Paliperidone: new drug. Just a metabolite of risperidone, a neuroleptic soon off-patent

Abstract

(1) For patients with schizophrenia, risperidone is one of many available neuroleptics. It has no tangible advantages over conventional neuroleptics such as haloperidol. (2) Paliperidone, the main active metabolite of risperidone, has now arrived on the European market, in the form of sustained-release osmotic tablets. Clinical evaluation is based on 3 placebo-controlled trials lasting 6 weeks. As expected, paliperidone was effective in relieving symptoms of schizophrenia. However, it was no more effective than olanzapine and has not been compared with risperidone. (3) The adverse effect profile of paliperidone in these trials was predictable, consisting mainly of short-term neurological effects and dose-dependent weight gain. Paliperidone also provokes tachycardia and lengthens the QT interval in some patients. The rigid osmotic tablets can cause gastrointestinal complications. (4) Paliperidone does not represent a therapeutic advance. It is better to continue using a conventional neuroleptic such as haloperidol.