Dosing & Uses
Dosage Forms & Strengths
tablet, extended release
- 1.5mg
- 3mg
- 6mg
- 9mg
IM injectable suspension prefilled syringe (once monthly, Invega Sustenna)
- 39mg
- 78mg
- 117mg
- 156mg
- 234mg
IM injectable suspension prefilled syringe (q3month, Invega Trinza)
- 273mg
- 410mg
- 546mg
- 819mg
IM injectable suspension prefilled syringe (q6month, Invega Hafyera)
- 1,092mg/3.5mL
- 1,560mg/5mL
Schizophrenia
PO
- 6 mg PO qAM; may be titrated upward or downward in increments of 3 mg/day at intervals ≥5 days; not to exceed 12 mg/day
IM, extended-released 1-month (Invega Sustenna)
- 234 mg in deltoid on treatment day 1, then 156 mg 1 week later (day 8)
- Recommended maintenance dose is 117 mg IM once monthly, although some patients may require lower or higher dosages (monthly dose range 39-234 mg)
IM, extended-released 3-months (Invega Trinza)
- Patients must be adequately treated with Invega Sustenna (1-month paliperidone) for at least 4 months before initiating Invega Trinza
-
Dose initiation dependent on once-monthly Invega Sustenna dose
- Initiate Invega Trinza when the next 1-month paliperidone dose is scheduled with an Invega Trinza dose based on the previous 1-month injection dose (see below)
-
Conversion from monthly injection to 3-month injection
- Invega Sustenna 78 mg/month: Initiate Invega Trinza at 273 mg IM q3mo
- Invega Sustenna 117 mg/month: Initiate Invega Trinza at 410 mg IM q3mo
- Invega Sustenna 156 mg/month: Initiate Invega Trinza at 546 mg IM q3mo
- Invega Sustenna 234 mg/month: Initiate Invega Trinza at 819 mg IM q3mo
-
Conversion from 3-month IM injection to extended-release tablets
- 273 mg IM (last 3 months to 24wk): 3 mg ER tab
- 410 mg IM (last 3 months to 24wk): 3 mg ER tab; 6 mg if >24wk
- 546 mg IM (last 3 months to 18 wk): 3 mg ER tab; 6 mg if 18-24 wk; 9 mg if >24 wk
- 819 mg IM (last 3 months to 18 wk): 6 mg ER tab; 9 mg if 18-24 wk; 12 mg if >24 wk
IM, extended-released 6-months (Invega Hafyera)
- Patients must be adequately treated with Invega Sustenna (1-month paliperidone) for at least 4 months OR with Invega Trinza (3-month paliperidone) for at least one 3-month cycle before initiating Invega Hafyera
-
Conversion from monthly injection to 6-month injection
- Initiate Invega Hafyera when next Invega Sustenna dose is scheduled
- Invega Sustenna 156 mg/month: Initiate Invega Hafyera at 1,092 mg IM q6mo
- Invega Sustenna 234 mg/month: Initiate Invega Hafyera at 1,560 mg IM q6mo
- There are no equivalent doses of Invega Hafyera for Invega Sustenna 39-mg, 78-mg, or 117-mg doses, which were not studied
-
Conversion from 3-month injection to 6-month injection
- Initial Invega Hafyera dose is based on the previous Invega Trinza
- Initiate Invega Hafyera when next Invega Trinza dose is scheduled
- May administer Invega Hafyera dose up to 2 weeks before or after the next scheduled Invega Trinza
- Invega Trinza 546 mg q3mo: Initiate Invega Hafyera at 1,092 mg IM q6mo
- Invega Trinza 819 mg q3mo: Initiate Invega Hafyera at 1,560 mg IM q6mo
- There are no equivalent doses of Invega Hafyera for Invega Trinza 273-mg or 410-mg doses, which were not studied
-
Dosing interval and dosage adjustments
- Following initial dose, administer Invega Hafyera IM q6mo
- May adjust dosage every 6 months between 1,092 mg and 1,560 mg based on individual response and tolerability, if necessary
- Owing to the potential longer duration to Invega Hafyera, patient’s response to an adjusted dose may not be apparent for several months
Schizoaffective Disorder
Indicated for schizoaffective disorder as monotherapy and as an adjunct to mood stabilizers or antidepressants
6 mg PO qDay in am (range 3-12 mg); titration may not be necessary; if exceeding 6 mg/day, increases of 3 mg/day recommended at intervals of 4 days of more; not to exceed 12 mg/day
IM (initial): 234 mg in deltoid on treatment day 1, then 156 mg 1 week later (day 8)
IM (maintenance): Administer once each month IM in deltoid or gluteal muscle; adjust dose based on tolerability and/or efficacy using available strengths; maintenance dose ranges between 78-234 mg once monthly
Dosing Modifications
Renal impairment (PO)
- CrCl 50-79 mL/min: 3 mg/day initially; not to exceed 6 mg/day
- CrCl 10-49 mL/min: 1.5 mg/day initially; not to exceed 3 mg/day
- CrCl <10 mL/min: Not recommended
Renal impairment (IM)
- Invega Hafyera: Not recommended for all severities of renal impairment
-
Invega Sustenna
- Mild (CrCl 50-79 mL/min): 156 mg IM in deltoid on treatment day 1, then 117 mg 1 week later; maintenance: 78 mg IM monthly
- Moderate to severe (CrCl <50 mL/min): Not recommended
-
Invega Trinza
- Mild (CrCl 50-79 mL/min): Adjust dosage and stabilize the patient using the 1-month paliperidone palmitate extended-release injectable suspension (Invega Sustenna), then transition to Invega Trinza
- Moderate to severe (CrCl <50 mL/min): Not recommended
Hepatic impairment
- IM: Not studied
-
PO
- Mild-to-moderate: No dosage adjustment necessary
- Severe: Not studied
Dosing Considerations
Patients with Parkinson disease or dementia with Lewy bodies can experience increased sensitivity to paliperidone
Manifestations can include confusion, obtundation, postural instability with frequent falls, extrapyramidal symptoms, and clinical features consistent with neuroleptic malignant syndrome
Dosage Forms & Strengths
tablet, extended-release
- 1.5mg
- 3mg
- 6mg
- 9mg
Schizophrenia
<12 years: Safety and efficacy not established
≥12 years (<51 kg): 3 mg/day PO initially; may be increased if necessary in increments of 3 mg/day at intervals ≥5 days; not to exceed 6 mg/day
≥12 years (≥51 kg): 3 mg/day PO initially; may be increased if necessary in increments of 3 mg/day at intervals ≥5 days; not to exceed 12 mg/day
Schizoaffective Disorder
<18 years: Safety and efficacy not established
After oral administration in elderly subjects, the peak plasma concentration and AUC increased 1.2-fold compared to young subjects; may be attributable to age-related decreases in creatinine clearance
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Contraindicated (3)
- amisulpride
amisulpride, paliperidone. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndrome.
- goserelin
goserelin increases toxicity of paliperidone by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- leuprolide
leuprolide increases toxicity of paliperidone by QTc interval. Contraindicated. Increases risk of torsades de pointes.
Serious - Use Alternative (102)
- adagrasib
adagrasib, paliperidone. Either decreases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.
- afatinib
paliperidone increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.
- alfuzosin
alfuzosin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- amiodarone
amiodarone and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- amisulpride
amisulpride and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- anagrelide
anagrelide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- apomorphine
paliperidone decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
apomorphine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. - aripiprazole
aripiprazole and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- arsenic trioxide
arsenic trioxide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
asenapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine transdermal
asenapine transdermal and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- atomoxetine
atomoxetine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, paliperidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- bromocriptine
paliperidone decreases effects of bromocriptine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- buprenorphine
buprenorphine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine transdermal
buprenorphine transdermal and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- cabergoline
paliperidone decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.
- calcium/magnesium/potassium/sodium oxybates
paliperidone, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- ceritinib
ceritinib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- clozapine
clozapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- degarelix
degarelix and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- desflurane
desflurane and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- disopyramide
disopyramide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- donepezil
donepezil and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- dopamine
paliperidone decreases effects of dopamine by pharmacodynamic antagonism. Contraindicated.
- edoxaban
paliperidone will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended
- eliglustat
eliglustat and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.
- entrectinib
paliperidone and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
- erdafitinib
erdafitinib will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.
- eribulin
eribulin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.
- escitalopram
escitalopram increases toxicity of paliperidone by QTc interval. Avoid or Use Alternate Drug.
- fexinidazole
fexinidazole and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
- fingolimod
fingolimod and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- gilteritinib
gilteritinib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- glasdegib
paliperidone and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.
