Paliperidone Palmitate Toxicity in Chronic Kidney Disease: A Case of Life-Threatening Autonomic Failure

Long-acting injectable antipsychotics (LAIs) are among the treatment options available for patients with schizophrenia. This case report discusses a case of a 50-year-old patient with a complex medical background, including chronic kidney disease (CKD), who presented clinically unwell with autonomic instability requiring cardio-respiratory support. The patient was on three-monthly doses of long-acting injectable antipsychotics; the last dose was administered two months ago before the presentation. The patient's creatinine clearance (CrCl) at the time of admission was 12 ml/min, and the estimated glomerular filtration rate (eGFR) was 9 ml/min/1.73 m². This case highlights the autonomic side effects of long-acting injectable antipsychotics (LAIs) in a patient with chronic kidney disease (CKD), underscoring the need for close therapeutic drug monitoring and consideration of alternative treatment approaches in patients with moderate to severe renal dysfunction due to the risk of drug accumulation and toxicity.