome." Lancet 344 (1994): 1228-9
  38. Gleason PP, Conigliaro RL "Neuroleptic malignant syndrome with risperidone." Pharmacotherapy 17 (1997): 617-21
  39. DasGupta K, Young A "Clozapine-induced neuroleptic malignant syndrome." J Clin Psychiatry 52 (1991): 105-7
  40. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
View all 40 references
Major

Neuroleptics (Includes Risperdal M-Tab) ↔ Tardive Dyskinesia

Severe Potential Hazard, High 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. Yesavage JA, Tanke ED, Sheikh JI "Tardive dyskinesia and steady-state serum levels of thiothixene." Arch Gen Psychiatry 44 (1987): 913-5
  2. Kopala LC, Honer WG "Schizophrenia and severe tardive dyskinesia responsive to risperidone." J Clin Psychopharmacol 14 (1994): 430-1
  3. 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
  4. Ghelber D, Belmaker RH "Tardive dyskinesia with quetiapine." Am J Psychiat 156 (1999): 796-7
  5. "Product Information. Abilify (aripiprazole)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  7. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
  8. Buzan RD "Risperidone-induced tardive dyskinesia." Am J Psychiatry 153 (1996): 734-5
  9. Little JT, Jankovic J "Tardive myoclonus." Mov Disord 2 (1987): 307-11
  10. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  11. Dave M "Clozapine-related tardive dyskinesia." Biol Psychiatry 35 (1994): 886-7
  12. Tamminga CA, Thaker GK, Moran M, Kakigi T, Gao XM "Clozapine in tardive dyskinesia - observations from human and animal model studies." J Clin Psychiatry 55 (1994): 102-6
  13. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  14. Yassa R, Mohelsky HE "Tardive dyskinesia in thiothixene treatment ." J Clin Psychiatry 46 (1985): 151
  15. Branchey MH, Branchey LB, Richardson MA "Effects of neuroleptic adjustment on clinical condition and tardive dyskinesia in schizophrenic patients." Am J Psychiatry 138 (1981): 608-12
  16. Bruun RD "Subtle and underrecognized side effects of neuroleptic treatment in children with Tourette's disorder." Am J Psychiatry 145 (1988): 621-4
  17. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  18. "Product Information. Navane (thiothixene)." Roerig Division, New York, NY.
  19. de Leon J, Moral L, Camunas C "Clozapine and jaw dyskinesia: a case report." J Clin Psychiatry 52 (1991): 494-5
  20. Meltzer HY, Luchins DJ "Effect of clozapine in severe tardive dyskinesia: a case report." J Clin Psychopharmacol 4 (1984): 286-7
  21. Portnoy RA "Hyperkinetic dysarthria as an early indicator of impending tardive dyskinesia." J Speech Hear Disord 44 (1979): 214-9
  22. Pakkenberg H, Fog R "Spontaneous oral dyskinesia. Results of treatment with tetrabenazine, pimozide, or both." Arch Neurol 31 (1974): 352-3
  23. Gwinn KA, Caviness JN "Risperidone-induced tardive dyskinesia and parkinsonism." Mov Disord 12 (1997): 119-21
  24. Bransgrove LL, Kelly MW "Movement disorders in patients treated with long-acting injectable antipsychotic drugs." Am J Hosp Pharm 51 (1994): 895-9
  25. Mahmood T, Clothier EB, Bridgman R "Risperidone-induced extrapyramidal reactions." Lancet 346 (1995): 1226
  26. Elliott ES, Marken PA, Ruehter VL "Clozapine-associated extrapyramidal reaction." Ann Pharmacother 34 (2000): 615-8
  27. Herran A, Vazquez-Barquero JL "Tardive dyskinesia associated with olanzapine." Ann Intern Med 131 (1999): 72
  28. Friedman JH "Clozapine treatment of psychosis in patients with tardive dystonia: report of three cases." Mov Disord 9 (1994): 321-4
  29. Woerner MG, Sheitman BB, Lieberman JA, Kane JM "Tardive dyskinesia induced by risperidone?" Am J Psychiatry 153 (1996): 843
  30. Owens DGC "Extrapyramidal side effects and tolerability of risperidone - a review." J Clin Psychiatry 55 Suppl (1994): 29-35
  31. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  32. Peabody CA, Brody D, Warner MD "Tardive dyskinesia after low-dose haloperidol." Biol Psychiatry 22 (1987): 111-2
  33. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  34. Riddle MA, Hardin MT, Towbin KE, et al "Tardive dyskinesia following haloperidol treatment in Tourette's syndrome." Arch Gen Psychiatry 44 (1987): 98-9
  35. Narendran R, Young CM, Pato MT "Possible risperidone-induced tardive dystonia." Ann Pharmacother 34 (2000): 1487-8
  36. Small JG, Milstein V, Marhenke JD, Hall DD, Kellams JJ "Treatment outcome with clozapine in tardive dyskinesia, neuroleptic sensitivity, and treatment-resistant psychosis." J Clin Psychiatry 48 (1987): 263-7
  37. Lamberti JS, Bellnier T "Clozapine and tardive dystonia." J Nerv Ment Dis 181 (1993): 137-8
  38. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  39. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  40. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  41. Dave M "Tardive oculogyric crises with clozapine." J Clin Psychiatry 55 (1994): 264-5
  42. Heel RC, Brogden RN, Speight TM, Avery GS "Loxapine: a review of its pharmacological properties and therapeutic efficacy as an antipsychotic agent." Drugs 15 (1978): 198-217
View all 42 references
Major

