Risperidone

(RISS-PURR-ih-dohn) Risperdal Oral solution: 1 mg/mL Tablets: 0.25 mg Tablets: 0.5 mg Tablets: 1 mg Tablets: 2 mg Tablets: 3 mg Tablets: 4 mg Class: Antipsychotic, Benzisoxazole Farmakodinamik: Mekanisme Kerja: bekerja dengan memblok reseptor dopamine dan serotonin pada sistem saraf pusat, sehingga digunakan pada gangguan psikotik Dosis: Dewasa: PO 1 mg 2 kali sehari pada hari pertama, 2 mg 2 kali sehari pada hari kedua, 3 mg 2 kali sehari pada hari ketiga. Dosis kemudian ditingkatkan 1 mg 2 kali sehari tiap 1 minggu. Efek maksimum umumnya terjadi pada dosis 4-8 mg/hari. Pada pasien dengan gangguan fungsi renal/hepar atau orang tua, dosis inisial PO 0.5 mg 2 kali sehari; ditingkatkan 0.5 mg 2 kali sehari untuk selanjutnya. INTERAKSI Alcohol, CNS depressants: May cause additive CNS depressant effects. Antihypertensives: Risperidone may enhance hypotensive effects of some antihypertensives. Carbamazepine: May decrease risperidone plasma levels. Clozapine, paroxetine: May increase risperidone plasma levels. Levodopa: The effects of levodopa may be antagonized. EFEK SAMPING CARDIOVASCULAR: Orthostatic hypotension; tachycardia; palpitations; hypertension; cardiac arrhythmias; syncope; angina pectoris; lightheadedness; ECG changes. CNS: Tardive dyskinesia; extrapyramidal symptoms such as pseudoparkinsonism, akathisia, and dystonias; drowsiness; increased sleep duration; headache; insomnia; agitation; anxiety; aggressive reaction; dizziness; seizure. DERMATOLOGIC: Rash; dry skin; seborrhea; photosensitivity. EENT: Abnormal vision/accommodation; tinnitus; rhinitis; sinusitis; pharyngitis. GI: Constipation; nausea; dyspepsia; vomiting; abdominal pain; increased salivation; toothache; anorexia; reduced salivation. GU: Menorrhagia; orgasmic dysfunction; dry vagina; erectile dysfunction. HEMATOLOGIC: Epistaxis; purpura; anemia. HEPATIC: Hepatic failure; hepatitis. METABOLIC: Increased AST and ALT. RESPIRATORY: Coughing; upper respiratory tract infection; shortness of breath. OTHER: Arthralgia; back pain; chest pain; fever; polyuria or polydipsia; increased weight; elevated prolactin levels.

Precautions Pregnancy: Category C. Lactation: Undetermined; do not breastfeed. Children: Safety and efficacy not established. Elderly and debilitated patients: May have reduced ability to eliminate risperidone. At increased risk of tardive dyskinesia, especially elderly women. Cardiac effects: Appears to have proarrhythmic effects. Orthostatic hypotension may also occur. Change in drug therapy: When patient is switched from another antipsychotic to risperidone, it is recommended that the other antipsychotic be discontinued before starting risperidone therapy or to minimize period of overlap. Hepatic/Renal function impairment: Patients with hepatic/renal impairment may experience enhanced effect of risperidone because of reduced ability to eliminate risperidone. Dose adjustment may be required. Long-term use (more than 8 wk): Long-term use not well evaluated. Periodically re-evaluate usefulness. Neuroleptic malignant syndrome: Neuroleptic malignant syndrome has occurred with antipsychotics; is potentially fatal. Signs and symptoms are hyperpyrexia, muscle rigidity, altered mental status, irregular pulse, irregular BP, tachycardia, and diaphoresis. Tardive dyskinesia: A potentially irreversible syndrome of involuntary body and facial movements may occur.

