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Management of the overdose of paliperidone 3-monthly injection: A case report

Management of the overdose of paliperidone 3-monthly injection: A case report Correspondence Australasian Psychiatry 2023, Vol. 0(0) 1 © The Royal Australian and New Zealand College of Psychiatrists 2023 Article reuse guidelines: sagepub.com/journals-permissions journals.sagepub.com/home/apy team after discharge to a residential plasma therapeutic drug monitoring Management of the overdose aged care facility. (TDM) in the decision-making process of paliperidone 3-monthly for the recommencement of paliper- injection: A case report Despite the overdose, Mrs L’sphysical idone once the levels normalise. Dear Sir, observations were within the normal limits and she was medically stable. We Acknowledgements Long acting injectable (LAI) anti- monitored for potential cardiac/ The authors would like to thank Professor Vladan Starcevic psychotics assist in ensuring medication circulatory (e.g. arrhythmias, QTc pro- for his contributions to this paper. compliance. paliperidone palmitate LAI longation and postural hypotension) has one-monthly (PP1M), three- and neurological (e.g. seizures, dystonia Disclosure monthly (PP3M) and six-monthly and neuroleptic malignant syndrome) The author reports no conflict of interest. The author alone is (PP6M) options available in Australia. complications. Weekly blood tests, responsible for the content and writing of the paper. The overdose from LAI is almost always paliperidone levels and ECGs were iatrogenic due to either a medication conducted for 5 weeks post-discharge. Funding error or occasionally, overzealous pre- Fortunately, no adverse effects arose and The author(s) received no financial support for the research, scribing practice. We present a case of her mental state remained in remission. authorship, and/or publication of this article. iatrogenic overdose with paliperidone Paliperidone levels (therapeutic range palmitate LAI to add to the limited case 20–60 ng/mL) were recorded at 40.4 ng/ Patient Consent reports published for the management mL (21 January 2022), 35.3 ng/mL (27 Written informed consent for patient information to be 1,2 of overdose with PP1M and PP3M. January 2022), 32. 2 ng/mL (3 February published was provided by the patient’s legally authorised representative. 2022), 29.1 ng/mL (11 February 2022) Mrs L, an 87-year-old woman of Chi- and24.2ng/mL (17February 2022), nese heritage with an established his- ORCID iD indicating a gradual decline in the se- tory of schizophrenia (primarily rum concentrations. Her general blood Fei Xue Jin  https://orcid.org/0000-0001-6392-1462 auditory hallucinations), transitioned biochemistry (including creatine kinase from PP1M 50 mg to PP3M 175 mg in levels) and QTc remained within nor- September 2021 after a period of sta- References mal limits. She was restarted on oral bility on PP1M since 2019. She was 1. Ojimba C, Oyelakin A and Khandaker T. Accidental paliperidone 3 mg after the last plasma then admitted to a local hospital’sge- overdose of paliperidone palmitate. Case Rep Psychiatry level and later switched to PP1M 50 mg 2019; 2019: 7406298. riatric ward on 19th November 2021 in April 2022 without any significant for management of delirium unrelated 2. Parker R, Vellar K, Khalid U, et al. Clinical management of adverse effects. to her psychosis. Her medical history medication overdose: three-monthly paliperidone pal- imitate injectable medication. Aust N Z J Psychiatry 2022; included asthma and osteoarthritis. This case demonstrates no persisting 56(4):413. During her admission, Mrs L was or severe adverse effects from pal- inadvertently administered PP1M at iperidone palmitate LAI overdose. In Fei Xue Jin 175 mg (more than three times the the other cases, minor QTc changes Northern Sydney Local Health equivalent dose of PP1M) on 14th were noted post PP1M overdose and District, Sydney, NSW, Australia December 2021 due to a medication transient hypotension followed in- advertent PP3M administration. To- error from the geriatric medicine Asad Malik gether, this may suggest that gradual nursing staff. The error was only de- Napean Blue Mountains Older changes in antipsychotic serum levels tected days prior to her discharge Persons’ Mental Health Service, from the LAI formulation have less from the hospital on 14th January Kingswood, NSW, Australia likelihood of adverse events from 2022 by a pharmacist. Her care was overdose. We highlight the use of DOI: 10.1177/10398562231162233 handed over to a new mental health http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australasian Psychiatry SAGE

Management of the overdose of paliperidone 3-monthly injection: A case report

Australasian Psychiatry , Volume 31 (3): 2 – Jun 1, 2023

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References (2)

