Antipsychotic therapy deemed likely cause of man’s angioedema
Use of risperidone thought to trigger swelling in 80-year-old patient
An 80-year-old man in Texas developed angioedema thought to be triggered by the antipsychotic therapy risperidone, according to a new case study highlighting a possible risk with the use of this medication.
The researchers noted that “only 10 cases listing risperidone as the only probable causative agent for angioedema have been reported” to the U.S. Food and Drug Administration (FDA).
But, “although likely to be a rare complication of risperidone use, clinicians should remain aware of the potential risk of angioedema related to risperidone that may not be dose- or formulation-dependent,” the team wrote.
Their study, detailing the case of a man treated in the North Texas Veterans Health Care System, was titled “Risperidone-induced angioedema” and published in the journal Mental Health Clinician.
Swelling followed switch in patient’s antipsychotic therapy
Angioedema refers to swelling that occurs in the deeper layers of the skin and mucous membranes. It may be triggered by several factors, including arising as a side effect of certain medications.
Risperidone, sold under the brand name Risperdal and others, is a second-generation antipsychotic medication that’s used to treat schizophrenia, bipolar disorder, and other psychiatric conditions.
“Angioedema secondary to risperidone use is an uncommon reaction with unreported frequency based on package insert data,” the researchers wrote.
The 10 reported cases of angioedema related to use of the antipsychotic therapy were “based on FDA Adverse Event Reporting System Public Dashboard data, which comprises reports from 1969 to the present day,” the authors, both clinical pharmacist practitioners at the Sam Rayburn Memorial Veterans Center in Bonham, wrote.
Here, they described the case of an elderly male patient who developed angioedema after being treated with risperidone.
The man developed facial swelling following a cross taper — the process of switching from one medication to another — from the antipsychotic olanzapine (sold as Zyprexa and others) to risperidone. His medical history included bipolar disorder, dementia, cerebrovascular accident, and other health conditions for which he was heavily medicated.
Swelling first believed to be allergic reaction to medication
Facial swelling was noted and reported by nursing staff at the patient’s long-term care facility approximately 15 hours after the first dose of risperidone. His vital signs at the time were normal.
Six hours later, the swelling had worsened on the right side of his face and jaw, but his vital signs remained unaltered.
The nurses called the physician on duty less than an hour later due to the patient’s persistent swelling. He was prescribed oral prednisone, a glucocorticoid, until he could be evaluated the next morning.
The swelling continued throughout the night and spread to his right hand. In the morning, the patient was unable to open his eyes due to swelling, and his right ear and lip also were affected. The left side of his face had also started to swell.
The patient was brought to the local emergency department for further evaluation and treatment. At this time, he had received a total of three 0.25 mg oral doses of risperidone.
Risperidone was then discontinued and the patient was given methylprednisolone and the antihistamine diphenhydramine, along with routine supportive care. He returned to the long-term care facility two days later in stable condition.
As the patient’s initial symptoms began 15 hours after the first dose, steadily progressed in symptom severity despite administration of prednisone, and no hives or rash developed, this case is more consistent with drug-induced nonallergic angioedema [than an allergic-type reaction].
“The patient’s angioedema was first treated as an allergic-type reaction with the usual treatment of corticosteroids and antihistamines; then, it was later treated as a nonallergic-type reaction, which involves discontinuation of the offending agent,” the team wrote.
“As the patient’s initial symptoms began 15 hours after the first dose, steadily progressed in symptom severity despite administration of prednisone, and no hives or rash developed, this case is more consistent with drug-induced nonallergic angioedema,” the clinicians wrote.
The team also noted that the combination of risperidone with one or more of the other medications the patient was being given might have caused his swelling symptoms, adding that “clinician awareness and monitoring [are] crucial to manage these types of reactions.”
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