Risperidone-induced respiratory depression in a neonate through breast milk

Risperidone is commonly used in postnatal mothers for depression and psychotic symptoms in spite of little data on its safety profile in neonates. It is reported previously that 6 mg/day can be used in mothers without having any untoward in breastfed neonates. Excretion of risperidone is dependent on the enzyme CYP2D6 whose activity varies as per individual phenotype. Maximum therapeutic levels are achieved at 2 h of administration of the drug. We are reporting a case of preterm breastfed neonate who presented with respiratory depression twice due to risperidone usage in its mother. This is the first reported case where 1 mg/day dosage of risperidone in nursing mother was associated with acute adverse effects such as respiratory depression in her neonate. The Naranjo Adverse Drug Reaction Probability Assessment Scale scored to 8 which suggests probable relation between the drug and its reaction in neonates. It underscores cautious use in mothers and close monitoring of neonates when risperidone is prescribed irrespective of dosage.