Risperdal (Risperidone) is an atypical antipsychotic drug that is primarily utilized to manage symptoms of schizophrenia. Additionally the drug is commonly prescribed for other conditions such as schizoaffective disorder, bipolar disorder, and for irritability associated with autism. It was initially approved by the FDA in 1994 and at the time was considered to be an improvement from older, “typical” antipsychotics.
This drug tends to act mainly as a dopamine antagonist, which helps reduce positive symptoms of schizophrenia. It can also acts as an antihistamine and tends to reduce serotonin and norepinephrine in the brain. Risperdal has become a highly popular medication and is even regarded by the World Health Organization as being an “essential medicine” to have in a basic health system.
Risperdal may work well to treat certain diseases like schizophrenia, but those taking it often complain about unwanted side effects. Experiencing side effects is common with any antipsychotic medication and an unfortunate part of treatment. For most individuals, it can be a tough decision as to whether the perceived benefits of the medication outweigh the side effects.
Factors that influence Risperdal side effects
When taking an antipsychotic medication like Risperdal, it is important to understand that factors can influence the side effects that you experience. Factors that have most influence over side effects include: individual physiology, the dosage, how long you’ve taken the drug, and whether you are currently taking any other medications.
1. Individual Variation
The most important factor in determining the side effects that you’ll experience is your individual physiology. Although some side effects are universal and affect everyone, most people will not experience the exact same side effects. Two people could be given the same dosage of Risperdal, and one may exhibit extreme restlessness, while the other may not experience any restlessness.
Your individual physiology will play an important role in determining how you react to the drug. If your body doesn’t react well to Risperdal, you may experience significant unwanted side effects and get no reduction in symptoms. Someone else may find Risperdal very helpful and have minimal side effects. It is always important to understand that side effects are usually based mostly on the individual.
2. Dosage (2 mg, 4 mg, 8 mg, 16 mg)
What dosage of Risperdal are you taking? In general, the greater the dose of the drug you take, the more you increase your chances of unwanted side effects. As you increase the dose, the drug will have more of an influence over your nervous system and brain functioning. At high doses, it will significantly interfere with your body’s natural processes and you will likely experience many side effects.
At lower doses, you may experience very minimal side effects. When taking an antipsychotic, it is always recommended to stay on as low of a dose as possible that provides you with symptom relief. By staying on a low dose, you aren’t allowing the drug to have as much of an influence over the functioning of your nervous system and you will be able to minimize unwanted side effects.
Risperdal is available in the form of a tablet (pill) or intramuscular injection. The intramuscular injections are essentially formulations of the drug that are administered once every two weeks. If you aren’t sure whether you’ll be able to tolerate side effects from the drug, it is recommended to try the pill first as it will not stay in your system for two weeks.
For those with schizophrenia, the starting dose is 2 mg. A doctor will usually titrate a patient up to a dose between 4 mg and 8 mg for optimal symptom relief, but in extreme cases, doses up to 16 mg can be used. Keep in mind that as the dosage increases, the more likely you are to exhibit side effects. It is usually recommended to start at the lowest dose of 0.5 mg and slowly titrate up to the lowest effective dose.
3. Time Span
How long have you been taking Risperdal? Those who are just starting the medication may notice significant side effects. This is because when you are just starting a medication, your body hasn’t adapted to the changes being made by Risperdal. As your body adapts to the drug over the course of several weeks, most initial side effects will be reduced.
In some cases, people that have been on this drug for a long-term (i.e. years) will notice side effects developing or worsening over time. In other words, the effects of the drug may wear off after a year or two or more severe side effects may emerge after a few years. These are known as long-term side effects and are usually caused by Risperdal significantly altering the natural functioning of the nervous system.
4. Other Drugs
Do you currently take any other medications with Risperdal? Prior to taking your first dose, it is important to talk to your doctor about any contraindications or interactions that other medications may have with this drug. In some cases, people get prescribed a cocktail of medications to help with their symptoms and the interaction among drugs can produce potent side effects.
If you notice an interaction between other medications and Risperdal and an increase in unwanted side effects as a result, be sure to talk to your doctor. In some cases, various psychotropic drugs can act synergistically to promote unwanted weight gain, slowed metabolism, etc.
Risperdal Side Effects: List of Possibilities
Below is a list of possible side effects that you may experience while taking Risperdal. Understand that the severity and number of side effects you experience will be highly influenced by the factors listed above.
