both increase QTc interval. Use Caution/Monitor.tacrolimusMonitor Closely (2)tacrolimus will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. tacrolimus and risperidone both increase QTc interval. Use Caution/Monitor.tapentadolMonitor Closely (1)tapentadol and risperidone both increase sedation. Use Caution/Monitor.tazemetostatMonitor Closely (1)risperidone will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.telavancinMonitor Closely (1)risperidone and telavancin both increase QTc interval. Use Caution/Monitor.temazepamMonitor Closely (1)temazepam and risperidone both increase sedation. Use Caution/Monitor.tepotinibSerious - Use Alternative (1)tepotinib will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.terbinafineMonitor Closely (1)terbinafine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.terbutalineMonitor Closely (1)risperidone increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.tetrabenazineMonitor Closely (1)risperidone and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)tetrabenazine and risperidone both increase QTc interval. Avoid or Use Alternate Drug.thioridazineMonitor Closely (3)thioridazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely. risperidone and thioridazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. risperidone and thioridazine both increase sedation. Use Caution/Monitor.Minor (1)thioridazine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.thiothixeneMonitor Closely (2)risperidone and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. risperidone and thiothixene both increase sedation. Use Caution/Monitor.tinidazoleMonitor Closely (1)risperidone will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tiotropiumMonitor Closely (3)tiotropium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. tiotropium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor. risperidone increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tipranavirMinor (1)tipranavir will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.tolazamideMonitor Closely (1)risperidone, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.tolbutamideMonitor Closely (1)risperidone, tolbutamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.tolterodineMonitor Closely (3)tolterodine decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. tolterodine decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor. risperidone increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tolvaptanMonitor Closely (1)tolvaptan will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.topiramateMonitor Closely (1)risperidone and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolMonitor Closely (1)tramadol and risperidone both increase sedation. Use Caution/Monitor.tranylcypromineMonitor Closely (1)tranylcypromine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).trazodoneMonitor Closely (3)trazodone will decrease the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. trazodone and risperidone both increase QTc interval. Modify Therapy/Monitor Closely. risperidone and trazodone both increase sedation. Use Caution/Monitor.triazolamMonitor Closely (1)triazolam and risperidone both increase sedation. Use Caution/Monitor.triclabendazoleMonitor Closely (1)triclabendazole and risperidone both increase QTc interval. Use Caution/Monitor.triclofosMonitor Closely (1)triclofos and risperidone both increase sedation. Use Caution/Monitor.trifluoperazineMonitor Closely (3)trifluoperazine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely. risperidone and trifluoperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. risperidone and trifluoperazine both increase sedation. Use Caution/Monitor.trihexyphenidylMonitor Closely (1)risperidone increases effects of trihexyphenidyl by pharmacodynamic synergism. Use Caution/Monitor. Potential for additive anticholinergic effects.trimethoprimMonitor Closely (1)risperidone and trimethoprim both increase QTc interval. Use Caution/Monitor.trimipramineMonitor Closely (2)trimipramine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely. risperidone and trimipramine both increase sedation. Use Caution/Monitor.triprolidineMonitor Closely (1)triprolidine and risperidone both increase sedation. Use Caution/Monitor.tropisetronMonitor Closely (1)risperidone and tropisetron both increase QTc interval. Use Caution/Monitor.trospium chlorideMonitor Closely (3)trospium chloride decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. trospium chloride decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor. risperidone increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.tucatinibMonitor Closely (1)tucatinib will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.umeclidinium bromide/vilanterol inhaledSerious - Use Alternative (1)risperidone increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.valbenazineMonitor Closely (1)valbenazine and risperidone both increase QTc interval. Use Caution/Monitor.vandetanibSerious - Use Alternative (1)risperidone, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.vecuroniumMonitor Closely (3)vecuronium decreases levels of risperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. vecuronium decreases levels of risperidone by pharmacodynamic antagonism. Use Caution/Monitor. risperidone increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.vemurafenibSerious - Use Alternative (1)vemurafenib and risperidone both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.venlafaxineMonitor Closely (3)venlafaxine, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). venlafaxine will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. risperidone and venlafaxine both increase QTc interval. Use Caution/Monitor.verapamilMonitor Closely (1)verapamil will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.vilanterol/fluticasone furoate inhaledSerious - Use Alternative (1)risperidone increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.vilazodoneMonitor Closely (1)vilazodone, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).voclosporinMonitor Closely (1)voclosporin, risperidone. Either increases effects of the other by QTc interval. Use Caution/Monitor.voriconazoleMonitor Closely (1)risperidone and voriconazole both increase QTc interval. Use Caution/Monitor.vorinostatMonitor Closely (1)vorinostat and risperidone both increase QTc interval. Use Caution/Monitor.xylometazolineMonitor Closely (1)risperidone increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineMonitor Closely (1)risperidone increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideMonitor Closely (1)risperidone and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (3)risperidone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely. risperidone and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. risperidone and ziprasidone both increase sedation. Use Caution/Monitor.zolmitriptanMonitor Closely (1)zolmitriptan, risperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).zotepineMonitor Closely (2)risperidone and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. risperidone and zotepine both increase sedation. Use Caution/Monitor. >10% Somnolence (40-45%) Insomnia (26-30%) Agitation (20-25%) Anxiety (10-15%) Headache (10-15%) Rhinitis (10-15%) Fatigue (18-31%) Parkinsonism (28-62%) Akathisia (5-11%) Increased appetite (4-44%) Vomiting (10-20%) Drooling (<12%) Urinary incontinence (5-22%) Tremor (11-24%) Nasopharyngitis (4-19%) Rhinorrhea (4-12%) Enuresis (1-16%) ER suspension Increased weight (12.8-13%) 1-10% Constipation (5-10%) Dyspepsia (5-10%) Nausea (5-10%) Abdominal pain (1-5%) Aggressive reaction (1-5%) Facial edema (<4%) QT prolongation (<4%) Dizziness (1-5%) Extrapyramidal symptoms (EPS; 1-5%) Gynecomastia in children (1-5%) Rash (1-5%) Tachycardia (1-5%) Syncope (1-2%) Bradycardia (<4%) Palpitation (<4%) Chest pain (<4%) Agitation (<4%) Postural dizziness (<4%) Pruritus (<4%) Acne (1-2%) Hyperprolactinemia (<4%) Sexual dysfunction (<4%) Xerostomia (7-10%) ER suspension Sedation (7-7.7%) Pain in extremity (0.9-7.7%) Constipation (7-7/7%) Anxiety (2.6-6.8%) Akathisia (2.6-6.8%) Back pain (3.5-6.8%) Musculoskeletal pain (5.2%) Extrapyramidal disorder (1.7-4.3%) Increased appetite (1.7-3.4%) Musculoskeletal stiffness (0.9-2.6%) Abdominal discomfort (2.6%) Muscle spasms (0-2.6%) Dry mouth (1.7-2.6%) <1% Agranulocytosis Cholesterol increased Delirium Ketoacidosis Orthostatic hypotension Seizures Frequency Not Defined Diabetes mellitus Hyperthermia Hypoglycemia Hypothermia Myelosuppression Neuroleptic malignant syndrome (NMS) Priapism Prolonged QT interval Tardive dyskinesia Thrombotic thrombocytopenic purpura (TTP) Sleep apnea syndrome Urinary retention Blood and lymphatic system disorders: Anemia, granulocytopenia Cardiac disorders: Tachycardia, sinus bradycardia, sinus