Appropriate Treatment for Incarcerated People with Schizophrenia - Episode 15

The Benefits of Paliperidone Palmitate for Schizophrenia

Peter Salgo, MD: There’s another product, a 3-month interval drug, composed of Invega [paliperidone palmitate] extended release. How does that compare with the drug we were discussing in terms of mechanisms of action, bioavailability, and half-life?

Mauricio Tohen, MD, DPH, MBA: It’s great that now we have drugs with a 3-month duration. It’s not for everybody, but there are some patients who will benefit profoundly.

Peter Salgo, MD: Can you compare these 2 drugs in terms of mechanism of action? Are they different?

Mauricio Tohen, MD, DPH, MBA: Simply put, the main difference is the duration.

Peter Salgo, MD: It’s a half-life issue, that’s all?

Mauricio Tohen, MD, DPH, MBA: The efficacy depends entirely on the patient.

Richard Jackson, MD: But they are different active compounds.

Peter Salgo, MD: Yes, how do they work?

Richard Jackson, MD: Abilify [aripiprazole], which is a partial agonist, so it’s more of a dopaminergic modulator; and the other is based on another agent.

Peter Salgo, MD: The paliperidone.

Richard Jackson, MD: Which is really related to Risperidal [risperidone]. So they’re going to have different adverse effect profiles and mechanisms, to some degree. It’s really individualized to the patient.

Peter Salgo, MD: Well, no, it’s OK. You’re always going to say that there’s patient variability. What about the extrapyramidal symptoms [EPS]; is one better than the other?

Richard Jackson, MD: Depends on the patient, but you may see an overall lessening of variability. When we talk about extrapyramidal symptoms, we mean the dopamine-induced Parkinsonism because that’s what happens when you block dopamine. It can be different by dose and by patient. There’s a difference with prolactin levels and a whole host of adverse events that are different between drugs.

Mauricio Tohen, MD, DPH, MBA: This was the main difference between first- and second-generation injectables—more EPS in the first generation. Tardive dyskinesia, as we mentioned, is present in both, but the prevalence is certainly higher with the first-generation drugs.

Peter Salgo, MD: Are there any complications when switching from first- to second-generation injectables and vice versa?

Richard Jackson, MD: You don’t want to start patients off on the 3-month injectable. There’s a preparation phase with 1-months. Once you’re stable on those, you can transition to the 3-month medications. The 2-month preparation—aripiprazole lauroxil—you can start immediately. There’s not a schedule you have to abide by.

Transcript edited for clarity.