Drug points: Angio-oedema associated with risperidone

Abstract

An 80 year old man with membranous glomerulonephritis was reviewed in clinic after an emergency admission in heart failure. His prednisolone, nizatidine, and amiloride were stopped, his frusemide was halved to 80 mg once daily, and his enalapril was increased from 5 mg to 10 mg once daily. One week later, he developed a widespread, pruritic maculo-

Risperidone induced angioedema with concurrent EPS symptoms: a case report and review of literature

“…The commonly described adverse effects include insomnia, agitation, anxiety, fatigue, and extrapyramidal symptoms, such as the acute dystonia as seen in our patient [7]. Angioedema, a rare side effect, was first reported in 1995 by Cooney et al [2]. They reported a case of a 30-year-old female with schizoaffective disorder who was treated with oral risperidone.…”

“…Three days after decreasing the dose to 3 mg/day, the angioedema resolved. However, when the oral risperidone was increased to 6 mg/day again, the angioedema again returned [2]. …”

“…Second, it is possible that risperidone’s action on muscarinic M1, histamine H1, serotonin HT2 receptors can downregulate the adenosine triphosphate-dependent calcium pump and lead to a secondary reduction in smooth muscle contractility, resulting in vasodilation and edema [11]. Finally, an immunological mechanism was suggested in the first reported case of risperidone related angioedema by Cooney and Nagy [2]. The authors hypothesized that risperidone may have further suppressed the patient’s already low C1 inhibitor activity, allowing the C4-C2 activation, thereby resulting in angioedema.…”

“…Angioedema is an adverse effect seen in patients taking risperidone, as described in recent case reports by Cooney 1995, Kores 2001, and Soumya 2010 [2–4]. Angioedema is an abrupt swelling of skin, mucous membranes, and/or both which can include the upper respiratory and gastrointestinal tracts.…”

Rapid Onset of Pedal Edema Associated with Risperidone in Two Male Patients: Simultaneous Clinical Cases

“…According to some authors, rapid dose increase of antipsychotics may also be a factor in inducing peripheral edema. Immune components that were reported in case reports include low C 4 and C 1 esterase inhibitor in relation to risperidone (19). And also, older age has been suggested as a risk factor, especially in those with severe edema (17).…”