Home Drug Guide Paliperidone

Drug Guide

Generic Name

Paliperidone

Brand Names Invega

Classification

Therapeutic: Antipsychotic, Mood Stabilizer

Pharmacological: Atypical Antipsychotic

FDA Approved Indications

  • Schizophrenia in adults and adolescents (ages 12 and older)
  • Schizoaffective disorder in adults

Mechanism of Action

Paliperidone is an atypical antipsychotic that primarily acts as an antagonist at dopamine D2 and serotonin 5-HT2A receptors, which helps to balance neurotransmitters in the brain and reduce psychotic symptoms.

Dosage and Administration

Adult: Starting dose is typically 6 mg once daily, titrated up to 12 mg as needed based on response and tolerability.

Pediatric: Approved for adolescents 12 and older; doses vary based on individual response.

Geriatric: Use with caution; start at lower doses due to increased sensitivity.

Renal Impairment: Reduce dose in patients with moderate to severe renal impairment.

Hepatic Impairment: No dose adjustment needed for mild to moderate hepatic impairment.

Pharmacokinetics

Absorption: Well absorbed orally, bioavailability approximately 100%.

Distribution: Begins within an hour of administration, widely distributed.

Metabolism: Minimal hepatic metabolism; primarily excreted unchanged in urine.

Excretion: Excreted mainly through urine, with some fecal elimination.

Half Life: Approximately 23 hours, allowing for once-daily dosing.

Contraindications

  • Hypersensitivity to paliperidone or any components of the formulation.

Precautions

  • Use cautiously in patients with cardiovascular disease, cerebrovascular disease, or a history of seizures.
  • Risk of metabolic syndrome; monitor weight, glucose, and lipid levels.
  • Evaluate for extrapyramidal symptoms and tardive dyskinesia.

Adverse Reactions - Common

  • Akathisia (Occasional)
  • Headache (Common)
  • Sleep disturbance (Common)
  • Dizziness (Common)
  • Sedation (Common)

Adverse Reactions - Serious

  • Neuroleptic Malignant Syndrome (Rare)
  • Extrapyramidal Symptoms (Uncommon)
  • QT prolongation (Uncommon)
  • Hyperglycemia / Diabetes Mellitus (Less common)
  • Leukopenia / Neutropenia (Rare)

Drug-Drug Interactions

  • Other central nervous system depressants, medications prolonging QT interval, drugs affecting renal function.

Drug-Food Interactions

  • High-fat meals may delay absorption.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mental status, risk of falls, metabolic parameters, cardiovascular status, weight, glucose, lipids, and signs of extrapyramidal symptoms.

Diagnoses:

  • Risk for falls, related to dizziness or sedation.
  • Impaired skin integrity, related to possible sedation or orthostatic hypotension.

Implementation: Administer once daily, monitor for side effects, educate patient about potential adverse effects, especially signs of metabolic changes and movement disorders.

Evaluation: Assess efficacy of symptom control and monitor for side effects regularly.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any signs of movement issues, fever, or severe side effects promptly.
  • Maintain regular follow-up appointments for metabolic monitoring.
  • Advise against abrupt discontinuation.

Special Considerations

Black Box Warnings:

  • Increased risk of mortality in elderly patients with dementia-related psychosis.

Genetic Factors: Potential genetic predisposition to tardive dyskinesia and metabolic adverse effects.

Lab Test Interference: May affect blood glucose and lipid measurements.

Overdose Management

Signs/Symptoms: Dizziness, tachycardia, sedation, extrapyramidal symptoms, hypotension, sedation.

Treatment: Supportive care, monitor cardiac function, and provide symptomatic treatment. Dialysis is not effective for drug removal.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable under recommended storage conditions; check expiration date regularly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.