Publisher
SAGE
Copyright
© The Royal Australian and New Zealand College of Psychiatrists 2023
ISSN
1039-8562
eISSN
1440-1665
DOI
10.1177/10398562231162233
Publisher site
See Article on Publisher Site

Abstract

Correspondence Australasian Psychiatry 2023, Vol. 0(0) 1 © The Royal Australian and New Zealand College of Psychiatrists 2023 Article reuse guidelines: sagepub.com/journals-permissions journals.sagepub.com/home/apy team after discharge to a residential plasma therapeutic drug monitoring Management of the overdose aged care facility. (TDM) in the decision-making process of paliperidone 3-monthly for the recommencement of paliper- injection: A case report Despite the overdose, Mrs L’sphysical idone once the levels normalise. Dear Sir, observations were within the normal limits and she was medically stable. We Acknowledgements Long acting injectable (LAI) anti- monitored for potential cardiac/ The authors would like to thank Professor Vladan Starcevic psychotics assist in ensuring medication circulatory (e.g. arrhythmias, QTc pro- for his contributions to this paper. compliance. paliperidone palmitate LAI longation and postural hypotension) has one-monthly (PP1M), three- and neurological (e.g. seizures, dystonia Disclosure monthly (PP3M) and six-monthly and neuroleptic malignant syndrome) The author reports no conflict of interest. The author alone is (PP6M) options available in Australia. complications. Weekly blood tests, responsible for the content and writing of the paper. The overdose from LAI is almost always paliperidone levels and ECGs were iatrogenic due to either a medication conducted for 5 weeks post-discharge. Funding error or occasionally, overzealous pre- Fortunately, no adverse effects arose and The author(s) received no financial support for the research, scribing practice. We present a case of her mental state remained in remission. authorship, and/or publication of this article. iatrogenic overdose with paliperidone Paliperidone levels (therapeutic range palmitate LAI to add to the limited case 20–60 ng/mL) were recorded at 40.4 ng/ Patient Consent reports published for the management mL (21 January 2022), 35.3 ng/mL (27 Written informed consent for patient information to be 1,2 of overdose with PP1M and PP3M. January 2022), 32. 2 ng/mL (3 February published was provided by the patient’s legally authorised representative. 2022), 29.1 ng/mL (11 February 2022) Mrs L, an 87-year-old woman of Chi- and24.2ng/mL (17February 2022), nese heritage with an established his- ORCID iD indicating a gradual decline in the se- tory of schizophrenia (primarily rum concentrations. Her general blood Fei Xue Jin  https://orcid.org/0000-0001-6392-1462 auditory hallucinations), transitioned biochemistry (including creatine kinase from PP1M 50 mg to PP3M 175 mg in levels) and QTc remained within nor- September 2021 after a period of sta- References mal limits. She was restarted on oral bility on PP1M since 2019. She was 1. Ojimba C, Oyelakin A and Khandaker T. Accidental paliperidone 3 mg after the last plasma then admitted to a local hospital’sge- overdose of paliperidone palmitate. Case Rep Psychiatry level and later switched to PP1M 50 mg 2019; 2019: 7406298. riatric ward on 19th November 2021 in April 2022 without any significant for management of delirium unrelated 2. Parker R, Vellar K, Khalid U, et al. Clinical management of adverse effects. to her psychosis. Her medical history medication overdose: three-monthly paliperidone pal- imitate injectable medication. Aust N Z J Psychiatry 2022; included asthma and osteoarthritis. This case demonstrates no persisting 56(4):413. During her admission, Mrs L was or severe adverse effects from pal- inadvertently administered PP1M at iperidone palmitate LAI overdose. In Fei Xue Jin 175 mg (more than three times the the other cases, minor QTc changes Northern Sydney Local Health equivalent dose of PP1M) on 14th were noted post PP1M overdose and District, Sydney, NSW, Australia December 2021 due to a medication transient hypotension followed in- advertent PP3M administration. To- error from the geriatric medicine Asad Malik gether, this may suggest that gradual nursing staff. The error was only de- Napean Blue Mountains Older changes in antipsychotic serum levels tected days prior to her discharge Persons’ Mental Health Service, from the LAI formulation have less from the hospital on 14th January Kingswood, NSW, Australia likelihood of adverse events from 2022 by a pharmacist. Her care was overdose. We highlight the use of DOI: 10.1177/10398562231162233 handed over to a new mental health

Journal

Australasian PsychiatrySAGE

Published: Jun 1, 2023

There are no references for this article.