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.
Major

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
Major

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
Moderate

Antidepressant/Antipsychotic Agents (Includes Risperdal M-Tab) ↔ Depression

Moderate Potential Hazard, Moderate plausibility

Applies to: Depression, Bipolar Disorder

Adult and pediatric patients with depression and other psychiatric disorders may experience worsening of their symptoms and may have the emergence of suicidal thoughts and behavior. Patients should be monitored appropriately and observed closely for worsening of their symptoms, suicidality or changes in their behavior, especially during the first few months of treatment, and at times of dose changes. Discontinuing the medication should be considered if symptoms are persistently worse, or abrupt in onset.

Moderate

Antipsychotic Agents (Includes Risperdal M-Tab) ↔ Aspiration

Moderate Potential Hazard, Moderate plausibility

Applies to: Dysphagia

Esophageal dysmotility and aspiration have been associated with the use of antipsychotic drugs. These drugs should be administered cautiously in patients at risk for aspiration pneumonia.

Moderate

Antipsychotic/Neuroleptic Agents (Includes Risperdal M-Tab) ↔ Seizure

Moderate Potential Hazard, Moderate plausibility

Applies to: Alcoholism, Seizures, Head Injury

Antipsychotic and neuroleptic drugs can lower the seizure threshold and trigger seizures in a dose-dependent manner. This risk is greatest in patients with a history of seizures or with conditions that lower the seizure threshold. Therapy with these drugs should be administered cautiously in patients with a history of seizures or other predisposing factors, such as head trauma, CNS abnormalities, and alcoholism.

Moderate

Atypical Antipsychotic Agents (Includes Risperdal M-Tab) ↔ Hematologic Abnormalities

Moderate Potential Hazard, High plausibility

Applies to: Neutropenia

Cases of leukopenia, neutropenia, and agranulocytosis have been reported with the use of atypical antipsychotic agents. Patients with preexisting low white blood cell count may be at increased risk. Therapy with these agents should be administered cautiously in patients with a history of, or predisposition to, decreased white blood cell or neutrophil counts. Clinical monitoring of hematopoietic function is recommended. At the first sign of a clinically significant decline in white blood cells, discontinuation of atypical antipsychotic therapy should be considered in the absence of other causative factors, and the patient closely monitored for fever or other signs and symptoms of infection.

