Risperidone cardiovascular

In a report of 122 elderly patients on risperidone, hypotension was noted in 28.7% and symptomatic orthostatic hypotension was noted in 9.8%. Significant decreases in blood pressure occurred with risperidone treatment (p = 0.0001) and were common in patients with cardiovascular disease and those taking an SSRI or valproate (p = 0.03) (502). Hence, like other antipsychotics, risperidone should be prescribed cautiously for elderly patients and those with preexisting cardiac disease. Its hypotensive versus its orthostatic hypotensive effects may be an age-related pharmacodynamic response. Blood pressure, including orthostatic blood pressure, should be monitored routinely until the risperidone dosage is stabilized. Furthermore, when risperidone therapy is initiated in the elderly, dosage should be titrated from 0.25 to 0.5 mg two times a day with increments of 0.25 to 0.5 mg weekly (92). 

The debate about the need to restrict drug therapy in relation to the risk of cardiovascular events is open, and some authors have already expressed agreement (61) or disagreement about it (62), as well as pointing to the need for individual patient meta-analyses and significant changes to clinical trial methods in order to better assess the effectiveness, in contrast to the efficacy, of risperidone and other drugs in dementia (63). 

Chlorpromazine has complex actions on the cardiovascular system, directly affecting the heart and blood vessels and indirectly acting through CNS and autonomic reflexes. Chlorpromazine and less potent antipsychotic agents, as well as reserpine, risperidone, and olanzapine, can cause orthostatic hypotension, usually with rapid development of tolerance. 

Cardiovascular Cardiovascular disease mortahty in patients with chronic schizophrenia treated with cloz ine has been retrospectively assessed [71 ]. Patients with schizophrenia who started to take clozapine ( = 1084) were compared with patients who took risperidone and had never taken clozapine ( = 602). During the follow-up period of 6-10 years 43 deaths were attributed to cardiovascular disease. There was no difference in cardiovascular mortality in patients aged under 55 years at the start of treatment (clozapine 1.1% and 2.7% versus risperidone 1.0% and 2.8% at 5 years and 10 years respectively). Patients who started treatment at an age of at least 55 years had higher cardiovascular mortality... 

Choure BK, Gosavi D, Nanotkar S (2014) Comparative cardiovascular safety of risperidone and olanzapine, based on electrocardiographic parameters and blood pressure a prospective open label observational study. Indian J Pharmacol 46 493 97... 

Cardiovascular A case report of a 23-year-old man who presented with sinus bradycardia and second degree Mobiz Type I AV block after ingestion of 42 alprazolam tables, risperidone, acetaminophen and hydrocodone [1 ]. The exact quantity, dose and ingestion times were unknown. The AV block resolved 5 h after his presentation, he refused further follow-up. This case suggests the possibility of potential arrhythmogenicity associated with benzodiazepine exposure. 

A post hoc analysis of 64 studies with risperidone and paliperidone assessed risk of sudden death, cardiovascular and cerebrovascular events [33" ]. The overall risk was significantly increased compared to placebo for adverse events including syncope, tachycardia, palpitations, oedema peripheral, dysarthria and transient ischaemic attack. 

Cardiovascular QT prolongation associated with risperidone is predominantly related to its 9-hydroxy metabolite paliperidone. A study of 61 patients on risperidone foxmd significant positive correlation between plasma paliperi-done levels and a significant positive correlation between age- and dose-corrected plasma paliperidone levels [247 ]. 

Gopal S, Hough D, Karcher K, Nuamah I, Palumbo J, Berlin JA, et al. Risk of cardiovascular morbidity with risperidone or paliperidone treatment analysis of 64 randomized, double-blind trials. J Clin Psychopharmacol 2013 33(2) 157-61. 

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