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An Evaluation of Risperidone Dosing for Pediatric Delirium in Children Less Than or Equal to 2 Years of Age

Christopher T Campbell1,2, Erin Grey1, Jennifer Munoz-Pareja3

  • 1University of Florida College of Pharmacy, Gainesville, FL, USA.

The Annals of Pharmacotherapy
|November 28, 2019
PubMed

Insights

This study found risperidone to be safe and well-tolerated for treating ICU delirium in infants under two years old. Doses between 0.1-0.25 mg daily, given once or twice, effectively reduced other sedative medications.

Area of Science:

  • Pediatric Intensive Care
  • Pharmacology
  • Critical Care Medicine

Background:

  • Limited data exists on risperidone dosing and safety in pediatric patients under two years old.
  • Antipsychotic use in critically ill infants requires careful consideration of efficacy and safety profiles.

Purpose of the Study:

  • To characterize risperidone dosing strategies, safety, and tolerability in infants aged two years and younger.
  • To provide evidence-based recommendations for risperidone use in a vulnerable pediatric population.

Main Methods:

  • Retrospective study of 17 patients aged ≤2 years receiving risperidone for ICU delirium.
  • Analysis of initial and mean daily doses, dosing frequency, treatment duration, and adverse events.
  • Comparison of concomitant sedative and analgesic medication use before and after risperidone initiation.

Main Results:

  • Initial daily risperidone doses ranged from 0.1 to 0.25 mg (0.01-0.04 mg/kg), with most patients receiving once-daily dosing.
  • Over 80% of patients required a dose increase; however, no adverse events led to discontinuation.
  • Initiation of risperidone was associated with decreased median doses of fentanyl, morphine, ketamine, and midazolam.

Conclusions:

  • Risperidone is safe and well-tolerated at 0.1-0.25 mg/day in patients ≤2 years old for managing ICU delirium.
  • This study offers the largest cohort to date with specific risperidone dosing recommendations for this age group.
  • Further research is needed to explore the impact of antipsychotics on other sedation and analgesic regimens in pediatric ICU patients.

Keywords:
antipsychotic agentsdeliriuminfantmanagementoutcomerisperidone

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