Reply To: FACIAL EDEMA 2/2 ANTIPSYCHOTICS?

[Harvinder]

Thanks for sharing this interesting case. Note that antipsychotic-induced edema is not an uncommon side-effect and can occur with any antipsychotic and any dose (risk is higher with a faster increase in medication). The most common site ie eyelid and face.

Case reports have shown the association of edema with the following antipsychotics:

• Risperidone
• Quetiapine
• Olanzapine
• Clozapine
• Ziprasidone
• Clozapine
• Amisulpride

The treatment recommendations are as follows:

1. Avoid antipsychotics if possible.
2. If an antipsychotic is chosen: change to different antipsychotics at low dose with slow titration: aripiprazole may be a good next option.
3. I will consider medications in the following orders: antidepressants followed by lamotrigine, clonidine, guanfacine, and aripiprazole
4. Get genetic testing to rule out the risk of slow metabolizers for certain medications.
5. If she responds to certain antipsychotics and edema remains a limiting factor: the addition of a diuretic may be used as a last resort.

I will work on creating a separate chapter on this topic soon. Please keep us updated of your progress.