Elderly patients with dementia
In elderly patients, irrespective of therapy, dehydration increases the risk of death, therefore, in elderly patients with dementia, fluid loss should be avoided.
Cerebrovascular side effects
Ridonex® should be used with extreme caution in the treatment of behavioral disorders in patients with dementia, because the risk of cerebrovascular side effects (cerebrovascular complications, transient cerebral circulation impairment) may increase, and therefore it is advisable to conduct a short-term course of therapy.
Alpha-adrenergic blocking effect
Ridonex®, due to the alpha-adrenergic blocking effect - especially at the beginning of therapy, during the titration period - can cause orthostatic hypotension, so it may be necessary to reduce the dose.
Care should also be taken with Ridonex ® in the presence of cardiovascular pathology (eg, heart failure, myocardial infarction, conduction disorders, dehydration, hypovolemia or cerebrovascular disease.) Although risperidone did not show an extension of the interval QT, it is necessary to apply the drug with caution in the event that the patient uses drugs that are characterized by lengthening the interval QT.
In case the sedative effect caused by Ridonex® is insufficient, instead of increasing the dose of risperidone, it is advisable to use other drugs, for example benzodiazepines, to reduce the risk of side effects.
Late dyskinesia / extrapyramidal syndrome
Drugs that have an antagonistic effect on dopamine receptors may cause tardive dyskinesia, which are characterized by involuntary rhythmic jerking, primarily of the tongue and / or face. The appearance of extrapyramidal signs is a risk of the formation of tardive dyskinesia. In the event that signs of tardive dyskinesia appear, a decision must be made to stop the use of all antipsychotics.
Malignant neuroleptic syndrome
During the course of therapy with neuroleptics, malignant neuroleptic syndrome (hyperthermia, rigidity of muscles, autonomic (instable) instability, impaired consciousness and increased levels of creatine phosphokinase (CK), myoglobinuria (acute skeletal muscle necrosis), and acute renal failure may develop).When these signs appear, it is necessary to interrupt the course of therapy with antipsychotic drugs, including Ridonex®, and prescribe symptomatic therapy (eg, dantrolene infusion solution for intravenous administration).
Hyperglycaemia
Very rarely in the treatment with risperidone, hyperglycemia or exacerbation of the course of diabetes mellitus was noted, therefore, in the presence of diabetes or in the presence of a risk of developing hyperglycemia, it is necessary to monitor the level of glucose in the blood.
Classical antipsychotics reduce the threshold of convulsive activity, so care must be taken when treating patients with epilepsy.
To prevent weight gain, you can advise the patient to control food intake.
The sudden cessation of the use of antipsychotics, especially with the preliminary administration of large doses of the drug, can very rarely cause nausea, vomiting, sweating, anxiety, insomnia, the resumption of psychotic symptoms or impaired coordination of movement (akathisia, dystonia, dyskinesia).
Like other dopamine antagonists D2-receptors, risperidone can also increase the level of prolactin in the blood plasma. This should be taken into account when appointing risperidone to patients who have a history of malignant breast tumor or prolactin-dependent tumor.
There is insufficient experience in the use of risperidone in patients with schizophrenia younger than 15 years.
Due to the fact that Ridonex® tablets contain lactose monohydrate, the drug should not be used with rarely encountered hereditary intolerance to galactose, lactase deficiency, or glucose / galactose malabsorption syndrome.