聊療書

　　之前看會診一個跌倒後bil. frontal lobe SAH再加delirium的病人，問過主任建議給予Risperidal 0.25ml bid+Seroquel 25mg 2~4# hs. 會選擇滴劑是因為擔心腦傷病人對藥物太敏感，用滴劑才能用到1/4的劑量。

　　今天當科電聯，說做復健時病人跌倒，血壓低，懷疑跟Risperidal有關，詢問是否能再調低劑量或改成其他藥物。我就先建議改成當初建議的另一藥物Fute 0.5mg了。

　　Risperidal會不會有低血壓的副作用，有可能，雖然較少聽說；Drugs.com的資料如下：

https://www.drugs.com/sfx/risperidone-side-effects.html

General

The most commonly reported adverse reactions included parkinsonism, dizziness, akathisia, anxiety, fatigue, constipation, tremor, sedation, increased appetite, nausea, vomiting, abdominal pain, drooling, insomnia, nasopharyngitis, and nasal congestion.

Local

Uncommon (0.1% to 1%): Redness, swelling, induration at injection site
Postmarketing reports: Serious injection site reactions, including abscess, cellulitis, cyst, hematoma, necrosis, nodule, and ulcer

Nervous system

Very common (10% or more): Sedation (up to 63%), parkinsonism (up to 28%), akathisia (up to 10%), dizziness, (up to 14%), tremor (up to 11%), drooling (up to 12%), headache (up to 12%)
Common (1% to 10%): Dystonia, dyskinesia, gait disturbance
Uncommon (0.1% to 1%): Syncope
Rare (less than 0.1%): Tardive dyskinesia, cerebral ischemia, unresponsive to stimuli, depressed or loss of consciousness, psychomotor hyperactivity, balance disorder, abnormal coordination, attention disturbance 
Very rare (less than 0.01%): Neuroleptic malignant syndrome, cerebrovascular disorder, head titubation 
Frequency not reported: Vertigo, dysarthria, movement disorder, cerebrovascular accident, speech disorder, hypoesthesia, convulsion, paresthesia
Postmarketing reports: Dysgeusia

Cardiovascular

Common (1% to 10%): Tachycardia, palpitations, orthostatic hypotension, hypotension
hypertension, peripheral edema, chest pain
Uncommon (0.1% to 1%): ECG QT prolonged, bundle branch block right, flushing
Frequency not reported: bradycardia, atrioventricular block, bundle branch block left, abnormal ECG
Postmarketing reports: Atrial fibrillation, deep vein thrombosis, cardiopulmonary arrest

Endocrine

Common (1% to 10%): Hyperprolactinemia
Uncommon (0.1% to 1%): Gynecomastia, galactorrhea, breast pain, breast discomfort
Rare (less than 0.1%): Inappropriate antidiuretic hormone secretion, breast enlargement, breast discharge, breast engorgement
Postmarketing reports: Precocious puberty

Genitourinary

Risperidone is associated with higher levels of prolactin elevation than other antipsychotic drugs. Hyperprolactinemia may suppress hypothalamic gonadotropin-releasing hormone (GnRH) resulting in reduced pituitary gonadotropin secretion and in turn inhibit reproductive function by impairing gonadal steroidogenesis. Galactorrhea, amenorrhea, gynecomastia, and impotence have been reported in patients receiving prolactin-elevating compounds.

Very common (10% or more): Enuresis (16%) 
Common (1% to 10%): Urinary incontinence, urinary tract infection
Uncommon (0.1% to 1%): Amenorrhea, urinary retention, dysuria, pollakiuria, erectile dysfunction, ejaculation disorder, menstrual disorder, sexual dysfunction, vaginal discharge, cystitis
Rare (less than 0.1%): Delayed menstruation, 
Frequency not reported: Retrograde ejaculation, ejaculation failure, libido decreased, anorgasmia
Postmarketing reports: Priapism, urinary retention

Gastrointestinal

Very common (10% or more): Nausea (16%), vomiting (20%), constipation (17%), abdominal pain (16%)
Common (1% to 10%): Dyspepsia, dysphagia, dry mouth, salivary hypersecretion, diarrhea, stomach discomfort
Uncommon (0.1% to 1%): Toothache, gastroenteritis, flatulence
Rare (less than 0.1%): Pancreatitis, swollen tongue, cheilitis
Frequency not reported: Aptyalism, fecaloma
Postmarketing reports: Ileus

