Risperidone Related Pretibial Edema: A Case Report

Pretibial edema associated with antipsychotics has been documented in the literature, however this side effect is very frequently under-recognized. Among the antipsychotics, risperidone stands out with its wide range of indications and antagonist effect on various receptors, but it should be used with caution due to its side effects such as extrapyramidal symptoms, dizziness, nausea and sedation. Pretibial edema associated with risperidone is uncommon. We found very few incidences of pretibial edema related to risperidone in our review of the literature. We report a case of pretibial edema that developed when risperidone was added to the existing treatment which resolved after the medication was discontinued. A 52-year-old female patient presented to the psychiatry outpatient clinic with moderate depressive disorder symptoms. Initial treatment with escitalopram 10 mg/day led to partial symptom relief, but persistent ruminative thoughts were noted during the mental examination. Risperidone 1 mg/day was added to her treatment, resulting in clinical improvement; however, pretibial edema developed. Risperidone was discontinued and pretibial edema completely resolved one week after discontinuation. The patient’s psychiatric complaints partially recurred, upon recurrence of complaints, at her own decision, the patient started taking risperidone at a dose of 0.5 mg per day, but the medication had to be discontinued due to re-development of edema. Aripiprazole 2.5 mg/day was then added to the medication during the follow-up exam, and the patient continued to be in remission without experiencing edema. Pretibial edema is one of the uncommon but potentially dangerous adverse effects of risperidone. During the course of treatment, clinicians should be aware of these adverse effects, manage them, and consider alternative treatment options if necessary.