Risperidone-Induced Weight Gain in Referred Children with Autism Spectrum Disorders

30 Dec

Risperidone, also known as Risperdal, is the one drug FDA approved for treatment of irritability and behavior issues some autistics have. According to Vincent Iannelli, M.D., at about.com, these include:

* aggression
* deliberate self-injury
* temper tantrums
* quickly changing moods

Risperidone is serious medicine, and as such has side effects that can occur. Again, according to Dr. Iannelli:

The most common side effects of taking Risperdal include drowsiness, constipation, fatigue and weight gain. The drowsiness is sometimes a ‘good’ side effect, as many kids who take Risperdal do not sleep well, which adds to their behavior problems during the day.

as well as

Ask your doctor about other less common, although more serious side effects, including neuroleptic malignant syndrome, tardive dyskinesia, and hyperglycemia and diabetes.

There are also questions as to whether Risperidone loses effectiveness with long term usage.

One of the most commonly discussed side effects is weight gain. A recent study gives preliminary findings indicating that this weight gain may be associated with the genetic makeup of the person taking the drug.

Here’s the abstract:

Risperidone-Induced Weight Gain in Referred Children with Autism Spectrum Disorders Is Associated with a Common Polymorphism in the 5-Hydroxytryptamine 2C Receptor Gene.

Hoekstra PJ, Troost PW, Lahuis BE, Mulder H, Mulder EJ, Franke B, Buitelaar JK, Anderson GM, Scahill L, Minderaa RB.

1 Department of Psychiatry, University Medical Center Groningen, University of Groningen , Groningen, The Netherlands .

Abstract Weight gain is an important adverse effect of risperidone, but predictors of significant weight gain have yet to be identified in pediatric patients. Here, we investigated differences between age- and gender-normed body mass index-standardized z scores at baseline and after 8 weeks of open-label, flexible-dose risperidone treatment (mean dose: 1.70?mg/day) in 32 youths with pervasive developmental disorder (mean age?=?8.74, range?=?5-16 years) in relation to -759C/T 5-hydroxytryptamine 2C receptor (HTR2C) promoter and rs1414334 HTR2C intragenic C/G alleles, along with gender, age, and risperidone dose, using repeated measures analyses of variance. Carriers of the HTR2C promoter T allele gained an average of 0.043?±?0.017 body mass index-standardized z scores (1.84?±?1.51?kg) versus 0.64?±?0.35 z (3.23?±?1.47?kg) for non-T-allele carriers (p?<?0.001). Presence of the rs1414334 C allele played no significant role. Further, weight gain appeared to be associated with younger age and higher doses of risperidone. The current preliminary findings suggest that the variant T allele of the -759C/T HTR2C promoter polymorphism is protective against risperidone-induced weight gain. Younger children and those treated with higher doses of risperidone may be at higher risk for weight gain.

Neurodiversity.com compiled a list of articles on Risperdone.

More information on the clinical trials of risperidone can be found in this article
Risperidone in the treatment of behavioral disorders associated with autism in children and adolescents.

Risperidone in the treatment of behavioral disorders associated with autism in children and adolescents.

Canitano R, Scandurra V.

Division of Child Neuropsychiatry, University Hospital of Siena Siena, Italy.

This is a review of the clinical trials investigating the efficacy and safety of risperidone in the treatment of children with autistic spectrum disorders (ASD). The main clinical characteristics are impairment in social skills, communication difficulties, repetitive movements and behaviors, including stereotypies. Pharmacotherapy is mainly directed at the so-called target symptoms, ie, behavioral disorders and the various kinds of repetitions associated with ASD. According to the available data, risperidone seems to be moderately efficacious and safe for treating behavioral disorders. 4 double blind controlled trial. 3 reanalysis studies, and 12 open studies have documented the role of risperidone in children with ASD. Controlled studies have been thoroughly considered in this review.

The paper is free online, and includes discussion of effectiveness and adverse reactions to the drug as well as a commentary on the unknown effect of long-term use on the developing brain.

5 Responses to “Risperidone-Induced Weight Gain in Referred Children with Autism Spectrum Disorders”

  1. farmwifetwo December 30, 2010 at 18:13 #

    1. Yes, it works and it works well for those issues listed above.
    2. Yes, on the weight gain.
    3. Yes, on proper monitoring.
    4. Yes, on better sleeping
    5. Yes, on the fact that it can and does “rebound”. BUT, as the child psych told us – need to know after it already happened – children on meds should have them removed every 6 to 12 mths for 2 to 4 weeks to see if they are still effective.

    6. It didn’t work to deal with a need for a lot of sensory input – sensory diet still works best – and in that case, sleeping actually deteriorated.

  2. Val December 30, 2010 at 18:36 #

    Risperdal and Lithium were last resort meds for my daughter who suffered from psychosis that looked like schizophrenia. She was refractory to treatment for several years until trying Lithium with Risperdal.

    Hist: My daughter worsened from moderate-severe autism (labeled at three years of age) to psychosis nos at ten. We had not medicated before the worsening and had utilized behavioral approach.

    She is a slow metabolizer of the 2D6 enzyme and so the risperdal had to be dosed in a thoughtful manner. Meaning small doses thought the daytime hours. Larger doses just two times a day did not work.

    She has a problem with weight but actually did develop that weight problem before having utilized meds. She might have Hashimotos and years of watching for that possibility verify such. She was not heavy in her earliest years but she was not too thin – and she barely ate. When she started eating like a normal person she began with the weight gain problems. The meds did make it worse though.

    We have been able to stabilize her weight by watching the carbs and sugar intake. She is always in motion and getting exercise – all her life actually – so the weight issue was not due to lack of exercise.

    Thanks for your article.

    Oh. Per Commenter: We did what she suggested. Tried taking my daughter off of the risperdal to see if she still required it. Not a good scene at all. But worth trying to settle if she still needed that risperdal.

  3. livsparents December 30, 2010 at 21:15 #

    “Risperidone is serious medicine”

    Now if we could get mainstream to heed that warning, we’d be in a better place. I have had at least one Dev Ped push us to put our child on this medication, her only qualm was the weight gain side effect. This for a child with NONE of the 4 symptoms you listed. I’ve seen countless other examples of very young children being put on this very powerful drug, for seemingly ‘minor’ behavioral issues.

    There are a plethora of people out there willing to jump on the pharma conspiracy bandwagon when it comes to the ridiculous; yet when it comes to truly legitimate ‘conspiracies’ they really seem to care less. Jannsen has all but put a “Think Autism…think Risperdal” poster in every devPed’s, psychiatrist’s and pedneuro’s office. The ‘target market’ for this drug has progressively gotten younger and I put the blame squarely on the sales forces of these companies for overplaying the autism card.

    I think there are some very legitimate reasons to have some on this drug; it can be a very important tool to help someone who is a danger to themselves or others and there have been many other things tried. But, since it is the only pill with an official FDA AUTISM tag on it, I see it becoming something a doctor reaches for first to get patients in and out of their door faster. Doctors are taught to ‘diagnose and prescribe’; they need to think beyond autism as a medical diagnosis that needs prescribing. Treat the issues that they are having and not the autism that they ‘have’.

    I hope that my experiences/perceptions are the exception and not the rule, but I fear that they are not.

  4. Joseph December 31, 2010 at 17:17 #

    I think the most serious side-effect of Risperidone is neuroleptic malignant syndrome — rare, but sometimes fatal.


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