- granisetron
granisetron and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- histrelin
histrelin increases toxicity of paliperidone by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.
- hydrocodone
hydrocodone, paliperidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- hydroxyzine
hydroxyzine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- ibutilide
ibutilide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- indapamide
indapamide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- inotuzumab
inotuzumab and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.
- isoflurane
isoflurane and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
ivosidenib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
- lasmiditan
lasmiditan increases levels of paliperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- lefamulin
lefamulin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- levodopa
paliperidone decreases effects of levodopa by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- levodopa inhaled
paliperidone decreases effects of levodopa inhaled by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Atypical (2nd generation) antipsychotics inhibit dopamine D2 receptors in varying degrees (clozapine and quetiapine are lower risk). .
- lisuride
paliperidone decreases effects of lisuride by pharmacodynamic antagonism. Contraindicated.
- lithium
lithium and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- macimorelin
macimorelin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.
- mefloquine
mefloquine increases toxicity of paliperidone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
- methyldopa
paliperidone decreases effects of methyldopa by pharmacodynamic antagonism. Contraindicated.
- metoclopramide intranasal
paliperidone, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
paliperidone increases toxicity of metoclopramide intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive effects, including increased frequency and severity of tardive dyskinesia, other extrapyramidal symptoms, and neuroleptic malignant syndrome. - mirtazapine
mirtazapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
mobocertinib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.
- olanzapine
olanzapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- olopatadine intranasal
paliperidone and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- ondansetron
paliperidone and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
- oxaliplatin
oxaliplatin will increase the level or effect of paliperidone by Other (see comment). Avoid or Use Alternate Drug. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.
oxaliplatin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. - panobinostat
paliperidone and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.
- pentamidine
paliperidone and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- pimavanserin
paliperidone and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.
- pimozide
paliperidone and pimozide both increase QTc interval. Avoid or Use Alternate Drug.
- pitolisant
paliperidone and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- pomalidomide
paliperidone increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- pramipexole
paliperidone decreases effects of pramipexole by pharmacodynamic antagonism. Contraindicated.
- primaquine
primaquine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- procainamide
paliperidone and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- quinidine
quinidine will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
quinidine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. - ribociclib
ribociclib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- riociguat
paliperidone will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed
- romidepsin
paliperidone and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.
- ropinirole
paliperidone decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.
- safinamide
paliperidone decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.
- saquinavir
saquinavir, paliperidone. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Increased risk of QT prolongation and cardiac arrhythmias.
- selinexor
selinexor, paliperidone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.
- sertraline
sertraline and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- sevoflurane
sevoflurane and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- siponimod
siponimod and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- sodium oxybate
paliperidone, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- solifenacin
solifenacin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- sotalol
paliperidone and sotalol both increase QTc interval. Avoid or Use Alternate Drug.
- sotorasib
sotorasib will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.
- sufentanil SL
sufentanil SL, paliperidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- sunitinib
sunitinib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- tacrolimus
tacrolimus and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- tepotinib
tepotinib will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.
- tetrabenazine
tetrabenazine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- triptorelin
triptorelin increases toxicity of paliperidone by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.
- umeclidinium bromide/vilanterol inhaled
paliperidone increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
- vandetanib
paliperidone, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.
- vemurafenib
vemurafenib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.
- venetoclax
paliperidone will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.
- vilanterol/fluticasone furoate inhaled
paliperidone increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
- vorinostat
vorinostat and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (389)
- abobotulinumtoxinA
abobotulinumtoxinA increases effects of paliperidone by pharmacodynamic synergism. Use Caution/Monitor. Use of anticholinergic drugs after administration of botulinum toxin-containing products may potentiate systemic anticholinergic effects.
- acarbose
paliperidone, acarbose. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- aclidinium
aclidinium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - acrivastine
acrivastine and paliperidone both increase sedation. Use Caution/Monitor.
- albiglutide
paliperidone, albiglutide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- albuterol
paliperidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
albuterol and paliperidone both increase QTc interval. Use Caution/Monitor. - alfentanil
alfentanil and paliperidone both increase sedation. Use Caution/Monitor.
- alfuzosin
paliperidone and alfuzosin both increase QTc interval. Use Caution/Monitor.
- almotriptan
almotriptan, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- alprazolam
alprazolam and paliperidone both increase sedation. Use Caution/Monitor.
- amifostine
amifostine, paliperidone. Either increases effects of the other by anti-hypertensive channel blocking. Use Caution/Monitor. Due to its alpha adrenergic antagonism, atypical antipsychotic agents has the potential to enhance the effect of certain antihypertensive agents. Monitor blood pressure and adjust dose accordingly.
- amiodarone
amiodarone will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- amitriptyline
amitriptyline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and amitriptyline both increase sedation. Use Caution/Monitor. - amobarbital
amobarbital and paliperidone both increase sedation. Use Caution/Monitor.
- amoxapine
paliperidone and amoxapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.
amoxapine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and amoxapine both increase sedation. Use Caution/Monitor. - anticholinergic/sedative combos
anticholinergic/sedative combos decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
anticholinergic/sedative combos decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of anticholinergic/sedative combos by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - apomorphine
paliperidone and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
paliperidone increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
arformoterol and paliperidone both increase QTc interval. Use Caution/Monitor. - aripiprazole
aripiprazole and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
aripiprazole and paliperidone both increase sedation. Use Caution/Monitor. - armodafinil
paliperidone increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- artemether/lumefantrine
artemether/lumefantrine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
- asenapine
asenapine and paliperidone both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and paliperidone both increase sedation. Use Caution/Monitor.
- atorvastatin
atorvastatin will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- atracurium
atracurium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atracurium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - atropine
atropine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of atropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - atropine IV/IM
paliperidone increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
atropine IV/IM decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
atropine IV/IM decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. - avapritinib
avapritinib and paliperidone both increase sedation. Use Caution/Monitor.
- azelastine
azelastine and paliperidone both increase sedation. Use Caution/Monitor.
- baclofen
baclofen and paliperidone both increase sedation. Use Caution/Monitor.
- bedaquiline
paliperidone and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely
- belladonna alkaloids
belladonna alkaloids decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
belladonna alkaloids decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of belladonna alkaloids by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - belladonna and opium
belladonna and opium and paliperidone both increase sedation. Use Caution/Monitor.
belladonna and opium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
belladonna and opium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - benazepril
paliperidone increases toxicity of benazepril by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.
benazepril increases toxicity of paliperidone by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension. - benperidol
benperidol and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
benperidol and paliperidone both increase sedation. Use Caution/Monitor. - benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen and paliperidone both increase sedation. Use Caution/Monitor.
- benzphetamine
paliperidone increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- berotralstat
berotralstat will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.
- betrixaban
paliperidone increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.
- bosutinib
bosutinib increases levels of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- brexanolone
brexanolone, paliperidone. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brexpiprazole
brexpiprazole and paliperidone both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and paliperidone both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and paliperidone both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and paliperidone both increase sedation. Use Caution/Monitor.
- buprenorphine
buprenorphine and paliperidone both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
buprenorphine buccal and paliperidone both increase sedation. Use Caution/Monitor.
- buprenorphine subdermal implant
buprenorphine subdermal implant and paliperidone both increase sedation. Use Caution/Monitor.
- buprenorphine transdermal
buprenorphine transdermal and paliperidone both increase sedation. Use Caution/Monitor.
- buprenorphine, long-acting injection
paliperidone increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.
buprenorphine, long-acting injection and paliperidone both increase sedation. Use Caution/Monitor. - butabarbital
butabarbital and paliperidone both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and paliperidone both increase sedation. Use Caution/Monitor.
- butorphanol
butorphanol and paliperidone both increase sedation. Use Caution/Monitor.
- caffeine
paliperidone increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- captopril
paliperidone, captopril. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.
- carbamazepine
carbamazepine will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Paliperidone dose may need to be increased when coadministered with strong inducers of both CYP3A4 and P-gp
- carbinoxamine
carbinoxamine and paliperidone both increase sedation. Use Caution/Monitor.
- carisoprodol
carisoprodol and paliperidone both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate, paliperidone. Either increases effects of the other by sedation. Use Caution/Monitor.
- ceritinib
paliperidone increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- chloral hydrate
chloral hydrate and paliperidone both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and paliperidone both increase sedation. Use Caution/Monitor.
- chloroquine
chloroquine increases toxicity of paliperidone by QTc interval. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and paliperidone both increase sedation. Use Caution/Monitor.
