What should clinicians know about Perseris (risperidone subcutaneous LAI)?

Perseris is a long-acting injectable (LAI) formulation of risperidone. It is the first available antipsychotic LAI available which is administered subcutaneously (rather than intramuscularly). Subcutaneous injections are given under the skin using shorter and smaller gauge needles. Intramuscular injections are given deeper into muscular tissue using longer and larger gauge needles. Perseris is FDA-indicated to treat adults with schizophrenia.

Establishing Tolerability

• Prior to initiating Perseris, establish tolerability with oral risperidone in risperidone-naïve patients.

Dosing

• Once monthly subcutaneous abdominal injection only, must be administered by a healthcare provider. Use of this LAI formulation of risperidone (Perseris) decreases necessary frequency of injections over original risperidone LAI (Risperdal Consta).
• Available in 90 mg or 120 mg kits:
  • 4 mg oral risperidone corresponds to 120 mg (injection volume of 0.8 ml) Perseris
  • 3 mg oral risperidone corresponds to 90 mg (injection volume of 0.6 ml) Perseris

    Dose Conversion of Oral Risperidone to Risperidone Subcutaneous LAI
    PO Dose	LAI/SC Dose
    3 mg daily	90 mg every 4 weeks
    4 mg daily	120 mg every 4 weeks
    Recommended available dose formulations include 90 mg and 120 mg pre-filled vial kits. Dose reduction may be necessary for CYP450 interactions of side effect intolerance. References: 1. Indivior. (2018). Perseris dosing and administration. 2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841

• Patients who are stable on oral risperidone doses lower than 3 mg/day or higher than 4 mg/day may not be candidates for Perseris.
• No loading dose or oral supplementation recommended.
• Provides initial peak plasma concentration in 4 to 6 hours of both risperidone and its metabolite, yielding steady plasma levels following initial injection.
• Refer to this tip on how to address missed doses.

Practical issues (including administration)

• Must remain refrigerated, but can remain at room temperature for up to 7 days.
  • Should be brought to room temperature for at least 15 minutes prior to mixing.
  • Mixing requires at least 60 cycles between liquid and powder syringes.
• Choose abdominal injection site around umbilicus that has adequate subcutaneous tissue free of skin conditions.
  • It is recommended that patient is supine. Pinch the skin at injection site before and during injection administration.
  • Rotate injection sites.
• Advise patients not to rub or massage the injection site.

FDA Medication Label

Information on this topic is found in the FDA medication label.  Prescribing should always be informed by the FDA medication label. Medication labels can be found by searching Drugs@FDA at the FDA website. Labels are also available using the Drugs@FDA app for Apple or Android devices.

Labels change over time, and the current label should always be consulted. Here is the most recent label, at time of writing.

Administration/Dosing Guide

More information about administration (including a detailed video) and dosing can be found here.