How long do you stay on risperidone?

October 9, 2025 •

5 min read

For some conditions like schizophrenia, antipsychotic treatment is generally needed lifelong. How long do you stay on risperidone, however, is a highly individualized decision that depends on the specific diagnosis, a patient's response to treatment, and the balance between therapeutic benefits and potential long-term side effects.

Quick Summary

The duration of risperidone therapy is highly individualized, depending on the condition being treated and patient response. Some conditions, like schizophrenia, often require long-term maintenance to prevent relapse, while others may require only short-term use. The decision to stop or continue is made with a doctor, and discontinuation should always be gradual.

Key Points

Duration Depends on Diagnosis: The length of risperidone treatment varies significantly by condition, from weeks or months for some acute issues to potentially lifelong for chronic conditions like schizophrenia.
Long-Term for Schizophrenia: For schizophrenia, long-term maintenance therapy is generally recommended to prevent relapse, with guidelines suggesting several years of treatment even after a first episode.
Bipolar Mania is Often Shorter-Term: For acute manic episodes in bipolar disorder, risperidone might be used for a more limited period, with continuing treatment decisions reviewed after about 24 weeks.
Never Stop Abruptly: Abruptly stopping risperidone is dangerous and can cause significant withdrawal symptoms or a relapse of the original condition. Always consult a doctor for a supervised tapering plan.
Monitor Long-Term Side Effects: Extended use requires regular monitoring for potential side effects such as metabolic changes (weight gain, high blood sugar), elevated prolactin levels, and movement disorders (tardive dyskinesia).
Regular Medical Review is Crucial: Regardless of the condition, treatment duration and continued necessity should be regularly reviewed by a healthcare professional to re-evaluate the risk-benefit balance.

Determining the Right Treatment Duration

There is no one-size-fits-all answer to the question of how long to stay on risperidone. For many chronic conditions that risperidone is used to treat, long-term maintenance therapy is often recommended to prevent the return of symptoms. However, the exact duration is a collaborative decision made between a patient and their healthcare provider, taking into account the patient's medical history, diagnosis, and overall stability.

Duration Based on Medical Condition

The intended duration of treatment varies significantly based on the condition for which risperidone is prescribed. Here’s a breakdown of common scenarios:

Schizophrenia: For individuals with schizophrenia, maintenance treatment is often long-term, and in some cases, lifelong. Studies show that continued treatment at an effective dose significantly lowers the risk of relapse compared to dose reduction. Experts recommend that after a first episode, patients continue treatment for at least two years. For those with multiple episodes, a period of at least five years, or even longer, is advised. This long-term approach helps maintain stability and manage psychotic symptoms effectively.
Bipolar Disorder (Mania): Risperidone may be prescribed for a shorter period to manage acute manic or mixed episodes in bipolar I disorder, often as an adjunctive therapy alongside mood stabilizers like lithium or valproate. Research suggests that continuing risperidone for at least 24 weeks after remission from an acute manic episode can prolong the time to a manic relapse. However, the benefit beyond 24 weeks is not always clear, and the decision to continue is based on individual needs and the balance of risk and reward.
Irritability associated with Autism: In children and adolescents with autism spectrum disorder, risperidone is used to manage severe irritability, aggression, and self-injurious behaviors. The duration is determined by how well it controls symptoms, and patients are reviewed regularly by their doctor. Treatment may continue for an extended period if it proves to be consistently helpful. A doctor should regularly review the risks and benefits of long-term use.
Other indications: For aggressive or agitated behaviors, especially in dementia-related psychosis (bearing in mind the FDA black box warning regarding increased risk of death in elderly patients), the treatment period may be short-term. However, regular evaluations are necessary to assess effectiveness and risk.

Factors Influencing the Decision to Continue or Stop

Beyond the specific diagnosis, several other factors play a crucial role in deciding the duration of risperidone treatment:

Response to Treatment: The effectiveness of the medication in controlling symptoms is the primary driver. If a patient achieves and maintains stability with minimal side effects, continuing treatment is often the best course of action to prevent relapse.
Tolerance and Side Effects: The tolerability of risperidone is a major consideration. If a patient experiences significant, intolerable side effects like weight gain, movement disorders (tardive dyskinesia), or elevated prolactin levels, a doctor may decide to reduce the dose or switch to a different medication.
Relapse History: Patients who have experienced multiple relapses or have a history of severe symptoms often require longer maintenance periods. A history of stopping medication and subsequently relapsing is a strong indicator for long-term therapy.
Long-Term Risk vs. Benefit Analysis: The decision-making process involves a careful comparison of the risks of long-term risperidone use against the risk of symptom relapse if the medication is stopped. This must be an ongoing dialogue with the healthcare provider.