- chlorpromazine
chlorpromazine and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
chlorpromazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
chlorpromazine and paliperidone both increase sedation. Use Caution/Monitor. - chlorpropamide
paliperidone, chlorpropamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- chlorzoxazone
chlorzoxazone and paliperidone both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and paliperidone both increase sedation. Use Caution/Monitor.
- ciprofloxacin
ciprofloxacin and paliperidone both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.
- cisatracurium
cisatracurium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
cisatracurium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - citalopram
paliperidone and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- clarithromycin
clarithromycin will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
clarithromycin and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. - clemastine
clemastine and paliperidone both increase sedation. Use Caution/Monitor.
- clobazam
paliperidone, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).
- clomipramine
clomipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and clomipramine both increase sedation. Use Caution/Monitor. - clonazepam
clonazepam and paliperidone both increase sedation. Use Caution/Monitor.
- clonidine
clonidine, paliperidone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.
- clorazepate
clorazepate and paliperidone both increase sedation. Use Caution/Monitor.
- clotrimazole
clotrimazole will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- clozapine
clozapine and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
clozapine and paliperidone both increase sedation. Use Caution/Monitor. - codeine
codeine and paliperidone both increase sedation. Use Caution/Monitor.
- crizotinib
crizotinib and paliperidone both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- cyclizine
cyclizine and paliperidone both increase sedation. Use Caution/Monitor.
cyclizine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
cyclizine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of cyclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - cyclobenzaprine
cyclobenzaprine and paliperidone both increase sedation. Use Caution/Monitor.
cyclobenzaprine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
cyclobenzaprine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - cyproheptadine
cyproheptadine and paliperidone both increase sedation. Use Caution/Monitor.
- dabigatran
paliperidone will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min
- dantrolene
dantrolene and paliperidone both increase sedation. Use Caution/Monitor.
- daridorexant
paliperidone and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- darifenacin
darifenacin decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
darifenacin decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of darifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - dasatinib
dasatinib and paliperidone both increase QTc interval. Use Caution/Monitor.
- desflurane
desflurane and paliperidone both increase sedation. Use Caution/Monitor.
- desipramine
desipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and desipramine both increase sedation. Use Caution/Monitor. - deutetrabenazine
paliperidone and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
paliperidone and deutetrabenazine both increase sedation. Use Caution/Monitor.
paliperidone and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation). - dexchlorpheniramine
dexchlorpheniramine and paliperidone both increase sedation. Use Caution/Monitor.
- dexfenfluramine
paliperidone increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
dexmedetomidine and paliperidone both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
paliperidone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
paliperidone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromethorphan
dextromethorphan, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- dextromoramide
dextromoramide and paliperidone both increase sedation. Use Caution/Monitor.
- diamorphine
diamorphine and paliperidone both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and paliperidone both increase sedation. Use Caution/Monitor.
- dicyclomine
dicyclomine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
dicyclomine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of dicyclomine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - diethylpropion
paliperidone increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and paliperidone both increase sedation. Use Caution/Monitor.
- difenoxin hcl
difenoxin hcl and paliperidone both increase sedation. Use Caution/Monitor.
- dihydroergotamine
dihydroergotamine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- dimenhydrinate
dimenhydrinate and paliperidone both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and paliperidone both increase sedation. Use Caution/Monitor.
diphenhydramine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
diphenhydramine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of diphenhydramine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - diphenoxylate hcl
diphenoxylate hcl and paliperidone both increase sedation. Use Caution/Monitor.
- dipipanone
dipipanone and paliperidone both increase sedation. Use Caution/Monitor.
- dobutamine
paliperidone increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dofetilide
dofetilide and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
- dolasetron
dolasetron and paliperidone both increase QTc interval. Use Caution/Monitor.
- dopamine
paliperidone increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
paliperidone increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
paliperidone and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
doxepin and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and doxepin both increase sedation. Use Caution/Monitor. - doxylamine
doxylamine and paliperidone both increase sedation. Use Caution/Monitor.
- dronedarone
dronedarone will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
dronedarone and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. - droperidol
droperidol and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
droperidol and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
droperidol and paliperidone both increase sedation. Use Caution/Monitor. - elagolix
elagolix will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- eletriptan
eletriptan, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- eliglustat
eliglustat increases levels of paliperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.
- ephedrine
paliperidone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
epinephrine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. - epinephrine racemic
epinephrine racemic and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. - ergoloid mesylates
ergoloid mesylates, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- ergotamine
ergotamine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- erythromycin base
erythromycin base will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
erythromycin base and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. - erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
erythromycin ethylsuccinate and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. - erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
erythromycin lactobionate and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. - erythromycin stearate
erythromycin stearate will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
erythromycin stearate and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. - esketamine intranasal
esketamine intranasal, paliperidone. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- estazolam
estazolam and paliperidone both increase sedation. Use Caution/Monitor.
- ethanol
paliperidone and ethanol both increase sedation. Use Caution/Monitor.
- exenatide injectable solution
paliperidone, exenatide injectable solution. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- exenatide injectable suspension
paliperidone, exenatide injectable suspension. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- ezogabine
ezogabine, paliperidone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.
- felodipine
felodipine will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- fenfluramine
paliperidone increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
paliperidone decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately. - fentanyl
fentanyl, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- fesoterodine
fesoterodine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
fesoterodine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of fesoterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - flavoxate
flavoxate decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
flavoxate decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of flavoxate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - flecainide
flecainide and paliperidone both increase QTc interval. Use Caution/Monitor.
- flibanserin
flibanserin, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- fluconazole
fluconazole and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
- fluoxetine
fluoxetine and paliperidone both increase QTc interval. Use Caution/Monitor.
- fluphenazine
fluphenazine and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
fluphenazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
fluphenazine and paliperidone both increase sedation. Use Caution/Monitor. - flurazepam
flurazepam and paliperidone both increase sedation. Use Caution/Monitor.
- fluvoxamine
fluvoxamine and paliperidone both increase QTc interval. Use Caution/Monitor.
- formoterol
formoterol and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. - foscarnet
foscarnet and paliperidone both increase QTc interval. Use Caution/Monitor.
- fosphenytoin
fosphenytoin will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- fostemsavir
paliperidone and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- frovatriptan
frovatriptan, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- ganaxolone
paliperidone and ganaxolone both increase sedation. Use Caution/Monitor.
- gemifloxacin
gemifloxacin and paliperidone both increase QTc interval. Use Caution/Monitor.
- gemtuzumab
paliperidone and gemtuzumab both increase QTc interval. Use Caution/Monitor.
- glecaprevir/pibrentasvir
paliperidone will increase the level or effect of glecaprevir/pibrentasvir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
glecaprevir/pibrentasvir will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. - glimepiride
paliperidone, glimepiride. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- glipizide
paliperidone, glipizide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- glyburide
paliperidone, glyburide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- glycopyrrolate
paliperidone increases effects of glycopyrrolate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
- glycopyrrolate inhaled
glycopyrrolate inhaled decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
glycopyrrolate inhaled decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - guanfacine
guanfacine, paliperidone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.
- haloperidol
haloperidol and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
haloperidol and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
haloperidol and paliperidone both increase sedation. Use Caution/Monitor. - henbane
henbane decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
henbane decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of henbane by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - homatropine
homatropine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
homatropine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of homatropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - hydromorphone
hydromorphone and paliperidone both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and paliperidone both increase sedation. Use Caution/Monitor.
- hyoscyamine
hyoscyamine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
hyoscyamine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - hyoscyamine spray
paliperidone increases effects of hyoscyamine spray by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
hyoscyamine spray decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
hyoscyamine spray decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor. - iloperidone
iloperidone and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
iloperidone and paliperidone both increase QTc interval. Use Caution/Monitor.
iloperidone and paliperidone both increase sedation. Use Caution/Monitor. - imipramine
imipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and imipramine both increase sedation. Use Caution/Monitor. - indacaterol, inhaled
indacaterol, inhaled, paliperidone. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
- indinavir
indinavir will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- insulin aspart
paliperidone, insulin aspart. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- insulin degludec
paliperidone decreases effects of insulin degludec by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.
- insulin degludec/insulin aspart
paliperidone decreases effects of insulin degludec/insulin aspart by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.
- insulin detemir
paliperidone, insulin detemir. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- insulin glargine
paliperidone, insulin glargine. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- insulin glulisine
paliperidone, insulin glulisine. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- insulin inhaled
paliperidone decreases effects of insulin inhaled by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.
- insulin lispro
paliperidone, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- insulin NPH
paliperidone, insulin NPH. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- insulin regular human
paliperidone, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- ipratropium
ipratropium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
ipratropium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - isoproterenol
paliperidone increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- istradefylline
istradefylline will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.
