Paliperidone

About Paliperidone

Paliperidone blocks dopamine D2 and serotonin 5-HT2A receptors, easing hallucinations, delusions and disordered thinking. Adults usually take 6 mg once a day in the morning, within a range of 3 to 12 mg; adolescents start at 3 mg. In schizoaffective disorder it is used alone or with a mood stabilizer or antidepressant. The tablet releases the drug slowly as it passes through the gut, so it is swallowed whole, never chewed, split or crushed, and the empty shell may appear in the stool, which is normal; it is not used in people with severe pre-existing narrowing of the gut.

The boxed warning says elderly people with dementia-related psychosis treated with antipsychotics have a higher risk of death, and it is not approved for them. Restlessness, tremor, stiffness and other movement effects, a fast heartbeat and sleepiness are the most common side effects; weight, blood sugar and cholesterol are monitored, as is prolactin, which it raises and which can cause breast changes and missed periods. Other warnings cover tardive dyskinesia, neuroleptic malignant syndrome, QT prolongation, low blood pressure on standing, low white blood cells, seizures and prolonged erections; it must not be taken by anyone allergic to paliperidone or risperidone.

The kidneys clear it, so the dose is cut in kidney impairment: in mild impairment the start is 3 mg and the most 6 mg a day, in moderate to severe impairment 3 mg every other day or 1.5 mg daily up to 3 mg, and it is not recommended when kidney function is very poor. The long-acting injections, given by a health professional, are Invega Sustenna monthly, Invega Trinza every three months after at least four months on Sustenna, and Invega Hafyera every six months.

Taking Paliperidone

How to take it

Once a day in the morning, with or without food, swallowed whole with liquid; do not chew, split or crush it. The shell may pass in the stool without meaning the dose was missed.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip it and carry on as usual. Do not take two doses to catch up.

Storage

At room temperature in a tightly closed container, away from heat and moisture, out of reach of children.

Interactions to know about

Carbamazepine and other strong CYP3A4 and P-glycoprotein inducers lower its levels, so the dose may need to rise. Medicines that prolong the QT interval are avoided with it, alcohol and sedatives add to drowsiness, blood pressure medicines add to dizziness on standing, and it can block the effect of levodopa.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Paliperidone differs from pharmacy to pharmacy

Generic paliperidone has many makers, but it costs pharmacies more than a commodity generic, so quotes differ widely by pharmacy and strength, and one 9 mg tablet is not priced the same as 6 mg plus 3 mg. A prescription that names Invega and blocks substitution is filled at the brand price; the injections are brand-only and priced separately.

Ways to pay less for Paliperidone without insurance

• Ask for generic substitution, and ask the pharmacy to quote the strength combinations that make up your dose.
• Ask for a ninety-day supply once you are stable; it is not a controlled substance.
• If cost is a barrier, ask the prescriber whether risperidone, an older generic the body converts to paliperidone, would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Paliperidone

1. 1.Is it normal to see the tablet shell in my stool?
2. 2.Is my dose adjusted for my kidney function?
3. 3.Which movement symptoms, fever or stiffness mean I should call?
4. 4.When will my weight, blood sugar, cholesterol and prolactin be checked?

Related medications