A Case of Extrapyramidal Symptoms Secondary to Long-Acting Injectable Paliperidone Palmitate
Received Date: November 20, 2019; Published Date: December 04, 2019
Paliperidone palmitate is a long-acting injectable formulation of the atypical antipsychotic paliperidone. The once-monthly injection is approved for acute and maintenance therapy of schizophrenia in adults. Extrapyramidal symptoms are a known adverse effect of antipsychotics; incidence rates of EPS with PP are up to 18%. Given its longer half-life and steady blood levels, PP-induced EPS can cause a sustained and serious functional impairment of several months’ duration, significantly impacting the quality of life. We report a case of severe combined EPS following the first injection of PP. Rapid improvement of symptoms occurred after providing a combination of diphenhydramine, trihexyphenidyl, diazepam, and carbidopa/levodopa.
Keywords: Paliperidone palmitate; Long-acting injectable; Side effects; Extrapyramidal symptoms; Carbidopa/levodopa
Abbreviations:PP: Paliperidone Palmitate; EPS: Extrapyramidal Symptoms; LAI: Long-Acting Injectable; NMS: Neuroleptic Malignant Syndrome; SAS: Simpson-Angus EPS Scale; ESRS: Extrapyramidal Symptom Rating Scale; XR: Extended Release; IM: Intramuscular