What should clinicians know about Perseris (risperidone subcutaneous LAI)?

Perseris

Indication(s)

Schizophrenia

Dosing available as prefilled syringes

Available in 90 mg or 120 mg kits:
4 mg oral risperidone corresponds to 120 mg (injection volume of 0.8 ml) Perseris
3 mg oral risperidone corresponds to 90 mg (injection volume of 0.6 ml) Perseris 

Recommended starting and maintenance dose

Based on the oral dose of risperidone 

Drug Metabolizing Enzyme

Dosing exclusions

In patients with renal or hepatic impairment, titrate with oral risperidone up to at least 3 mg daily. 

Loading dose

No loading dose recommended

Oral overlap

No oral supplementation recommended

Establishing tolerability

Prior to initiating Perseris, establish tolerability with oral risperidone in risperidone-naïve patients.

Storage

Must remain refrigerated, but can remain at room temperature for up to 7 days.
Should be brought to room temperature for at least 15 minutes prior to mixing.

Reconstitution or mixing

Should be brought to room temperature for at least 15 minutes prior to mixing. Mixing requires at least 60 cycles between liquid and powder syringes.

Injection site

Subcutaneous abdominal or back of upper arm injection

Injection interval

Every 4 weeks

Preparation

Hold the powder syringe upright and tap the barrel of the syringe to dislodge the packed powder. Remove the cap from the liquid syringe, then remove the cap from the powder syringe.  Place the liquid syringe on top of the powder syringe and connect the syringes by twisting approximately ¾ turn.  Keep your fingers off the plungers during this step to avoid spillage of the medication.  Transfer the contents of the liquid syringe into the powder syringe. Gently push the powder syringe plunger until you feel resistance.  Repeat this gently back and forth process for 5 cycles.  Continue mixing the syringes for an additional 55 cycles.  Transfer all contents into the liquid syringe.  Simultaneously maintain slight pressure on the powder syringe plunger and pull back gently on the liquid syringe plunger while twisting the syringes apart.  Attach needle and inject as directed per the package insert. Priming of the syringe is recommended.

Administration considerations

Select the injection site: subcutaneously in the abdomen or back of the upper arm.  See package insert for full details.  Pinch the skin around the injection area.  Lift the adipose tissue from the underlying muscle to prevent accidental intramuscular injection.  Insert needle fully into the subcutaneous tissue.  Inject the medication slow and steady.  Withdraw the needle at the same angle used for insertion and release pinched skin.

When a dose is missed

Refer to this tip on how to address missed doses.

REMS

No

Additional information

Use of this LAI formulation of risperidone (Perseris) decreases necessary frequency of injections over original risperidone LAI (Risperdal Consta).  
Provides initial peak plasma concentration in 4 to 6 hours of both risperidone and its metabolite, yielding steady plasma levels following initial injection.
Patients who are stable on oral risperidone doses lower than 3 mg/day or higher than 4 mg/day may not be candidates for Perseris.

Dose Conversion of Oral Risperidone to Risperidone Subcutaneous LAI

PO Dose

LAI/SC Dose

3 mg daily

90 mg every 4 weeks

4 mg daily

120 mg every 4 weeks

Recommended available dose formulations include 90 mg and 120 mg pre-filled vial kits.

Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

References:
1. Indivior. (2018). Perseris dosing and administration.
2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841