【藥品性質提示】 根據 2019 AGS Beers Criteria，本藥品為【潛在不適當用藥 (PIM)】，不建議用於老年人 (除非用於思覺失調、雙極症、或化療止吐)。

思覺失調症 Indicated for the acute and maintenance treatment of schizophrenia in adults

Second Generation (Atypical) Antipsychotic
Paliperidone is the major active metabolite of risperidone. While the mechanism of action is unknown, its proposed therapeutic activity is antagonism of both the central D2 and 5HT2A receptors. It also has antagonistic effects on the alpha-1 adrenergic, alpha-2 adrenergic, and H1 histaminergic receptors.

Tmax, IM: 13 days (1-month extended-release)
Excretion: Renal (80%), 59% unchanged
Elimination Half Life: 25 to 49 days (1-month extended-release)

Hypersensitivity to paliperidone, risperidone, or any component of the product.

C

enters breast milk; use caution

Injection site reactions, somnolence/sedation, dizziness, akathisia, extrapyramidal disorder

Note: Before starting monthly IM paliperidone, establish tolerability with a test dose of oral paliperidone or oral risperidone. After initiating monthly IM paliperidone, overlap with oral antipsychotics is not necessary.

Initiation:
1. Dose: 234 mg paliperidone palmitate (=150 mg paliperidone) on treatment day 1; followed by 156 mg paliperidone palmitate (=100 mg paliperidone) 1 week later, with both doses administered in the deltoid muscle.
2. Missed dose managment: The second dose may be administered 4 days before or after the 1-week time point.
3. Note: When converting from other long-acting injectable antipsychotics (at steady state), initiation doses are not required.
Maintenance:
1. Dose: Five weeks after the first initiation dose, begin a maintenance dose of 39-234 mg paliperidone palmitate (=25-150 mg aliperidone) every month administered in either the deltoid or gluteal muscle.
2. Missed dose managment: The monthly maintenance dose may be administered 7 days before or after the monthly time point.

Dose conversions:

Paliperidone ER tablet	Invega Sustenna
3mg/day	25-50 mg aliperidone QM
6mg/day	75 mg aliperidone QM
9mg/day	100 mg aliperidone QM
12mg/day	150 mg aliperidone QM

1. Mild renal impairment (CrCl 50- 80 mL/min): Initiate 156 mg (=100 mg paliperidone) IM on day 1 and 117 mg (=75 mg paliperidone) 1 week later; maintenance 78 mg (=50 mg paliperidone) IM monthly.
2. Moderate or severe renal impairment (CrCl＜50 mL/min): Use not recommended.