Moderate

Atypical Antipsychotic Agents (Includes Risperdal M-Tab) ↔ Hyperglycemia/Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus, Obesity

Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported with the use of atypical antipsychotic agents. Patients with diabetes should be monitored for worsening control of blood glucose when treated with these agents. It is recommended that patients with risk factors for diabetes mellitus starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment, and periodically thereafter. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when treatment with these agents was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the atypical antipsychotic drug.

Moderate

Atypical Antipsychotic Agents (Includes Risperdal M-Tab) ↔ Hypotension

Moderate Potential Hazard, Moderate plausibility

Applies to: Hypotension, Dehydration, Diarrhea, Vomiting, Syncope, Ischemic Heart Disease, Congestive Heart Failure, History - Myocardial Infarction, Arrhythmias, Cerebrovascular Insufficiency

The use of atypical antipsychotic agents has been associated with orthostatic hypotension and syncope. Therapy with atypical antipsychotics should be administered cautiously in patients with hypotension or conditions that could be exacerbated by hypotension, such as a history of myocardial infarction, angina, or ischemic stroke. Patients with dehydration (e.g., due to severe diarrhea or vomiting) may be predisposed to hypotension and should also be managed carefully during therapy with atypical antipsychotics. Blood pressure should be monitored at regular intervals, particularly during dosage escalation or whenever dosage has been altered, and patients should be advised not to rise abruptly from a sitting or recumbent position.

Moderate

Atypical Antipsychotic Agents (Includes Risperdal M-Tab) ↔ Lipid Alterations

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperlipidemia

Atypical antipsychotic drugs have been associated with undesirable alterations in lipid levels. While all agents in the class have been shown to produce some changes, each drug has its own specific risk profile. Before or soon after initiation of antipsychotic medication, obtain a fasting lipid profile at baseline and monitor periodically during treatment.

Moderate

Atypical Antipsychotic Agents (Includes Risperdal M-Tab) ↔ Priapism

Moderate Potential Hazard, Moderate plausibility

Applies to: Priapism, Peyronie's Disease, Sickle Cell Anemia, Thalassemia, Multiple Myeloma, Leukemia

Atypical antipsychotic agents with alpha-adrenergic blocking effects may cause priapism. The condition is characterized by prolonged, often painful erections lasting longer than 4 hours. If not treated promptly, priapism can cause irreversible damage to the erectile tissue. Therapy with these agents should be administered cautiously in patients with a history of priapism, conditions that may predispose them to priapism (e.g., sickle cell anemia, multiple myeloma, leukemia, thalassemia), or anatomical deformations of the penis (e.g., angulation, cavernosal fibrosis, Peyronie's disease). Patients who experience an erection lasting longer than 4 hours, whether painful or not, should immediately discontinue the drug and seek emergency medical attention.

Moderate

Atypical Antipsychotic Agents (Includes Risperdal M-Tab) ↔ Renal Impairment

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Therapy with some atypical antipsychotic agents should be administered cautiously in patients with renal impairment and the dosage should be reduced accordingly. These agents are not recommended in patients with severe renal impairment.

Moderate

Atypical Antipsychotic Agents (Includes Risperdal M-Tab) ↔ Weight Gain

Moderate Potential Hazard, Moderate plausibility

Applies to: Obesity

Weight gain has been observed with atypical antipsychotic use. While all agents in the class have been shown to produce some changes, each drug has its own specific risk profile. When treating pediatric patients with atypical antipsychotic agents, weight gain should be monitored and assessed against that expected for normal growth. Monitor weight at baseline and frequently thereafter.

