Q:  Edema & BP Meds

Ever seen anyone with serious peripheral edema (and the blood pressure to go with it) from their med cocktail?  I tend to be one of those people who gets weird side effects from many meds, processes some meds weirdly (I can't achieve a blood level of over 50 on regular depakote.  Depakote er let me reach a therapeutic level but I have to be over 130 for a good effect.  This is true with most meds).  I recently started risperdal, swelled up and developed sudden hypertension when the dose was increased at 2 weeks to .75 mgs.  I stopped it immediately.  Lasix did not do much to get the fluid off; don't know if they didn't give me enough or what.  But I've been off for weeks now and still have +2 edema.  At times I have puffy hands and arms and face as well.  My weight went down 15 lbs in 4 days but is now back up concurrent with more swelling.  The only things that help are elevating my legs which isn't practical and just not possible given that I'm a bit agitated now   which is why I was taking risperdal to begin with, and eating little to no salt, which I don't think I'm supposed to do because I'm on lithium.

I'm taking depakote, lithium (again high levels--1.1 or 1.2 I think), remeron (60 mgs), ativan .5 mg, and provigil.  I know it's not the theoretically best cocktail in terms of stability, but for me, this has been arrived at scientifically after many, many failures.  It's still not ideal, partly because there is no give room anywhere (hence the need for risperdal when I started cycling), but years of combos have resulted in only this one giving me really good stability.  I'm scared to change things but clearly something needs to change as I miss having ankles.

I can't find much about this particular problem. 

Thanks
 

Dear Puffed -- 
Sounds very tricky. I have some patients like this as well: once you work out the combinations it gets pretty hard to think about having to change one. Risperidone does have "edema" (swelling with fluid, particularly legs and ankles and fingers) as a reported side effect ("Infrequent" listing on the product information, page 5). I've seen this with Zyprexa somewhat more often I think, but then I use Zyprexa (briefly, as a temporary strategy) more often.  In that case, the swelling has subsided in  some people who chose to continue it.  But we can't assume that the swelling with Zyprexa is the same as with risperidone or that it might go away. Just wanted you to know that you had some company there. 

Dr. Phelps

Published August, 2005