Risperidone-associated rhinitis

[clausewitz2]

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Have a young person on risperidone who definitely ought to stay on risperidone who has been complaining of having a perpetual running nose for the past two months they have been on it, going through kleenex quite quickly, blowing their noses 10-12 times per day. I am satisfied they do not have an infection and the literature does support connection between risperidone in particular and rhinitis. I could puzzle out based on receptors and theory etc things that might be helpful, but do any of y'all have any actual experience addressing this?

Assume arguendo that stopping risperidone, switching to a different neuroleptic or lowering it is not an option.

 

[clozareal]

No clue. Send to PCP. Make sure they don't have any risk factors for a pituitary macroadenoma from hyperprolactinemia (no vision changes, headaches, if female amenorrhea, etc) or a CSF leak.

 

[BobbyKoch]

obligatory just a med stud, but I saw the same thing in clinic a few weeks ago. I wonder if intranasal steroids/cetirizine would be of any help? our clinic patient was newly initiated, only about two weeks of risperidone, so I believe the attending just said it would likely resolve on its own.

 

[splik]

if the offending drug can't be discontinued then they can try some intranasal corticosteroids. that is what is typically done for symptomatic management.

 

[annoyedpsychiatrist]

ive never seen this before, personally I would send to an allergy doctor, it could be pure coincidence and the kid could have seasonal allergies or something else in the house triggering it.

 

[Batman's Underwear]

Just to be a devil, (not a devil's advocate), there are few folks out their mixing of cocaine and risperidone for intranasal use

 

[annoyedpsychiatrist]

Just to be a devil, (not a devil's advocate), there are few folks out their mixing of cocaine and risperidone for intranasal use

What really? I see people abusing seroquel all the time, havent seen anyone abuse risperdal yet

 

[Batman's Underwear]

What really? I see people abusing seroquel all the time, havent seen anyone abuse risperdal yet

Yea Seroquel has the highest rate of abuse/misuse, then risperidone but far below than Seroquel

 

[comp1]

Send to PCP and make sure PCP knows that you don't believe the risperidone has anything to do with this.

 

[clausewitz2]

Send to PCP and make sure PCP knows that you don't believe the risperidone has anything to do with this.

Except I do actually think risperidone has something to do with this. This is the first frank rhinitis I've seen but sinus congestion is a complaint I hear pretty often about risperidone in particular. Rhinitis also gets reported a lot more with risperidone in the data I can find v. other SGAs, for example.

 

[Penguin10]

Except I do actually think risperidone has something to do with this. This is the first frank rhinitis I've seen but sinus congestion is a complaint I hear pretty often about risperidone in particular. Rhinitis also gets reported a lot more with risperidone in the data I can find v. other SGAs, for example.

One of my primary care patients had rhinitis that was temporally related to starting citalopram (although they are on risperidone too now that you mention it). UpToDate's rhinitis article cited this paper (PMID 20210811) on drug induced rhinitis. The authors recommend intranasal steroids or intranasal antihistamines, either alone or in combination.

 

[whopper]

I don't see why options other than Risperidone can't be considered. Palliperidone is almost the same medication. All neuroleptics ending in the Idone have molecular similarity.

Sometimes patients c/o very odd side effects that aren't in the literature. E.g. there's confirmed cases of Escitalopram causing baldness but this is so rare that this is realistically not to be expected and not even published in the list of known side effects.

Also sometimes it turned out the medication did cause the side effect and the side effect is actually common but the FDA didn't catch it in the initial study. E.g. Aripiprazole. The data is strong now that it can cause weight gain but when it first came out the initial studies didn't show much of it. For this reason it was even advertised as metabolically neutral the first year it came out.

I have a patient who was on Rogaine and developed several symptoms of low testosterone after he was on it. Later data, although very small, showed in some men it may have caused an autoimmune reaction against testosterone receptors.

 

[Stagg737]

Never encountered this to a level that needed to be addressed, but is the same association with rhinitis present with paliperidone?

 

[docksan]

Alpha 1 antagonism has been associated with rhinitis for quite some time.

 

[clozareal]

Alpha 1 antagonism has been associated with rhinitis for quite some time.

Yeah and alpha 1 agonism treats runny noses (oxymetazoline) although it shouldn't be used long term due to risk of hypertension. Makes sense if the risperidone is going to cause block vasoconstriction (which is the reason for orthostatic hypotension).