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Risperidone (Risperdal TM) (Janssen Pharmaceutica, FDA approved in 1994)

Primary medical role: Management of psychotic disorders.

Role in Alzheimer's disease: Treatment of behavioral disorders (delusions, aggression, anxiety, verbalizations) in geriatric patients with dementia

Pharmacological role: Serotonin-dopamine antagonist; not fully known

Contraindications: Certain cardiac patients, arrhythmics and allergics can not take this drug

Side effects: (Low) Orthostatic hypotension (29%), syncope (0.2%), seizures (0.3%), hyperprolactinemia with chronic administration, somnolence (41% vs. 16% of controls), priapism (rare), TTP (very rare),

Evidence pro its efficacy: One of the most prevalent symptoms associated with Alzheimer's disease is delusions (in the area of 40% of patients have one sort or other). Alzheimer's patients also may exhibit agitation, harsh vocalizations, and emotional outbursts. At least 20 papers exist in the scientific literature testifying to the efficacy of Risperdal in lessening these types of positive symptoms.

Some evidence has been put forward that Risperdal also helps the negative symptoms (i.e., cognitive loss in AD). However, this evidence is not very good, and in fact some evidence goes against it.

Evidence con its efficacy: Risperdal is probably quite good at decreasing the symptoms of delusions, agitation, and vocalizations. It is probably not good at increasing the cognitive status of Alzheimer's patients and in fact probably slightly decreases cognitive skills.

Dosage: 1mg/day

Cost: High.

For more information: An excellent info packet is available from Janssen: 1125 Trenton-Harbourton Rd., PO Box 200, Titusville, NJ 08560-0200.

Selected References:

de Deyn PP, Katz IR. Control of aggression and agitation in patients with dementia: efficacy and safety of risperidone. Int J Geriatr Psychiatry. 2000 Apr;15(S1):S14-S23. Abstract.

De Deyn PP, Rabheru K, Rasmussen A, Bocksberger JP, Dautzenberg PL, Eriksson S, Lawlor BA. A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia. Neurology. 1999 Sep 22;53(5):946-55. Abstract.

Irizarry MC, Ghaemi SN, Lee-Cherry ER, Gomez-Isla T, Binetti G, Hyman BT, Growdon JH. Risperidone treatment of behavioral disturbances in outpatients with dementia. J Neuropsychiatry Clin Neurosci. 1999 Summer;11(3):336-42. Abstract.

Katz IR, Jeste DV, Mintzer JE, Clyde C, Napolitano J, Brecher M. Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial. Risperidone Study Group. J Clin Psychiatry. 1999 Feb;60(2):107-15. Abstract.

Moechars D, Gilis M, Kuiperi C, Laenen I, Van Leuver F. Aggressive behaviour in transgenic mice expressing APP is alleviated by serotonergic drugs. Neuroreport 9(16): 3561-4 (Nov. 1998) Abstract.

Riva E, Nobili A, Tecate F. "Judicious" use of neuroleptic drugs in the treatment of behavioral symptoms in the course of Alzheimer Disease. Recenti Prg Med 89(11): 598-603 (Nov. 1998) Abstract.

Lavretsky H, Sultzer D. A structured trial of risperidone for the treatment of agitation in dementia. Am J Geriatr Psychiatry 6(2):127-135 (1998) Abstract.

Frenchman IB, Prince T. Clinical experience with risperidone, haliperidal and thioridazine for dementia-associated behavioural distubances. Int Psychogeriatr 9(4): 431-5 (Dec. 1997) Abstract.

Aronson SM. Cost-effectiveness and quality of life in psychosis: the pharmacoeconomics of risperidone. Clin Ther 19(1):139-147 (Jan 1997) Abstract.

Jeste DV, Klausner M, Brecher M, Clyde C, Jones R. A clinical evaluation of risperidone in the treatment of schizophrenia: a 10-week, open-label, multicenter trial. ARCS Study Group. Assessment of
Risperdal in a Clinical Setting. Psychopharmacology (Berl) 131(3):239-247 (Jun 1997) Abstract.