Abstract
BackgroundCombination lithium, a mood stabilizer, and risperidone, an atypical antipsychotic drug, is widely used for treatment of psychotic disorders. Rare reports concern severe adverse drug reaction in multiple organic systems with their combined use. We report two episodes of neurotoxicity and nephrotoxicity in a patient following the combined use of lithium and risperidone.Case presentationA 55-year-old male had a diagnosis of schizoaffective disorder at the age of 51. He was initially treated with a combination of lithium and olanzapine 5 to 15 mg/day for 2 years. He was admitted to psychiatric ward at the age of 53 due to manic episode with psychotic feature. Because of poor blood sugar control, we switched olanzapine 20 mg/day to risperidone 4.5 mg/day with combination of lithium 900mg/day. The patient presented neurotoxicity, neuroleptic-malignant-syndrome like symptoms, and nephrotoxicity, elevation of blood creatinine and decreased urine output few days later. These signs were fully recovered within 2 days after we discontinued all medications and gave normal saline hydration. Then we re-administered decreased dosage of lithium 600 mg/day and risperidone 3 mg/day, and the similar episode occurred again 3 days later. All drugs were discontinued again, then his delirium resolved and abnormal data returned to normal 1 day later. Finally, the patient was treated with risperidone 2 mg/day as monotherapy, and no episode of neurotoxicity and nephrotoxicity appeared in the following 2 years.ConclusionsThe case exemplifies neurotoxicity and nephrotoxicity after combined use of lithium and risperidone. These adverse effects resolved soon after discontinuing these medications and adequate hydration. Clinicians should be cautious about neurological and renal adverse effects.
Highlights
Combination lithium, a mood stabilizer, and risperidone, an atypical antipsychotic drug, is widely used for treatment of psychotic disorders
Combination of lithium and risperidone is commonly used for bipolar disorder or schizoaffective disorder [2]
The delirium and abnormal laboratory data were fully recovered within 2 days, as follows: blood urea nitrogen (BUN) (12 mg/dL), creatinine (0.82 mg/dL), and serum lithium (0.82 mEq/L)
Summary
Our patient had 2 episodes of neurotoxicity and nephrotoxicity during this hospitalization He presented delirium, acute kidney injury (AKI) with increased level of serum creatinine [10], and lithium intoxication, which had developed soon after combined administration of lithium and risperidone, and subsided after discontinuing these medications. The switching of antipsychotics was suitable for our patient with history of type 2 diabetes mellitus and hyperlipidemia [11] His clinical features were considered to be side effects of lithium-risperidone interaction. Our case is an indicator to prove the nephrotoxicity by the concomitant use of these pharmaceuticals He did not have a history of AKI while being treated with lithium or risperidone alone. Further monitoring of renal function for nephrotoxicity survey is required Discontinuance of these agents will lead to remission of the aforementioned adverse effects. Abbreviation BD: Bipolar disorder; BUN: Blood urea nitrogen; CPK: Creatine phosphokinase; Cr: Creatinine; DKA: Diabetic ketoacidosis; EEG: Electroencephalography; Li: Lithium; NA: Not available; NMS: Neuroleptic malignant syndrome; R.N.: Reference number; SD: Schizoaffective disorder
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