Risperdal
Risperdal (Risperidone)Indications
- Acute both chronic schizophrenia and other psychotic conditions with productive and-or negative semiology;
- Affective disorders at various mental diseases;
- Behavioural disorders at patients with a dementia at implication of symptoms of aggression (fit of anger, physical violence), at activity disturbances (excitation, delirium) or psychotic symptoms;
- As auxiliary therapy (as the mood stabilizer) - behavioural disorders at teenagers aged are more senior 15 years and adult patients with the lowered intellectual level or a delay of mental development, in cases, if the destructive behaviour (aggression, impulsiveness, an autoaggression) is the leader in a clinical picture of illness;
- As auxiliary therapy at treatment of manias at bipolar disorders.
Dosage regimen
At schizophrenia to adults and teenagers 15 years the preparation aged is more senior prescribe 1-2 times/days the Initial daily dose makes 2 mg. For 2nd day the daily dose should be enlarged to 4 mg. Then the dose can or be kept at former level, or if necessary individually to correct. An optimum daily dose - 4-6 mg. Slower rising of a dose and lower initial and supporting doses in some cases can be justified.
At appointment of a daily dose more than 10 mg are noted higher efficiency in comparison with smaller doses. Development of extrapyramidal symptoms thus can become perceptible. Because safety of doses more than 16 mg/sut was not studied, doses above this level to apply it is impossible.
To patients of advanced age the recommended initial dose makes 500 mkg 2 times/days the Dose it is possible to enlarge individually by 500 mkg a day to 1-2 mg 2 times/days
At patients with diseases of a liver and kidneys the recommended initial dose makes 500 mkg 2 times/days the Dose it is possible to enlarge gradually to 1-2 mg 2 times/days
Data on use of a preparation for treatment of schizophrenia at children are more younger 15 years are absent.
At abusing medical products or medicinal dependence a recommended daily dose of a preparation - 2-4 mg.
At behavioural disorders at patients with a dementia the recommended initial dose makes on 250 mkg 2 times/sut (it is necessary to use the corresponding medicinal form). The dose if necessary can be enlarged individually by 250 mkg a day (not more often than in day). For the majority of patients an optimum dose are 500 mkg 2 times/days However to some patients be shown preparation reception in a dose on 1 mg 2 times/days After achievement of an optimum dose can reception of a preparation of 1 times/days is recommended
At manias at bipolar disorders the initial dose of a preparation is recommended - 2 mg of 1 times/days If necessary a dose can be raised on 2 mg a day, not more often than in day. For the majority of patients an optimum daily dose are 2-6 mg.
At disorders of behaviour at patients with a delay of mental development to patients with mass of a body 50 kg and more recommended initial dose of a preparation - 500 mkg of 1 times/days If necessary the dose can be raised on 500 mkg a day, not more often than in day. For the majority of patients an optimum daily dose - 1 mg.
However preparation reception is more preferable to some patients in a dose of 500 mkg/sut whereas the augmentation of a dose to 1.5 mg/days is required to some patients
To patients with mass of a body less than 50 kg a recommended initial dose of a preparation - 250 mkg of 1 times/days If necessary this dose can be raised on 250 mkg a day, not more often than in day. For the majority of patients an optimum dose is the dose of 500 mkg/days However for some patients more preferably preparation reception in a dose of 250 mkg/sut whereas the augmentation of a dose to 750 mkg/days is required to some
Long Risperdal reception at teenagers should be spent under the constant control of the doctor.
Application for children is more younger 15 years it is not recommended.
Side effect
From nervous system: a sleeplessness, agitation, alarm, a headache; sometimes - drowsiness, undue fatigability, giddiness, disturbance of concentration of attention, a sight illegibility; seldom - extrapyramidal symptoms (a tremor, a rigidity, a hypersalivation, a bradykinesia, an akathisia, an acute dystonia), a mania or a hypomania, a stroke (at elderly patients with contributing factors), and also a hypervolemia (either because of a polydipsia, or because of a syndrome of inadequate secretion of an antidiuretic hormone), a late dyskinesia (consensual rhythmic movements mainly tongue and-or the person), an antipsychotic malignant syndrome (a hyperthermia, a muscular rigidity, instability of independent functions), disturbances of a thermoregulation and epileptic attacks.
