Risponz/Risponz 1/Risponz 2/Risponz 3 Drug Interactions

Risponz 1/Risponz 2/Risponz 3: The risk of using Risperidone (Risponz) in combination with other medicines has not been systematically evaluated. Risperidone (Risponz) should be used with caution in combination with alcohol and other centrally acting medicines. It may antagonize the effect of levodopa and other dopamine agonists.
Carbamazepine has been shown to decrease the plasma levels of the active antipsychotic fraction of Risperidone (Risponz). Similar effects may be observed with other hepatic enzyme inducers. On discontinuation of carbamazepine or other hepatic enzyme inducers the dosage of Risperidone (Risponz) should be re‑evaluated and, if necessary, decreased. Fluoxetine may increase the plasma concentration of Risperidone but less so of the anti‑psychotic fraction.
Phenothiazines, tricyclic antidepressants and some beta‑blockers may increase the plasma concentration of Risperidone but not that of the antipsychotic fraction.
When Risperidone (Risponz) is taken together with other highly protein‑bound medicines (e.g. diazepam, warfarin, digitoxin, imipramine and propranolol), there is no clinically relevant displacement of either agent from the plasma proteins.
Risponz: As with other antipsychotics, caution is advised when prescribing risperidone with medicinal products known to prolong the QT interval, e.g., class Ia antiarrhythmics (e.g., quinidine, disopyramide, procainamide), class III antiarrhythmics (e.g., amiodarone, sotalol), tricyclic antidepressant (i.e., amitriptyline), tetracyclic antidepressants (i.e., maprotiline), some antihistaminics, other antipsychotics, some antimalarials (i.e., chinice and mefloquine), and with medicines causing electrolyte imbalance (hypokalaemia, hypomagnesaemia), bradycardia, or those which inhibit the hepatic metabolism of risperidone. This list is indicative and not exhaustive.
Potential for risperidone to affect other medicinal products: Risperidone should be used with caution in combination with other centrally-acting substances notably including alcohol, opiates, antihistamines and benzodiazepines due to the increased risk of sedation.
Risperidone may antagonize the effect of levodopa and other dopamine agonists. If this combination is deemed necessary, particularly in end-stage Parkinson's disease, the lowest effective dose of each treatment should be prescribed.
Clinically significant hypotension has been observed post-marketing with concomitant use of risperidone and antihypertensive treatment.
Risperidone does not show a clinically relevant effect on the pharmacokinetics of lithium, valproate, digoxin or topiramate.
Potential for other medicinal products to affect risperidone: Carbamazepine has been shown to decrease the plasma concentrations of the active antipsychotic fraction of risperidone. Similar effects may be observed with e.g. rifampicin, phenytoin and phenobarbital which also induce CYP3A4 hepatic enzyme as well as P-glycoprotein. When carbamazepine or other CYP3A4 hepatic enzyme/P-glycoprotein (P-gp) inducers are initiated or discontinued, the physician should re-evaluate the dosing of risperidone.
Fluoxetine and paroxetine, CYP2D6 inhibitors, increase the plasma concentration of risperidone, but less so of the active antipsychotic fraction. It is expected that other CYP2D6 inhibitors, such as quinidine, may affect the plasma concentrations of risperidone in a similar way. When concomitant fluoxetine or paroxetine is initiated or discontinued, the physician should re-evaluate the dosing of risperidone.
Verapamil, an inhibitor of CYP3A4 and P-gp, increases the plasma concentration of risperidone.
Galantamine and donepezil do not show a clinically relevant effect on the pharmacokinetics of risperidone and on the active antipsychotic fraction.
Phenothiazines, tricyclic antidepressants, and some beta-blockers may increase the plasma concentrations of risperidone but not those of the active antipsychotic fraction. Amitriptyline does not affect the pharmacokinetics of risperidone or the active antipsychotic fraction. Cimetidine and ranitidine increase the bioavailability of risperidone, but only marginally that of the active antipsychotic fraction.
Erythromycin, a CYP3A4 inhibitor, does not change the pharmacokinetics of risperidone and the active antipsychotic fraction.
The combined use of psychostimulants (e.g methylphenidate) with risperidone in children and adolescents did not alter the pharmacokinetics and efficacy of risperidone.
Regarding increased mortality in elderly patients with dementia concomitantly receiving furosemide.
Concomitant use of oral risperidone with paliperidone is not recommended as paliperidone is the active metabolite of risperidone and the combination of two may lead to additive active antipsychotic fraction exposure.