Risperidone LAI

PERSERIS

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What it isLong-acting D2 and 5-HT2A antagonist with broad adrenergic and serotonergic blockade; schizophrenia.

Why this oneMonthly subcutaneous risperidone depot that forms an implant under the abdominal skin. No loading doses and no oral overlap.

What limits itSubcutaneous delivery brings injection-site lumps and soreness; prolactin elevation, EPS, weight gain, and orthostasis can limit use.

FDA label

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BOXED WARNING Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; not approved for dementia-related psychosis.

FDA dosing	Population	Start	Target	Max
Schizophrenia	Adult	90 mg or 120 mg SC once monthly	90–120 mg once monthly	120 mg per month

Renal Titrate with oral risperidone up to at least 3 mg daily before initiating; then 90 mg once monthly based on response/tolerability

Hepatic Titrate with oral risperidone up to at least 3 mg daily before initiating; then 90 mg once monthly based on response/tolerability

One dose per month only; no loading dose.

Instructions

Establish tolerability with oral risperidone before initiating
Subcutaneous injection in the abdomen or back of the upper arm by a healthcare provider; do not give by any other route
Do not give more than one dose (90 mg or 120 mg) per month; supplemental oral risperidone not recommended
Fully mix the medication before administration

Contraindications

Known hypersensitivity to risperidone, paliperidone, or any components of PERSERIS (anaphylactic reactions and angioedema reported).

Cautions

Increased mortality in elderly patients with dementia-related psychosis (boxed; not approved for this use)
Cerebrovascular adverse events, including stroke, in elderly dementia patients
Neuroleptic malignant syndrome
Tardive dyskinesia
Metabolic changes (hyperglycemia/diabetes, dyslipidemia, weight gain)
Hyperprolactinemia
Orthostatic hypotension and syncope
Falls
Leukopenia/neutropenia; seizures; potential for cognitive/motor impairment; dysphagia; priapism; disruption of body temperature regulation

Adverse reactions

increased weight
sedation/somnolence
musculoskeletal pain

Pregnancy Neonates exposed to antipsychotics in the third trimester are at risk for extrapyramidal and/or withdrawal symptoms after delivery. Pregnancy registry available.

Lactation Risperidone and 9-hydroxyrisperidone present in human milk (relative infant dose 2.3–4.7% of maternal); reports of sedation, failure to thrive, jitteriness, and extrapyramidal symptoms in breastfed infants.

⚠ BOXED WARNING