From the alimentary system: constipations, a dyspepsia, a nausea or vomiting, an abdominal pain, rising of activity of hepatic transaminases, dryness in a mouth, hypo-or a hypersalivation, an anorexia and-or appetite intensifying, rising or depression of mass of a body.
From cardiovascular system: sometimes an orthostatic hypotension, a reflex tachycardia or BP rising.
From hemopoiesis organs: a neutropenia, a thrombocytopenia.
From endocrine system: a galactorrhea, a gynecomastia, disturbance of a menstrual cycle, an amenorrhea, augmentation of mass of a body, a hyperglycaemia and an exacerbation existing before a diabetes.
From genitourinary system: a priapism, disturbances of an erection, ejaculation disturbance, an urine incontience.
Allergic reactions: a rhinitis, an eruption, a Quincke's disease, a photosensitization.
From integuments: a xeroderma, a hyperpegmentation, an itch, a seborrhea.
The other: an arthralgia.
Contraindications
- The lactemia period (thoracal feeding);
- A hypersensibility to preparation components.
With care it is necessary to prescribe a preparation at diseases of cardiovascular system (the chronic heart failure, the transferred myocardial infarction, conductivity disturbances), dehydration and a hypovolemia, disturbances of a cerebral circulation, illness Parkinson, cramps (including in the anamnesis), serious renal or hepatic insufficiency, abusing medical products or medicinal dependence, the conditions contributing to development of a tachycardia of type "pirouette" (a bradycardia, disturbance of the electrolytic balance, accompanying reception of the medical products extending interval QT), tumours of a brain, intestinal impassability, cases of an acute overdosage medicines, syndrome Reie (the antiemetic Risperdal effect can mask symptoms of these conditions), pregnancy, children's age till 15 years (efficiency and safety are not established).
Pregnancy and lactemia
Safety Risperdal at pregnant women was not studied. At pregnancy it is possible to use only in the event that the positive effect justifies possible risk.
As Risperdal and 9-gidroksi-risperidon get into thoracal milk, to the women applying a preparation, it is necessary to stop thoracal feeding.
Special indicatings
At schizophrenia in the beginning of Risperdal treatment is recommended to cancel gradually the previous therapy if it is clinically justified. If patients are translated from therapy of depot by forms of antipsychotic preparations Risperdal reception is recommended to be begun instead of the following planned injection. In connection with an alpha-adrenoblokirujushchim the orthostatic hypotension, especially in initial selection of a dose can arise Risperdal action. At hypotension occurrence it is necessary to consider the problem on a dose decline. At patients with diseases of cardiovascular system, and also at dehydration, a hypovolemia or cerebrovascular disturbances, the dose should be enlarged gradually, according to references.
Occurrence of extrapyramidal symptoms is a risk factor for development of a late dyskinesia. In case of occurrence of signs and symptoms of a late dyskinesia, it is necessary to consider the problem on cancellation of all antipsychotic preparations. At occurrence of the malignant antipsychotic syndrome characterised by a hyperthermia, a muscular rigidity.
At cancellation of carbamazepine and other inductors of hepatic enzymes the Risperdal dose should be lowered.
Patients should to recommend refrain from a hyperalimentation in connection with possibility of augmentation of mass of a body.
During treatment it is necessary to refrain from alcohol reception.
Influence on ability to driving of motor transport and to management of mechanisms
During treatment it is necessary to abstain from employment by potentially dangerous kinds of the activity demanding raised concentration of attention and speed of psychomotor reactions.
Overdosage
Symptoms: drowsiness, a sedation, consciousness oppression, a tachycardia, an arterial hypotension, extrapyramidal disorders, in rare instances elongation of interval QT.
Treatment: it is necessary to provide free passableness of respiratory tracts for maintenance of adequate oxygenation and ventilation, a gastric lavage (after an intubation, if the patient without consciousness) and appointment of the activated coal in a combination to purgatives. Spend the symptomatic therapy referred on maintenance of the vital functions of an organism. The specific antidote is absent.
For timely diagnosing of possible disturbances of a rhythm of heart, it is necessary to begin electrocardiogram monitoring as soon as possible. Careful medical observation and an electrocardiogram-monitoring spend before full disappearance of symptoms of an intoxication.
Conditions and periods of storage
The preparation should be stored in a place inaccessible to children at temperature not above 25 C. The Period of validity - 3 years.
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