CamW... ? about Risperdal

Hi, CamW

I started taking Risperdal last week. I take it before going to bed and it takes me forever to wake up in the morning but I have noticed an immediate change. Yet when it gets to around noon time, I start to decline and need to take Klonopin to get me through the rest of my day. Does this mean I have to wait for it to build up in my system or do you think that my dosage needs to be increased?

Thanks...

One day in retrospect the years of struggle will strike you as the most beautiful. - Sigmund Freud

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

<font color=blue>"Life is what happens to you while you are busy making other plans." - John Lennon</font color=blue>

My med person started me out at 1mg. at night and gave me .25mg to take if I needed during the day. That in a sense would give her an idea if the dosage needed to be increased. I did try that today... taking .25 around lunchtime but didn't notice much of a change.

My official diagnosis is bipolar II disorder, panic disorder, and possibly PTSD. Along with the Risperdal, I'm on Lamictal (150mg.), Remeron (45mg.), and Klonopin (.5mg). They are all taken before I go to bed... except for the Klonopin, of course. That is my safety net during the day. I don't think that the Remeron is helping my "morning hangover".

Your explanation made perfect sense but I'm wondering about the cytochrome P450 system.

I do have another appt. on the 22nd. I'm so lucky to have found someone of your expertise to talk to in this infinite world of cyberspace. Thanks, Cam.

One day in retrospect the years of struggle will strike you as the most beautiful. - Sigmund Freud

I split my Risperdal into 2 - 1 mg doses and it got rid of the hangover.