- itraconazole
itraconazole and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
itraconazole will increase the level or effect of paliperidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - ketoconazole
ketoconazole will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
ketoconazole and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. - ketotifen, ophthalmic
paliperidone and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- lapatinib
lapatinib will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
lapatinib and paliperidone both increase QTc interval. Use Caution/Monitor. - lasmiditan
lasmiditan, paliperidone. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- lemborexant
lemborexant, paliperidone. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.
- lenvatinib
paliperidone and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.
- levalbuterol
paliperidone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levofloxacin
levofloxacin and paliperidone both increase QTc interval. Use Caution/Monitor.
- levoketoconazole
levoketoconazole and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
levoketoconazole will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. - levomilnacipran
levomilnacipran, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- levorphanol
levorphanol and paliperidone both increase sedation. Use Caution/Monitor.
- linezolid
linezolid, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- liraglutide
paliperidone, liraglutide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- lisdexamfetamine
paliperidone increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lithium
lithium, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- lofepramine
lofepramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and lofepramine both increase sedation. Use Caution/Monitor. - lofexidine
paliperidone and lofexidine both increase sedation. Use Caution/Monitor.
paliperidone and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended. - lomitapide
lomitapide increases levels of paliperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.
- lonafarnib
lonafarnib will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.
- loprazolam
loprazolam and paliperidone both increase sedation. Use Caution/Monitor.
- loratadine
loratadine will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- lorazepam
lorazepam and paliperidone both increase sedation. Use Caution/Monitor.
- lorcaserin
lorcaserin, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- lormetazepam
lormetazepam and paliperidone both increase sedation. Use Caution/Monitor.
- lovastatin
lovastatin will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- loxapine
loxapine and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine and paliperidone both increase sedation. Use Caution/Monitor. - loxapine inhaled
loxapine inhaled and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
loxapine inhaled and paliperidone both increase sedation. Use Caution/Monitor. - lumefantrine
lumefantrine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
- lurasidone
lurasidone, paliperidone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
- maprotiline
maprotiline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and maprotiline both increase sedation. Use Caution/Monitor. - maraviroc
maraviroc, paliperidone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.
- marijuana
paliperidone and marijuana both increase sedation. Use Caution/Monitor.
- meclizine
meclizine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
meclizine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of meclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - melatonin
paliperidone and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
meperidine and paliperidone both increase sedation. Use Caution/Monitor.
meperidine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). - meprobamate
paliperidone and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
paliperidone increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
metaxalone and paliperidone both increase sedation. Use Caution/Monitor.
- metformin
paliperidone, metformin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- methadone
methadone and paliperidone both increase QTc interval. Use Caution/Monitor.
methadone and paliperidone both increase sedation. Use Caution/Monitor.
methadone, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). - methamphetamine
paliperidone increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
methocarbamol and paliperidone both increase sedation. Use Caution/Monitor.
- methscopolamine
methscopolamine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
methscopolamine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of methscopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - methylenedioxymethamphetamine
paliperidone increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methylergonovine
methylergonovine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- methylphenidate
paliperidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.
- metoclopramide
paliperidone and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
- midazolam
midazolam and paliperidone both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, paliperidone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.
- midodrine
paliperidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mifepristone
mifepristone, paliperidone. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- miglitol
paliperidone, miglitol. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- milnacipran
milnacipran, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- mirtazapine
paliperidone and mirtazapine both increase sedation. Use Caution/Monitor.
- modafinil
paliperidone increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
morphine and paliperidone both increase sedation. Use Caution/Monitor.
- motherwort
paliperidone and motherwort both increase sedation. Use Caution/Monitor.
- moxifloxacin
moxifloxacin and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
- moxonidine
paliperidone and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
paliperidone and nabilone both increase sedation. Use Caution/Monitor.
- nalbuphine
nalbuphine and paliperidone both increase sedation. Use Caution/Monitor.
- naldemedine
paliperidone increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.
- naratriptan
naratriptan, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- nateglinide
paliperidone, nateglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- nicardipine
nicardipine will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nifedipine
nifedipine will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nilotinib
nilotinib will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
nilotinib and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. - nintedanib
paliperidone increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy.
- norepinephrine
paliperidone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
nortriptyline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and nortriptyline both increase sedation. Use Caution/Monitor. - octreotide
octreotide and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
- octreotide (Antidote)
octreotide (Antidote) and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
- ofloxacin
ofloxacin and paliperidone both increase QTc interval. Use Caution/Monitor.
- olanzapine
olanzapine and paliperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
olanzapine and paliperidone both increase sedation. Use Caution/Monitor. - oliceridine
oliceridine, paliperidone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.
- olodaterol inhaled
paliperidone and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias
- onabotulinumtoxinA
onabotulinumtoxinA decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
onabotulinumtoxinA decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - opium tincture
opium tincture and paliperidone both increase sedation. Use Caution/Monitor.
- orphenadrine
orphenadrine and paliperidone both increase sedation. Use Caution/Monitor.
- osilodrostat
osilodrostat and paliperidone both increase QTc interval. Use Caution/Monitor.
- osimertinib
osimertinib and paliperidone both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.
- oxazepam
oxazepam and paliperidone both increase sedation. Use Caution/Monitor.
- oxybutynin
oxybutynin decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
oxybutynin decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of oxybutynin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - oxybutynin topical
oxybutynin topical decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
oxybutynin topical decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of oxybutynin topical by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - oxybutynin transdermal
oxybutynin transdermal decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
oxybutynin transdermal decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of oxybutynin transdermal by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - oxycodone
oxycodone and paliperidone both increase sedation. Use Caution/Monitor.
- oxymorphone
oxymorphone and paliperidone both increase sedation. Use Caution/Monitor.
- ozanimod
ozanimod and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
- pancuronium
pancuronium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pancuronium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of pancuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - papaveretum
papaveretum and paliperidone both increase sedation. Use Caution/Monitor.
- papaverine
paliperidone and papaverine both increase sedation. Use Caution/Monitor.
- paroxetine
paliperidone and paroxetine both increase QTc interval. Use Caution/Monitor.
paroxetine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). - pasireotide
paliperidone and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.
- pentazocine
pentazocine and paliperidone both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and paliperidone both increase sedation. Use Caution/Monitor.
- perphenazine
paliperidone and perphenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
perphenazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and perphenazine both increase sedation. Use Caution/Monitor. - phendimetrazine
paliperidone increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenelzine
phenelzine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- phenobarbital
phenobarbital will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
phenobarbital and paliperidone both increase sedation. Use Caution/Monitor. - phentermine
paliperidone increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
paliperidone increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
paliperidone increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- phenytoin
phenytoin will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- pholcodine
paliperidone and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
paliperidone and pimozide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
paliperidone and pimozide both increase sedation. Use Caution/Monitor. - pioglitazone
paliperidone, pioglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- pirbuterol
paliperidone increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- posaconazole
paliperidone and posaconazole both increase QTc interval. Use Caution/Monitor.
- pralidoxime
pralidoxime decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
pralidoxime decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - pramlintide
paliperidone, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- primidone
primidone and paliperidone both increase sedation. Use Caution/Monitor.
- procarbazine
procarbazine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- prochlorperazine
paliperidone and prochlorperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
prochlorperazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and prochlorperazine both increase sedation. Use Caution/Monitor. - promazine
promazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
- promethazine
paliperidone and promethazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
promethazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
promethazine and paliperidone both increase sedation. Use Caution/Monitor.
promethazine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). - propantheline
propantheline decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
propantheline decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of propantheline by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - propofol
propofol and paliperidone both increase sedation. Use Caution/Monitor.
- propylhexedrine
paliperidone increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
protriptyline and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and protriptyline both increase sedation. Use Caution/Monitor. - quazepam
quazepam and paliperidone both increase sedation. Use Caution/Monitor.
- quercetin
quercetin will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- quetiapine
paliperidone and quetiapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
paliperidone and quetiapine both increase sedation. Use Caution/Monitor.
quetiapine, paliperidone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT. - quinine
paliperidone and quinine both increase QTc interval. Use Caution/Monitor.
- quizartinib
quizartinib, paliperidone. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.
- ramelteon
paliperidone and ramelteon both increase sedation. Use Caution/Monitor.
- ranolazine
ranolazine will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
paliperidone and ranolazine both increase QTc interval. Use Caution/Monitor. - rapacuronium
rapacuronium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
rapacuronium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of rapacuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - remimazolam
remimazolam, paliperidone. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.