tachycardia, atrioventricular block first degree, bundle branch block left, bundle branch block right, atrioventricular block Ear and labyrinth disorders: Ear pain, tinnitus Eye Disorders: Vision blurred, oculogyration, ocular hyperemia, eye discharge, conjunctivitis, eye rolling, eyelid edema, eye swelling, eyelid margin crusting, dry eye, lacrimation increased, photophobia, glaucoma, visual acuity reduced Gastrointestinal disorders: Dysphagia, fecaloma, fecal incontinence, gastritis, lip swelling, cheilitis, aptyalism General disorders: Thirst, gait disturbance, chest pain, influenza-like illness, pitting edema, edema, chills, sluggishness, malaise, face edema, discomfort, generalized edema, drug withdrawal syndrome, peripheral coldness, feeling abnormal Immune system disorders: Drug hypersensitivity Infections and infestations: Nasopharyngitis, upper respiratory tract infection, sinusitis, urinary tract infection, pneumonia, influenza, ear infection, viral infection, pharyngitis, tonsillitis, bronchitis, eye infection, localized infection, cystitis, cellulitis, otitis media, onychomycosis, acarodermatitis, bronchopneumonia, respiratory tract infection, tracheobronchitis, otitis media chronic Investigations: Body temperature increased, alanine aminotransferase increased, heart rate increased, eosinophil count increased, white blood cell count decreased, hemoglobin decreased, blood creatine phosphokinase increased, hematocrit decreased, body temperature decreased, blood pressure decreased, transaminases increased Metabolism and nutrition disorders: Polydipsia, anorexia Musculoskeletal, connective tissue, and bone disorders: Joint swelling, musculoskeletal chest pain, posture abnormal, myalgia, neck pain, muscular weakness, muscle rigidity, muscle contracture, rhabdomyolysis Nervous system disorders: Dizziness postural, disturbance in attention, unresponsive to stimuli, depressed level of consciousness, movement disorder, hypokinesia, bradykinesia, transient ischemic attack, coordination abnormal, cerebrovascular accident, masked facies, speech disorder, syncope, loss of consciousness, muscle contractions involuntary, Parkinson disease, tongue paralysis, akinesia, cerebral ischemia, cerebrovascular disorder, neuroleptic malignant syndrome, diabetic coma, head titubation Psychiatric disorders: Agitation, blunted affect, confusional state, middle insomnia, nervousness, sleep disorder, listlessness Renal and urinary disorders: Enuresis, dysuria, pollakiuria, urinary incontinence Reproductive system and breast disorders: Vaginal discharge, menstrual disorder, retrograde ejaculation, sexual dysfunction Postmarketing Reports Falls Alopecia, anaphylactic reaction, angioedema, atrial fibrillation, cardiopulmonary arrest, diabetic ketoacidosis in patients with impaired glucose metabolism, dysgeusia, hypoglycemia, hypothermia, ileus, inappropriate antidiuretic hormone secretion, intestinal obstruction, jaundice, mania, pancreatitis, pituitary adenoma, precocious puberty, pulmonary embolism, QT prolongation, sleep apnea syndrome, sudden death, thrombocytopenia, thrombotic thrombocytopenic purpura, urinary retention, Stevens-Johnson syndrome, toxic epidermal necrolysis (SJS/TEN), and water intoxication Black Box Warnings Elderly patients with dementia-related psychosis Not approved for dementia-related psychosis Elderly patients with dementia-related psychosis who are treated with antipsychotic drugs are at increased risk of death, as shown in short-term controlled trials; deaths in these trials appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature Contraindications Documented hypersensitivity Cautions Increased incidence of cerebrovascular disease reported; may alter cardiac conduction; life threatening arrhythmias reported with therapeutic doses of antipsychotics May cause anticholinergic effects including blurred vision, urinary retention, agitation, confusion, blurred vision, and xerostomia Use with caution in patients with history of seizures, Parkinson disease, Lewy body dementia, cardiovascular disease, hypovolemia, dehydration Leukopenia/neutropenia and agranulocytosis reported; possible risk factors for leukopenia/neutropenia include preexisting low white blood cell (WBC) count and history of drug-induced leukopenia/neutropenia If patient has history of clinically significant low WBC count or drug-induced leukopenia/neutropenia, monitor