Accidental Overdose of Paliperidone Palmitate

Abstract

Long-acting injectable (LAI) antipsychotics first introduced in 1960s are useful in the treatment of schizophrenic patients with poor medication adherence due to their maintaining feature of therapeutic plasma level without daily administration. Paliperidone Palmitate is one of such LAI antipsychotic drugs used due to its benefit of maintaining a therapeutic plasma level with four-week interval of injections. We report the case of a 21-year-old male with a history of mental illness that presented with selective mutism, disorganized speech, thought process and behavior, and auditory hallucinations who accidentally received 624 mg Paliperidone Palmitate intramuscularly with no reported side effects after 2 weeks of monitoring and observation. Paliperidone is a D2, 5HT2A receptor antagonist with additional antagonist activity at α-1 and α-2, H-1 receptor sites, and four metabolic pathways identified for its metabolism. Studies have reported adverse effects such as acute dystonia, acute renal failure, and cardiovascular abnormalities with Paliperidone overdose; however there is no reported literature on Paliperidone Palmitate overdose, though there have been reported cases of Paliperidone Palmitate side effects of hypersexuality and angioedema with the standard dose.

Acute Kidney Injury because of Implanted Tobramycin Pellets

“…In toxicology, the problem is frequently encountered with unintentional overdose of injectable long-acting antipsychotics and pose significant challenge because it is difficult to enhance the elimination or stop the absorption. 13 In a clinical context, the case report attribute with important knowledge and highlights the importance of quick action and multiple treatments with dialysis. Furthermore, this case underlines the importance of cautious administration of intraosseous antibiotics.…”

Clinical management of medication overdose: Three-monthly paliperidone palimitate injectable medication

“…The literature is scant regarding long-acting injectable antipsychotic medication overdose and its clinical management. Although there has been a report in the literature (Ojimba et al, 2019) of a patient inadvertently receiving multiple one-monthly paliperidone (Sustenna) in close sequence, this may be the first reported case of an inadvertent multiple three-monthly injection, fortunately with no adverse outcomes.…”

Physico-Chemical Characterization of Paliperidone Palmitate and Compatibility Studies with its Pharmaceutical Excipients

“…Drug-excipient compatibility studies during the formulation development is a significant process in getting to know about the physical and chemical interaction between the substance and excipients [6][7][8]. This process of knowing the in compatibility, by comparing the thermal curves of substance with pharmaceutical excipients used in formulation in the ratio of 1:1 for their evaluation.…”