- repaglinide
paliperidone, repaglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- rifampin
rifampin will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Paliperidone dose may need to be increased when coadministered with strong inducers of both CYP3A4 and P-gp
- rifaximin
paliperidone increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- rilpivirine
rilpivirine increases toxicity of paliperidone by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.
- risperidone
paliperidone and risperidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
paliperidone and risperidone both increase QTc interval. Use Caution/Monitor.
paliperidone and risperidone both increase sedation. Use Caution/Monitor.
paliperidone, risperidone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Paliperidone is the major active metabolite of risperidone, consideration should be given to the additive paliperidone exposure if any of these medications are coadministered. - ritonavir
ritonavir will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- rocuronium
rocuronium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
rocuronium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of rocuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - rosiglitazone
paliperidone, rosiglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- salmeterol
paliperidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sarecycline
sarecycline will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.
- saxagliptin
paliperidone, saxagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- scopolamine
scopolamine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
scopolamine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - scullcap
paliperidone and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and paliperidone both increase sedation. Use Caution/Monitor.
- selegiline
selegiline, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- selpercatinib
selpercatinib increases toxicity of paliperidone by QTc interval. Use Caution/Monitor.
- shepherd's purse
paliperidone and shepherd's purse both increase sedation. Use Caution/Monitor.
- simvastatin
simvastatin will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- sirolimus
sirolimus will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- sitagliptin
paliperidone, sitagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of paliperidone by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
sodium sulfate/?magnesium sulfate/potassium chloride increases effects of paliperidone by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant. - sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of paliperidone by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
sodium sulfate/potassium sulfate/magnesium sulfate increases effects of paliperidone by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant. - solifenacin
solifenacin decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
solifenacin decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - sorafenib
sorafenib and paliperidone both increase QTc interval. Use Caution/Monitor.
- St John's Wort
St John's Wort will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Paliperidone dose may need to be increased when coadministered with strong inducers of both CYP3A4 and P-gp
- stiripentol
stiripentol will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.
stiripentol, paliperidone. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence. - sufentanil
sufentanil and paliperidone both increase sedation. Use Caution/Monitor.
- sulfamethoxazole
sulfamethoxazole and paliperidone both increase QTc interval. Use Caution/Monitor.
- sumatriptan
sumatriptan, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- sumatriptan intranasal
sumatriptan intranasal, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- tacrolimus
tacrolimus will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- tapentadol
tapentadol and paliperidone both increase sedation. Use Caution/Monitor.
- telavancin
paliperidone and telavancin both increase QTc interval. Use Caution/Monitor.
- temazepam
temazepam and paliperidone both increase sedation. Use Caution/Monitor.
- terbutaline
paliperidone increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tetrabenazine
paliperidone and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.
- thioridazine
paliperidone and thioridazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
thioridazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and thioridazine both increase sedation. Use Caution/Monitor. - thiothixene
paliperidone and thiothixene both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
paliperidone and thiothixene both increase sedation. Use Caution/Monitor. - tiotropium
tiotropium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
tiotropium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - tolazamide
paliperidone, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- tolbutamide
paliperidone, tolbutamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.
- tolterodine
tolterodine decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
tolterodine decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - tolvaptan
tolvaptan will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- topiramate
paliperidone and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
tramadol and paliperidone both increase sedation. Use Caution/Monitor.
- tranylcypromine
tranylcypromine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- trazodone
trazodone will decrease the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
trazodone and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and trazodone both increase sedation. Use Caution/Monitor. - triazolam
triazolam and paliperidone both increase sedation. Use Caution/Monitor.
- triclabendazole
triclabendazole and paliperidone both increase QTc interval. Use Caution/Monitor.
- triclofos
triclofos and paliperidone both increase sedation. Use Caution/Monitor.
- trifluoperazine
paliperidone and trifluoperazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
trifluoperazine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and trifluoperazine both increase sedation. Use Caution/Monitor. - trimethoprim
paliperidone and trimethoprim both increase QTc interval. Use Caution/Monitor.
- trimipramine
trimipramine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and trimipramine both increase sedation. Use Caution/Monitor. - triprolidine
triprolidine and paliperidone both increase sedation. Use Caution/Monitor.
- tropisetron
paliperidone and tropisetron both increase QTc interval. Use Caution/Monitor.
- trospium chloride
trospium chloride decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
trospium chloride decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - tucatinib
tucatinib will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.
- valbenazine
valbenazine and paliperidone both increase QTc interval. Use Caution/Monitor.
- vecuronium
vecuronium decreases levels of paliperidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
vecuronium decreases levels of paliperidone by pharmacodynamic antagonism. Use Caution/Monitor.
paliperidone increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia. - venlafaxine
paliperidone and venlafaxine both increase QTc interval. Use Caution/Monitor.
venlafaxine, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). - verapamil
verapamil will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- vilazodone
vilazodone, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- voclosporin
voclosporin, paliperidone. Either increases effects of the other by QTc interval. Use Caution/Monitor.
- voriconazole
paliperidone and voriconazole both increase QTc interval. Use Caution/Monitor.
- xylometazoline
paliperidone increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
paliperidone increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
paliperidone and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
paliperidone and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
paliperidone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.
paliperidone and ziprasidone both increase sedation. Use Caution/Monitor. - zolmitriptan
zolmitriptan, paliperidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
- zotepine
paliperidone and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
paliperidone and zotepine both increase sedation. Use Caution/Monitor.
Minor (8)
- azithromycin
azithromycin and paliperidone both increase QTc interval. Minor/Significance Unknown.
- brimonidine
brimonidine increases effects of paliperidone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- chasteberry
chasteberry decreases effects of paliperidone by pharmacodynamic antagonism. Minor/Significance Unknown. (Theoretical interaction).
- ethanol
ethanol, paliperidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.
- eucalyptus
paliperidone and eucalyptus both increase sedation. Minor/Significance Unknown.
- nefazodone
nefazodone will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.
- pazopanib
paliperidone and pazopanib both increase QTc interval. Minor/Significance Unknown.
- sage
paliperidone and sage both increase sedation. Minor/Significance Unknown.
Adverse Effects
>10%
Invega Hafyera
- Upper respiratory tract infection (12%)
- Injection site reactions (11%)
Invega Sustenna
- Injection site reaction (12%)
Oral (adults)
- Extrapyramidal symptoms (7-20%)
- Akathisia (4-17%)
- Tachycardia (12-14%)
- Headache (11-14%)
- Somnolence (6-11%)
Oral (children and adolescents)
- Somnolence (9-26%)
- Extrapyramidal symptoms (4-23%)
- Akathisia (4-17%)
- Vomiting (6-11%)
1-10%
Invega Hafyera
- Weight increased (9%)
- Headache (7%)
- Extrapyramidal symptoms (7%)
- Parkinsonism (5%)
- Akathisia (4%)
- Hyperkinesia (4%)
- Urinary tract infection (3%)
