Extrapyramidal Symptoms Probably Related to Risperidone Treatment: A Case Series

Abstract

Background: Atypical antipsychotics, like risperidone purportedly, score over their typical counterparts in terms of their lower propensity toward producing extrapyramidal symptoms (EPS). However, recent studies have furnished evidence to the contrary. Hereby, we present a case series implicating risperidone as the causative agent for EPS. Methods: As a part of the pharmacovigilance programme of India, the authors have assessed 10 physician-reported cases of EPS among the 1,830 patients who were prescribed risperidone within the time period of January 2012-December 2014 in a tertiary care hospital in South India. Causality, severity, and preventability assessments of adverse reaction were done as per Naranjo's, Hartwig's, and Thornton'scale respectively. Results: Of the 10 cases, a dose-dependent occurrence of EPS was noted in all and the time duration for development of EPS ranged from 1 week to 2 years. Four patients developed EPS at a dose of 6-8 mg, 4 developed at a dose of 4-6 mg, and the remaining 2 developed at 2 and 1 mg. Conclusion: A strong temporal correlation between risperidone and EPS was noted in all cases. High doses produced EPS early, whereas moderate to low doses produced EPS at a later date. Thus, cautious use and close monitoring are warranted in the chronic use of risperidone.

Adverse Events Associated with Risperidone Use in Pediatric Patients: A Retrospective Biobank Study

“…Similarly, the majority of children in our cohort with extrapyramidal symptoms were on low starting doses of risperidone. Data from multiple fixed-dose (1–16 mg/day and placebo) trials of risperidone in adults with schizophrenia suggested extrapyramidal symptoms are risperidone dose related [ 31 , 32 ]. Those on placebo or low-dose risperidone (1 mg/day) experienced more extrapyramidal symptoms than those on high doses (2–16 mg/day).…”

Segurança Da Risperidona Em Crianças E Adolescentes Com Transtorno Do Espectro Autista

“…Os antipsicóticos atípicos, como a risperidona, supostamente têm vantagens importantes sobre os antipisicóticos mais antigos, particularmente em relação à menor incidência de efeitos extrapiramidais (40,61). No entanto, estudo mais recentes forneceram evidências em contrário (62).…”

“…A menor propensão ao desenvolvimento de EEP com antipsicóticos atípicos tem sido atribuída à relativamente fraca ligação destes aos receptores D2 em comparação com os antipsicóticos convencionais, como o haloperidol. No entanto, a risperidona é igualmente potente no bloqueio dos receptores D2 e 5-HT2, e sua potência no bloqueio de receptores D2 depende da dose utilizada, possuindo, assim, uma capacidade inata de produzir uma gama de efeitos adversos (62).…”

Efficacy and safety of high-dose antipsychotic therapy

“…1 At risperidone dosages >6 mg/d, the balance between D2 and serotonin-2A (5-HT2A) receptor potency is lost, which increases the potential for EPS. 32 In one RCT, long-acting injectable (LAI) risperidone, up to 100 mg biweekly, was well-tolerated but no more effective for TRS than 50 mg biweekly. 33 A case report suggested improvement of TRS in a patient administered risperidone LAI, 75 mg vs 37.5 mg biweekly, but it is unclear if a 50-mg dosage was tried.…”