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Ziprasidone-Paliperidone LA

There are 2 switch possibities:

Number 1 (the general approach):

  • Day 1: Switch to oral risperidone (or oral paliperidone): see this switch in the main cross table.
  • Day 1-29: Maintain on oral risperidone (or oral paliperidone) and examine the effects.
  • Day 30: stop oral risperidone (or oral paliperidone) and administer paliperidone-LA: see this switch in the main cross table.

Oral risperidone has better and more stable bioavailability properties than has oral 9-OH-risperidone=paliperidone. Food increases the absorption with 50-60% of the latter.


Number 2 (if a patient in the past reacted well on risperidon or paliperidone=9-OH-risperidone):

Ziprasidone
Type Antipsychotic
Group Atypical AP
Other use Moodstabilizer
links
Medscape Ziprasidone
PubChem 60854
PubMed Ziprasidone
Wikipedia Ziprasidone
Paliperidone
long acting
Type Antipsychotic
Group Atypical AP
links
Medscape Paliperidone
PubChem 23724979
PubMed Paliperidone
Kompas (Dutch) Paliperidone
Wikipedia Paliperidone

Switch medication from Ziprasidone to Paliperidone_LA.[1] [2]

Nietinrijdenbord.png Stop Ziprasidone
  • Week 1-3: approx. 75% of initial dose
  • Week 4-6: approx. 50% of initial dose
  • Week 7-9: approx. 25% of initial dose
  • Week 10: stop
Eenrichtingbord.png Start Paliperidone_LA
  • Day 1: Start depot according general dosing advice (Dotted line in graph)
Infobord.png More information
  • During this switch you could monitor ECG, especially in patients prone to QT-conduction problems.
  • There is a possibility of QT interval prolongation.[3]
  • Alternatively, first switch to oral form and then switch to depot to manage possible (adverse) reactions. With a direct switch to a depot it is advisable to administer a low testdose in order to exclude adverse reactions.
    Stop10WeeksStartDepot.jpg
Nietinrijdenbord.png — Ziprasidone
Eenrichtingbord.png — Paliperidone_LA


  1. Switches are based on literature references on this page and expert opinions of the authors. The authors have used pharmacokinetic and receptor affinity properties to determine the switch schedules
  2. Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
  3. Stöllberger C, Huber JO, Finsterer J, Antipsychotic drugs and QT prolongation. Int Clin Psychopharmacol. 2005 Sep;20(5):243-51.
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