Paliperidone palmitate injections for schizophrenia: new Cochrane systematic review


We know that people with schizophrenia who adhere to their treatment are more likely to experience sustained periods of time without psychotic symptoms. However, lots of patients find it hard to stick to the prescribed medication, so doctors sometimes recommend alternative treatments to try and encourage adherence.

Long-acting intramuscular injections are one option available to people who take antipsychotic drugs. A risperidone injection (which must be refrigerated) has been available for some time, which patients need to take every 2 weeks. A new systematic review from the Cochrane Schizophrenia Group looks at a different injection of paliperidone palmitate (a metabolite of risperidone), which patients take once a month and does not require refrigeration.

The reviewers carried out a gold standard search for randomised controlled trials that compare the effects of paliperidone palmitate with any other treatment for people with schizophrenia and schizophrenia-like illnesses. They found 5 trials (involving a total of 2,215 patients) to include in their meta-analysis.

Here’s what they found:

  • Short term trials showed that paliperidone palmitate is more effective than placebo
  • The side effects of paliperidone palmitate were similar to other antipsychotics with extrapyramidal movement disorders, weight gain, and tachycardia all more common than with placebo
  • Paliperidone palmitate is associated with substantial increases in serum prolactin, but the review found no increase in the reported incidence of sexual side effects
  • The review did not find any data about use of services, quality of life, behaviour, patient satisfaction, cognitive functioning or cost

The authors concluded:

When flexibly dosed with a mean doses of approximately 70 to 110 mg every four weeks, paliperidone palmitate appears comparable in efficacy and tolerability to risperidone long-acting injection flexibly dosed with mean doses of approximately 35 mg every two weeks.


Nussbaum AM, Stroup TS. Paliperidone palmitate for schizophrenia. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD008296. DOI: 10.1002/14651858.CD008296.pub2.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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