Paliperidone Eg 150 Mg (Paliperidone)

Paliperidone is an atypical antipsychotic that modulates dopamine and serotonin pathways in psychotic disorders.

• Schizophrenia: Reduces positive and negative symptoms and helps prevent relapse.
• Schizoaffective disorder: Controls mood swings and psychotic features.
• Maintenance therapy: Supports long‑term stability after acute symptom control.

• Paliperidone acts as a potent antagonist at dopamine D2 and serotonin 5‑HT2A receptors, with additional activity at α‑adrenergic and histamine H1 receptors. By blocking D2 receptors in mesolimbic pathways, it reduces psychotic symptoms, while 5‑HT2A antagonism helps balance dopamine activity and improves mood and cognition.

Adverse reactions to paliperidone vary in frequency and severity.

Common Side Effects

• Akathisia: Restlessness and an urge to move.
• Weight gain: Increased appetite leading to modest weight increase.
• Somnolence: Drowsiness or fatigue.
• Dry mouth: Reduced salivation.
• Constipation: Decreased bowel motility.
• Extrapyramidal symptoms: Tremor, rigidity, or bradykinesia.

Serious or Rare Side Effects

• Neuroleptic malignant syndrome: Life‑threatening reaction with fever and muscle rigidity.
• Tardive dyskinesia: Persistent involuntary movements.
• Seizures: Increased risk, especially at higher doses.
• Orthostatic hypotension: Sudden drop in blood pressure upon standing.
• Hyperglycaemia: Elevated blood glucose levels.
• QT prolongation: Potential cardiac rhythm disturbance.

When prescribing paliperidone, clinicians should consider several safety aspects.

• Cardiac monitoring: Baseline and periodic ECGs for patients with cardiac risk factors.
• Metabolic assessment: Monitor weight, glucose, and lipid levels regularly.
• CNS effects: Evaluate for signs of sedation, dizziness, or movement disorders.
• Pregnancy: Use only if the potential benefit justifies the potential risk to the fetus.
• Renal function: Adjust dose in patients with impaired kidney function.
• Store at ambient temperature: Keep below 25 °C in the original packaging, protected from moisture.

Paliperidone may interact with other medicines, requiring attention to the interaction severity.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole): May increase paliperidone plasma levels.
• CNS depressants (e.g., benzodiazepines): May enhance sedation and respiratory depression.

Moderate Interactions (Monitor Closely)

• Antihypertensives: May potentiate orthostatic hypotension.
• Anticholinergic agents: May worsen dry mouth and constipation.
• Lithium: May increase risk of neurotoxic effects.
• NSAIDs: May raise the risk of bleeding when combined with antiplatelet therapy.