Rapidly worsening hypertriglyceridemia during treatment with risperidone

Area of Science:

• Geriatric Medicine
• Psychopharmacology
• Endocrinology

Background:

• Atypical antipsychotics, including risperidone, are commonly used for schizophrenia in geriatric patients.
• Hypertriglyceridemia is a known potential side effect of atypical antipsychotics, often associated with weight gain.
• Metabolic syndrome is prevalent in elderly populations and can predispose individuals to lipid abnormalities.

Observation:

• A 70-year-old obese woman with metabolic syndrome developed rapidly worsening hypertriglyceridemia within two weeks of starting risperidone.
• Her triglyceride levels increased from 188 mg/dL to 395 mg/dL without associated weight gain.
• Lipid levels improved after discontinuation of risperidone, suggesting a probable adverse drug event.

Findings:

• This case presents a rapid onset of severe hypertriglyceridemia (within 2 weeks) linked to risperidone, which is faster than previously reported.
• The patient had pre-existing metabolic syndrome and obesity, which may be risk factors for this rapid adverse reaction.
• Causality assessment indicated a probable link between risperidone and the hypertriglyceridemia.

Implications:

• Clinicians should be vigilant for rapid-onset hypertriglyceridemia in elderly patients initiating risperidone, particularly those with metabolic syndrome.
• Close monitoring of lipid profiles is crucial during the initial weeks of risperidone treatment in this demographic.
• Further research is warranted to explore the role of pre-existing metabolic syndrome in predicting rapid hypertriglyceridemia with atypical antipsychotics.