Risperidone in the treatment of bipolar mania

Martha Sajatovic¹, Subramoniam Madhusoodanan², Matthew A Fuller³

¹Case Western Reserve University School of Medicine, Cleveland, OH, USA; ²Health Science Center at Brooklyn, New York, NY, USA; ³Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA

Abstract: Atypical antipsychotic medications have assumed growing importance for the treatment of bipolar disorder, an illness that affects approximately 1.2%–3.7% of the general population in a given year. Current practice guidelines for the treatment of bipolar mania support the use of atypical antipsychotic medications as monotherapy or as a component of polytherapy, and in clinical settings the use of atypical antipsychotics to treat bipolar disorder is widespread. Risperidone is an atypical antipsychotic, sometimes referred to as a secondgeneration antipsychotic. The receptor-binding profile of risperidone, which includes potent antagonism of the serotonin 5-HT2_A, dopamine D₂, and alpha-adrenergic receptors, is believed to be related to positive effects on mood. The FDA-approved bipolar indications for risperidone include: 1) monotherapy for short-term treatment of acute manic or mixed episodes associated with bipolar I disorder and 2) combination therapy with lithium or valproate for the shortterm treatment of acute manic or mixed episodes associated with bipolar I disorder. This review of risperidone for bipolar mania will address the chemistry, pharmacodynamics, pharmacokinetics, and metabolism of risperidone, use with concomitant medications, clinical trials in bipolar mania, as well as safety and tolerability issues. Finally, dosing and administration are addressed as well as use for bipolar mania in geriatric, child, or adolescent patients.

Keywords: risperidone, bipolar disorder, mania, antipsychotic, psychopharmacology