Is it safe for a person with dementia?

Risperidone is an antipsychotic medication. These are medications that people can take to treat the symptoms of psychosis. Psychosis occurs when a person experiences a loss of contact with reality. This can result in hallucinations and delusions.

A 2020 article notes that although the Food and Drug Administration (FDA) has not approved risperidone for treating dementia, some doctors may prescribe it to treat the behavioral and psychological symptoms of dementia.

In recent years, safety concerns have increased regarding the use of risperidone to treat dementia. This is because the medication may not be safe to use in older adults and can increase their risk of certain side effects.

Medical professionals may use risperidone to treat psychological and behavioral symptoms in people with dementia.

However, the Alzheimer’s Association states that people with dementia should only use antipsychotic medications under one of the following conditions:

• they are experiencing behavioral symptoms due to mania or psychosis
• the symptoms they have are presenting a danger to themselves or other people
• the person is experiencing inconsolable or persistent distress, has a significant decline in function, or is having substantial difficulty receiving care

Risperidone and other antipsychotic medications can help with certain behavioral and psychological symptoms of dementia. These include:

What symptoms does risperidone not treat?

There is no evidence that risperidone will help with:

• memory loss and confusion
• difficulty speaking
• difficulty understanding and expressing thoughts
• difficulty reading and writing
• getting lost in familiar places
• repeating questions
• taking longer than usual to complete daily tasks
• losing balance and problems with movement

If a medical professional prescribes risperidone for dementia, they should prescribe the minimum dose for the shortest time possible.

A person should take 0.25–2 milligrams a day for 6–12 weeks.

A person should also stop taking risperidone after 12 weeks if their risk of adverse side effects increases or if they experience no benefit from the treatment.

If a person has dementia and takes risperidone to treat certain behavioral symptoms, a doctor may wish to review them after a set period of time.

Doctors should review antipsychotic drug treatments after 6 or 12 weeks, or both.

This review will help the doctor decide whether the person needs to stop taking the medication or whether they require a different medication.

During this review, a doctor may recommend that the person stops taking risperidone in one go if they are on a low dose. If they are taking a higher dose, the doctor may suggest a more gradual reduction. Doctors call this tapering.

If a person stops taking risperidone, a doctor will monitor the effects that this has on their behavioral and psychological symptoms. If the symptoms worsen again, then they may restart treatment.

Medical professionals need to use extreme caution when deciding whether to use antipsychotic medications such as risperidone to treat people with dementia.

The Alzheimer’s Association notes that research has shown that these drugs have an association with an increased risk of stroke and death in older adults who have dementia.

The FDA has ordered manufacturers to label these drugs with a “black box” warning. This outlines their major risks so that doctors can make the best decisions for the people they treat.

Due to risperidone’s associated risks, doctors should only use it to treat people with dementia when the patient has severe symptoms of aggression, agitation, or psychosis and does not respond adequately to nonpharmacological treatments.

Will it interact with other medications?

The National Alliance on Mental Illness (NAMI) notes that risperidone can reduce the efficacy of the following Parkinson’s medications:

• levodopa/carbidopa (Sinemet)
• bromocriptine
• pramipexole (Mirapex)
• ropinirole (Requip)

It can also lower a person’s blood pressure. Taking risperidone alongside medications to lower blood pressure, such as propanolol (Inderal), can increase a person’s risk of falling.

Other medications can increase and decrease the effects of risperidone. Medications that increase the effects of risperidone include:

Medications that decrease the effects of risperidone include:

• carbamazepine (Tegretol and Equetro)
• phenytoin (Dilantin)
• phenobarbital
• rifampin (Rifadin)

According to NAMI, common side effects include:

Rare side effects

Risperidone increases the blood levels of the hormone prolactin. This can cause females to stop having their period and produce breast milk. It can also cause males to lose their sex drive and experience erectile problems.

If a person has increased prolactin levels over a long period of time, it can cause osteoporosis and increase a person’s risk of bone fractures.

Risperidone can also cause some muscle-related side effects. These include extrapyramidal symptoms, such as:

• the inability to sit still
• involuntary muscle contractions
• involuntary facial movements

Tardive dyskinesia is another muscle-related side effect. This includes uncontrollable slow or jerky movements that often begin in the mouth with tongue rolling or chewing movements.

Risperidone can also impact temperature regulation, which may cause a person to become too hot. A person should take care when undergoing strenuous exercise or exposing themselves to heat.

All antipsychotics, including risperidone, have an association with an increased risk of sudden cardiac death. This is often due to arrhythmia, which is an irregular heartbeat.

Another very rare but life-threatening side effect of risperidone is neuroleptic malignant syndrome. This occurs in less than 1 in 100 people who take the drug.

Symptoms include:

• confusion
• fear
• extreme muscle stiffness
• sweating

If a person takes risperidone and experiences these symptoms, they should contact a doctor immediately.

The NAMI suggests that a person or caregiver discusses the following topics with a doctor before taking risperidone:

• if they have had thoughts of suicide or harming themselves
• medications they have taken in the past for their condition and how effective they were
• if they have ever had the following symptoms:
  • muscle stiffness
  • shaking
  • tardive dyskinesia
  • neuroleptic malignant syndrome
  • weight gain due to a medication
• any psychiatric or medical problems they have, including:
• if they have a family history of diabetes or heart disease
• any other medications they are currently taking, including over-the-counter products, herbal supplements, and nutritional supplements
• any medication allergies they may have
• other, nonmedication, treatments they are having, such as talk therapy
• if they smoke, drink alcohol, or use illegal drugs

There are a number of other medications that a person can use to treat the symptoms associated with dementia, which include:

Carbamazepine (Tegretol)

Although a doctor may prescribe antipsychotic medications to treat agitation, they may prescribe carbamazepine (Tegretol) instead.

This is a type of seizure medication or mood stabilizer.

Suvorexant

Suvorexant (Belsomra) is a treatment that the FDA has approved for treating insomnia in people with dementia.

It works by blocking the activity of a chemical messenger that is involved in the sleep-wake cycle.

Antidepressants

A doctor may prescribe antidepressants to a person with dementia to treat their low mood and irritability.

Common antidepressants include:

• citalopram (Celexa)
• fluoxetine (Prozac)
• paroxeine (Paxil)
• sertraline (Zoloft)
• trazodone (Desyrel)

Anxiolytics

A doctor may prescribe anxiolytics to treat anxiety, restlessness, verbally disruptive behavior, and resistance in people with dementia.

Common anxiolytics include lorazepam (Ativan) and oxazepam (Serax).

Risperidone is an antipsychotic medication. Some doctors also use it to treat certain behavioral and psychological symptoms of dementia. These symptoms include hallucinations, delusions, aggression, agitation, hostility, and uncooperativeness.

The medication has some possible risks and side effects that may make it a dangerous treatment option for people with dementia. These drugs have an association with an increased risk of stroke and death in older adults who have dementia.

These risks mean that doctors should only use risperidone to treat people with dementia when they have severe symptoms of aggression, agitation, or psychosis and do not respond well to nonpharmacological treatments.