Paliperidone/risperidone

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Hyperprolactinaemia and akathisia: 2 case reports In a case series, a 32-year-old woman developed hyperprolactinaemia and akathisia following treatment with paliperidone longacting injection (LAI) and a 48-year-old woman developed hyperprolactinaemia following treatment with paliperidone and risperidone LAIs [routes and durations of treatments to reaction onsets not stated; not all dosages and outcomes stated]. Case 1: A 32-year-old woman developed hyperprolactinaemia following treatment with paliperidone for schizoaffective disorder. Additionally, she developed akathisia following treatment with paliperidone. At a young age, she was diagnosed with developmental delay and later on, she developed a schizoaffective disorder of bipolar type. Her medical history was significant for autism spectrum disorder, encephalopathy, oesophageal stricture, asthma, Crohn’s disease. She had attempted suicide, which had resulted in an anoxic brain injury leading to neurocognitive disorder and she was subsequently admitted in a hospital in the USA. During hospitalisation in 2018, she refused her existing medication. Therefore, she received LAI of paliperidone [paliperidone palmitate] 234mg on 25 January 2018, to improve adherence. Shortly after initiating the loading dose process of paliperidone LAI, she developed adverse effects of severe akathisia and hyperprolactinaemia with a prolactin level of 138.9 ng/mL. Her akathisia was accompanied by increased agitation and aggression. She received other 2 LAIs of paliperidone; 156mg on 2 Feb 2018 and 78mg on 2 March 2018. In order to decrease LAI-induced hyperprolactinaemia, she was treated with aripiprazole, and LAI paliperidone treatment was stopped. She also received haloperidol, mirtazapine and trazodone concomitantly with aripiprazole. Subsequently, her prolactin level decreased gradually. Considering further decompensation and worsening symptoms, aripiprazole was switched to clozapine, which successfully decreased her psychosis and maintained prolactin level within normal range. Case 2: A 48-year-old woman developed hyperprolactinaemia following treatment with paliperidone and risperidone long-acting injections (LAI) to improve medication adherence in schizophrenia. Her medical history was significant for schizophrenia and nonadherence to psychotropic medications. Her concurrent conditions included, hypothyroidism managed with levothyroxine-sodium [levothyroxine] and hyperlipidaemia. During her fourth inpatient admission to a state hospital facility, she started refusing psychotropic medications and became increasingly paranoid. She was admitted to a community hospital and was initially treated with paliperidone and olanzapine to improve medication adherence. Later, she was shifted to a state hospital in the USA, where she first switched to LAI of paliperidone and subsequently to LAI of risperidone to improve compliance. Her LAI treatment was discontinued due to hyperprolactinaemia with a prolactin level of 275.4 ng/mL. In order to decrease LAI-induced hyperprolactinaemia, she w

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