- Back pain (3%)
- Musculoskeletal pain (3%)
- Psychosis (3%)
- Anxiety (3%)
- Insomnia (3%)
- Diarrhea (2%)
- Dyskinesia (2%)
- Dystonia (1%)
Invega Sustenna
- Weight increased (10%)
- Headache (7%)
- Parkinsonism (4-6%)
- Hyperkinesia (5%)
- Upper respiratory tract infection (5%)
- Akathisia (3-5%)
- Tremor (2%)
- Dystonia (1%)
Invega Trinza
- Upper respiratory tract infection (10%)
- Headache (9%)
- Weight increased (9%)
- Parkinsonism (4-6%)
- Hyperkinesia (5%)
- Akathisia (3-5%)
- Injection site reaction (3%)
- Urinary tract infection (3%)
- Dyskinesia (1-3%)
- Tremor (1%)
- Dystonia (1%)
Oral (adults)
- Salivary hypersecretion (<4%)
- Upper abdominal pain (1-3%)
- Dry mouth (1-3%)
- Bundle branch block (<3%)
- Sinus arrhythmia (<3%)
- Atrioventricular (AV) block (1-2%)
- Fatigue (1-2%)
- Asthenia (<2%)
Oral (children and adolescents)
- Tachycardia (6-9%)
- Anxiety (4-9%)
- Increased weight (2-7%)
- Salivary hypersecretion (2-6%)
- Dizziness (2-6%)
- Amenorrhea (6%)
- Galactorrhea (4%)
- Nasopharyngitis (4%)
- Gynecomastia (3%)
- Blurred vision (3%)
- Dry mouth (3%)
- Swollen tongue (3%)
- Lethargy (3%)
- Tongue paralysis (3%)
- Asthenia (2-3%)
- Fatigue (2-3%)
- Epistaxis (2%)
<1%
Invega Hafyera
- Tremor
Invega Sustenna
- Dyskinesia
- Urinary tract infection
Frequency Not Defined
Invega Hafyera
- Blood and lymphatic system disorders: Anemia
- Cardiac disorders: Bradycardia, tachycardia
- Ear and labyrinth disorders: Vertigo
- Gastrointestinal disorders: Constipation, nausea, vomiting
- General disorders and administration site conditions: Fatigue
- Hepatobiliary disorders: Transaminases increased
- Infections and infestations: Cystitis, respiratory tract infection, tonsillitis
- Metabolism and nutritional disorders: Decreased appetite, increased appetite, weight decreased
- Psychiatric disorders: Depression
- Reproductive system and breast disorders: Breast pain, menstrual disorder
- Skin and SC tissue disorders: Rash
- Vascular disorders: Hypertension
Invega Sustenna and Trinza
- Cardiac disorders: AV block first degree, bundle branch block, palpitations, postural orthostatic tachycardia syndrome
- Eye disorders: Eye movement disorder, eye rolling, oculogyric crisis, vision blurred
- Gastrointestinal disorders: Abdominal discomfort/abdominal pain upper, diarrhea, dry mouth, toothache
- General disorders and administration site conditions: Asthenia, chest discomfort
- Immune system disorders: Hypersensitivity
- Investigations: Electrocardiogram (ECG) abnormal
- Metabolism and nutrition disorders: Hyperinsulinemia
- Musculoskeletal and connective tissue disorders: Myalgia, pain in extremity, joint stiffness, muscle spasms, muscle twitching, nuchal rigidity
- Nervous system disorders: Bradykinesia, cerebrovascular accident, convulsion, dizziness, dizziness postural, dysarthria, hypertonia, lethargy, oromandibular dystonia, psychomotor hyperactivity, syncope
- Psychiatric disorders: Agitation, nightmare
- Reproductive system and breast disorders: Breast discharge, erectile dysfunction, gynecomastia, sexual dysfunction
- Respiratory, thoracic, and mediastinal disorders: Cough
- Skin and SC tissue disorders: Drug eruption, eczema, pruritus, pruritus generalized, urticaria
- Vascular disorders: Hypotension, orthostatic hypotension
Tablets
- Cardiac disorders: Bradycardia, palpitations
- Eye disorders: Eye movement disorder
- Gastrointestinal disorders: Flatulence
- General disorders: Edema
- Immune system disorders: Anaphylactic reaction
- Infections and infestations: Urinary tract infection
- Investigations: ALT/AST increased
- Musculoskeletal and connective tissue disorders: Arthralgia, pain in extremity
- Nervous system disorders: Opisthotonos
- Psychiatric disorders: Agitation, insomnia, nightmare
- Reproductive system and breast disorders: Breast discomfort, menstruation irregular, retrograde ejaculation
- Respiratory, thoracic, and mediastinal disorders: Nasal congestion
- Skin and SC tissue disorders: pruritus, rash Vascular disorders: Hypertension
Postmarketing Reports
Angioedema, catatonia, ileus, somnambulism, swollen tongue, thrombotic thrombocytopenic purpura, urinary incontinence, and urinary retention
Invega Sustenna
- Anaphylactic reactions
Warnings
Black Box Warnings
Increased mortality in elderly patients with dementia-related psychosis
- Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death
- Not approved for use in patients with dementia-related psychosis
Contraindications
Documented hypersensitivity to paliperidone or risperidone
Cautions
Increased incidence of cerebrovascular adverse reactions (eg, stroke, transient ischemic attack, including fatalities) reported
Neuroleptic malignant syndrome (NMS) reported in association with antipsychotic drugs; if NMS is suspected, discontinue treatment and provide symptomatic treatment and monitoring
May induce orthostatic hypotension; use with caution in patients with known cardiovascular or cerebrovascular disease and patients predisposed to hypotension
Motor instability, somnolence, and orthostatic hypotension reported, which may lead to falls and, consequently, fractures or other fall-related injuries; assess risk of falls when initiating treatment and recurrently for patients receiving repeated doses, particularly the elderly, with diseases, conditions, or medications that could exacerbate these effects
Hyperprolactinemia reported; may suppress hypothalamic GnRH, resulting in reduced pituitary gonadotrophin secretion and gonadal steroidogenesis in female and male patients; galactorrhea, amenorrhea, gynecomastia, and impotence reported; long-standing hyperprolactinemia when associated with hypogonadism may lead to decreased bone density in both female and male subjects
May cause CNS depression (somnolence, sedation, dizziness), which may impair abilities to perform tasks requiring mental alertness, including operating heavy machinery
Use cautiously in patients with a history of seizures or with conditions that lower the seizure threshold
Antipsychotic use has been associated with esophageal dysmotility and aspiration; use with caution in patients at risk of aspiration pneumonia
Rare cases of priapism reported
Use caution when prescribing to patients who will be experiencing conditions which may contribute to elevation in core body temperature (eg, exercising strenuously, extreme heat exposure, concomitant medication with anticholinergic activity, dehydration)
Avoid use in severe preexisting GI stenosis
Rare cases of intraoperative floppy iris syndrome reported with risperidone in patients undergoing cataract surgery; paliperidone is active metabolite of risperidone; use caution; benefits or risks of interrupting paliperidone or risperidone use prior to cataract surgery not established
Patients with Parkinson disease may be more sensitive to CNS and extrapyramidal effects
May mask toxicity of other drugs or conditions (eg, intestinal obstruction) due to antiemetic effects
May increase risk of death in elderly patients with dementia-related psychosis
Use caution in patients with history of suicidal ideation or any form of psychotic illness; may increase risk of suicide attempt
Certain circumstances may increase risk of the occurrence of Torsades de pointes and/or sudden death in association with the use of drugs that prolong the QTc interval, including bradycardia; hypokalemia or hypomagnesemia; concomitant use of other drugs that prolong the QTc interval; and presence of congenital prolongation of the QT interval
Patient should see healthcare provider or go to the nearest emergency room right away if erection lasts more than 4 hr
Tardive dyskinesia
- Tardive dyskinesia may develop
- Risk of developing tardive dyskinesia and likelihood that it will become irreversible appears to increase with duration of treatment and cumulative dose; syndrome may develop after relatively brief treatment periods or after discontinuing treatment
- May remit, partially or completely, if treatment withdrawn; antipsychotic treatment may suppress (or partially suppress) signs and symptoms of syndrome and thereby possibly mask underlying process
- Reserve chronic antipsychotic treatment for patients who suffer from a chronic illness known to respond to antipsychotic drugs, and for whom alternative are not available or appropriate
- In patients who require chronic treatment, use lowest dose and the shortest duration of treatment producing a satisfactory clinical response; periodically reassess need for continued treatment
Metabolic changes
- Atypical antipsychotic drugs have been associated with metabolic changes that may increase cardiovascular or cerebrovascular risk (eg, hyperglycemia, dyslipidemia, hyperprolactinemia, body weight gain)
- Hyperglycemia and diabetes mellitus (DM), in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, have also been reported
- Regularly monitor patients diagnosed with DM who started an atypical antipsychotic for worsening of glucose control
- Patients with risk factors for DM (eg, obesity, family history of diabetes) who are starting treatment should undergo fasting blood glucose testing upon initiation and periodically during treatment
- Monitor any patient treated with atypical antipsychotics for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness
Leukopenia, neutropenia, and agranulocytosis
- Leukopenia/neutropenia and agranulocytosis reported
- Possible risk factors for leukopenia/neutropenia include preexisting low white blood cell (WBC) count and history of drug-induced leukopenia/neutropenia
- Monitor patients with clinically significant neutropenia for fever or other symptoms or signs of infection and treat promptly if such symptoms or signs occur
- If history of clinically significant low WBC count or drug-induced leukopenia/neutropenia, monitor complete blood cell count (CBC) frequently during first few months of therapy; discontinue if WBC decline <1000/ mm3 and continue monitoring WBC until recovery
