Risperidone induced oedema in a child with learning disability and autism

Abstract

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

Peripheral Edema Occurring during Treatment with Risperidone Combined with Citalopram

“…It was hypothesized that this occurrence of edema may have been due to the supersensitivity of the α -receptors to risperidone, which may have occurred during the drug-free period. In addition, there is a “critical drug-free period” during which, if risperidone is reinstated, the side effects are exaggerated because of the supersensitivity of the neurons [12]. …”

“…Among them, one case documented an allergic reaction to risperidone resulting in edema [11]. Consequently, only the last 3 cases reported the occurrence of edema subsequent to oral risperidone administered alone [5, 12]. Nevertheless, edema occurring during treatment with risperidone combined with citalopram, an antidepressant agent, has not been reported previously.…”

Low-dose risperidone-induced facial edema in a child with conduct disorder

“…Two of these involved adolescents and one a child of 8 (5-7). Bilateral ankle edema developed in an autistic male adolescent using carbamazepine, sodium valproate and melatonin following the addition of 2 mg/day risperidone (5). In the case of a 15-year-old male under observation due to schizophrenia, facial edema developed with 2 mg/day risperidone monotherapy (6).…”

“…Third, allergic reactions, supersensitivity of receptors and complex drug interactions (10). Fourth, supersensitivity of the α-receptors of neurons (5). Fifth, risperidone-induced 5-HT2 receptor blockade which can potentially increase the plasma cyclic adenosine monophosphate levels that relax the vascular smooth muscle through the phosphorylation of myosin light chain kinase (11).…”

Bilateral Pretibial Edema Associated with Paliperidone Palmitate Long-acting Injectable: A Case Report

“…Like risperidone, paliperidone primarily acts by blocking 5HT2, D2, α-1, α-2 and H1 receptors 1). These antipsychotics may cause edema by blocking α-1 receptors, resulting in vasodilation, decreased vascular resistance and an increase in hydrostatic pressure in the capillaries 16). Secondly, 5HT2 receptor blockade can increase cyclic adenosine monophosphate concentration, which relaxes vascular smooth muscle and results in edema 11).…”