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[Pharmacology](https://durgical.com/en/pharmacology/) · [Second-generation antipsychotics](https://durgical.com/en/pharmacology/classes/second-generation-antipsychotics/)

# Risperidone

An atypical antipsychotic for schizophrenia, bipolar mania and irritability in autism; the atypical that raises prolactin the most.

Updated 2026-11-01

- Class: [Second-generation antipsychotics](https://durgical.com/en/pharmacology/classes/second-generation-antipsychotics/)
- Receptor: Dopamine D2 receptor
- ATC code: N05AX08
- WHO Model List of Essential Medicines

◎**Dopamine D2 receptor**Risperidone

ⓘ The figure shows risperidone in the human D2 receptor (fused to a lysozyme for crystallisation).

**Target in 3D:** Dopamine D2 receptor. PDB structure 6CM4 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/6CM4) · Drag to rotate · pinch to zoom

## Mechanism of action

Risperidone blocks 5-HT2A and D2 receptors strongly, with α1 and H1 blockade. Its strong D2 blockade, also at the pituitary, raises prolactin markedly, and extrapyramidal effects increase with dose. Its active metabolite, 9-hydroxyrisperidone, adds to the effect.

- Risperidone blocks 5-HT2A and D2 receptors
- Psychotic and manic symptoms improve
- Pituitary D2 block: prolactin rises markedly
- Higher doses: more extrapyramidal effects

## Pharmacokinetics

**Absorption**
Taken by mouth (tablets, solution, orally disintegrating tablets); long-acting injections exist

**Metabolism**
CYP2D6 converts it to the active 9-hydroxyrisperidone; the effect comes from both together

**Elimination**
Mainly in the urine; slower in older people and in kidney disease

## Indications

- Schizophrenia
- Acute manic or mixed episodes of bipolar I disorder
- Irritability associated with autistic disorder (aggression, self-injury, tantrums)

## Adverse effects

### Common

- High prolactin: galactorrhoea, amenorrhoea, gynaecomastia, sexual dysfunction, reduced fertility
- Dose-related extrapyramidal effects and akathisia
- Orthostatic hypotension, especially at the start
- Weight gain and sedation

### Serious (rare, important)

- Hyperglycaemia, dyslipidaemia and weight gain
- Neuroleptic malignant syndrome
- Tardive dyskinesia (may be irreversible)
- Leukopenia and neutropenia
- Higher mortality in older people with dementia-related psychosis (boxed warning)

## Contraindications

- Hypersensitivity to risperidone or paliperidone

## Key interactions

**Fluoxetine, paroxetine and other CYP2D6 inhibitors**
Higher risperidone levels

**Carbamazepine and other enzyme inducers**
Lower levels of risperidone and its active metabolite

**Antihypertensives**
Additive hypotension

## What is monitored

- Symptoms of high prolactin (menstrual changes, galactorrhoea, sexual problems)
- Weight, glucose and lipids
- Abnormal movements
- Blood pressure at the start and after dose changes

## Administration and safety

- Oral and long-acting injectable forms are different products and are not interchanged one-for-one
- Look-alike name: risperidone can be confused with ropinirole; the label is read carefully

## Nursing care

- Asks tactfully about breast changes, menstrual changes and sexual problems
- Checks lying and standing blood pressure and helps the patient stand up slowly (orthostatic hypotension, falls)
- Records weight, waist, glucose and lipids at baseline and during treatment
- Watches for fever, rigidity and confusion (neuroleptic malignant syndrome) and for abnormal movements; reports them at once

## Pregnancy and breastfeeding

Newborns exposed in the third trimester may have extrapyramidal or withdrawal symptoms (agitation, abnormal tone, tremor, feeding problems); use weighs benefit and risk.

## Memory aid

«RisPRoLidone»: the «PRL» (prolactin) inside its name.

## Test yourself

Think of the answer, then tap the question to see it.

## Which atypical antipsychotic most often causes galactorrhoea and amenorrhoea?

Risperidone, through strong D2 blockade at the pituitary that raises prolactin.

## Which enzyme converts risperidone to its active metabolite?

CYP2D6, producing 9-hydroxyrisperidone; CYP2D6 inhibitors such as fluoxetine raise risperidone levels.

## Which behavioural problem in autism is a labelled use of risperidone?

Irritability: aggression, deliberate self-injury, tantrums and quick mood changes.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/risperidone/)

## Related drugs

- [Haloperidol](https://durgical.com/en/pharmacology/haloperidol/)
- [Aripiprazole](https://durgical.com/en/pharmacology/aripiprazole/)
- [Olanzapine](https://durgical.com/en/pharmacology/olanzapine/)

[← Back to the class: Second-generation antipsychotics](https://durgical.com/en/pharmacology/classes/second-generation-antipsychotics/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - RISPERIDONE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a6767972-2d3f-482b-80bd-ac93e28fdd05) (DailyMed (U.S. National Library of Medicine), 2026); [Risperidone: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a694015.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/?query=risperidone) (World Health Organization, 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 19 (McGraw Hill, 2023).

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Representative model, for educational purposes only.

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