92 - Paliperidone LAI 6 monthly (PP6M)

Paliperidone LAI 6-monthly (PP6M)

96 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 (Table 1.20). Dose adjustments should not be necessary but may be made at 3-­monthly intervals thereafter; however, the full response to the new dose may not be apparent for several months.15 The administration process is important for avoiding incomplete administration of the suspension. This requires shaking vigorously the prefilled syringe with the cap and a loose wrist, in a vertical motion for at least 15 seconds to ensure an evenly distributed suspension.15 Points to note ■ ■Patients should be on a stable and effective therapeutic dose of PP1M before changing to PP3M to ensure optimal dosing and avoid relapse and hospital admissions.14,20–22 ■ ■PP3M should be given in place of the next PP1M injection at an equivalent dose. ■ ■The median time to maximum plasma concentration is 30–33 days.15 ■ ■The median half-­life for deltoid injection is 84–95 days and for gluteal injection is 118–139 days. ■ ■After IM injection of PP3M into the deltoid muscle, there was an average increase of 11–12% maximum concentration in plasma compared with gluteal injection. Paliperidone LAI 6-­monthly (PP6M) PP6M is indicated for patients on maintenance treatment with 100mg or 150mg of PP1M (ideally for 4 months or more, same dose for the last two injections) or patients who have had at least one injection of 350mg or 525mg of PP3M and do not require any dose changes. It is designed to be given once every 6 months into the gluteal muscle. It should not be administered via any other route. There are no corresponding PP6M doses for 25mg, 50mg, 75mg of PP1M or for 263mg and 350mg of PP3M.23 Table 1.21 gives equivalent doses for paliperidone LAI. Table 1.20  Dosing of paliperidone long-­acting injection 3-­monthly.15 Dose of PP1M Dose of PP3M 50mg 175mg 75mg 263mg 100mg 350mg 150mg 525mg Table 1.21  Paliperidone long-­acting injection – equivalent doses. Dose of PP1M (mg) Dose of PP3M (mg) Dose of PP6M (mg) 350 150 1000