Risperidone-Associated Increase in Triglyceride Levels

“Mr. A” was a 27-year-old man who suffered from DSM-IV paranoid schizophrenia for 9 years and had been previously treated with perazine and flupentixole. Upon his hospitalization, the patient presented with normal triglyceride (97 mg/dl) and total cholesterol (121 mg/dl) levels (body weight: 98 kg; body mass index: 30.25 kg/m ² ). His exacerbated psychotic syndrome remitted after risperidone was increased to 8 mg per day (serum level: 6.4 μg/L). His scores on the Positive and Negative Syndrome Scale (PANSS) were as follows: positive subscale, 9; negative subscale, 11; and global psychopathology subscale, 19. After 12 weeks, we observed an exceptional increase in his triglyceride levels, up to 627 mg/dl, and a marked rise in his total cholesterol levels, up to 249 mg/dl. Mr. A’s uric acid level was slightly elevated, at 8.1 mg/dl. His fasting serum leptin was 14 μg/L, and his insulin level was 11 mU/L. His C-peptide level was 0.78 nmol/L, and his HbA1c level was 5.4%, both of which were normal. The patient’s body weight increased to 112 kg (body mass index: 34.57 kg/m ² ). After switching to aripiprazole, 45 mg per day, he experienced no change in body weight. However, significantly lower triglyceride and total cholesterol levels were observed during the subsequent 8 weeks (triglyceride level: 263 mg/dl; total cholesterol level: 104 mg/dl). Unfortunately, the patient’s symptoms worsened, with a PANSS global psychopathology subscale score of 60, a positive subscale score of 29, and negative subscale score of 39.

After intensive consultation, Mr. A agreed to the reintroduction of risperidone, 8 mg/day, and his psychosis remitted (PANSS scores: positive subscale=10; negative subscale=8; global subscale=18), but his lipid levels re-increased (triglyceride level: 512 mg/dl; total cholesterol level: 278 mg/dl), with his body weight at 114 kg and a body mass index of 35.18 kg/m ² . Consequently, we suggested adding bezafibrate, a fibrate drug for reducing hyperlipidemia.