Risperidone alternatives: What can I take instead of risperidone?

Compare risperidone alternatives | Abilify | Haloperidol | Zyprexa | Seroquel | Invega | Natural alternatives | How to switch meds

Risperidone is a generic prescription medication used to treat certain mental health disorders. It is approved by the Food and Drug Administration (FDA) for the treatment of schizophrenia, bipolar mania, and irritability associated with autism. Risperidone is sometimes used off-label, meaning without an FDA indication, for Tourette syndrome, aggression in patients with dementia, obsessive-compulsive disorder, major depressive disorder, and other psychiatric conditions.

Risperidone belongs to a class of medications called atypical antipsychotics, also known as second-generation antipsychotics. These antipsychotic drugs help regulate mood and behavior by balancing levels of dopamine and serotonin in the brain. The brand-name version of risperidone is Risperdal, which is available as a tablet, oral solution, orally disintegrating tablet (Risperdal M-Tab), and injection (Risperdal Consta). 

While risperidone is effective for improving psychotic symptoms, it may also cause bothersome side effects. Drowsiness, weight gain, sexual dysfunction, elevated blood pressure, and high cholesterol, blood sugar, and prolactin levels are common side effects. Risperidone can also cause movement disorders known as extrapyramidal symptoms (EPS). Fortunately, other antipsychotic medications are available for patients seeking a risperidone alternative. 

What can I take in place of risperidone?

Patients who don’t tolerate risperidone may want to try a different antipsychotic under the guidance of a healthcare provider. When choosing an alternative, it’s important to consider the indication, dosage, side effects, and formulation of the medication. The table below outlines common risperidone alternatives based on some of these considerations. 

Other alternatives to risperidone

• Abilify Maintena (aripiprazole injection)
• Abilify MyCite Starter Kit (aripiprazole tablets with sensor) 
• Aristada (aripiprazole lauroxil injection)
• Caplyta (lumateperone)
• Fanapt (iloperidone)
• Invega Sustenna (paliperidone injection)
• Invega Trinza (paliperidone injection)
• Secuado (asenapine transdermal system)
• Seroquel XR (quetiapine extended release)
• Zyprexa Zydis (olanzapine orally disintegrating tablet)
• Zyprexa Relprevv (olanzapine injection)

Top 5 risperidone alternatives

The following are some of the most common alternatives to risperidone.

1. Abilify (aripiprazole)

Abilify is an atypical antipsychotic that is approved to treat the same conditions as risperidone: schizophrenia, bipolar disorder, and irritability associated with autism. In addition, Abilify is also used for Tourette’s disorder and for major depressive disorder in combination with antidepressants. As well as Abilify tablets, other dosage forms include a monthly injection (Abilify Maintena) and tablets containing a digital sensor (Abilify Mycite). For adults with schizophrenia or bipolar disorder, the recommended starting dose of Abilify is 10 mg or 15 mg once daily.

Adverse effects of risperidone and Abilify are similar. They can include constipation and movement disorders such as tardive dyskinesia, which is characterized by involuntary and repetitive movements. However, Abilify is associated with lower incidences of weight gain, high cholesterol, and high blood sugar compared to risperidone. 

RELATED: Abilify side effects and how to avoid them

2. Haloperidol

Haloperidol is another medication used to treat psychotic disorders such as schizophrenia, as well as severe behavioral problems and hyperactivity in children. It can also be used to control tics due to Tourette’s disorder. Unlike risperidone, haloperidol is an older first-generation antipsychotic, but it works in the same way by targeting chemical receptors in the brain to balance dopamine levels. Haloperidol is a generic drug that is also available under the brand name Haldol. The dosage depends on the condition being treated, but haloperidol tablets are typically given at 0.5 mg to 2 mg twice or three times daily for adults with moderate psychosis symptoms.

Common side effects of haloperidol include sedation, weight gain, and EPS. Because of its ability to cause abnormal movements, haloperidol should not be used in individuals with Parkinson’s disease. A serious side effect called neuroleptic malignant syndrome (NMS) can also occur. Patients that notice symptoms of NMS—including fever, sweating, muscle rigidity, and mental status changes—should immediately stop haloperidol and seek medical help right away.

