GUIDELINES FOR THE USE OF RISPERIDONE LONG-ACTING INJECTION
("Risperdal Consta")
Indications
Risperdal Consta is indicated for the treatment of schizophrenic psychoses and other psychotic conditions …. and … is also effective in maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response to oral risperidone or another antipsychotic drug.
Dose
| Status | Action |
| Compliant with oral risperidone | Continue oral risperidone. |
| No previous history of oral risperidone | Pre-treat with oral risperidone for at least several days to assess tolerability before the first injection |
| Documented exposure to, and toleration of, oral risperidone within last year, but not stabilised | 25 mg Risperdal Consta™ every two weeks |
| Patient stabilised on a fixed dose of oral risperidone for two weeks or more | Up to 4mg/d consider 25 mg Risperdal Consta fortnightly. Above 4mg/d, consider 37.5 mg Risperdal Consta. |
| Elderly ( >65 years) | The only recommended dose is 25 mg IM every two weeks. |
| Dose increments | From 25 mg to 37.5 mg or from 37.5 mg to 50 mg should be considered after a minimum of four weeks from the previous dose adjustment. |
Commencing treatment
"Risperdal Consta" releases only small amounts of risperidone for the first 3 weeks. The main release starts in week 4 and peaks in weeks 5-6.
Weeks 1-3 post-first injection:
· Supplement with oral risperidone, where appropriate, with the previously used dose, to ensure coverage until the main release phase of risperidone has begun.
· Prescription should have a three-week stop date added at the time of writing
· Monitor for adverse effects and adjust oral dose accordingly, as a small peak may occur after a few days
Week four:
· Taper and discontinue oral risperidone over the next week.
Storage - temperature
· The entire pack should be stored in a refrigerator at 2oC to 8oC
· Do not expose to temperatures above 25°C.
· If refrigeration is unavailable, Risperdal Consta can be stored at temperatures not exceeding 25°C for no more than 7 days prior to administration
Storage and carriage
The product is quite bulky and may not fit into a lockable box that CPNs carry nor a small fridge. This needs to be considered before prescribing.
Some clinical waste is produced giving the injection and CPNs may need to consider carrying sharps or other similar boxes
Training
Nurse should familiarise themselves with the method of reconstitution and injection before administering.
General
Risperdal Consta is relatively bulky and difficult to use, and in a price band above the typical
antipsychotic depot injections, and so use should be considered when other depots have either been tried and caused unacceptable side effects or oral atypicals are not appropriate or unacceptable.
NICE recommended in June 2002 that:
· Atypicals (including risperidone) should be "considered in the choice of first-line treatments for … newly diagnosed schizophrenia".
· Atypicals should be considered as options for people “currently receiving typical antipsychotic drugs who, despite adequate symptom control, are experiencing unacceptable side effects” and those in relapse with previous poor management or unacceptable side effects with typicals