Clozapine-Risperidone LA

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Clozapine
Type Antipsychotic
Group Atypical AP
links
Medscape Clozapine
PubChem 2818
PubMed Clozapine
Kompas (Dutch) Clozapine
Wikipedia Clozapine
Risperidone
long acting
Type Antipsychotic
Group Atypical AP
links
Medscape Risperidone
PubChem 5073
PubMed Risperidone
Kompas (Dutch) Risperidone
Wikipedia Risperidone

Switch medication from Clozapine to Risperidone_LA.[1] [2]

Nietinrijdenbord.png Stop Clozapine
  • Day 1: Decrease daily dose with 25 mg every 2 days
Eenrichtingbord.png Start Risperidone_LA
  • Day 1: Start depot according general dosing advice (Dotted line in graph)
Infobord.png More information
  • Clozapine is generally considered to be more effective than other antipsychotic drugs. Clozapine is often used in treatment-resistant schizophrenia (poor treatment response to 2 or more antipsychotic drugs). So a switch from clozapine to another antipsychotic drug could cause problems regarding effectiveness.[3] [4] [5]
  • During this switch you could monitor ECG, especially in patients prone to QT-conduction problems.
  • There is a possibility of QT interval prolongation.[6]
  • Alternatively, first switch to oral form and then switch to depot to manage possible (adverse) reactions. With a direct switch to a depot it is advisable to administer a low testdose in order to exclude adverse reactions.
    StopClozSlowStartDepotRisp.jpg
Nietinrijdenbord.png — Clozapine
Eenrichtingbord.png — Risperidone_LA


  1. Switches are based on literature references on this page and expert opinions of the authors. The authors have used pharmacokinetic and receptor affinity properties to determine the switch schedules
  2. Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
  3. McEvoy J P et al., Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006;163:600–610.
  4. Lewis S W et al., Randomized Controlled Trial of Effect of Prescription of Clozapine Versus Other Second-Generation Antipsychotic Drugs in Resistant Schizophrenia. Schizophrenia Bulletin vol.32 no.4 pp.715–723,2006.
  5. Agid O, Kapur S, Remington G, Emerging drugs for schizophrenia. Expert Opin Emerg Drugs. 2008 Sep;13(3):479-95.
  6. Stöllberger C, Huber JO, Finsterer J, Antipsychotic drugs and QT prolongation. Int Clin Psychopharmacol. 2005 Sep;20(5):243-51.
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