Drug interaction overview
- Substrate of P-gp and CYP3A4
-
Centrally-acting drugs and alcohol
- Use with caution
- Centrally-acting drugs and alcohol may modulate the CNS effects of paliperidone
-
Drugs that cause orthostatic hypotension
- Monitor orthostatic vital signs in patients who are vulnerable to hypertension
- Drugs that induce orthostatic hypotension may enhance the orthostatic hypotensive effects of paliperidone
-
Strong CYP3A4 and P-gp inducers (Invega Hafyera only)
- Avoid coadministration of CYP3A4 and/or P-gp inducers
- If a strong inducer is necessary, consider using paliperidone extended-release tablets
-
Levodopa and other dopamine agonists
- Monitor and manage appropriately
- Paliperidone may antagonize the effect of levodopa and other dopamine agonists
-
Drugs that prolong QT interval
- Avoid coadministration with other drugs that are known to prolong QTc including Class 1A (eg, quinidine, procainamide) or Class III (eg, amiodarone, sotalol) antiarrhythmic medications, antipsychotic medications (eg, chlorpromazine, thioridazine), fluoroquinolones (eg, moxifloxacin), or any other class of medications known to prolong the QTc interval
- Paliperidone may enhance the QT-prolonging effects of such drugs
Pregnancy & Lactation
Pregnancy
Neonates exposed to antipsychotic drugs during third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery
Available data of pregnant females exposed to paliperidone have not established a drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes
Drug detected in plasma in adults up to 18 months after a single 3-month paliperidone injection; clinical significance administered before pregnancy or anytime during pregnancy is unknown
Pregnancy exposure registry
- Monitors pregnancy outcomes in females exposed to atypical antipsychotics during pregnancy
- Register patients by contacting the National Pregnancy Registry for atypical antipsychotics at 1-866-961-2388 or online at http://womensmentalhealth.org/clinical-andresearch-programs/pregnancyregistry/
Clinical considerations
- There are risks to the mother associated with untreated schizophrenia and with exposure to antipsychotics during pregnancy
- Extrapyramidal and/or withdrawal symptoms, including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorder have been reported in neonates who were exposed to antipsychotic drugs; monitor for extrapyramidal and/or withdrawal symptoms and manage appropriately
Infertility
- Based on pharmacologic action of paliperidone (D2 receptor antagonism), treatment may result in an increase in serum prolactin levels, which may lead to a reversible reduction in fertility in females of reproductive potential
Lactation
Limited data from published literature report presence of paliperidone in human breast milk
There is no information on effects on breastfed infant, or on milk production
Sedation, failure to thrive, jitteriness, and extrapyramidal symptoms (tremors and abnormal muscle movements) reported in breastfed infants exposed to risperidone (parent compound of paliperidone)
Monitor infants exposed to treatment through breast milk for excess sedation, failure to thrive, jitteriness, and extrapyramidal symptoms (tremors and abnormal muscle movements)
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Paliperidone palmitate is hydrolyzed to paliperidone, a major active metabolite of risperidone
Mechanism of action of paliperidone is unclear
However, its efficacy in the treatment of schizophrenia could be mediated through a combination of central dopamine D2 and serotonin 5HT2A receptor antagonism
Absorption
Bioavailability: 28%
Peak plasma time
- PO: 24 hr
- Invega Sustenna: 13 days
- Invega Trinza: 30-33 days
- Invega Hafyera: 29-32 days; release profile and dosing regimen results in sustained concentrations over 6 months
Distribution
Protein bound: 74% (racemic paliperidone)
Vd
- PO: 487 L
- Invega Sustenna: 391 L
- Invega Trinza and Hafyera: 1,960 L
Metabolism
Metabolized by CYP2D6 and CYP3A4
Elimination
Excretion
- PO: Urine (80%), feces (11%)
Half-life
- PO: 23 hr
- Invega Sustenna: 25-49 days
- Invega Trinza: 118-139 days
- Invega Hafyera: 148 days (1,092-mg dose); 159 days (1,560-mg dose)
Administration
Oral administration
May be taken with or without food
Swallow tablet whole with liquids; do not chew, crush or divide
The tablet shell, along with insoluble core components, is eliminated from the body; patients should not be concerned if they occasionally notice in their stool, something that looks like a tablet
Avoid alcohol during treatment
IM Preparation
Invega Sustenna or Trinza: Shake prefilled syringe vigorously for at least 15 seconds within 5 minutes before administration to ensure a homogeneous suspension
Invega Hafyera: Shake syringe with the syringe tip cap pointing up VERY FAST for at least 15 seconds, rest briefly, then shake again for 15 seconds; do not divide dose into multiple injections
IM administration
Administer only by a healthcare professional
Visually inspect syringe for foreign matter and discoloration prior to administration, whenever product and container permit
Do not mix with any other product or diluent
Avoid inadvertent injection into a blood vessel
Administer dose in a single injection; do not administer the dose in divided injections
Inject slowly, deep into the upper-outer quadrant of the gluteal muscle
Future injections should be alternated between the two gluteal muscles
Needle length and gauge
- Deltoid injection: If patient ≥90 kg, use 1.5-in. 22-gauge needle; if patient <90 kg, use 1-in. 23-gauge needle
- Gluteal injection: Use 1.5-in. 22-gauge needle regardless of patient weight
-
Invega Hafyera
- Do not use needles from Invega Sustenna or Trinza or other commercially-available needles to reduce the risk of blockage
Once monthly IM injection
- Before initiating once monthly IM therapy, establish PO tolerability with paliperidone or risperidone
- First 2 doses are injected into deltoid; maintenance doses may be injected into either deltoid or gluteal muscle
Every 3-months IM administration
- Before initiating q3mo IM therapy, establish tolerability with once-monthly paliperidone for at least 4 months
- Initiate Invega Trinza when the next 1-month paliperidone dose is scheduled with an Invega Trinza dose based on the previous 1-month injection dose
Every 6-months IM administration
- Before initiating q6mo IM therapy, establish tolerability with once-monthly paliperidone for at least 4 months
- May administer Invega Hafyera dose up to 1 week before or after the next scheduled Invega Sustenna
- Ensure the 2 injection cycles preceding the switch should be the same dosage strength before starting Invega Hafyera
-
Incomplete administration
- Proper shaking can reduce likelihood for an incomplete injection
- Storing carton in a horizontal orientation improves the ability to resuspend this highly concentrated product
- In the event of an incompletely administered dose, do not reinject the dose remaining in the syringe and do not administer another Invega Hafyera
- Closely monitor and treat with oral paliperidone supplementation as clinically appropriate until the next scheduled Invega Hafyera
- See prescribing information of the oral paliperidone product for the recommended dosage of these products
Missed Doses
Invega Sustenna
-
Second dose
- To avoid a missed dose, may give second dose 4 days before or after the one-week time point
- <4 wk since first injection: Administer second initiation dose of 156 mg IM in deltoid muscle as soon as possible, then administer a third injection of 117 mg IM (deltoid or gluteal) 5 weeks afterwards; thereafter resume regular monthly dosing
- 4-7 wk since first injection: Resume dose with 2 injections of 156 mg IM in deltoid muscle 1 week apart; thereafter, resume regular monthly dosing
- >7 wk since first injection: Restart with recommended initiation
-
Third and subsequent doses
- To avoid a missed dose, may give injection 7 days before or after the monthly time point
- 4-6 wk since last injection: Resume regular monthly dosing as soon as possible at previous stabilized dose; followed in monthly injections
- >6 wk to 6 months since last injection: Resume same dose as previously stabilized, unless stabilized on 234 mg/month, then the first 2 injections should each be 156 mg given 1 wk apart; thereafter, resume previously stabilized dose 1 month later
- >6 months since last injection: Administer 234 mg IM in deltoid on Day 1, then 156 mg IM in deltoid on Day 8; thereafter, resume administration 1 month after Day 8 at the previously stabilized dose (deltoid or gluteal)
Invega Trinza
- If necessary, patients may be given the injection up to 2 weeks before or after the 3-month time point
- Missed dose >9 months since last injection: Must reinitiate with the 1-month paliperidone as previously described
- Missed dose 3.5-4 months since last injection: Administer the patient’s regular dose as soon as possible, then continue with the 3-month injection following this dose
- Missed dose 4-9 months since last injection: Do not administer the next dose, instead use reinitiation schedule
-
Reinitiation schedule based on last dose of Invega Trinza
- Administer Invega Sustenna, 2 doses given 1 week apart into deltoid muscle (ie, Day 1 and Day 8), then administer Invega Trinza 1 month after Day 8 (in deltoid or gluteal muscle)
- Last dose 273 mg: Invega Sustenna 78 mg IM on Days 1 and 8, then Invega Trinza 273 mg IM 1 month after Day 8
- Last dose 410 mg: Invega Sustenna 117 mg IM on Days 1 and 8, then Invega Trinza 410 mg IM 1 month after Day 8
- Last dose 546 mg: Invega Sustenna 156 mg IM on Days 1 and 8, then Invega Trinza 546 mg IM 1 month after Day 8
- Last dose 819 mg: Invega Sustenna 156 mg IM on Days 1 and 8, then Invega Trinza 819 mg IM 1 month after Day 8