Hepatic

Uncommon (0.1% to 1%): Increased gamma-glutamyltransferase, hepatic enzyme increases
Rare (less than 0.1%): Jaundice
Frequency not reported: Transaminases increased

Psychiatric

Very common (10% or more): Insomnia (32%), anxiety (16%)
Uncommon (0.1% to 1%): Nervousness
Rare (less than 0.1%): Mania, confusional state, nightmare
Very rare (less than 0.01%): Blunted affect
Frequency not reported: Agitation, sleep disorder, listlessness, depression

Ocular

Common (1% to 10%): Blurred vision, conjunctivitis
Uncommon (0.1% to 1%): Photophobia, dry eye, lacrimation increased,
Rare (less than 0.1%): Glaucoma, eye movement disorder, eyelid margin crusting
Frequency not reported: Ocular hyperemia, eye discharge, eye rolling, eyelid edema, eyelid swelling, visual acuity reduced, eye infection, blepharospasm
Postmarketing reports: Floppy iris syndrome, retinal artery occlusion

Metabolic

Very common (10% or more): Increased appetite (up to 44%), 
Common (1% to 10%): Increased weight, decreased appetite
Uncommon (0.1% to 1%): Diabetes mellitus, hyperglycemia, polydipsia, weight decreased, anorexia, increased cholesterol, 
Rare (less than 0.1%): Hypoglycemia, increased triglycerides, 
Very rare (less than 0.01%): Diabetic coma
Postmarketing reports: Diabetic ketoacidosis, hyperinsulinemia, water intoxication, aggravated diabetes mellitus

Respiratory

Very common (10% or more): Nasopharyngitis (up to 19%), cough (up to 17%), rhinorrhea (up to 12%)
Common (1% to 10%): Upper respiratory tract infection, rhinitis, sinusitis, nasal congestion, dyspnea, pharyngolaryngeal pain 
Uncommon (0.1% to 1%): Epistaxis, aspiration pneumonia, pulmonary congestion, rales, wheezing dysphonia, tonsillitis
Rare (less than 0.1%): Hyperventilation
Frequency not reported: Tonsillitis, bronchitis, pharyngitis, nasal edema, pneumonia, pharyngitis, bronchitis, bronchopneumonia 
Postmarketing reports: Pulmonary embolism, sleep apnea syndrome

Other

Very common (10% or more): Fatigue (up to 31%), Pyrexia (up to 16%), 
Common (1% to 10%): Asthenia, thirst, 
Rare (less than 0.1%): Chills, 
Very rare (less than 0.01%): Hypothermia, decreased body temperature, peripheral coldness, drug withdrawal syndrome, drug withdrawal in neonate
Frequency not reported: Ear pain, malaise, feeling abnormal, Influenza-like illness, ear infection, otitis media, tinnitus 
Postmarketing reports: Sudden death, drug withdrawal syndrome,

Dermatologic

Common (1% to 10%): Rash, erythema, dry skin, acne, dandruff
Uncommon (0.1% to 1%): Seborrheic dermatitis, hyperkeratosis, urticaria, pruritus, alopecia, eczema, skin discoloration, skin lesion, skin disorder
Rare (less than 0.1%): Drug eruption
Postmarketing reports: Angioedema

Musculoskeletal

Common (1% to 10%): Back pain, arthralgia, extremity pain, muscle spasms
Uncommon (0.1% to 1%): Myalgia, neck pain, increased creatine phosphokinase, joint stiffness, joint swelling, abnormal posture, muscular weakness
Very rare (less than 0.01%): Rhabdomyolysis

Hypersensitivity

There have been post marketing reports of anaphylactic reaction in patients receiving long-acting injection who had previously tolerated oral risperidone.

Uncommon (0.1% to 1%): Hypersensitivity
Postmarketing reports: Anaphylactic reaction

Hematologic

Uncommon (0.1% to 1%): Neutropenia, WBC decreased, thrombocytopenia, anemia, decreased hematocrit, increased eosinophil count
Frequency not reported: Granulocytopenia, decreased hemoglobin, 
Postmarketing reports: Agranulocytosis, thrombotic thrombocytopenic purpura

Immunologic

Uncommon (0.1% to 1%): Onychomycosis, acarodermatitis

Oncologic

Postmarketing reports: Pituitary adenoma