Does Risperidol (risperidone) cause oral candidiasis (thrush)?

Does Risperidone Cause Oral Candidiasis (Thrush)?

No, risperidone is not known to cause oral candidiasis (thrush). Based on the available medical evidence, there is no established association between risperidone use and the development of oral thrush.

Understanding Oral Candidiasis

Oral candidiasis (thrush) is an opportunistic fungal infection of the oral cavity caused primarily by Candida species, with C. albicans accounting for approximately 76.8% of infections 1. It presents as:

• Painless, creamy white, plaque-like lesions on the buccal or oropharyngeal mucosa or tongue
• Lesions that can be easily scraped off with a tongue depressor
• Sometimes as erythematous patches without white plaques
• Occasionally with angular cheilitis (cracks at the corners of the mouth)

Risk Factors for Oral Candidiasis

The development of oral candidiasis is associated with specific risk factors that are well-documented in clinical guidelines:

• Immunosuppression: HIV infection, with prevalence of 35% in this population 1
• Medication use: Antibiotics, corticosteroids 2
• Salivary gland dysfunction: Dry mouth (xerostomia) increases risk by 11.5% 1
• Local factors: Denture use, poor oral hygiene 3
• Systemic conditions: Diabetes, malnutrition 3

Risperidone and Side Effects

Risperidone is an atypical antipsychotic medication used for various psychiatric conditions. While it has numerous documented side effects, oral candidiasis is not among them. The known side effects of risperidone include:

• Extrapyramidal symptoms (when dose >6 mg/24h)
• Orthostatic hypotension
• Drowsiness, dizziness
• Insomnia, agitation, anxiety 2
• Urinary incontinence (in some cases) 4

Clinical Implications

For patients on risperidone who develop oral candidiasis:

1. Look for other risk factors: The thrush is likely due to other causes such as:

   • Concomitant medication use (especially antibiotics or corticosteroids)
   • Underlying immunosuppression
   • Poor oral hygiene
   • Xerostomia (which can be caused by multiple medications)

2. Treatment approach: For patients with oral candidiasis, regardless of risperidone use:

   • Topical antifungals: Clotrimazole troches, nystatin suspension/pastilles 2
   • Oral fluconazole: 100-200 mg daily for 7-14 days for moderate to severe disease 2
   • Single-dose fluconazole 150 mg has shown 96.5% improvement in palliative care patients 5

3. Prevention measures:

   • Maintain good oral hygiene
   • Regular dental care
   • Proper denture cleaning if applicable
   • Address modifiable risk factors

Conclusion

If a patient on risperidone develops oral candidiasis, the clinician should investigate other risk factors rather than attributing it to risperidone use. The treatment should focus on appropriate antifungal therapy based on severity, while addressing underlying predisposing factors.