Does risperidone calm you down?

Risperidone is an antipsychotic medication that is commonly used to manage aggression or agitation induced by psychosis. However, it is unclear whether risperidone can effectively calm a person down. In fact, according to a review of nine randomized controlled trials conducted by the Cochrane Schizophrenia Group, the evidence for the effectiveness of risperidone in rapidly tranquilizing individuals with psychosis-induced aggression is of very low quality.

The Trials

The nine trials examined in the Cochrane review were small and under-sampled, with a total of 582 participants. The trials compared the rapid use of risperidone with other drugs, combinations of drugs, or placebo for individuals exhibiting aggression or agitation (or both) thought to be due to psychosis.

The Outcomes

The main outcomes examined in the trials were agitation or aggression, the need for restraint, and the incidence of adverse effects. None of the included studies provided usable data on the primary outcome of tranquilization or sleep by 30 minutes, repeated need for tranquilization, or any economic outcomes.

Risperidone Versus Other Drugs

The Cochrane review found no clear difference between risperidone and haloperidol in terms of efficacy for the outcome of specific behavior – agitation, measured as at least a 50% reduction in the Positive and Negative Syndrome Scale – Psychotic Agitation Sub-score (PANSS-PAS) or for the need to use restraints. Similarly, no effect was observed for agitation measured as PANSS-PAS endpoint score at two hours for the comparison of risperidone versus olanzapine.

For the comparison of risperidone versus quetiapine, aggression was measured using the Modified Overt Aggression Scale (MOAS) endpoint score at two weeks. A clear difference, favoring quetiapine, was observed. For the comparison of risperidone versus risperidone + oxcarbazepine, one trial found a clear difference favoring the combination treatment for agitation using the PANSS-EC endpoint score at one week. Finally, for the comparison of risperidone versus risperidone + valproic acid, no clear differences between the treatment groups were observed for aggression or the incidence of akathisia after 24 hours.

Conclusion

In conclusion, while risperidone is commonly used to manage aggression or agitation induced by psychosis, the evidence for its effectiveness in rapidly tranquilizing individuals with psychosis-induced aggression is of very low quality. The trials examined in the Cochrane review were small and under-sampled, and the outcomes measured were indirect and lacked pragmatic measures. Therefore, it is difficult to say with certainty whether risperidone can calm a person down. Further high-quality research is needed to determine the effectiveness of risperidone in managing aggression or agitation induced by psychosis.


There are various forms of drugs available, such as tablets or liquids, and each may have a separate patient information leaflet (PIL) for different doses. It is important to refer to the PIL for the specific form and dose of the drug that you have been prescribed.

You can search for further information and PILs on websites such as:

  • The British National Formulary (BNF)
  • Electronic medicines compendium (emc)
  • The National Library of Medicine's DailyMed
  • The Food and Drug Administration (FDA) 
  • Different drug forms like tablets or liquids have specific patient information leaflets (PIL) for various doses. Refer to the PIL for your prescribed drug form and dose.

    Search for PILs on websites like:

    France

    • ANSM (Agence nationale de sécurité du médicament et des produits de santé): ansm.sante.fr

    Spain

    • AEMPS (Agencia Española de Medicamentos y Productos Sanitarios): aemps.gob.es

    Germany

    • BfArM (Bundesinstitut für Arzneimittel und Medizinprodukte): bfarm.de

    Italy

    For questions about your medication:

    • Consult your doctor, a healthcare professional, or a pharmacist

    France

    • Contact SOS Médecins: 3624
    • For mental health support, contact SOS Suicide: 01 45 39 40 00

    Belgium (French)

    Switzerland (French)

    • La Main Tendue: 143
    • Website: 143.ch

    Canada (French)

    • Centre de prévention du suicide du Québec: 1 866 APPELLE (1 866 277-3553)
    • Website: cpsquebec.ca

    Spain

    • Contact emergency number: 112
    • For mental health support, contact Teléfono de la Esperanza: 717 003 717

    Germany

    • Contact emergency number: 112
    • For mental health support, contact Telefonseelsorge: 0800 111 0 111 or 0800 111 0 222

    Italy

    • Contact emergency number: 112
    • For mental health support, contact Telefono Amico: 199 284 284

    Netherlands

    • Contact emergency number: 112
    • For mental health support, contact 113 Zelfmoordpreventie: 0800 0113

    Portugal

    • Contact emergency number: 112
    • For mental health support, contact Sos Voz Amiga: 21 354 45 45, 91 280 26 69, or 96 352 46 60

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