3. Zyprexa (olanzapine)

Zyprexa is a popular alternative to risperidone indicated for the treatment of schizophrenia, bipolar disorder, and treatment-resistant depression (in combination with an antidepressant). Zyprexa and risperidone are both atypical antipsychotics and are available in a variety of dosage forms. In addition to regular tablets, Zyprexa comes as an orally disintegrating tablet (Zyprexa Zydis) that may be preferable for patients who have a hard time swallowing pills. An injectable form known as Zyprexa Relprevv is also available. The standard maintenance dosage of Zyprexa is 5 mg to 20 mg once daily.

Zyprexa and risperidone are both known to affect metabolism, leading to weight gain, high blood sugar, and high cholesterol. In a systematic review comparing these two drugs, people taking risperidone were less likely to gain weight compared to those taking Zyprexa, but patients on risperidone had more sexual dysfunction. Both drugs were effective in alleviating symptoms of schizophrenia.

4. Seroquel (quetiapine)

Seroquel also belongs to the class of atypical antipsychotics and is FDA approved to treat schizophrenia and bipolar disorder. The extended-release version (Seroquel XR) is also approved as an adjunctive treatment for major depressive disorder. The immediate-release version of Seroquel is usually started at a low dose of 25 mg twice daily for the treatment of schizophrenia. Seroquel XR is longer acting and can be given once daily.

The most common side effects of Seroquel are drowsiness, dizziness, low blood pressure upon standing, weight gain, high cholesterol, and high blood sugar. Compared to risperidone, Seroquel is less likely to cause EPS and is a better choice for people with movement disorders such as Parkinson’s disease.

RELATED: Seroquel side effects, warnings, interactions, and how to avoid them

5. Invega (paliperidone)

Invega is an atypical antipsychotic indicated for the treatment of schizophrenia and schizoaffective disorder. The active ingredient in Invega—paliperidone—is a metabolite of risperidone and works similarly in the body. There are two injectable forms of Invega known as Invega Sustenna, given monthly, and Invega Trinza, given every three months. Invega tablets are dosed at 6 mg once daily for adults and 3 mg once daily for adolescents with schizophrenia.

Because Invega and risperidone have a similar mechanism of action, they also have many overlapping side effects. Patients taking Invega should be monitored for changes in weight and cholesterol and blood sugar levels. Another common side effect of Invega is increased levels of a hormone called prolactin, which can lead to irregular periods in women and sexual dysfunction in men.

Natural alternatives to risperidone

There are some natural alternatives to risperidone that can help alleviate the severity of psychotic disorders. However, these alternative remedies may not be enough to manage symptoms and do not replace prescription antipsychotics in people who need them. A healthcare provider or psychiatrist is the best resource to determine the treatment plan that improves your quality of life. 

Healthy diet

Some studies have found that a ketogenic diet can help people with schizophrenia. A ketogenic diet consists of foods that are low in carbohydrates and high in fat, such as fatty fish, eggs, nuts, avocados, and olive oil. It’s thought that the ketogenic diet improves psychiatric symptoms by restoring energy metabolism in the brain, although more research is needed to fully understand its effect.

Exercise 

Regular exercise has been shown to improve mental health in several ways. In patients with schizophrenia, exercise was found to improve cognition, quality of life, and negative symptoms such as loss of motivation. Effective types of exercise can include yoga, brisk walking, biking, or swimming. 

RELATED: The link between physical and mental health

Supplements

There is some evidence supporting the use of certain supplements for psychotic disorders. B vitamins, vitamin D, folic acid, and omega-3 fatty acids may help symptoms of schizophrenia and bipolar disorder when used along with prescription medications. These nutrients can be found in foods or over-the-counter supplements.

How to switch to a risperidone alternative

It’s important to talk to a healthcare provider before making the switch to a risperidone alternative. Unless a serious side effect occurs, it’s not safe to suddenly stop taking risperidone because doing so can lead to antipsychotic withdrawal. Symptoms of withdrawal can include agitation, anxiety, restlessness, insomnia, sweating, and involuntary movements. The dose of risperidone may be gradually tapered down to avoid these withdrawal effects. A healthcare provider can also provide information about supplements and potential drug interactions that may occur when they are taken alongside an antipsychotic. Make sure to discuss all changes in prescription and over-the-counter medicines, vitamins, and supplements with your doctor first. If a medication is not covered by your insurance, you can use a SingleCare discount card to save on risperidone and its alternatives at your local pharmacy.