Potential Long-Term Risks of Risperidone

While risperidone is effective, long-term use can carry certain risks that need to be monitored. These risks include:

Metabolic Issues: Weight gain is a common side effect, especially during the first six months of treatment. This can lead to other metabolic problems, such as high blood sugar and an increased risk of developing type 2 diabetes.
Hyperprolactinemia: Risperidone is associated with higher levels of the hormone prolactin, which can lead to various issues. In women, this can cause menstrual irregularities or cessation. In men, it can lead to gynecomastia (breast enlargement) and erectile dysfunction. Sustained elevated prolactin levels also increase the risk of osteoporosis over time.
Tardive Dyskinesia (TD): A serious, and sometimes irreversible, neurological condition characterized by involuntary movements of the face, tongue, and body. While the risk of TD is lower with atypical antipsychotics like risperidone compared to older antipsychotics, it can still occur, particularly with long-term treatment.
Cardiovascular and Cerebrovascular Events: Especially in elderly patients with dementia-related psychosis, risperidone carries an increased risk of stroke and even death.
Other Side Effects: Long-term use can also be associated with fatigue, sedation, sexual dysfunction, and cognitive impairment.

Comparison of Treatment Duration and Outcome


Condition	Typical Duration	Risk of Abrupt Discontinuation	Key Long-Term Monitoring Considerations
Schizophrenia (First Episode)	At least 2 years	High risk of relapse, potentially more severe symptoms	Metabolic syndrome, tardive dyskinesia, prolactin levels, weight
Schizophrenia (Multiple Episodes)	5+ years or lifelong	Very high risk of relapse, significant return of symptoms	Metabolic syndrome, tardive dyskinesia, prolactin levels, weight
Bipolar Disorder (Acute Mania)	24 weeks or longer post-remission	Increased risk of manic or mixed episode relapse	Weight gain, metabolic changes, effectiveness in delaying relapse
Irritability in Autism	Regularly reviewed, potentially long-term	Potential return of severe irritability or aggression	Weight gain, metabolic issues, developmental effects
Dementia-related Aggression	Short-term, if used	Potential return of aggression and agitation	Cardiovascular events, cerebrovascular events, sedation (due to FDA warning)

The Critical Role of Tapering

Stopping risperidone abruptly, or even reducing the dose too quickly, is strongly discouraged due to the risk of withdrawal symptoms and rapid symptom relapse. The brain adapts to the medication's effects on dopamine and serotonin receptors, and a sudden change can disrupt this balance.

A gradual tapering schedule, developed in close consultation with a doctor, is essential for a safe discontinuation. The pace of the taper can vary based on the individual's dose, duration of treatment, and tolerance. Slow reductions over weeks or months allow the brain to readjust, minimizing the likelihood of withdrawal effects such as anxiety, insomnia, dizziness, and nausea.

For more information on the potential hepatic effects of risperidone, you can consult reliable sources like the LiverTox entry on NCBI Bookshelf.

Conclusion: Navigating Treatment with a Professional

Ultimately, the decision of how long you stay on risperidone is not a simple choice but an ongoing process of assessing clinical response, managing side effects, and weighing the risks of continuation versus discontinuation. For many serious and chronic mental health conditions like schizophrenia, long-term medication is a critical part of a successful management strategy. For others, a shorter course may be appropriate. The most important step is to maintain open, honest, and regular communication with a qualified healthcare provider. Never stop taking this medication on your own. A supervised, gradual reduction plan is the safest way to proceed if discontinuation is deemed appropriate, ensuring the best possible health outcomes while minimizing the risk of relapse or withdrawal symptoms.

Frequently Asked Questions

Stopping risperidone suddenly can lead to withdrawal symptoms, which can include anxiety, nausea, dizziness, insomnia, and the return of the original symptoms. This is often more intense and increases the risk of a relapse.

The decision to stop risperidone should be made in consultation with your doctor. It's often considered after a long period of symptom stability, successful management of side effects, and when the risk of stopping is deemed lower than the risk of continued use.

A tapering schedule is highly individualized and determined by a doctor. A common approach involves a gradual dose reduction while monitoring for any symptom changes.

Yes, for many individuals with chronic schizophrenia, lifelong maintenance therapy with risperidone or another antipsychotic is necessary to prevent severe relapse. For other conditions, the duration may be shorter.

Long-term monitoring should focus on potential risks such as significant weight gain, changes in blood sugar, elevated prolactin levels, cholesterol and triglyceride levels, and the emergence of involuntary movement disorders like tardive dyskinesia.

In older adults with dementia-related psychosis, risperidone has been linked to an increased risk of stroke and death. The FDA has issued a black box warning against its use for this condition.

For conditions like autism-related irritability, children may be on risperidone long-term if it is helping, but this requires regular reevaluation. Studies in juvenile animals have raised concerns about the potential long-term effects on growth and sexual maturation.