Moderate

Neuroleptics (Includes Risperdal M-Tab) ↔ Hyperprolactinemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Breast Cancer, Hyperprolactinemia

The chronic use of neuroleptic agents can cause persistent elevations in prolactin levels due to antagonism of dopamine D2 receptors. 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. Caution is also advised in patients with preexisting hyperprolactinemia. Hyperprolactinemia may suppress hypothalamic gonadotrophin releasing hormone (GnRH), resulting in reduced pituitary gonadotropin secretion. This, in turn, may inhibit reproductive function by impairing gonadal steroidogenesis in both female and male patients. Galactorrhea, amenorrhea, gynecomastia, and impotence have been reported in patients receiving prolactin-elevating compounds; however, the clinical significance of elevated serum prolactin levels is unknown for most patients. Long-standing hyperprolactinemia when associated with hypogonadism may lead to decreased bone density in both female and male patients.

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. Navane (thiothixene)." Roerig Division, New York, NY.
  3. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  4. Meco G, Falaschi P, Casacchia M, et al "Neuroendocrine effects of haloperidol decanoate in patients with chronic schizophrenia." Adv Biochem Psychopharmacol 40 (1985): 89-93
  5. Ash PR, Bouma D "Exaggerated hyperprolactinemia in response to thiothixene ." Arch Neurol 38 (1981): 534-5
  6. "Product Information. Compazine (prochlorperazine)." SmithKline Beecham, Philadelphia, PA.
  7. "Product Information. Risperdal (risperidone)." Janssen Pharmaceutica, Titusville, NJ.
  8. Bai YM, Ciu HJ, Guo ZZ "Risperidone-induced hyperprolactinemia in an elderly woman." Am J Psychiatry 159 (2002): 2112
  9. Huang ML, Van Peer A, Woestenborghs R, De Coster R, Heykants J, Jansen AA, Zylicz Z, Visscher HW, Jonkman JH "Pharmacokinetics of the novel antipsychotic agent risperidone and the prolactin response in healthy subjects." Clin Pharmacol Ther 54 (1993): 257-68
  10. "Product Information. Seroquel (quetiapine)." Zeneca Pharmaceuticals, Wilmington, DE.
  11. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.
  12. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  13. "Product Information. Clozaril (clozapine)." Novartis Pharmaceuticals, East Hanover, NJ.
  14. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  15. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  16. "Product Information. Zyprexa (olanzapine)." Lilly, Eli and Company, Indianapolis, IN.
View all 16 references
Moderate

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. 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
  3. "Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
  4. Boston Collaborative Drug Surveillance Program "Drug-induced extrapyramidal symptoms." JAMA 224 (1973): 889-91
  5. "Product Information. Loxitane C Oral Concentrate (loxapine)" Watson Laboratories Inc, Corona, CA.
  6. Gwinn KA, Caviness JN "Risperidone-induced tardive dyskinesia and parkinsonism." Mov Disord 12 (1997): 119-21
  7. Sheppard C, Merlis S "Drug-induced extrapyramidal symptoms: their incidence and treatment." Am J Psychiatry 123 (1967): 886-9
  8. Mahmood T, Clothier EB, Bridgman R "Risperidone-induced extrapyramidal reactions." Lancet 346 (1995): 1226
  9. "Product Information. Haldol (haloperidol)." McNeil Pharmaceutical, Raritan, NJ.
  10. Heel RC, Brogden RN, Speight TM, Avery GS "Loxapine: a review of its pharmacological properties and therapeutic efficacy as an antipsychotic agent." Drugs 15 (1978): 198-217
  11. "Product Information. Moban (molindone)." Gate Pharmaceuticals, Sellersville, PA.
  12. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM "Pharmacotherapy: A Pathophysiologic Approach 4th" Stamford, CT: Appleton & Lange (1999):
  13. Bransgrove LL, Kelly MW "Movement disorders in patients treated with long-acting injectable antipsychotic drugs." Am J Hosp Pharm 51 (1994): 895-9
  14. Owens DGC "Extrapyramidal side effects and tolerability of risperidone - a review." J Clin Psychiatry 55 Suppl (1994): 29-35
View all 14 references

Risperdal M-Tab (risperidone) drug Interactions

There are 1133 drug interactions with Risperdal M-Tab (risperidone)

Risperdal M-Tab (risperidone) alcohol/food Interactions

There are 4 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.
Unknown No information available.

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

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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