We report a case of risperidone induced pedal oedema in a 16-year-old boy with severe learning disability, autism, epilepsy and challenging behaviour. When he was referred to our clinic for the management of his challenging behaviour he was on a daily dose of sodium valproate 1600 mg and carbamazepine 400 mg for his epilepsy and on melatonin 5 mg for his sleep disturbance.As his challenging behaviour was related to his autism, we started him on a low dose of risperidone and titrated the dose to 2 mg daily. His behaviour improved significantly and after 4 months of stable behaviour we gradually withdrew the risperidone. However, soon after its withdrawal, his behaviour and sleep worsened again, following which risperidone was reinstated to 2 mg per day. But within a few weeks he seemed to have developed bilateral ankle oedema. The oedema was minimal in the morning but became significant by the end of the day.On examination, there was mild non-pitting oedema in the right ankle but no oedema in the left ankle. He did not have associated medical conditions like cardiac failure, renal disease, hepatic dysfunction or thyroid disorder. Physical examination and blood investigations (urea and electrolytes, liver function tests, thyroid function tests, FBC) were normal. The oedema fully resolved 2 weeks after the risperidone was reduced to 1 mg per day. Fortunately his behaviour did not deteriorate.Oedema was recently included as a side-effect of risperidone in the British National Formulary (2002). There have been a number of case autism
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