A systematic review and combined analysis of therapeutic drug monitoring studies for oral paliperidone

Expert Review of Clinical Pharmacology
Georgios SchoretsanitisJose de Leon

Abstract

This article includes a combined analysis of therapeutic drug monitoring (TDM) studies and a review of the marketer's data on pharmacological mechanisms. Areas covered: An article search led to the inclusion of 21 paliperidone studies in the systematic review plus 2 case reports. Paliperidone clearance was calculated from: 1) steady-state studies using concentration/dose (C/D) ratios, and 2) single-dose studies describing 24-h area under the curve calculations. The marketed extended-release formulation has 28% bioavailability. Calculated mean C/D ratios (ng/ml/mg/d) were: 1) 4.09 in 6 studies of 221 non-Korean and non-geriatric adult patients, 2) 2.59 in 2 studies of 100 Korean adult patients, and 3) 6.89 in 1 study with 15 elderly Japanese patients. The limited drug-drug interaction studies indicated that carbamazepine is a clinically relevant inducer requiring three times the dosage, and that valproate, probably an inhibitor, requires half the dosage. Renal impairment markedly decreased paliperidone elimination, and other antipsychotics should be considered. Expert Commentary: We recommend more use of: 1) paliperidone TDM in clinical practice, 2) TDM when moving from oral to long-acting paliperidone, 3) better designs for pal...Continue Reading

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Citations

Sep 25, 2018·Expert Opinion on Pharmacotherapy·Miquel Bioque, Miquel Bernardo
Nov 20, 2018·Expert Review of Clinical Pharmacology·Georgios SchoretsanitisJose de Leon
Feb 19, 2020·Journal of Pharmacy Practice·Ian R McGraneRobert C Munjal
Feb 25, 2020·British Journal of Clinical Pharmacology·Lin LiYu-Ping Ning
Apr 3, 2020·Expert Opinion on Drug Metabolism & Toxicology·Georgios SchoretsanitisAndreas A Westin
Jun 18, 2019·Journal of Clinical Psychopharmacology·Jaqueline BarclayJose de Leon
Apr 7, 2021·European Archives of Psychiatry and Clinical Neuroscience·Georgios SchoretsanitisMichael Paulzen
Jun 19, 2021·Clinical Pharmacokinetics·Georgios SchoretsanitisMichael Paulzen
Oct 16, 2020·Pharmacogenomics·Jose de Leon, Georgios Schoretsanitis
Dec 18, 2021·Expert Review of Clinical Pharmacology·Georgios SchoretsanitisMichael Paulzen

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