If you or a loved one has dementia, you might have heard doctors mention risperidone. It’s an antipsychotic that can calm severe agitation, but it also comes with a list of warnings. Below we break down when doctors prescribe it, what to watch for, and how to use it safely.
Risperidone isn’t a first‑line treatment for memory loss or confusion. Doctors usually turn to it only when a person with dementia shows frequent aggression, screaming, or dangerous wandering that can’t be managed with non‑drug strategies. The drug works by blocking dopamine and serotonin receptors, which helps reduce psychotic symptoms and extreme mood swings.
Before starting risperidone, most clinicians will try behavioral approaches—like structured routines, calm environments, and caregiver training. If those steps fail and the person’s safety is at risk, the doctor may consider a low dose of risperidone for a short period. The goal is to use the smallest amount that gives relief, and to stop it as soon as the behavior improves.
Risperidone can cause a range of side effects, especially in older adults. The most common are drowsiness, dizziness, and a drop in blood pressure when standing up. Some people develop tremors, muscle stiffness, or an increased risk of falls. Because dementia patients often have other health issues, doctors keep a close eye on heart rhythm, blood sugar, and cholesterol levels while the drug is in use.
One serious concern is the increased risk of stroke or a mini‑stroke. Studies show that people over 65 taking antipsychotics have a higher chance of these events. That’s why the medication should be prescribed at the lowest effective dose, and only for as long as needed.
Here’s a quick checklist for caregivers:
If side effects become hard to manage, discuss alternative options. Some clinicians switch to other antipsychotics with a slightly lower stroke risk, while others try mood‑stabilizing drugs or low‑dose antidepressants.
Remember, medication is only one piece of the puzzle. Keeping a calm routine, engaging the person in simple activities, and ensuring they get enough sleep can reduce the need for drugs. Talk openly with your healthcare team about the pros and cons of risperidone, and keep a written log of any changes you notice.
Bottom line: risperidone can help calm severe agitation in dementia, but it comes with real risks. Use it sparingly, monitor closely, and always pair it with non‑pharmacologic strategies for the safest outcome.
