Edema related to treatment with psychotropic drugs

Abstract

Edema as an adverse drug reaction is a commonly underestimated yet potentially debilitating condition. This study analyzes the incidence of severe psychotropic drug-induced edema (e.g., edema affecting the face, legs, or multiple body parts and lasting for more than 1 week, or in any case necessitating subsequent diuretic use) among psychiatric inpatients. The cases under examination are derived from an observational pharmacovigilance program conducted in German-speaking countries (“Arzneimittelsicherheit in der Psychiatrie”, AMSP) from 1993 to 2016. Among the 462,661 inpatients monitored, severe edema was reported in 231 cases, resulting in an incidence of 0.05%. Edema occurred more frequently in women (80% of all cases) and older patients (mean age 51.8 years). Pregabalin had the highest incidence of severe edema, affecting 1.46‰ of patients treated with pregabalin, followed by mirtazapine (0.8‰). The majority of edema cases showed a positive response to appropriate countermeasures, such as dose reduction and drug discontinuation, and resolved by the end of the observation period. While most instances of drug-induced edema are reversible, they can have a significant impact on patient well-being and potentially result in decreased treatment adherence. It is, therefore, crucial to remain vigilant regarding risk-increasing circumstances during treatment with psychotropic drugs.

Case report: Escitalopram-associated lower limb edema

“…In psychiatry, considering psychotropic drugs and their association with peripheral edema, antipsychotics and antidepressants are mostly reported. The medications with the highest rate of association were mirtazapine, olanzapine, quetiapine, risperidone and pregabalin (5). Four main mechanisms account for the etiology of drug-associated edema: sodium and water retention (renal edema), increased capillary permeability (permeability edema), lymphatic insufficiency (lymphedema), and precapillary arteriolar vasodilation (vasodilatory edema) (4).…”