Paliperidone palmitate: Once-monthly treatment option for schizophrenia
Fast onset of action and long half-life simplifies administration
Adverse events
Common side effects include insomnia (15%), anxiety (10%), and headaches (9%). Dizziness, agitation, gastrointestinal upset, hypotension, and urinary tract infection have been reported. Rarely, tachycardia, clinically nonsignificant QTc prolongation, and tardive dyskinesia occur. Increased prolactin levels have been observed, particularly in females. This drug should not be prescribed to pregnant or lactating women or elderly patients with dementia-related psychosis. In the 13-week trial, patients gained up to 3.3 lbs. Other adverse effects include allergic reactions, blood dyscrasias, elevated liver enzymes, lower seizure thresholds, body temperature dysregulation, neuroleptic malignant syndrome, dysphagia, and motor impairments.1
Clinically significant adverse effects were reported in 25% of paliperidone-treated subjects compared with 20% in the risperidone IM group. The discontinuation rate was 5% for paliperidone palmitate, compared with 3% for IM risperidone. Hyperkinesia with paliperidone (6%) was less prominent than with risperidone (10%).3
Drug brand names
- Carbamazepine • Tegretol
- Divalproex • Depakote
- Paliperidone • Invega
- Paliperidone palmitate • Invega Sustenna
- Risperidone IM • Risperdal Consta
Disclosure
Dr. Lindenmayer has received grant support from AstraZeneca, Otsuka, Pfizer Inc., Dainippon Sumitomo, Azur, Janssen, Eli Lilly and Company, and National Institute of Mental Health. He is a consultant to Eli Lilly and Company and Janssen. Drs. Sedky, Nazir, and Lippmann report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
Acknowledgments
The authors thank Dr. Roop Parlapalli, an observer physician at University of Louisville School of Medicine, for his editorial revision.