- Agitation: If you experience internal sensations of uncomfortable excitement, this is known as feeling agitated. Agitation is a relatively common side effect that people experience on antipsychotics. If it becomes overwhelming, be sure to tell your doctor – this symptom may make it difficult to stay on the medication.
- Akathisia: Some people may experience akathisia or the urge to constantly keep moving their body. Common signs of akathisia include rocking the body, swaying side to side, moving the legs, fidgeting, and lifting feet. This effect is closely linked to feeling restless, which is common on this medication.
- Anxiety: Although for some people Risperdal may work well to reduce anxiety, others may respond with increases in anxiety. The effect this drug has on various neurotransmitters such as dopamine, histamine, and serotonin indicate sedating properties, but the changes it creates could increase feelings of anxiety.
- Appetite changes: Most people notice significant changes in appetite as a side effect of this drug. Initially your appetite may fluctuate, but eventually it is likely to increase. Decreased appetite is considered a rarer side effect. The increase in appetite is one of the reasons people tend to gain weight on Risperdal.
- Balance problems: Some individuals have noticed balance and coordination problems after taking this medication. If you feel unable to maintain a steady balance and as though your equilibrium is out of sync. These problems usually improve as your body adjusts to the drug, but if they become overwhelming, talk to your doctor.
- Blurred vision: It is common to notice visual changes when taking Risperdal. Most people notice blurred vision or changes in ability to focus. This is thought to be caused by alterations in neurotransmitter levels and not any problem with your actual eyes.
- Constipation: You may become constipated as a reaction to taking this medication. If you are unable to pass a bowel movement and the constipation becomes a problem, discuss it with your doctor. Consider increasing your intake of fiber and foods that are likely to help rectify this situation.
- Coughing: Medical reports have indicated that some people develop effects similar to that of the common cold from taking this drug. One of the side effects that people have reported is that of increased coughing. If you notice that you are coughing after you take this drug, it is could be a side effect.
- Depression: Risperdal is commonly prescribed as an antidepressant augmentation strategy to help ease depressive symptoms. However, not everyone gets an antidepressant effect out of this antipsychotic. For some individuals, it may actually make their depression worse and more intense.
- Dizziness: If you feel dizzy or have sensations of vertigo, it’s likely a result of using this drug. Adapting to the effects of the drug can lead someone to become dizzy, which can make a person feel sick or as if they have balance problems. Dizziness is more common when first starting the drug and during Risperdal withdrawal.
- Drowsiness: There are warnings on all antipsychotic medications about experiencing drowsiness. When taking this medication, it is not recommended to operate heavy machinery and/or drive a motor vehicle as you may put yourself or others at risk. If you feel drowsy, it should improve after a few weeks, but if not it may be a significant impairment.
- Dry mouth: If your mouth suddenly dries up and feels as though it has no lubrication from saliva, this could be a side effect. Dry mouth is a very common side effect from all psychotropic medications. It may subside over time, but if it doesn’t go away, you may just have to put up with it.
- Extrapyramidal effects: Compared to older typical antipsychotics, Risperdal is associated with less extrapyramidal side effects. It is thought that the action it has on various serotonin receptors such as the 5-HT2A and 5-HT2C reduce these effects. With that said, it is still a possibility that you’ll experience extrapyramidal effects such as the inability to move or extreme restlessness. These tend to be brought on by the action of the drug in reducing levels of dopamine. As a general rule of thumb, the higher the dose you take, the more likely you are to experience extrapyramidal effects.
- Headaches: A very common side effect associated with any medication is experiencing headaches. Headaches may range from minor aches to severe migraines. If you notice that you have a headache from this medication, just know that it’s relatively common. Most headaches will go away as you adapt to the drug.
- Insomnia: Another common effect that this medication can have is triggering insomnia. You may be unable to fall asleep at a normal time because your mind is wandering, you feel restless, and/or anxious. For some individuals this drug will help with insomnia, but for others it can actually cause it.
- Itching: If you become itchy after taking Risperdal, it may be caused by an allergic reaction. If you feel that the itchiness is unbearable, you will obviously want to switch medications. For others, the itching may go away after a few weeks. Understand that itching may not necessarily be accompanied by a visible rash.
