Quetiapine-Paliperidone LA

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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):

Quetiapine
Type antipsychotic
Group atypical AP
Other use moodstabilizer
links
ATC-code N05AH04
Medscape Quetiapine
PubChem 5002
PubMed Quetiapine
Drugs.com quetiapine-fumarate
Kompas (Dutch) Quetiapine
Wikipedia Quetiapine
Paliperidone
long acting
Type Antipsychotic
Group Atypical AP
links
Medscape Paliperidone
PubChem 23724979
PubMed Paliperidone
Kompas (Dutch) Paliperidone
Wikipedia Paliperidone

Switch medication from Quetiapine to Paliperidone_LA.[5] [6]

Nietinrijdenbord.png Stop Quetiapine
  • 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.[7]
  • 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 — Quetiapine
Eenrichtingbord.png — Paliperidone_LA


  1. 1.0 1.1 1.2 KNMP; Informatorium Medicamentorum 2023; Monografie "quetiapine" (Dutch)
  2. NVZA; Toxicology.org; Monografie 73 (dutch)
  3. Woods SW Chlorpromazine equivalent doses for the newer atypical antipsychotics J Clin Psychiatry 2003;64:663-667
  4. Drugs.com quetiapine-fumarate
  5. 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
  6. Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge University Press.
  7. Stöllberger C, Huber JO, Finsterer J, Antipsychotic drugs and QT prolongation. Int Clin Psychopharmacol. 2005 Sep;20(5):243-51.
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