Rapidly worsening hypertriglyceridemia during treatment with risperidone

To report a case of rapidly worsening hypertriglyceridemia in a geriatric patient that occurred 2 weeks after treatment with risperidone. The patient is a 70-year-old morbidly obese woman admitted to an inpatient psychiatric unit for exacerbation of schizophrenia. She had a pre-existing metabolic syndrome at baseline with a baseline triglyceride level of 188 mg/dL (>150 mg/dL), high-density lipoprotein of 34 mg/dL (<50 mg/dL), and fasting blood glucose of 100 mg/dL. She was started on risperidone and rapidly developed worsening hypertriglyceridemia after 2 weeks of being on the medication without any associated weight gain. Two weeks after admission, a repeat fasting lipid profile revealed serum triglycerides of 395 mg/dL with a direct low-density lipoprotein of 79 mg/dL, high-density lipoprotein of 21 mg/dL, and total serum cholesterol of 155 mg/dL. The hypertriglyceridemia improved when the medication was stopped. We postulate that the worsening hypertriglyceridemia was due to the effects of risperidone. An objective causality assessment revealed that the adverse drug event was probable. There have been numerous reports in the literature of hypertriglyceridemia without weight gain associated with atypical antipsychotics. None of the published cases had reported a rapidly occurring hypertriglyceridemia within 2 weeks of starting an atypical antipsychotic. It is possible that baseline obesity and baseline metabolic disorder may be risk factors for worsening hypertriglyceridemia in patients started on atypical antipsychotics. Clinicians treating elderly patients with risperidone should be aware of the potential for rapidly developing hypertriglyceridemia and monitor such patients accordingly. We caution clinicians to be aware that hypertriglyceridemia can worsen rapidly after initiation of atypical antipsychotics even in the first 2 weeks of treatment. Further studies are needed to see whether pre-existing metabolic syndrome is a possible risk factor for developing rapid hypertriglyceridemia in patients started on atypical antipsychotic drugs.