Switching from Oral Antipsychotics to Paliperidone er

• Due to OROS technology, paliperidone ER can be initiated at full desired dose; however, titration over 1–2 weeks may be appropriate for some patients

• With aripiprazole and amisulpride, immediate stop is possible; begin paliperidone ER at an intermediate, or if needed, effective dose

• Risperidone, ziprasidone, iloperidone, and lurasidone can be tapered off over a period of 1 week due to the risk of withdrawal symptoms such as insomnia

• Clinical experience has shown that quetiapine, olanzapine, and asenapine should be tapered off slowly over a period of 3–4 weeks, to allow patients to readapt to the withdrawal of blocking cholinergic, histaminergic, and alpha 1 receptors

• Clozapine should always be tapered off slowly, over a period of 4 weeks or more

* Benzodiazepine or anticholinergic medication can be administered during cross-titration to help alleviate side effects such as insomnia, agitation, and/or psychosis

Switching from Oral Antipsychotics to Paliperidone Palmitate

• With aripiprazole, amisulpride, and paliperidone ER, immediate stop is possible

• Risperidone, ziprasidone, iloperidone, and lurasidone can be tapered off over a period of 1 week due to the risk of withdrawal symptoms such as insomnia

• Clinical experience has shown that quetiapine, olanzapine, and asenapine should be tapered off slowly over a period of 3–4 weeks, to allow patients to readapt to the withdrawal of blocking cholinergic, histaminergic, and alpha 1 receptors

• Clozapine should always be tapered off slowly, over a period of 4 weeks or more

* Benzodiazepine or anticholinergic medication can be administered during cross-titration to help alleviate side effects such as insomnia, agitation, and/or psychosis

Suggested Reading

Meltzer HY, Bobo WV, Nuamah IF, et al. Efficacy and tolerability of oral paliperidone extended-release tablets in the treatment of acute schizophrenia: pooled data from three 6-week, placebo-controlled studies. J Clin Psychiatry 2008 May;6 e1–e13. [Epub ahead of print]

Nasrallah HA. Atypical antipsychotic-induced metabolic side effects: insights from receptor-binding profiles. Mol Psychiatry 2008;13(1): 27–35.

Nussbaum A, Stroup TS. Paliperidone for schizophrenia. Cochrane Database Syst Rev 2008;16(2):CD006369.

PAROXETINE

PAROXETINE: THERAPEUTICS

Brands

• Paxil

• Paxil CR

see index for additional brand names

Generic?

Yes

Class

• SSRI (selective serotonin reuptake inhibitor); often classified as an antidepressant, but it is not just an antidepressant

Commonly Prescribed for

(bold for FDA approved)

• Major depressive disorder (paroxetine and paroxetine CR)

• Obsessive-compulsive disorder (OCD)

• Panic disorder (paroxetine and paroxetine CR)

• Social anxiety disorder (social phobia) (paroxetine and paroxetine CR)

• Posttraumatic stress disorder (PTSD)

• Generalized anxiety disorder (GAD)

• Premenstrual dysphoric disorder (PMDD) (paroxetine CR)

• Vasomotor symptoms (Brisdelle)

How the Drug Works

• Boosts neurotransmitter serotonin

• Blocks serotonin reuptake pump (serotonin transporter)

• Desensitizes serotonin receptors, especially serotonin 1A autoreceptors

• Presumably increases serotonergic neurotransmission

• Paroxetine also has mild anticholinergic actions

• Paroxetine may have mild norepinephrine reuptake blocking actions