J Belle - You may need a dose increase, but give the drug another week before making changes (unless the doc tells you to increase the dose). Many people experience immediate relief from Risperdal™ (risperidone), while others need a month or so before they notice an effect.

Right now (even though I am hesitant to suggest it), I would say to try taking the Risperdal a little earlier in the evening. This is to try to avoid that morning "hangover effect" that is happening. The only problem with this is that while the hangover effect may decrease, you may have the therapeutic effect run out earlier, as well.

Another thought that I just had is to ask the doc if you can divide the daily dose. Tell your doc about the the noontime "poop-out" and hangover effect. Ask him/her if you can divide the evening dose. I would say that take 1/2 to 3/4 of the dose at bedtime, and 1/4 to 1/2 of the dose, morning, mid-morning, or noon (adjust the dosing time so that you are not too groggy in the morning, but not so anxious that you need a Klonopin™ (clonazepam).

What is the nightly dose that you are taking?

Even though most people can take Risperdal once a day, but I have seen many people seem to have a midday poop-out of the drug's anti-anxiety/anti-rumination effects. This could be because these people are more effective at clearing the drug (ie. metabolizing and elimnating) or that their once daily dose is just barely too low. This may be due to the fact that later in the day, as the concentration of Risperdal in the brain is decreasing, the level falls below the minimal effective concentration, and stops working. Another reason for the Risperdal to poop-out too soon can be due to drug/drug interactions between Risperdal and other drugs that can inhibit the cytochrome P450 system.

I have always been a fan of twice a day dosing of Risperdal. Once daily dosing is used because it is how to maximize compliance. Twice daily dosing gives a more level plasma level of the drug. When taking Risperdal once daily, one experiences a peak concentration of the drug within an hour or two, and this level slowly drops (sometimes too far) until the next evening dose. When taking the same daily amount of Risperdal divided into 2 doses, there is not that big initial spike of Risperdal plasma concentration, and taking another dose about 12 hours should keep the plasma concentration of the drug above the minimum effective concentration (hence, no poop-out).

I hope that the above is sorta clear. I have to go (my darling wife is calling), so if anything is not clear, ask away, and I will try to explain my rationale of twice daily dosing with Risperdal more clearly (especially the part about 3/4 dose at bed and 1/4 dose in the morning).

I hope that this helps - Cam

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