Paliperidone
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Weight gain, off-label use and lack of efficacy: 2 case reports In a case series, a 20-year-old man developed weight gain following off-label dosing frequency of paliperidone for schizophrenia, and a 31-year-old man experienced lack of efficacy following off-label dosing frequency of paliperidone for schizophrenia. Case 1: A 20-year-old man, who was admitted due to auditory hallucinations, insomnia, odd behaviour, disorganisation and incoherent speech, was diagnosed with schizophrenia. Three months later, he was discharged with the prescription of quetiapine and IM paliperidone [paliperidone palmitate] 150mg every 3 weeks (off-label dosing frequency of paliperidone). One year after hospital discharge, residual blood concentration of paliperidone was above the therapeutic window (i.e. at 240 nmol/L). Additionally, he experienced weight gain (80kg; a 36% increase in body weight) as a side effect of paliperidone therapy. Therefore, paliperidone dose was reduced to 150mg every 4 weeks. Also, the dose of quetapine was reduced. Approximately two years after discharge, his schizophrenia was in full remission. The residual blood concentration of paliperidone was 250 nmol/L, despite reduction in the paliperidone dose. Three years after discharge, his schizophrenia remained in remission [outcome of weight gain not stated]. Case 2: A 31-year-old man, who was hospitalised for schizophrenia, started receiving treatment with IM paliperidone [paliperidone palmitate] 150mg every 4 weeks for 3 months, followed by IM paliperidone [paliperidone palmitate] 150mg every 3 weeks for several months of hospitalisation (off-label dosing frequency of paliperidone). He was discharged on IM paliperidone [paliperidone palmitate] 150mg every 3 weeks. Thirteen months after discharge ( i.e. 2 years after switching to dosing every 3 weeks), he was again hospitalised due to lack of efficacy with paliperidone. He did not have any adverse effect associated with paliperidone. However, residual concentration of paliperidone was above the therapeutic window (i.e. at 610 nmol/L). Paliperidone was then replaced by clozapine. After a month of treatment with clozapine, he did not have any schizophrenic symptoms. Approximately one year after discharge, the dose of clozapine was increased due to irritability and paranoid symptoms. Approximately 18 months after discharge, he was re-hospitalised due to poor observance of clozapine. He was then sent to a longterm psychiatric unit. Cohen JY, et al. Serum Concentration of Paliperidone Palmitate Administered Every 3 Weeks. Psychopharmacology Bulletin 49: 57-62, No. 2, Jun 2019. Available from: 803505184 URL: https://www.researchgate.net/publication/334520706_Serum_Concentration_of_Paliperidone_Palmitate_Administered_Every_3_Weeks
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Reactions 3 Oct 2020 No. 1824
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