Invega Hafyera
- To avoid a missed dose, may give injection up to 2 weeks before or 3 weeks after scheduled 6-mo dose
-
Missed dose >6 mo and 3 weeks to <8 mo since last injection
- Do not administer next Invega Hafyera dose
- Last dose 1,092 mg: Administer Invega Sustenna 156 mg IM into deltoid muscle on Day 1; 1 month after Day 1, administer Invega Hafyera 1,092 mg IM into gluteal muscle
- Last dose 1,560 mg: Administer Invega Sustenna 234 mg IM into deltoid muscle on Day 1; 1 month after Day 1, administer Invega Hafyera 1,560 mg IM into gluteal muscle
-
Missed dose >8 mo to ≤11 mo since last injection
- Do not administer next Invega Hafyera dose
- Last dose 1,092 mg: Invega Sustenna 156 mg IM on Days 1 and 8, then Invega Hafyera 1,092 mg IM 1 month after Day 8
- Last dose 1,560 mg: Invega Sustenna
- 156 mg IM on Days 1 and 8, then Invega Hafyera 1,560 mg IM 1 month after Day 8
-
Missed dose >11 mo since last injection
- Reinitiate treatment with Invega Sustenna as described in its prescribing information
- Resume Invega Hafyera after patient has been adequately treated with Invega Sustenna for at least 4 months
Storage
Tablets
- Store up to 25ºC (77ºF); excursions permitted to 15-30ºC (59-86ºF)
- Protect from moisture
- Keep out of reach of children
IM
- Store at room temperature 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF) are permitted
- Do not mix with any other product or diluent
- Ship and store in a horizontal position; see arrows on product carton for proper orientation
Images
BRAND | FORM. | UNIT PRICE | PILL IMAGE |
---|---|---|---|
Invega oral - | 1.5 mg tablet | ![]() | |
Invega oral - | 9 mg tablet | ![]() | |
Invega oral - | 6 mg tablet | ![]() | |
Invega oral - | 3 mg tablet | ![]() | |
paliperidone oral - | 6 mg tablet | ![]() | |
paliperidone oral - | 3 mg tablet | ![]() | |
paliperidone oral - | 9 mg tablet | ![]() | |
paliperidone oral - | 3 mg tablet | ![]() | |
paliperidone oral - | 1.5 mg tablet | ![]() | |
paliperidone oral - | 6 mg tablet | ![]() | |
paliperidone oral - | 3 mg tablet | ![]() | |
paliperidone oral - | 1.5 mg tablet | ![]() | |
paliperidone oral - | 9 mg tablet | ![]() | |
paliperidone oral - | 3 mg tablet | ![]() | |
paliperidone oral - | 9 mg tablet | ![]() | |
paliperidone oral - | 1.5 mg tablet | ![]() | |
paliperidone oral - | 6 mg tablet | ![]() | |
paliperidone oral - | 1.5 mg tablet | ![]() | |
paliperidone oral - | 9 mg tablet | ![]() | |
paliperidone oral - | 6 mg tablet | ![]() | |
paliperidone oral - | 3 mg tablet | ![]() | |
paliperidone oral - | 1.5 mg tablet | ![]() |
Copyright © 2010 First DataBank, Inc.
Patient Handout
paliperidone oral
PALIPERIDONE EXTENDED-RELEASE - ORAL
(PAL-ee-PER-i-done)
COMMON BRAND NAME(S): Invega
WARNING: There may be a slightly increased risk of serious, possibly fatal side effects (such as stroke, heart failure, fast/irregular heartbeat, pneumonia) when this medication is used by older adults with dementia. This medication is not approved for the treatment of dementia-related behavior problems. Discuss the risks and benefits of this medication, as well as other effective and possibly safer treatments for dementia-related behavior problems, with the doctor.If you are using paliperidone in combination with other medication to treat depression, also carefully read the drug information for the other medication.
USES: This medication is used to treat certain mental/mood disorders (such as schizophrenia, schizoaffective disorder). This medication can decrease hallucinations and help you to think more clearly and positively about yourself, feel less agitated, and take a more active part in everyday life.Paliperidone belongs to a class of drugs called atypical antipsychotics. It works by helping to restore the balance of certain natural substances in the brain.
HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually once daily. Swallow the tablets whole with liquid. Do not crush or chew the tablets. Doing so can release all of the drug at once, increasing the risk of side effects.The dosage is based on your age, medical condition, and response to treatment.Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. Keep taking this medication even if you feel well. Do not stop taking this medication without consulting your doctor.Tell your doctor if your condition lasts or gets worse.
SIDE EFFECTS: Drowsiness, dizziness, lightheadedness, drooling, stomach/abdominal pain, weight gain, or tiredness may occur. If any of these effects last or get worse, tell your doctor promptly.Dizziness and lightheadedness can increase the risk of falling. Get up slowly when rising from a sitting or lying position.An empty tablet shell may appear in your stool. This effect is harmless because your body has already absorbed the medication.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: difficulty swallowing, muscle spasms, shaking (tremor), mental/mood changes (such as restlessness), interrupted breathing during sleep.This drug may rarely make your blood sugar rise, which can cause or worsen diabetes. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. If you already have diabetes, check your blood sugar regularly as directed and share the results with your doctor. Your doctor may need to adjust your diabetes medication, exercise program, or diet.This drug may also cause significant weight gain and a rise in your blood cholesterol (or triglyceride) levels. These effects, along with diabetes, may increase your risk for developing heart disease. Discuss the risks and benefits of treatment with your doctor. (See also Notes section.)Paliperidone may rarely cause a condition known as tardive dyskinesia. In some cases, this condition may be permanent. Tell your doctor right away if you develop any unusual/uncontrolled movements (especially of the face, lips, mouth, tongue, arms, or legs).This medication may increase a certain natural substance (prolactin) made by your body. For females, this increase in prolactin may result in unwanted breast milk, missed/stopped periods, or difficulty becoming pregnant. For males, it may result in decreased sexual ability, inability to produce sperm, or enlarged breasts. If you develop any of these symptoms, tell your doctor right away.Get medical help right away if you have any very serious side effects, including: severe dizziness, fainting, seizures.This medication may rarely cause a very serious condition called neuroleptic malignant syndrome (NMS). Get medical help right away if you have any of the following symptoms: fever, muscle stiffness/pain/tenderness/weakness, severe tiredness, severe confusion, sweating, fast/irregular heartbeat, dark urine, signs of kidney problems (such as change in the amount of urine).Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking paliperidone, tell your doctor or pharmacist if you are allergic to it; or to risperidone; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, seizures, low white blood cell count, Parkinson's disease, dementia, esophagus/stomach/intestinal movement or blockage disorders (such as difficulty swallowing, peritonitis, cystic fibrosis, Meckel's diverticulum), certain eye problems (cataracts, glaucoma), personal or family history of diabetes, high cholesterol/triglyceride levels, heart disease, breathing trouble during sleep (sleep apnea).Paliperidone may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using paliperidone, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using paliperidone safely.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery (including cataract/glaucoma eye surgery), tell your doctor or dentist if you are taking or have ever taken this medication, and about all the other products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication may make you sweat less, making you more likely to get heat stroke. Avoid doing things that may cause you to overheat, such as hard work or exercise in hot weather, or using hot tubs. When the weather is hot, drink a lot of fluids and dress lightly. If you overheat, quickly look for a place to cool down and rest. Get medical help right away if you have a fever that does not go away, mental/mood changes, headache, or dizziness.Older adults may be more sensitive to the side effects of this drug, especially drowsiness, dizziness, lightheadedness, and QT prolongation (see above). Drowsiness, dizziness, and lightheadedness can increase the risk of falling.During pregnancy, this medication should be used only when clearly needed. Babies born to mothers who have used this drug during the last 3 months of pregnancy may rarely develop symptoms including muscle stiffness or shakiness, drowsiness, feeding/breathing difficulties, or constant crying. If you notice any of these symptoms in your newborn especially during their first month, tell the doctor right away.Since untreated mental/mood problems (such as schizophrenia, schizoaffective disorders, depression) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.This medication passes into breast milk and may have undesirable effects on a nursing infant. Tell the doctor right away if your baby develops symptoms such as muscle stiffness or shakiness, unusual sleepiness, or difficulty feeding. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: metoclopramide.Many drugs besides paliperidone may affect the heart rhythm (QT prolongation), including amiodarone, chlorpromazine, moxifloxacin, quinidine, sotalol, procainamide, thioridazine, among others.Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness/dizziness, fast/irregular heartbeat, unusual/uncontrolled movements.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as blood sugar, weight, blood pressure, blood cholesterol/triglyceride levels) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised December 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.