Multifocal atrial tachycardia caused by risperidone

Tachycardia during Treatment with Risperidone and Paliperidone Palmitate in a Patient without Previous Cardiovascular Disease

“…Left untreated, prolonged tachycardia can contribute to cardiomyopathy and heart failure [9]. This case contributes to the limited previous literature indicating an association, in some patients, between risperidone [3-5, 7, 10-12] and tachycardia, which can be further exacerbated by paliperidone palmitate [3,4,6,7,[10][11][12]. The following temporal relationships between medication administrations and Mr. S's tachycardia lend support to this conclusion for his case.…”

“…Additionally, treatment with antipsychotic medications can cause metabolic syndrome [1] and QTc interval prolongation, a risk factor for the polymorphic ventricular tachycardia Torsades de Pointes (TdP) [2]. The antipsychotic risperidone and its active metabolite, paliperidone, are associated with QTc prolongation and, more rarely, TdP, as well as other forms of tachycardia such as multifocal atrial tachycardia [3] and sinus tachycardia [4,5]. Risperidone's potential to induce tachycardia is especially prominent in cases of toxicity, with one study finding that 58% of patients who overdosed on it experienced tachycardia without dysrhythmia [2].…”

Atrial tachycardia associated with risperidone

“…The temporal relationship between the commencement of risperidone treatment and onset of atrial tachycardia, as well as the return to normal cardiac rhythm upon cessation of risperidone, is compelling evidence that risperidone was the responsible agent. Our literature review revealed only one other published case of atrial tachycardia induced with risperidone -a case of multifocal atrial tachycardia in an adolescent receiving risperidone for treatment of behavioural disorder in autism (Oner et al, 2016). This case adds to the limited literature around this potential cardiac side effect.…”