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deleted456421
I've had two patients that decompensated during transitions to Sustenna.
The first was very, very carefully titrated to 9 mg of oral paliperidone with almost complete remittance of psychosis before starting Sustenna. They were admitted for NMS after stopping Trinza and being overloaded with various antipsychotics at another hospital, so I wanted to make sure it wouldn't recur before restarting a long-acting injectable. I followed the manufacturer recommendations exactly (234 mg on day 1 and 156 mg on day 8) and discontinued oral Invega. They decompensated 2 days after the 2nd IM and required an additional two months of oral supplementation before discharge. This was in a thin individual, for whatever that's worth.
The second was doing great on Risperidone Consta but was threatening to stop the injection because of its frequency. I smartly told the patient and their mother that I had an easy trick: we'd switch to Sustenna, then Trinza, then Halyera. I showed them the manufacture's colorful website (here for those interested) and promised a simple transition. Again, I followed the recommendations exactly (they were on Consta 50 mg/biweekly so I transitioned to Sustenna 156 mg/monthly). Again, they experienced dramatically worsened auditory hallucinations and disorganization.
Has anyone else had similar experiences or know something about the pharmacokinetics of paliperidone that I'm missing?
The first was very, very carefully titrated to 9 mg of oral paliperidone with almost complete remittance of psychosis before starting Sustenna. They were admitted for NMS after stopping Trinza and being overloaded with various antipsychotics at another hospital, so I wanted to make sure it wouldn't recur before restarting a long-acting injectable. I followed the manufacturer recommendations exactly (234 mg on day 1 and 156 mg on day 8) and discontinued oral Invega. They decompensated 2 days after the 2nd IM and required an additional two months of oral supplementation before discharge. This was in a thin individual, for whatever that's worth.
The second was doing great on Risperidone Consta but was threatening to stop the injection because of its frequency. I smartly told the patient and their mother that I had an easy trick: we'd switch to Sustenna, then Trinza, then Halyera. I showed them the manufacture's colorful website (here for those interested) and promised a simple transition. Again, I followed the recommendations exactly (they were on Consta 50 mg/biweekly so I transitioned to Sustenna 156 mg/monthly). Again, they experienced dramatically worsened auditory hallucinations and disorganization.
Has anyone else had similar experiences or know something about the pharmacokinetics of paliperidone that I'm missing?
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