Risvan, the new risperidone long-acting injectable (LAI) has been approved by the FDA for treatment of schizophrenia in adults. It is administered IM once monthly.
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Advantages of Risvan over competing risperidone/paliperidone LAIs
No oral overlap is needed. Start one day after the last PO risperidone dose.
No loading dose required. The second Risvan injection is given one month after the first.
Minimal pain and low incidence of injection site reactions.
Does not need to be refrigerated.
Disadvantages of Risvan
Patients who are on stable oral risperidone doses lower than 3 mg per day (75 mg Risvan equivalent) or higher than 4 mg per day (100 mg Risvan equivalent) may not be candidates for Risvan.
A disadvantage for those who may prefer subcutaneous injections (Uzedy, Perseris), Risvan is an intramuscular injection like most of the competing products.
Preparation of the injection involves "QUICKLY mixing contents by pushing the plungers FAST and alternately for 100 pushes" between a solvent syringe and powder syringe. It must be administered within 15 minutes after reconstitution.
Interactions
The label recommends using Risvan 75 mg (not 100 mg) if co-administered with strong CYP2D6 inHibitor, although the magnitude of the interaction can be more substantial. Fluoxetine 20 mg increased (oral) risperidone concentration 2.5-fold. Paroxetine 20 mg increased risperidone concentration 3–9 fold.
The label recommends using Risvan 100 mg (not 75 mg) if co-administered with a strong CYP3A4 inDucer. Oral risperidone is decreased by about 50% by the strong CYP3A4 Inducer carbamazepine, although the metabolite of risperidone (paliperidone) has similar antipsychotic efficacy as the parent drug.
There were no significant interactions between oral risperidone and erythromycin, a moderate CYP3A4 inHibitor.
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