Fatal cardiac event following initiation of risperidone therapy

OBJECTIVE: To describe a patient who developed fatal pulseless electrical activity following treatment with risperidone. CASE SUMMARY: A 34-year-old white woman with no history of cardiac disease was initiated on risperidone therapy for an acute exacerbation of chronic schizophrenia. The patient developed postural hypotension and the risperidone dosage was held at 2 mg bid. On day 5 of risperidone therapy, the patient developed cardiac arrest and was treated for pulseless electrical activity. Her electrocardiogram revealed a prolonged QRS interval of 160 msec and an abnormal QTc interval of 480 msec. Despite resuscitative efforts, the patient became asystolic and was pronounced dead. DISCUSSION: Adverse cardiac events are rarely associated with risperidone therapy. Prolongation of the QRS and QTc intervals have been reported to occur following two cases of presumed risperidone overdose and also in 8 of 380 patients in a double-blind study reported by the manufacturer. Although other possibilities exists, risperidone cannot be ruled out as the cause of the patient's fatal episode of pulseless electrical activity. CONCLUSIONS: Prolongation of the QTc interval with severe adverse effects remains a possibility with the use of risperidone.