Risperidone
(riss-per-i-done) Risperdal, Risperdal M-TAB, Risperdal Consta Classification: Therapeutic: Antipsychotics, mood stabilizers; Pharmacological: Benzisoxazoles; Pregnancy Category C Indications: Schizophrenia in adults and adolescents 1317 yr. Bipolar mania (oral only) in adults and children 1017 yr; can be used with lithium or valproate (adults only) with autistic disorder in children 516 yr. Action: May act by antagonizing dopamine and serotonin in CNS. Pharmacokinetics: Absorption: 70% after administration of tablets, solution, or orally disintegrating tablets. Following IM administration, small initial release of drug, followed by 3week lag; rest of release starts at 3 weeks and lasts 46 weeks. Distribution: Unknown. Metabolism and Excretion: Extensively metabolized by liver. Metabolism genetically determined; extensive metabolizers (most clients) convert risperidone to 9-hydroxyrisperidone rapidly. Poor metabolizers (6%8% of whites) convert more slowly. The 9-hydroxyrisperidone is an antipsychotic compound. Risperidone and its active metabolite are eliminated renally. T 1/2: Extensive metabolizers: 3 hr for risperidone, 21 hr for 9-hydroxyrisperidone. Poor metabolizers: 20 hr for risperidone, 30 hr for 9-hydroxyrisperidone.

CARBAMAZEPINE

(KAR-bam-AZE-uh-peen) Atreol, Carbatrol, Epitol, Tegretol, Tegretol XR, Tegretol CR Class: Anticonvulsant APO-Carbamazepine, Novocarbamaz,

Action Mechanism appears to act by reducing polysynaptic responses and blocks posttetanic potentiation. Indications Treatment of epilepsy (partial seizures with complex symptoms, generalized tonic-clonic seizures [grand mal], mixed seizure patterns or other partial or generalized seizures), in patients refractory to or intolerant of other agents. Treatment of pain of trigeminal neuralgia. Unlabeled use(s): Management of neurogenic diabetes insipidus; treatment of certain psychiatric disorders; management of alcohol, cocaine and benzodiazepine withdrawal; relief of restless legs syndrome. Nonhereditary chorea in children. Contraindications Hypersensitivity to tricyclic antidepressants; history of bone marrow depression; active liver disease. Discontinue MAO inhibitors at least 14 days before administration of carbamazepine. Route/Dosage Epilepsy ADULTS: Initial dose: PO 200 mg bid (tablets) or 100 mg qid (suspension). Increase weekly by up to 200 mg/day in 34 divided doses to reach minimum effective dose (maximum 1200 mg/day). CHILDREN > 15 yr: PO 200 mg bid (tablets) or 100 mg qid (suspension). Increase weekly by up to 200 mg/day in 34 divided doses to reach minimum effective dose (maximum 1200 mg/day). CHILDREN 1215 YR: Initial dose: PO 200 mg bid (tablets) or 100 mg qid (suspension). Increase weekly by up to 200 mg/day in 34 divided doses to reach minimum effective dose (maximum 1000 mg/day). ADULTS & CHILDREN > 12 YR: Maintenance: 800 1200 mg/day. CHILDREN 612 YR: Initial dose: PO 100 mg bid (tablets) or 50 mg qid (suspension). Increase weekly by 100 mg/day in 34 divided doses to reach minimum effective dose (maximum 1000 mg/day). (Alternative regimen: 2030 mg/kg/day in divided doses tid or qid). Maintenance: 400800 mg/day in 34 divided doses. Extended Release: ADULTS & CHILDREN > 12 YR: Initial dose: PO 200 mg twice daily. Trigeminal Neuralgia ADULTS: initial dose: PO 100 mg bid (tablets) or 50 mg qid (suspension). may increase by up to 200 mg/day in 34 divided doses (tablets: 100 mg increments q 12 hr; suspension: 50 mg qid) prn (maximum 1200 mg/day). maintenance: 2001200 mg/day. use minimum effective dose or

