Risperidone

SDianeL

Just spoke with my DH's Neurologist. My DH is more angry & agitated lately and the Neurologist asked me 6 months ago if I wanted her to prescribe something. I said not at that time but I think it's time. She said she will put him on a very low dose of Risperidone. I agreed but decided to look up side effects and found this and am going to reach out to her again.

Is risperidone a high risk medication? Warnings: There may be a slightly increased risk of serious, possibly fatal side effects (such as stroke, heart failure, fast/irregular heartbeat, pneumonia) when this medication is used by older adults with dementia. This medication is not approved for the treatment of dementia-related behavior problems.

easy23

The doctor put my mother on risperidone after being very agitated and delusional. It has worked wonders with the agitation and the delusions have calmed down. She has not had any negative side effects. I think the benefits outweigh any slightly increased risks.

harshedbuzz

Risperidone is one of the atypical antipsychotic medications used off-label for the agitation and aggression in PWD. And I hear you on how scary it is to read the warnings that come with the medication. It is generally prescribed at much, much lower doses for PWD that prescribed for people with schizophrenia or bipolar disorder. It is also often used at similar very low doses for children with autism. At lower doses, it is much less likely to have the associated side effects but the odds are never zero.

I believe behavior is communication. He's got to be struggling with intense feelings he no longer has the cognitive bandwidth to process to get to a point where you're considering meds. My own dad took a similar medication twice daily at a very low dose (Seroquel 25mg) to deal with the anxiety that drove his challenging behavior. The meds dialed the emotional temperature down enough that non-medical strategies like validation and redirection were effective for us and allowed dad to stay in his own home until about 2 months before he died.

There is one medication in this class that does have FDA approval for agitation with dementia-- Rexulti. There is no generic for this newer drug and it costs close to $1400 for 30 tablets. There's a coupon program, but often these aren't applicable to patients using Medicare/Medicaid. You can get generic risperidone at Walmart for $4/30 days.

HB

Ed1937

I have a son who does not have dementia, but he was prescribed medication that had the dire warnings. If you read them, it will make you wonder if you should take it or not. He is taking the meds, and there have been no significant side effects. Several people on this forum have or are now using them.

Caro_Lynne

My LO was switched to risperidone in April (due to aggressive behavior and agitation) and taken off of seroquel; so far the risperidone has been very effective at controlling his aggressive behavior. I too was concerned since his cognitive impairment was caused by a vascular stroke; he went from being forgetful one day to coming home three months later severely cognitively compromised. He is also on klonopin, blood pressure, cholesterol and anti-seizure meds.

I recently found an amazing geripsych which he will be seeing every 3-4 weeks. Our goal is to modify his meds, if and as needed, to give him the best possible quality of life and minimize his symptoms/behaviors. I've learned this will be an ongoing process.

This has been my experience and TBH after seeing the ads on tv for various meds, the side effects sound worse than the condition being treated 😕.

Hopefully others on this board, which have more experience and have been doing this much longer than me, can give you more insight. Let us know how it goes.

ImMaggieMae

My husband was put on Risperidone about a year and a half ago by a hospital psychiatrist, during a week long stay for extreme agitation and lack of sleep. He was not violent or aggressive toward other people, but pulling IV’s out of his arm and trying to leave. (I was not allowed to stay with him due to Covid restrictions, only visit during visiting hours.) He had been on a low dose of Seroquel for about a month before the hospital stay and on Aricept for a couple of years. The Risperidone had a very positive effect and he was “normalish” when he came home. Before the Risperidone he couldn’t dress or feed himself and was awake half the night. It made a tremendous difference for him. The Risperidone was increased a little over time, up until now as the disease progressed.

i had long conversations with the hospital psychiatrist at the time, and later, when we could finally get into a neurologist, with him. Both agreed that the benefits outweighed the risks. It wasn’t only me who was being driven crazy by all the bouncing off the walls and very confused behaviors, but they greatly affected his quality of life as well. I also researched everything I could find on my own and spoke to a friend who is a retired statistician. The actual risk is small at the doses prescribed. 13+ years ago when my husband went through 6 months of chemotherapy, the risks for one of the chemo drugs was higher. But he survived the chemo drug and has been clear of the cancer ever since.

SDianeL

thank you all so much. This makes me feel better about my choices. He does need the medication some days and more frequently.

mrahope

Please pardon my ignorance on this topic. Is this a medication that can be used on an "as needed" basis?

harshedbuzz

https://alzconnected.org/discussion/comment/177318#Comment_177318

I know Seroquel, a medication in the same family, is sometimes used "as needed". I personally am not a fan of this option. IME, behavior is communication. If a PWD is acting out and the usual suspects have been eliminated-- no UTI or other infection and no one is interacting inappropriately (trying to reason with the PWD, for instance)-- then there's likely a baseline of anxiety they can't process and medicating proactively is the kinder, and more effective, option.

HB

ImMaggieMae

https://alzconnected.org/discussion/comment/177318#Comment_177318

No, I don’t believe so. I was told it needs to be given on a regular schedule, usually twice per day. I was told that in a crisis situation I could give him a one time extra dose. It isn’t the type of medication that can be stopped all at once. It needs to be overseen by a mental health professional.