Risperidone-Associated Hypocalcemia
2010; American Psychiatric Association; Volume: 167; Issue: 12 Linguagem: Italiano
10.1176/appi.ajp.2010.10071003
ISSN1535-7228
AutoresDragan Milovanović, Vladimir Janjić, Nenad Zornić, Slavica Djukic Dejanovic, Slobodan Јаnkovic,
Tópico(s)Schizophrenia research and treatment
ResumoBack to table of contents Previous article Next article Communications and UpdatesFull AccessRisperidone-Associated HypocalcemiaDragan R. Milovanovic, M.D., Ph.D., Vladimir Janjic, M.D., M.Sc., Nenad Zornic, M.D., M.Sc., Slavica Djukic Dejanovic, M.D., Ph.D., and Slobodan M. Jankovic, M.D., Ph.D.Dragan R. MilovanovicKragujevac, Serbia, M.D., Ph.D., Vladimir JanjicKragujevac, Serbia, M.D., M.Sc., Nenad ZornicKragujevac, Serbia, M.D., M.Sc., Slavica Djukic DejanovicKragujevac, Serbia, M.D., Ph.D., and Slobodan M. JankovicKragujevac, Serbia, M.D., Ph.D.Published Online:1 Dec 2010https://doi.org/10.1176/appi.ajp.2010.10071003AboutSectionsView articleSupplemental MaterialPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleTo the Editor: Drug-induced electrolyte disturbances have considerable implications. In our recent research dealing with this topic (1), an association between hypocalcemia and drug treatment was noted in a small subset of risperidone users. We then retrieved all medical files in our psychiatry clinic and examined adult patients with at least one measurement of serum calcium, regardless of diagnosis/drug therapy, excluding those with obvious risks for electrolyte disturbances.Finally, 1,320 record sets were derived from 1,245 patients (see the data supplement accompanying the online version of this letter). Risperidone users had more frequent incidence of hypocalcemia (≤2.1 mmol/l) (N=50/328) than comparison subjects (N=19/973) (odds ratio=9.21, 95% confidence interval [CI]=5.34–15.88, χ2=88.4, df=1, p<0.001). The mean calcemia level was significantly lower in the risperidone group (2.24 mmol/l [SD=0.13] vs. 2.33 mmol/l [SD=0.12], t=−11.7, df=1318, p<0.001). Additionally, there was significant correlation between the risperidone dose (mean daily dose: 2.5 mg [SD=1.2], 95% CI=2.4–2.8) and the serum calcium level (F=98.8, df=1, p<0.001; rs=−0.299, p<0.001), with the lowest concentrations at approximately 3 mg (Figure 1). Multivariable logistic regression, with confounders well-documented in the source data (age, gender, current drug treatment, data sets) (see the data supplement), confirmed independent association of risperidone and hypocalcemia (adjusted odds ratio=9.21, 95% CI=5.02–17.81, df=1, p<0.001). Both in the total number of hypocalcemic subjects (N=73) and in those with hypocalcemia within 99 percentiles (N=69), no significant association with any other study variable was found.FIGURE 1. Correlation Between Risperidone Daily Dose and Serum Calcium Levels in Adult PatientsPresently, it is not known whether the association has causal relationships. In addition, our method does have some shortcomings (e.g., possibility of selection bias), although we utilized a fairly large sample size, with the finding being stable on different statistics. However, correlation of calcemia level with risperidone dose and literature data probably justifies additional research of possible causality. Risperidone, as well as other antipsychotics, can induce hyperprolactinemia and hypogonadism (2), synthesis of calcium binding proteins in the tissues (3), and changes in calcium-dependent signaling pathways (4), which could cause a calcium-depleted state and/or trigger calcium redistribution within body compartments. Individuals treated with antipsychotics have small but variable risks of hip fracture (5). With additional risks, even small disturbances of calcium homeostasis could make this population prone to osteoporosis and increase the probability of fractures.Kragujevac, SerbiaThe authors report no financial relationships with commercial interests.The authors thank V. Janjic, N. Zornic, and their associates for collecting study data.This letter was accepted for publication in September 2010.References1. Zornic N , Radojevic DJ , Jankovic S , Djuric D , Varjacic M , Simic VD , Milovanovic DR : Monitoring of drug-associated electrolyte disturbances in a hospital. Pharmacoepidemiol Drug Saf 2009; 18: 1026–1033Crossref, Medline, Google Scholar2. Kishimoto T , Watanabe K , Shimada N , Makita K , Yagi G , Kashima H : Antipsychotic-induced hyperprolactinemia inhibits the hypothalamo-pituitary-gonadal axis and reduces bone mineral density in male patients with schizophrenia. J Clin Psychiatry 2008; 69: 385–391Crossref, Medline, Google Scholar3. 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J Clin Psychiatry 2007; 68: 929–934Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byAssociation between Vitamin D and Cognitive Deficiency in Alcohol Dependence14 September 2022 | Healthcare, Vol. 10, No. 9Journal of Nutritional Science and Vitaminology, Vol. 63, No. 2Psychiatry Investigation, Vol. 13, No. 1Physiological Reports, Vol. 1, No. 3, Vol. 34 Volume 167Issue 12 December 2010Pages 1533-1534 Metrics PDF download History Accepted 1 September 2010 Published online 1 December 2010 Published in print 1 December 2010
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