Footprints of an Adverse Effect: Olanzapine-related Pedal Edema

Abstract Olanzapine, a second-generation antipsychotic, is widely used in the management of schizophrenia and mood disorders due to its efficacy and relatively favorable extrapyramidal side effect profile. However, it is associated with various metabolic and vascular side effects. Peripheral edema is an uncommon but clinically relevant adverse effect that may be overlooked in routine psychiatric practice. A 43-year-old female diagnosed with schizophrenia developed bilateral pitting pedal edema following the initiation of olanzapine. The edema appeared in the absence of any systemic illness or concurrent medication use, and extensive evaluation ruled out renal, hepatic, cardiac, and endocrine causes. The edema resolved gradually after discontinuing olanzapine and switching to trifluoperazine, supporting a probable causal relationship as per the Naranjo Adverse Drug Reaction Probability Scale. This case underscores the importance of considering olanzapine as a potential etiology in patients with unexplained peripheral edema. Early recognition can prevent unnecessary investigations, improve medication adherence, and guide safer antipsychotic choices in susceptible individuals.