discontinue drug once every 3 mo. extended release: ADULTS: Initial dose: PO 100 mg twice daily. Interactions Anticoagulants: May decrease anticoagulant effects. Barbiturates: May result in decreased carbamazepine serum concentrations, possibly leading to decreased effectiveness. Charcoal, activated: May reduce absorption of carbamazepine. Cimetidine: May result in carbamazepine toxicity. Contraceptives, oral: Causes breakthrough bleeding and reduces effectiveness of contraceptives. Diltiazem, verapamil, danazol, propoxyphene, macrolide antibiotics (except azithromycin): May increase carbamazepine levels and may result in toxicity. Doxycycline hyclate: May decrease doxycycline hyclate levels. Felbamate: May decrease concentrations of felbamate or carbamazepine. Felodipine: May decrease effects of felodipine. Haloperidol: May decrease effects of haloperidol. Hydantoins (eg, phenytoin): May decrease carbamazepine levels; may alter hydantoin levels. Isoniazid: May result in toxicity of isoniazid, carbamazepine or both. Lithium: May cause adverse CNS effects regardless of drug levels. Macrolide antibiotics (eg, clarithromycin, erythromycin, troleandomycin): May increase toxicity. Nondepolarizing muscle relaxants: May make these agents less effective. Primidone: Decreased carbamazepine levels. Primidone's active metabolite (phenobarbital) may be increased. Propoxyphene: Increases carbamazepine levels. SSRIs (fluoxetine, fluvoxamine): Increased carbamazepine levels with possible toxicity. Theophylline: May reduce effects of theophylline and carbamazepine. Theophylline levels may be increased or decreased. Tricyclic antidepressants: May increase carbamazepine levels; may decrease tricyclic antidepressant levels. Valproic acid: May decrease valproic acid levels; may alter carbamazepine levels. Verapamil: Concomitant therapy has resulted in symptoms of toxicity. Lab Test Interferences None well documented. Adverse Reactions CV: AV block; CHF; hypertension; hypotension; syncope; edema; thrombophlebitis; aggravation of coronary artery disease; arrhythmias. CNS: Dizziness; drowsiness; unsteadiness; confusion; headache; hyperacusis; fatigue; speech disturbances; abnormal involuntary movements; peripheral neuritis and paresthesias; depression with agitation; talkativeness; behavior changes (children); paralysis. DERM: Pruritic and erythematous rashes; exfoliative dermatitis; erythema multiforme and nodosum; purpura; aggravation of disseminated lupus erythematosus; toxic epidermal necrolysis; urticaria; photosensitivity; pigment changes; alopecia; diaphoresis; Stevens-Johnson syndrome. EENT: Blurred vision; visual hallucinations; diplopia; nystagmus; punctate cortical lens opacities; conjunctivitis; tinnitus; dryness and irritation of the mouth and throat. GI: Nausea; vomiting; gastric distress; abdominal pain; diarrhea; constipation; anorexia; GU: Urinary frequency or retention; oliguria with hypertension; renal failure; azotemia; impotence; albuminuria; glycosuria; elevated BUN; urinary microscopic deposits. HEMA: Aplastic anemia; leukopenia; agranulocytosis; eosinophilia; leukocytosis; thrombocytopenia; pancytopenia; bone marrow depression. HEPA: Abnormal liver function tests; jaundice;

hepatitis. META: Hyponatremia; hypothyroidism. RESP: Pulmonary hypersensitivity (eg, fever, dyspnea, pneumonitis or pneumonia). OTHER: Aching joints and muscles; leg cramps; adenopathy; lymphadenopathy; fever; chills; SIADH. Precautions Pregnancy: Category D. Lactation: Excreted in breast milk. Children: Safety and efficacy in children < 6 yr not established. Elderly: May make elderly more prone to CNS side effects; may cause confusion, agitation or activation of latent psychosis. Special-risk patients: Use with caution in patients with prior adverse hematologic reactions to any drug; glaucoma; cardiac, hepatic or renal disease; and mixed seizure disorders, including absence seizures. Aplastic anemia and agranulocytosis: Has been associated with carbamazepine therapy. The risk of developing these reactions is 5 to 8 times greater than in the general population; however, the overall risk of these reactions in the untreated general population is low. Obtain complete pretreatment hematological testing as a baseline. If in the course of treatment, a patient exhibits low are decreased white blood cell or platelet counts, monitor the patient closely.