Risperidone drug withdrawal

Galactorrhea has been reported in relation to risperidone (SEDA-25, 69 SEDA-26, 65 SEDA-27, 63), and four new cases have been published (1036). It is suggested that this condition can occur after many weeks of risperidone treatment, with small dosages (2-4 mg/day), and at times even after drug withdrawal. 

Of 39 patients taking lithium, 18% had neutrophilia and 15% had raised activity of polymorphonuclear elas-tase (a marker of granulocyte activation) (345). In keeping with these observations, a chart review of 38 patients taking clozapine showed an increase in leukocyte count when lithium was added (42). A man with olanzapine-induced neutropenia (with a prior history of risperidone-induced neutropenia), which normalized with drug withdrawal, had no difficulty when the drug was reintroduced after the patient had been treated with lithium (43). 

A 17-year-old man, with a history of paranoid schizophrenia and irregular abuse of cannabis and alcohol, took risperidone (202). Starting at 0.5 mg/day, the dose was titrated up to 4 mg/day over 3 weeks. In a few weeks, he stopped taking risperidone because of a recurrent inability to ejaculate, despite normal libido, erection, and sense of orgasm he also had difficulty in urinating. These effects disappeared after drug withdrawal. However, risperidone was restarted because of relapse of schizophrenia, and the ejaculatory disturbance recurred within a few days. 

Sellers EM, Naranjo CA, Harrison M, et al Diazepam loading simplified treatment of alcohol withdrawal. Clin Pharmacol Ther 34 822-826, 1983 Sharp CW Introduction to inhalant Abuse, in Inhalant Abuse A Volatile Research Agenda (NIDA Research Monograph 129). Edited by Sharp CW, Beuvais F, Spence R. Rockville, MD, National Institute on Drug Abuse, 1992, pp 1-10 Smelson DA, Losonczy MF, Davis CW, et al Risperidone decreases craving and relapses in individuals with schizophrenia and cocaine dependence. Can J Psychiatry 47 671-675, 2002... 

Antiserotonergic drugs (e.g., risperidone and cyproheptadine) were of some value in treating the withdrawal psychosis and other somatic withdrawal symptoms. 

A hypertensive crisis in a 29-year-oid man after abrupt discontinuation of risperidone is the only report to date of any serious withdrawal reaction that we are aware of (484). Although the episode was attributed to risperidone s a -blocking effect, this is debatable because the hypertension was first detected within hours of discontinuation, the patient had been given multiple drugs, and he used cannabis in the hospital. 

Tardive or withdrawal dyskinesias, some transient but others irreversible, seen in 8%-51% of antipsychotic-treated children and adolescents, mandate caution regarding casual use of these drugs. Tardive dyskinesia has been documented in children and adolescents after as brief a period of treatment as 5 months and may appear even during periods of constant medication dose. Cases of tardive dyskinesia have been reported in youths treated with risperidone, indicating that atypical antipsychotics may also cause this serious adverse reaction. 

There has been one comprehensive meta-analysis including over 80 studies and over 30 000 patients (489). A meta-analysis of trials of neuroleptic drugs showed the following mean weight gains in kg after 10 weeks of treatment clozapine, 4.5 olanzapine, 4.2 thioridazine, 3.2 sertindole, 2.9 chlorpromazine, 2.6 risperidone, 2.1 haloperidol, 1.1 fluphenazine, 0.43 ziprasidone 0.04 molindone, —0.39 placebo, —0.74 (490,491). In one study, excessive appetite was a more frequent adverse event in patients treated with olanzapine versus haloperidol (24 versus 12%) (185). Loss of weight has been observed after withdrawal of neuroleptic drugs (492). 

Akathisia has been reported in 16% of patients taking olanzapine (SEDA-21, 56). Three patients developed severe akathisia during treatment with olanzapine (20-25 mg/day) (87). In two, the akathisia resolved after withdrawal of olanzapine and in one of those olanzapine was well tolerated when reintroduced in combination with lorazepam. In the third patient, the akathisia was controlled by dosage reduction. A 33-year-old man with AIDS and a prior history of extrapyramidal symptoms with both typical antipsychotic drugs and risperidone developed dose-dependent akathisia with olanzapine 15-19 mg/day the akathisia responded to dosage reduction and beta-blockade (88). 

A 26-year-old man, who had previously taken a variety of psychotropic medications, including typical neuroleptic drugs and risperidone, without sexual adverse effects, took olanzapine 10 mg at bedtime (240). Soon after, he developed priapism 24 hours after withdrawal of olanzapine, the adverse effect disappeared. 

A 28-year-old man complained of unbearable thirst 2 weeks after starting risperidone 8 mg/day, and would drink 4-5 liters of water within a variable period of a few minutes to 8 hours he did not develop hyponatremia (172). The condition lasted about 2 years and remitted after withdrawal of risperidone. After a drug-free interval of 2 weeks, clozapine was started and the condition had not recurred after 6 months. 

Supersensitivity psychosis has been reported in two men, aged 74 and 65 years, who had taken metoclopramide 5 mg qds for 6 and 3 months respectively (536). Hallucinations and delusions developed 12 hours after the drug was withdrawn in one patient and 3 days after withdrawal in the other. Both recovered after treatment with risperidone. 

In the final chapter, an expert pharmacologist. Dr. Terrell Gibbs presents a comprehensive review of pharmacotherapies in autism. He details their results from clinical trials, their effectiveness, and their role in the treatment of autistic behaviors. Special emphasis is given to the atypical antipsychotic drug risperidone that is frequently effective for ameliorating symptoms of irritability, hyperactivity, social withdrawal, and stereotypic, repetitive behavior in autism. 

Restless leg syndrome has been associated with olanzapine in three cases, in which it started after the beginning of treatment with olanzapine and resolved after withdrawal all three patients were subsequently treated with other atypical antipsychotic drugs (risperidone, quetiapine, or aripiprazole) without recurrence [105 ]. 

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