Janssen #The_nervous_system #Calming_silencing #HEALTH_CARE
Indications
Schizophrenia (acute and chronic) and other psychotic conditions with severe productive symptoms (hallucinations, delusions, thinking disorders, aggressiveness) and / or negative symptoms (emotional and social detachment, paucity of speech); to reduce affective symptoms (anxiety, fear, depression) in patients with schizoaffective disorders and schizophrenia; as a means of long-term maintenance therapy to prevent relapse in chronic schizophrenia; behavioral disorders in patients with dementia with symptoms of aggressiveness (verbal outbursts, physical abuse), behavioral disorders (anxiety, agitation) or with a predominance of psychotic symptoms; as an adjunct in the treatment of manic episodes in bipolar disorders (episodes are characterized by an increased, expansive or irritable mood, increased self-esteem, reduced need for sleep, accelerated speech, dispersion of thoughts, inability to concentrate and rejection of criticism, as well as antisocial or aggressive behavior.
Application
For adults, the preparation is prescribed at an initial dose of 2 mg / day. on the 2nd day, the dose is increased to 4 mg / day in 1 or 2 doses. in the future, a maintenance dose of the preparation is individually set, which is usually 4-8 mg / day. at a dose above 10 mg / day, the effectiveness does not increase, but the risk of developing extrapyramidal disorders increases. the maximum daily dose is 16 mg. if there is a need for additional sedation, benzodiazepines can be added to rispolept therapy.
In elderly patients or in patients with severe impairment of liver and / or kidney function, the recommended initial dose is 0.5 mg 2 times a day, it can be increased to 1-2 mg 2 times a day.
Treatment of behavioral disorders in patients with dementia begins with a dose of 0.25 mg 2 times a day. The optimal dose for most patients is 0.5 mg 2 times a day, for some patients the effective dose may be increased to 1 mg 2 times a day. After reaching an effective dose, the patient can receive the preparation 1 time per day.
The recommended starting dose for bipolar disorder is 2 mg/day. The dose can be increased by 2 mg / day no more than every other day. The optimal dose for most patients is 2–6 mg/day.
Contraindications
Hypersensitivity to the preparation.
Side effects
Most common - insomnia, agitation, anxiety, headache, less often - drowsiness, fatigue, dizziness, incoordination, constipation, dyspepsia, nausea or vomiting, abdominal pain, blurred vision, priapism, erectile dysfunction, ejaculation disorder, orgasmic disorder , urinary incontinence, rhinitis, skin rash and other allergic reactions. rispolept causes extrapyramidal symptoms much less frequently than classical antipsychotics, however, in some cases, extrapyramidal symptoms such as tremor, rigidity, hypersalivation, bradykinesia, akathisia, and acute dystonia may occur. these symptoms are usually mild and resolve with dose reduction and/or administration (if necessary) of antiparkinsonian agents. sometimes, when prescribing rispolept, orthostatic hypotension, reflex tachycardia or hypertension, slight neutropenia or thrombocytopenia were observed. rispolept can induce dose-dependent hyperprolactinemia, which can manifest as galactorrhea, gynecomastia, menstrual disorders and amenorrhea. during treatment with rispolept, an increase in body weight, the development of angioedema and an increase in the activity of liver enzymes were noted. cerebrovascular manifestations were noted mainly in elderly patients. hyperglycemia and progression of diabetes mellitus have been reported in very rare cases. as with the use of classical antipsychotics, but to a much lesser extent, patients with schizophrenia observed: hyperhydration due to polydyspepsia or syndrome of inappropriate secretion of antidiuretic hormone, tardive dyskinesia, neuroleptic malignant syndrome, thermoregulation disorders and convulsive seizures.
special instructions
Orthostatic hypotension may occur during treatment, especially during the initial dose selection period. rispolept should be used with caution in patients with diseases of the cardiovascular system (heart failure, myocardial infarction, conduction disturbances), as well as in dehydration, hypovolemia or cerebrovascular disorders; while the dose should be increased gradually, in accordance with the recommendations. if arterial hypotension occurs, consideration should be given to reducing the dose.
When using preparations with the properties of dopamine receptor antagonists, the development of tardive dyskinesia was noted, which is characterized by involuntary rhythmic movements (mainly of the tongue or facial muscles). There is a report that the occurrence of extrapyramidal symptoms is a risk factor for the development of tardive dyskinesia. Rispolept, compared with classical antipsychotics, is much less likely to provoke the development of tardive dyskinesia. If symptoms of tardive dyskinesia occur, consideration should be given to discontinuing all antipsychotics.
When using classical antipsychotics, cases of the onset of neuroleptic syndrome are described, which are characterized by hyperthermia, muscle rigidity, instability of autonomic functions, impaired consciousness, and an increase in the level of CPK in the blood. In the event of the development of neuroleptic syndrome, it is necessary to cancel all antipsychotic preparations, including Rispolept.
It is recommended to halve both the initial and further maintenance dose in elderly patients and in patients with renal insufficiency.
Caution should be exercised when prescribing Rispolept to patients with Parkinson's disease, as it may cause a worsening of the course of the disease.
Classical antipsychotics reduce the threshold for convulsive readiness during epileptic seizures, therefore it is recommended to use Rispolept with caution in patients with epilepsy.
Patients should be advised to follow a diet due to the possibility of weight gain.
In the process of treatment, it is recommended to refrain from performing work that requires an increased concentration of attention and speed of mental and motor reactions.
The safety of Rispolept during pregnancy has not been established, therefore Rispolept can be used during pregnancy only if the benefit to the expectant mother outweighs the risk to the fetus. Women who use Rispolept should not breastfeed.
Interactions
Rispolept should be used with caution in combination with other centrally acting preparations. rispolept may exhibit antagonistic effects against levodopa. when using carbamazepine, there was a decrease in the concentration of rispolept in the blood plasma. similar effects may be seen with other hepatic enzyme inducers. when canceling carbamazepine and other inducers of hepatic enzymes, the dose of rispolept is reduced if necessary.
Phenothiazines, tricyclic antidepressants and some α-adrenergic blockers may increase plasma concentrations of risperidone. Fluoxetine may increase the plasma concentration of risperidone. If Rispolept is used together with other preparations that are largely bound to plasma proteins, then there is no clinically significant displacement of the preparation from protein binding.
Overdose
It was reported about taking 360 mg of the preparation. manifested by drowsiness, sedation, tachycardia, arterial hypotension, extrapyramidal disorders, in isolated cases - prolongation of the q-t interval. there is no specific antidote. perform gastric lavage, prescribe activated charcoal, provide airway patency, adequate ventilation and oxygenation, constant medical supervision, monitor the function of the cardiovascular system, including ECG to detect arrhythmias, conduct symptomatic and supportive therapy. in case of arterial hypotension and collapse, an intravenous infusion of plasma-substituting solutions is carried out and sympathomimetics are administered. in case of development of acute extrapyramidal symptoms, anticholinergic preparations are prescribed.
Storage conditions
At a temperature of 15–30 °C. do not freeze.
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