Lingual Lesions With Orally Disintegrating Risperidone

To the Editor: There are reports of oral lesions occurring with the use of orally disintegrating atypical antipsychotic tablets. The reports of adverse reactions caused by orally disintegrating olanzapine indicate that mouth ulcerations and tongue edema are infrequent events, and glossitis and tongue discoloration are rare (1) . Paresthesia or anesthesia of the mouth, palate, or tongue; tongue discoloration; tongue edema; and taste loss have also been reported with the use of orally disintegrating mirtazapine (1, 2) . To our knowledge, no case of oral lesions associated with the use of orally disintegrating risperidone (Risperdal M-tab) has been reported. There is documentation of rare events of tongue discoloration, tongue edema, and gingivitis, but these are not specifically referenced to orally disintegrating risperidone (1) . We report two cases of lingual lesions occurring during treatment with orally disintegrating risperidone.

We identified no case reports of lingual lesions associated with the use of orally disintegrating risperidone (3) . In our reported cases, oral lesions resolved after switching to the swallow formulation. Hence, a possible explanation for the induction of oral lesions may be related to the mechanism of disintegration and formulation constituents (1) . These cases illustrate the risk of developing oral lesions when treating patients with orally disintegrating risperidone. Clinicians should be mindful of these potential adverse effects. Based on our experience, resolution of symptoms is probable after discontinuation of the orally disintegrating formulation; however, new concerns are raised regarding potential interference with treatment compliance. This may be noteworthy, since orally disintegrating risperidone is marketed as a possible means for enhancing medication compliance.