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Risperidone: Adverse Reactions, Prolactin Monitoring, and Management of Extrapyramidal Symptoms in Psychiatric Patients

A middle-aged Hispanic man in a medical consultation, attentively listening to a Hispanic female doctor who is explaining with a reassuring smile. On the desk, there are medical charts symbolizing the discussion about the use of risperidone, monitoring hyperprolactinemia, and managing extrapyramidal symptoms in patients with psychosis.

Risperidone is a widely used antipsychotic of the second generation for treating various psychiatric disorders, including psychosis. However, its use is not without side effects, with hyperprolactinemia being one of the most significant. This phenomenon can lead to a series of clinical complications that require careful monitoring. In this article, we will explore the adverse reactions associated with risperidone and the importance of prolactin monitoring in psychiatric patients.

Adverse Reactions of Risperidone

Risperidone, like other antipsychotics, can induce a range of side effects. Among the most common are extrapyramidal symptoms, which include tremors, rigidity, and bradykinesia. These symptoms are particularly concerning in patients with conditions such as Parkinson's disease, where tolerance to these effects is low [1].

Additionally, risperidone is associated with an increase in prolactin levels, which can lead to hyperprolactinemia. This increase can be significant and persistent, affecting both men and women, and may result in sexual dysfunction, galactorrhea, and amenorrhea [2]. In children and adolescents, the rise in prolactin may be even more pronounced, underscoring the need for regular monitoring [3].

Prolactin Monitoring in Psychiatric Patients

Monitoring prolactin levels is crucial to prevent and manage complications associated with risperidone-induced hyperprolactinemia. Studies have shown that prolactin elevation can be dose-dependent and that reducing the dose of risperidone can help normalize these levels [4]. Furthermore, the addition of aripiprazole has been shown to be effective in normalizing prolactin levels and treating antipsychotic-induced sexual dysfunction [5].

It is important for physicians to conduct periodic evaluations of prolactin levels in patients receiving risperidone, especially in those presenting clinical symptoms of hyperprolactinemia. This not only helps prevent long-term complications but also improves treatment adherence by minimizing unwanted side effects.

Conclusions

Risperidone is an effective antipsychotic for treating psychosis and other psychiatric disorders, but its use can be accompanied by significant side effects, such as hyperprolactinemia and extrapyramidal symptoms. Regular monitoring of prolactin levels is essential to manage these effects and ensure safe and effective treatment. Implementing management strategies, such as dose adjustment or the addition of other medications, may be necessary to optimize therapeutic outcomes.

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Created 6/1/2025