- Memory loss: It is very common to experience a temporary loss in memory functioning on this drug. Experiencing memory loss doesn’t mean that you won’t be able to remember anything, but it may be more difficult to retrieve memories and specific details may not be as clear. Usually if your memory function is impaired on the drug, it will recover if you discontinue.
- Muscle spasms: Some people notice that their muscles start to uncontrollably spasm as a result of this medication. If the spasms become excessive and/or embarrassing, you may want to discuss this with your doctor. It is thought that these may be caused by reductions in dopamine.
- Nausea: It is common to feel somewhat nauseated on this drug, especially when you initially start. Sometimes antipsychotics make people feel sick, but the feeling usually goes away after awhile. If the nausea never goes away, it’s probably a good idea to switch medications.
- Palpitations: These are characterized as sensations that your heart is beating abnormally fast or loudly. Heart palpitations are triggered by changes in arousal and throughout the nervous system. Do your best to not freak out over palpitations as they may increase your anxiety.
- Poor concentration: Another side effect is impairment in concentration and inability to focus. If you notice that you aren’t able to complete your schoolwork or work-related tasks because you cannot think clearly, it’s likely due to the medication. Reductions in dopamine and changes in neurotransmitters can make it very difficult to focus.
- Restlessness: You may become increasingly restless on this drug. The restlessness can be caused by changes in dopamine and other neurotransmission. If you feel an inner sensation to move around and you cannot seem to sit still, realize it’s a common side effect.
- Shaking: Some people report physically shaking or “tremors” when they take this medication. These tremors or “shakes” are thought to be caused by dopaminergic alterations in the brain. Excessive shaking could be a precursor to something more serious, so talk to your doctor if you notice this effect.
- Sexual dysfunction: Decreased interest in sex as well as other forms of sexual dysfunction are common side effects of this medication. Risperdal is known to increase prolactin and affect other neurotransmitters associated with pleasure like dopamine. For these reasons, some people become disinterested in sex and/or experience erectile dysfunction or inability to orgasm.
- Skin rash: In the event of an allergic reaction, you may develop a skin rash. Others may experience a skin rash accompanied by itching and it may eventually subside as the body adapts to the drug.
- Sleep problems: Your sleep quality and duration may change when you take this medication. Some people actually report feeling more rested, while others find their quality of sleep has diminished. If your sleep cycle has experienced change, it’s likely that the Risperdal had an effect.
- Sore throat: In addition to coughing, some people report feeling a sore throat. This is a reported reaction that some people have to this drug and other antipsychotics. Although sore throats aren’t as common as other side effects, they can be a reaction to the medication.
- Sweating: Another side effect from this medication is that of profuse sweating. You may notice that you are sweating throughout the day and/or throughout the night. Although this isn’t a pleasant side effect, it’s one that most people can put up with.
- Tremors: Certain people may start to experience shaking or tremors while taking this medication. Some tremors may be a sign that your body is trying to adapt to the drug. With that said, if you start to shake, it could be a sign of something more serious. Be sure to mention this side effect to your doctor.
- Urinary changes: You may notice changes in how often you have to urinate. Some people notice an increase in the amount of urine, while others may report effects such as urinary retention or inability to urinate. If this side effect is causing difficulties, discuss it further with your doctor.
- Vomiting: In some cases, the initial nausea associated with taking this drug can lead to vomiting. You may feel physically sick and as though you have the flu. Usually the vomiting will not last more than a week or two. If you experience vomiting, always tell your doctor because it may be a sign of an adverse reaction.
- Weakness: The physiological changes made by this medication can make you feel very weak. You may notice that your muscles lack their usual strength and it takes significantly more effort to complete physical tasks. An increase in prolactin from this drug has been linked to decreased bone-mineral density; thus contributing to weakness.
- Weight gain: One of the most common side effects associated with this medication is that of weight gain. You may pack on some serious weight as you continue taking this drug. This is caused by a slowed metabolism, hormonal changes, drops in activity level, and increased appetite. This is believed to be influenced by the effect the drug has on 5-HT serotonin receptors.
Risperdal Severe Side Effects / Adverse Reactions
In addition to the common side effects listed above, there are also adverse reactions that certain people have to Risperdal. If you experience any severe side effects, be sure to seek immediate medical attention. Although adverse reactions are not very common, they are very serious and important to detect early.
