paliperidone-palmitate and Drug-Overdose

Topics: Antipsychotic Agents; Drug Overdose; Humans; Injections; Paliperidone Palmitate; Schizophrenia

Paliperidone is a relatively novel atypical antipsychotic drug that is currently used to treat schizophrenia in adolescents and adults. The drug was generated by combining the active metabolite of risperidone, 9-hydroxyrisperidone, with osmotic controlled-release oral administration system (OROS) technology. Due to its specific design, the drug has been identified as a different form, albeit an active metabolite of risperidone. Such distinction mainly manifests itself during pharmacokinetic processes, because paliperidone is not affected by CYP2D6 metabolism. On the other hand, this drug is regularly released for a period of 24 hours. Even though it is possible to reach relevant literature on the efficacy and safety of paliperidone use in detail, limited data regarding its toxicity exists. A review of the literature in that sense, has revealed a scarce number of case reports and a retrospective study existing. Bearing in mind the specific form and design of the drug, we have hypothesized its toxicity might cause diverse clinical presentations, in the face of overdose or poisoning. This might in turn, prompt us to switch our usual evaluation and intervention practices. With this case report, we have aimed to discuss delayed onset toxicity with paliperidone overdose in an adolescent case, due to a suicide attempt with excessive intake of the medication.

Topics: Administration, Oral; Adolescent; Antipsychotic Agents; Delayed-Action Preparations; Drug Overdose; Humans; Male; Paliperidone Palmitate; Suicide, Attempted; Time Factors

Topics: Blood Pressure; Dose-Response Relationship, Drug; Drug Overdose; Emergency Service, Hospital; Female; Heart Rate; Humans; Paliperidone Palmitate; Posture; Respiratory Rate; Tachycardia; Young Adult

We report a case of delirium with anticholinergic symptoms in a 19-year-old female patient with schizophrenia. On the day the symptoms emerged, the patient received olanzapine long-acting injection and a higher dose of paliperidone. We observed symptoms ranging from confusion to delirium as well as some anticholinergic symptoms. The delirium lasted 24 hours and was managed by intravenous fluid substitution and oral benzodiazepines. Olanzapine pamoate, paliperidone and cannabis are central nervous system (CNS) depressants, and their combination can increase the risks of CNS depression. In this case report, we review the symptoms of delirium in a case of antipsychotic overdose and provide general guidelines for managing these symptoms. We also review possible complications in combined use of cannabis, olanzapine and paliperidone.

Topics: Antipsychotic Agents; Benzodiazepines; Cannabis; Central Nervous System; Cholinergic Antagonists; Delirium; Drug Overdose; Female; Humans; Olanzapine; Paliperidone Palmitate; Schizophrenia; Treatment Outcome; Young Adult

Topics: Acidosis; Acute Kidney Injury; Adult; Anticholesteremic Agents; Antihypertensive Agents; Antipsychotic Agents; Atenolol; Blood Urea Nitrogen; Creatinine; Dose-Response Relationship, Drug; Drug Overdose; Drug Therapy, Combination; Humans; Isoxazoles; Male; Paliperidone Palmitate; Pyrimidines; Self Medication; Simvastatin

Paliperidone, or 9-hydroxy risperidone, is the newest atypical antipsychotic agent to be approved for use by the Food and Drug Administration. Despite being the primary active metabolite of risperidone, paliperidone differs in several ways from risperidone. The most notable difference is that paliperidone is formulated as an extended-release product. We present a case of a 14-year-old, 59-kg girl with a history of psychosis and major depressive disorder who developed toxicity after an ingestion of 180 mg (3.1 mg/kg) of paliperidone. This case is not only one of the first cases of paliperidone overdose described in the literature but also is unique in that it describes delayed onset of toxicity, as well as extended duration of symptoms.

Topics: Adolescent; Antipsychotic Agents; Delayed-Action Preparations; Drug Overdose; Electrocardiography; Female; Humans; Isoxazoles; Paliperidone Palmitate; Pyrimidines; Tachycardia; Time Factors

Paliperidone, a novel serotonin and dopamine antagonist, is one of the newest atypical antipsychotics on the market. It is an orally administered drug that is indicated for the treatment of schizophrenia, and is considered to be safe and well tolerated. A 37-year-old female with a long-standing history of schizophrenia had been taking paliperidone 12 mg d-1 for about 1.5 years. She overdosed on a total of 756 mg of paliperidone in response to auditory command hallucinations. She was promptly hospitalized, and fortunately did not suffer any major adverse clinical events, adverse laboratory parameters, or long lasting sequelae. Herein we discuss the inherent characteristics of paliperidone that limit the danger associated with overdosing.

Topics: Adult; Antipsychotic Agents; Drug Overdose; Female; Hospitalization; Humans; Isoxazoles; Paliperidone Palmitate; Pyrimidines; Schizophrenia; Treatment Outcome

For toxicological purposes, a HPLC assay was developed for the simultaneous determination of risperidone and 9-hydroxyrisperidone in human plasma. After a single-step liquid-liquid extraction, both compounds were separated on a C(18) column and measured at 280 nm. A good inter-assay accuracy (<116%) was achieved with inter-assay precision less than 12%. Quantification limits were 10 ng/ml. This rapid method (run time <5 min) is currently used for poison management.

Topics: Antipsychotic Agents; Chromatography, High Pressure Liquid; Drug Overdose; Humans; Isoxazoles; Paliperidone Palmitate; Pyrimidines; Reproducibility of Results; Risperidone; Sensitivity and Specificity