Sizomax 2 mg Tablet

Atypical antipsychotic for:

• Schizophrenia and other psychotic disorders
• Moderate to severe manic episodes in bipolar disorder
• Short-term treatment of persistent aggression in Alzheimer's dementia (up to 6 weeks, specialist)
• Persistent aggression/conduct problems in children with intellectual disability or autism (specialist)

Schizophrenia (adults): 2 mg on day 1, 4 mg on day 2, then usually 4–6 mg daily in 1–2 doses (range 2–8; maximum 16 mg).

Bipolar mania: 2–3 mg once daily, adjusted by 1 mg/day (range 1–6 mg).

Elderly / kidney or liver impairment: start 0.5 mg twice daily, increase slowly to 1–2 mg twice daily.

Dementia aggression: 0.25 mg twice daily, up to 1 mg twice daily, for up to 6 weeks.

Children 5 years+ (conduct disorder, autism, specialist): under 50 kg start 0.25 mg daily; 50 kg and over start 0.5 mg daily.

• Long-acting injection: specialist only.
• Do not stop suddenly.

• Allergy to risperidone or paliperidone

Very common: drowsiness, headache, parkinsonism (stiffness, tremor, slowness), insomnia.

Common: weight gain, raised prolactin (breast enlargement or milk discharge, missed periods, sexual dysfunction), restlessness (akathisia), dizziness, low blood pressure on standing, fast heartbeat, constipation, increased appetite, raised sugar.

Rare but serious: neuroleptic malignant syndrome, tardive dyskinesia, seizures, QT prolongation, low white cells, priapism, floppy iris during cataract surgery, increased stroke and death risk in elderly with dementia.

• Monitor weight, sugar, lipids and prolactin-related symptoms.
• Heart disease, Parkinson's disease, epilepsy, diabetes, dehydration: caution.
• Elderly with dementia: increased risk of stroke — use only for severe aggression and briefly.
• May impair driving.

Use in pregnancy only if benefit outweighs risk; newborns exposed late may have movement or withdrawal symptoms. Passes into milk — specialist decision.

• Fluoxetine, paroxetine (raise levels)
• Carbamazepine, rifampicin, phenytoin (lower levels)
• Levodopa and dopamine agonists (opposing effects)
• Alcohol, sedatives (more drowsiness)
• Furosemide in elderly with dementia (higher mortality reported)
• QT-prolonging drugs; antihypertensives (low BP)

Drowsiness, fast heartbeat, low blood pressure, movement disorders, QT prolongation, seizures. Emergency care.

Store below 30°C.