Medication Use Evaluation of the Metabolic Side Effects of Paliperidone in an Inpatient Psychiatric Facility

Objective. The goal is to evaluate the metabolic outcomes of paliperidone use in an inpatient psychiatric setting. Background. Risperidone, approved in 1994, became first line treatment for schizophrenia due to its propensity to control both positive and negative symptoms. Although atypical antipsychotics produced less EPS, they yield a metabolic side effect profile. Paliperidone, the major metabolite of risperidone, is the first to use the OROS system, which allows for once-daily dosing. The antipsychotic level should remain more constant; Therefore, paliperidone should reduce side effects and increasing tolerability. Methods. This study is a retrospective medical chart review. Each subject’s lab values, vital signs, and physical assessments are recorded during paliperidone treatment for up to one year. Glucose, lipid profile, weight, BMI, and blood pressure of each subject are utilized to quantify the metabolic effects. Results. The mean decrease per subject for LDL, triglyceride, and total cholesterol were 36.57 mg/dL, 42.66 mg/dL, and 29.11 mg/dL, respectively. HDL cholesterol levels were not affected. There was a reduction in mean weight of 6.77 lbs per subject. 29.5% of subjects experienced significant weight loss (≥7% decrease); only 9% of subjects had significant weight gain (≥7% increase). The mean BMI was decreased 1.22 kg/m2 per subject. The mean systolic blood pressure was increased by 1.41 mm Hg per subject; the diastolic pressure was decreased by 2.20 mmHg. The mean individual increase in glucose was 7.03 mg/dL. Conclusion. Paliperidone significantly reduced LDL, triglycerides, total cholesterol, and weight. HDL and blood pressure were unaffected. However, glucose levels were increased.