Last update: Jan. 15, 2020

Risperidone

Very Low Risk for breastfeeding


Safe. Compatible.
Not risky for breastfeeding or infant.

An atypical antipsychotic indicated in the treatment of schizophrenia, manic episodes of bipolar disorder and persistent aggression in dementias such as Alzheimer's. Oral administration in two daily doses.

Risperidone and its active metabolite (paliperidone) are excreted in breastmilk in very small amounts (Weggelaar 2011, Aichhorn 2005, Ilett 2004, Hill 2000). No problems have been observed in infants whose mothers were taking it (Aichhorn 2005, Ilett 2004, Ratnayake 2002).
The plasma levels of these infants were undetectable or very low (Weggelaar 2011, Aichhorn 2005, Ilett 2004).

A one-month-old infant whose mother was treated daily with 1.5 mg of risperidone and 0.8 mg of haloperidol had no problems during the first month of life. Sedation and poor nutrition appeared when the dose of haloperidol was increased to 1.5 mg daily (Uguz 2019).

Risperidone frequently causes increased levels of prolactin and galactorrhea (Kc 2018, Pratheesh 2011, Afzal 2007, Holzer 2006, Madhusoodanan 2006, Ilett 2004, Haddad 2004, Kearns 2000, Popli 1998). Some authors have suggested its use as a galactogogue (Parashar 2007).

Expert authors consider this medication to probably be compatible with breastfeeding (Hale 2019, Parikh 2014, Klinger 2013) and preferable to antipsychotics derived from phenothiazine (Rowe 2013), although other alternatives, such as olanzapine or quetiapine, may be preferable (Hale 2019, Pacchiarotti 2016).

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Risperidone in other languages or writings:

Group

Risperidone belongs to this group or family:

Tradenames

Main tradenames from several countries containing Risperidone in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 77 - 88 %
Molecular weight 411 daltons
Protein Binding 77 - 90 %
VD 1 - 2 l/Kg
pKa 8,76 -
Tmax 1 - 2 hours
T1/2 3 - 20 hours
M/P ratio 0,4 -
Theoretical Dose 0,001 - 0,008 mg/Kg/d
Relative Dose 2,8 - 4,3 %

References

  1. Uguz F. Adverse Events in a Breastfed Infant Exposed to Risperidone and Haloperidol. Breastfeed Med. 2019 May 28. Abstract
  2. Kc Y, Baldridge HM, Ojha R. Symptomatic Extreme Elevation of Prolactin Related to Risperidone Use. Prim Care Companion CNS Disord. 2018 Sep 20;20(5). pii: 17l02208. Abstract
  3. Pacchiarotti I, León-Caballero J, Murru A, Verdolini N, Furio MA, Pancheri C, Valentí M, Samalin L, Roigé ES, González-Pinto A, Montes JM, Benabarre A, Crespo JM, de Dios Perrino C, Goikolea JM, Gutiérrez-Rojas L, Carvalho AF, Vieta E. Mood stabilizers and antipsychotics during breastfeeding: Focus on bipolar disorder. Eur Neuropsychopharmacol. 2016 Oct;26(10):1562-78. Abstract
  4. Parikh T, Goyal D, Scarff JR, Lippmann S. Antipsychotic drugs and safety concerns for breast-feeding infants. South Med J. 2014 Abstract
  5. Klinger G, Stahl B, Fusar-Poli P, Merlob P. Antipsychotic drugs and breastfeeding. Pediatr Endocrinol Rev. 2013 Abstract
  6. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  7. Weggelaar NM, Keijer WJ, Janssen PK. A case report of risperidone distribution and excretion into human milk: how to give good advice if you have not enough data available. J Clin Psychopharmacol. 2011 Feb;31(1):129-31. Abstract
  8. Pratheesh PJ, Praharaj SK, Srivastava A. Euprolactinemic gynecomastia and galactorrhea with risperidone-fluvoxamine combination. Psychopharmacol Bull. 2011;44(1):70-3. Abstract
  9. Afzal KI, Briones DF, DeVargas C. Risperidone-induced polydipsia and polyphagia associated with galactorrhea, abdominal pain, and rapid weight gain in an adolescent Hispanic female. CNS Spectr. 2007 Nov;12(11):818-20. Erratum in: CNS Spectr. 2007 Dec;12(12):883. Abstract
  10. Parashar A, Varma A, Sharp B. Risperidone as galactagogue? J Hum Lact. 2007 Abstract
  11. Holzer L, Eap CB. Risperidone-induced symptomatic hyperprolactinaemia in adolescents. J Clin Psychopharmacol. 2006 Apr;26(2):167-71. Abstract
  12. Madhusoodanan S, Moise D. Risperidone-induced hyperprolactinemia in adolescents: A case series. J Clin Psychiatry. 2006 Jul;67(7):1110-3. Abstract
  13. Aichhorn W, Stuppaeck C, Whitworth AB. Risperidone and breast-feeding. J Psychopharmacol. 2005 Mar;19(2):211-3. Abstract
  14. Ilett KF, Hackett LP, Kristensen JH, Vaddadi KS, Gardiner SJ, Begg EJ. Transfer of risperidone and 9-hydroxyrisperidone into human milk. Ann Pharmacother. 2004 Feb;38(2):273-6. Epub 2003 Dec 30. Abstract
  15. Haddad PM, Wieck A. Antipsychotic-induced hyperprolactinaemia: mechanisms, clinical features and management. Drugs. 2004 Abstract
  16. Ratnayake T, Libretto SE. No complications with risperidone treatment before and throughout pregnancy and during the nursing period. J Clin Psychiatry. 2002 Jan;63(1):76-7. No abstract available. Abstract
  17. Kearns AE, Goff DC, Hayden DL, Daniels GH. Risperidone-associated hyperprolactinemia. Endocr Pract. 2000 Abstract
  18. Hill RC, McIvor RJ, Wojnar-Horton RE, Hackett LP, Ilett KF. Risperidone distribution and excretion into human milk: case report and estimated infant exposure during breast-feeding. J Clin Psychopharmacol. 2000 Apr;20(2):285-6. No abstract available. Abstract
  19. Popli A, Gupta S, Rangwani SR. Risperidone-induced galactorrhea associated with a prolactin elevation. Ann Clin Psychiatry. 1998 Abstract

Total visits

26,261

Help us improve this entry

How to cite this entry

Do you need more information or did not found what you were looking for?

   Write to us at elactancia.org@gmail.com

e-lactancia is a resource recommended by Academy of Breastfeeding Medicine from United States of America

Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM