Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Paliperidone is a second-generation antipsychotic and the main active metabolite of risperidone, formulated to provide consistent therapeutic effects through an extended-release system, designed to provide consistent therapeutic effects through an extended-release formulation. While commonly used in clinical practice, switching from risperidone to paliperidone, particularly during valproate therapy, can pose challenges due to potential pharmacokinetic interactions that may increase the risk of extrapyramidal symptoms (EPS). Despite clinical observations suggesting these interactions, case reports documenting such adverse effects are scarce. CASE PRESENTATION: We report a case of a 48-year-old Japanese male with epilepsy-associated psychosis and mild intellectual disability who experienced severe EPS during a gradual cross-titration from risperidone to paliperidone while on valproate therapy. The patient had a history of well-controlled epilepsy with valproate and developed auditory hallucinations, delusions, and psychomotor agitation at age 48. Initial treatment with risperidone was partially effective but did not sufficiently manage his psychotic symptoms, prompting a switch to paliperidone. Shortly after increasing the paliperidone dose, the patient developed significant EPS, including muscle rigidity and elevated creatine kinase levels, indicative of potential neuroleptic malignant syndrome. Paliperidone was immediately discontinued, leading to a marked improvement in symptoms. DISCUSSION: This case highlights the pharmacokinetic interaction between valproate and paliperidone, which can elevate plasma levels of paliperidone and exacerbate EPS. Literature suggests that valproate can prolong the gastrointestinal retention time of paliperidone, leading to increased absorption and enhanced dopaminergic blockade. The gradual cross-titration method may have compounded these effects, emphasizing the need for careful dose adjustments and monitoring during antipsychotic switching, especially in patients on concomitant valproate therapy. CONCLUSION: The findings suggest that direct substitution methods, rather than gradual cross-titration, may be safer when switching from risperidone to paliperidone, particularly in patients receiving valproate. Clinicians should be aware of the potential interactions and closely monitor for signs of EPS during such therapy adjustments.

DOI： 10.1186/s12888-024-06456-x

PubMed

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Publishing type：Research paper (scientific journal)  

DOI： 10.1002/npr2.12487

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/10400435.2024.2348147

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Distinct oral atypical antipsychotics have different effects on autonomic nervous system (ANS) activity. Among them, oral aripiprazole has been linked to dysfunction of the ANS in schizophrenia. Long-acting injectable aripiprazole is a major treatment option for schizophrenia, but the effect of the aripiprazole formulation on ANS activity remains unclear. In this study, we compared ANS activity between oral aripiprazole and aripiprazole once-monthly (AOM) in schizophrenia. METHODS: Of the 122 patients with schizophrenia who participated in this study, 72 received oral aripiprazole and 50 received AOM as monotherapy. We used power spectral analysis of heart rate variability to assess ANS activity. RESULTS: Patients who received oral aripiprazole showed significantly diminished sympathetic nervous activity compared with those who received AOM. Multiple regression analysis revealed that the aripiprazole formulation significantly influenced sympathetic nervous activity. CONCLUSION: Compared with oral aripiprazole, AOM appears to have fewer adverse effects, such as sympathetic nervous dysfunction.

DOI： 10.1186/s12888-023-04617-y

PubMed

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

J-GLOBAL

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Language：Japanese   Publisher：(公社)日本精神神経学会  

J-GLOBAL

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Language：Japanese   Publisher：(公社)日本精神神経学会  

J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Poster presentation  

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