Importance of Long-Acting Injectable Antipsychotic Preparation, Administration, and Injection Site Tolerability: A Focus on Paliperidone Palmitate Once-Every-6-Months Formulation

Figure 1

Dose preparation for paliperidone palmitate formulations [17–19]. Note. PP1M, paliperidone palmitate once-monthly; PP3M, paliperidone palmitate once-every-3-months; PP6M, paliperidone palmitate once-every-6-months. ^aFollowing tolerability testing, the recommended initiation of PP1M is with a dose of 234 mg on treatment day 1 and 156 mg one week later, both administered in the deltoid muscle. After the second initiation dose, monthly maintenance doses can be administered in either the deltoid or gluteal muscle. The recommended maintenance dose for treatment of schizophrenia is 117 mg. Some patients may benefit from lower or higher maintenance doses within the additional available strengths (39, 78, 156, and 234 mg). ^bInitiate PP3M after patients have been adequately treated with PP1M for at least 4 months, with the last 2 doses being the same. When the next PP1M dose is scheduled, administer a PP3M dose based on the previous 1-month injection dose using the equivalent 3.5-fold-higher dose. ^cInitiate PP6M only after adequate treatment has been established with either PP1M for at least 4 months, with the last 2 doses being the same, or PP3M for at least one 3-month injection cycle. The recommended initial PP6M dose is based on the previous PP1M dose or PP3M dose. If the last dose was PP1M 156 mg or PP3M 546 mg, the initial dose of PP6M should be 1092 mg. If the last dose was PP1M 234 mg or PP3M 819 mg, the initial dose of PP6M should be 1560 mg. ^dPP should be administered by a healthcare professional as a single injection. The dose should not be divided into multiple injections. Please refer to the full prescribing information, including boxed warning, of each formulation for complete dosing and administration information.