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Paliperidone ER-Clozapine

* This switch is intended for paliperidone long acting (Xeplion®, 30 days)

Paliperidone
long acting
Type Antipsychotic
Group Atypical AP
links
Medscape Paliperidone
PubChem 23724979
PubMed Paliperidone
Kompas (Dutch) Paliperidone
Wikipedia Paliperidone
Clozapine
Type Antipsychotic
Group Atypical AP
links
Medscape Clozapine
PubChem 2818
PubMed Clozapine
Kompas (Dutch) Clozapine
Wikipedia Clozapine

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

Nietinrijdenbord.png Stop Paliperidone_LA
  • Day 1: Last depot injection
Eenrichtingbord.png Start Clozapine
  • Day 1: start with 12,5 mg at night
  • Day 2: 25 mg in divided doses
  • Day 3-15: increase daily dose every 1-2 day(s) with 25 mg
  • Day 16-28: if necessary, increase dose with 50-100 mg/week
  • Low dose in the morning, high dose at night (twice daily dosage)
  • Increments are dependent on the status of patient
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]
    StopDepotStartOralClo.jpg
Nietinrijdenbord.png — Paliperidone_LA
Eenrichtingbord.png — Clozapine


  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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