What should clinicians know about risperidone or Risperdal Consta (“Consta”) (risperidone microspheres LAI)?

Risperdal Consta was the first of the second-generation antipsychotics that became available as a long-acting injectable antipsychotic.  The efficacy and side effect profile corresponds to oral risperidone.  It is FDA-approved for the treatment of schizophrenia and for the maintenance treatment of bipolar 1 disorder.

Establishing Tolerability

Dosing

  • Risperdal Consta is given IM every two weeks.
  • Risperdal Consta is available as 12.5 mg (lowest dose) and 50 mg (highest dose); and as intermediate doses of 25 mg and 37.5 mg.
  • Initiating Consta requires overlap with oral risperidone (at a therapeutic dose) for 3 weeks.
  • There is no established loading-dose strategy.
  • In general, Consta is initiated with the 25 mg dose unless clinical factors suggest to start with 12.5 mg.
  • Adjustments in dose can be made at 4 week intervals, rather than at 2 week intervals.
  • Risperdal Consta 12.5 mg IM every two weeks corresponds to 1 mg oral risperidone per day. This means that the highest available Consta dose of 50 mg IM every two weeks corresponds to 4 mg oral per day. For many chronic patients with schizophrenia, this is at the low end of the dose range. Since Consta injections should not be combined, clinicians sometimes supplement Consta with oral risperidone if a higher dose is desired.

    Dose Conversion of Oral Risperidone to Risperidone Microspheres LAI

    PO Dose 

    LAI/IM Dose

    1 mg daily

    12.5 mg every 2 weeks

    2-3 mg daily

    25 mg every 2 weeks

    3-5 mg daily

    37.5 mg every 2 weeks

    4-5 mg daily

    50 mg every 2 weeks

    Recommended available dose formulations include 12.5 mg, 25 mg, 37.5 mg, and 50 mg pre-filled vial kits.

    Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

    References:
    Bai, Y.M., Chen, T.T., Chen, J-Y., Chang, W-H., Wu, B., Hung, C.H., & Lin, W.K. (2007). Equivalent switching dose from oral risperidone to risperidone long-acting injection: A 48-week randomized, prospective, single-blind pharmacokinetic study. Journal of Clinical Psychiatry, 68(8), 1218-1225. doi: 10.4088/jcp.v68n0808.

    Stahl, S. M. (2017). The prescriber’s guide: Stahl’s essential psychopharmacology (6th ed.). New York: Cambridge University Press.

Practical issues (including administration)

  • Risperdal Consta needs to be refrigerated, reconstituted and warmed up which poses some workflow issue in clinics. If prepared, reconstituted syringe sits out for more than 2 minutes, the suspension should be re-shaken prior to injection.
  • Use only components of the pre-packed dose packages containing the drug and syringe prefilled with diluent. Follow instructions from package insert regarding reconstitution.
  • Deltoid or gluteal injections are bioequivalent; the site can be chosen based on patient preference. Alternate sites and use 1-inch needle for deltoid, 2-inch needle for gluteal injection.
  • The injection is water-based which is less painful than decanoates. You don’t need to push hard.
  • Always give the full vial that you selected (the microspheres are not evenly distributed in the syringe). You should also not combine different doses of Consta.

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.

If you would like more information on this topic, or would like to provide any feedback, please send us a message using our consultation system. Be sure to let us know about which tip you are writing. We would love to hear from you, and the consultation system is free to use and confidential. Thank you!
  • Was this Helpful ?
  • YesNo

Join our #MissionForBetter now

Sign up for our newsletter. We’ll let you know about new resources, education, and more.

Saved Posts

X