Five Month-Persistent Extrapyramidal Symptoms following a Single Injection of Paliperidone Palmitate: A Case Report

Abstract

Long-acting injectable (LAI) antipsychotics are useful in the treatments for schizophrenic patients with poor adherence due to their maintaining feature of therapeutic plasma level without daily administrations. However, their long-lasting property can cause complicated problems such as a long-lasting side effect. We report a patient who experienced LAI-induced extrapyramidal symptoms (EPSs) for 5 months after a single injection. During that period, every trial to ameliorate this condition turned out to be a failure. The 3-month formulation of paliperidone palmitate is now close at hand. We have to be aware of possible long-lasting adverse events and confirm the tolerability to LAI before use.

Accidental Overdose of Paliperidone Palmitate

“…Paliperidone is not metabolized by CYP 2D6 cytochrome system [3]. The nanocrystal molecules which make up the Paliperidone Palmitate suspension also allow it to undergo slow dissolution, yielding a half-life of 25–49 days [1, 4]. Treatment-emergent adverse effects (TEAEs) occurring more frequently in the Paliperidone Palmitate group than in the placebo group included insomnia, headache, dizziness, sedation, vomiting, injection site pain, extremity pain, myalgia, and extrapyramidal symptoms [4].…”

“…Long-acting injectable (LAI) antipsychotics are useful in the treatment of schizophrenic patients with poor medication adherence due to their maintaining feature of therapeutic plasma level without daily administration. However, their long-lasting property can cause complicated long-lasting side effects [1]. Paliperidone Palmitate is one of the long-acting injectable (LAI) antipsychotic drugs used for schizophrenic patients with poor medication adherence.…”

“…Paliperidone Palmitate is one of the long-acting injectable (LAI) antipsychotic drugs used for schizophrenic patients with poor medication adherence. It has the benefit of maintaining a therapeutic plasma level with a four-week interval of injections [1]. Long-acting injectable antipsychotics help to achieve better adherence by replacing the need for taking daily oral antipsychotic medication.…”

Long-lasting extrapyramidal symptoms after multiple injections of paliperidone palmitate to treat schizophrenia

“…To the best of our knowledge, only a single case study has reported that PP induced 5-month persistent EPSs after a single injection. 10 Oral paliperidone extended-release is generally an effective and well-tolerated therapy 13 and one of the first-line drugs to treat patients with schizophrenia. The incidence rates of EPSs, except for hyperkinesia, were found to be lower with PP than with oral paliperidone.…”

“…To the best of our knowledge, only one previous case study reported that PP induced EPSs for 5 months after a single injection. 10 No studies to date, however, have reported the background of patients with schizophrenia in the case of PP-induced EPSs after 6 months. Consequently, this report also addresses the causes of EPSs by using several imaging techniques, namely magnetic resonance imaging (MRI) and dopamine transporter (DaT) scans, in the case of PP-induced EPSs in a patient with schizophrenia.…”