Risperidone dosing for severe impairment starts at what dose for week 1?

• A. 0.25 mg/BID
• B. 1 mg/BID
• C. 0.5 mg/BID
• D. 1 mg QD

Answer: (C)

In severe impairment, antipsychotic dosing is started low and titrated slowly to balance effectiveness with tolerability, since reduced clearance and greater sensitivity raise the risk of side effects like EPS and prolactin elevation. For risperidone, the recommended starting dose during the first week in such patients is 0.5 mg twice daily. This provides enough antipsychotic effect to begin addressing symptoms while keeping plasma levels more stable and minimizing adverse effects. A dose of 0.25 mg twice daily is typically too small to achieve a meaningful early response, while 1 mg twice daily would be a larger, less cautious start and 1 mg once daily does not provide the intended twice-daily exposure that helps maintain steadier levels. After week 1, dosing can be adjusted upward if tolerated and clinically needed.