Paliperidone

INTRODUCTION

Indications

Schizophrenia.

Action

May act by antagonizing dopamine and serotonin in the CNS. Paliperidone is the active metabolite of risperidone. Therapeutic Effects: Decreased manifestations of schizophrenia.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, drowsiness, headache, anxiety, confusion, dizziness, extrapyramidal disorders (dose related), fatigue, parkinsonism (dose related), syncope, tardive dyskinesia, weakness. EENT: blurred vision. Resp: dyspnea, cough. CV: palpitations, tachycardia (dose related), bradycardia, orthostatic hypotension, ↑ QTc interval. GI: abdominal pain, dry mouth, dyspepsia, nausea, swollen tongue. Endo: hyperglycemia. MS: back pain, dystonia (dose related). Neuro: akathisia, dyskinesia, tremor (dose related). Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor and report signs of neuroleptic malignant syndrome (hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure (BP), incontinence). Symptoms typically occur within 4–14 days after initiation of drug therapy, but can occur at any time during drug use.

• Assess motor function, and be alert for extrapyramidal symptoms. Report these symptoms immediately, especially tardive dyskinesia, because this problem may be irreversible. Common extrapyramidal symptoms include:

  • ∘ Tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities, lip smacking or puckering, puffing of cheeks, uncontrolled chewing, rapid or worm-like movements of tongue).

  • ∘ Pseudoparkinsonism (shuffling gait, rigidity, tremor, pill-rolling motion, loss of balance control, difficulty speaking or swallowing, mask-like face).

  • ∘ Akathisia (restlessness or desire to keep moving).

  • ∘ Other dystonias and dyskinesias (dystonic muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs).

• Monitor personality changes such as anxiety and confusion. Notify physician if these changes become problematic.

• Assess dizziness, drowsiness, and syncope that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess any back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess BP when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg, or diastolic BP falls >10 mm Hg.

• Report any troublesome respiratory problems, including severe or prolonged cough or difficult/labored breathing.

• Monitor signs of hyperglycemia, including drowsiness, fruity breath, increased urination, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

Interventions