Two case reports of nasal congestion side effect with oral risperidone

Risperidone is one of the most commonly used antipsychotic in Child and Adolescent Psychiatry. In two reports, the symptom of nasal congestion emerged within a few hours following risperidone use and disappeared after discontinuation of the drug. The first case was a 15-year-old-boy, who was brought in for aggression, irritability, fears, forgetfulness, attention problems, verbal violence to his friends and teachers. He was given a diagnosis of Attention deficit hyperactivity disorder (ADHD) and Oppositional Defiant Disorder (ODD). He was started on OROS MPH 27 mg/day (0.6 mg/kg/day) and risperidone 1 mg/day. All of the symptoms showed much improvement but there was nasal congestion after taking risperidone. In the days when he forgot to take medication, the problem did not repeat. He used to take an antihistaminic after taking risperidone and it had solved the problem. The second case was a 12-year-old girl was brought for attention deficit, irritability, aggression, anxiety. She had been diagnosed with Attention Deficit Disorder (ADD) and atomoxetine 25 mg/day and risperidone 0.25 ml/day was started. She noticed that 30-60 minutes after taking the risperidone her nose blocked. The next two days she did not take risperidone while taking atomoxetine and she realized that her nose did not blocked. The clinician should be aware of this side effect and counsel the children/adolescents and their families about its occurrence in order to improve the adaptation of risperidone treatment.