Paliperidone: a new extended-release oral atypical antipsychotic

Paliperidone extended release (ER) is the most recent atypical antipsychotic to become available for the treatment of schizophrenia. It has a unique extended-release delivery system, allowing once/day dosing with steady plasma concentrations of the medication. Several randomized, double-blinded, placebo-controlled trials have shown paliperidone ER to be efficacious in the management of acute schizophrenia as well as for the prevention of symptom recurrence when compared with placebo. Patients in the treatment groups receiving daily doses ranging from 3 to 12 mg displayed generalized symptom improvement using the Positive and Negative Syndrome Scale (PANSS) and improved functioning on the Personal and Social Performance Scale. Paliperidone ER has been shown to be generally safe and tolerable. At its recommended dose of 6 mg daily, the reported extrapyramidal symptom adverse events are similar to placebo, and weight gain is very modest. However, at higher doses, weight gain and extrapyramidal symptoms are more elevated. Paliperidone ER has the potential to offer advantages over its parent compound and other second generation agents, and may aid in ensuring compliance among persons with schizophrenia. At present, there are no published data from a comparative trial with paliperidone ER versus its parent compound or other second-generation antipsychotic agents.