- Bleeding / bruising: Some people are at an increased risk for bleeding and bruising while on this medication. If you notice that you are bleeding significantly more often or have noticed bruises throughout your body, be sure to report this to your doctor.
- Breast enlargement: Certain individuals may notice growth in their breasts after taking this drug for an extended period. This has been reported as a side effect in both males (“gynecomastia”) and females and is associated with abnormally high levels of prolactin.
- Breast milk production: The increase in the hormone prolactin may lead to lactation in females. If you notice that your breasts are producing milk uncontrollably, understand that this is a common side effect of the drug.
- Confusion: Due to the sheer potency of antipsychotics, they can sometimes cause a person to experience confusion. A little bit of confusion may be normal, but extreme confusion accompanied by disorientation is considered an adverse reaction. If you become too confused to properly function, you will likely need to discontinue this medication.
- Death risk: Among individuals with dementia, Risperdal has been associated with an increased risk of death. Therefore, it is important to explore alternative treatment options to avoid this unfortunate consequence.
- Diabetes: In some cases, the weight gain and metabolic changes caused by Risperdal can lead individuals to develop Type 2 diabetes. In other words, their pancreas will no longer be able to regulate blood sugars in their body. This is an adverse side effect that can be permanent as a result of using this drug.
- Drooling: If you notice significant drooling after taking this drug, realize that you are not alone. Most people report an increase in drooling near bedtime or right before they go to sleep. However, others report uncontrollable drooling throughout the day. As your body gets used to this medication, this side effect may diminish.
- Fever: This drug can cause temporary increases in body temperature when a person initially starts taking it. However, it is when a fever doesn’t go away that it becomes a significant problem. Keep in mind that a fever could be a sign of neuroleptic malignant syndrome as well. Closely monitor changes in body temperature while taking this drug.
- Neuroleptic Malignant Syndrome: This is a dangerous side effect that occurs from Risperdal affecting dopamine levels. When dopamine is decreased in the brain for extended periods of time, it can lead to permanent changes in motor functioning and muscle control. Signs of neuroleptic malignant syndrome include: highly rigid posture, delirium, confusion, and fever.
- Seizures: A rare side effect that some people deal with is that of seizures or convulsions. If you end up having a seizure, you obviously don’t react well to this particular drug. Your doctor will need to know about this adverse effect.
- Shivering: A physical reaction that some individuals have is that of shivering. You may experience goose bumps or just general chills throughout your body. If the shivering doesn’t go away after a few days, be sure to report it to a professional.
- Stroke: If you take this medication, you are at slightly increased risk of experiencing a stroke. Although strokes are not a common result of this medication, antipsychotics can increase your overall risk.
- Tardive Dyskinesia: This involves uncontrollable body movements such as tongue movements, grimacing, lip smacking, and puckering. In the event that someone is taking an antipsychotic and these symptoms are noted, they will require medical intervention. This side effect is associated with long-term use of antipsychotics at higher doses.
Risperdal: Weighing Cons (Side Effects) vs. Pros (Benefits)
While taking an antipsychotic medication like Risperdal, it is important to weigh whether the benefits of the drug are significant enough to justify any side effects that you experience. In other words, ask yourself whether you get any benefit from taking Risperdal. If you get benefit from the drug and it treats your symptoms. Next determine whether you will be able to put up with the side effects from the drug.
First of all, if the drug doesn’t work very well, you may want to discontinue or change medication. Secondly, if the side effects that you experience are so overwhelming or debilitating that they are affecting your ability to function in society, talk to your doctor. Unless you talk about what you are experiencing, most doctors assume everything is going well. If you have some unwanted side effects that you cannot tolerate, tell your doctor that you want to try a different medication.
At the end of the day, nobody knows what side effects you experience and their intensity except you. If Risperdal is your first antipsychotic medication and you are experiencing too many side effects, you may want to consider switching to something else. On the other hand, if you’ve already tried an array of other medications and find that this one works best, it may be worth dealing with the side effects.
Most antipsychotics are difficult to take over the long-term due to the fact that they actually cause brain impairment and other conditions like neuroleptic malignant syndrome. Not only do most act as major tranquilizing agents that affect concentration, weight, and physical health, they don’t really address the root of the illnesses that they treat. Unfortunately, medications like Risperdal are currently the best option for treating serious diseases like schizophrenia.