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TABLET, EXTENDED RELEASE;ORAL - 1.5MG **Federal Register determination that product was not discontinued or withdrawn for safety or effectiveness reasons**, TABLET, EXTENDED RELEASE;ORAL - 12MG **Federal Register determination that product was not discontinued or withdrawn for safety or effectiveness reasons**, TABLET, EXTENDED RELEASE;ORAL - 3MG, TABLET, EXTENDED RELEASE;ORAL - 6MG, TABLET, EXTENDED RELEASE;ORAL - 9MG

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Chemistry

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Also known as: 144598-75-4, 9-hydroxyrisperidone, Invega, 9-oh-risperidone, 3-(2-(4-(6-fluorobenzo[d]isoxazol-3-yl)piperidin-1-yl)ethyl)-9-hydroxy-2-methyl-6,7,8,9-tetrahydro-4h-pyrido[1,2-a]pyrimidin-4-one, Ro76477

Molecular Formula

C₂₃H₂₇FN₄O₃

Molecular Weight

426.5 g/mol

InChI Key

PMXMIIMHBWHSKN-UHFFFAOYSA-N

FDA UNII

838F01T721

A benzisoxazole derivative and active metabolite of RISPERIDONE that functions as a DOPAMINE D2 RECEPTOR ANTAGONIST and SEROTONIN 5-HT2 RECEPTOR ANTAGONIST. It is an ANTIPSYCHOTIC AGENT used in the treatment of SCHIZOPHRENIA.

Paliperidone is an Atypical Antipsychotic.

1 2D Structure

Paliperidone

2 Identification

2.1 Computed Descriptors

2.1.1 IUPAC Name

3-[2-[4-(6-fluoro-1,2-benzoxazol-3-yl)piperidin-1-yl]ethyl]-9-hydroxy-2-methyl-6,7,8,9-tetrahydropyrido[1,2-a]pyrimidin-4-one

2.1.2 InChI

InChI=1S/C23H27FN4O3/c1-14-17(23(30)28-9-2-3-19(29)22(28)25-14)8-12-27-10-6-15(7-11-27)21-18-5-4-16(24)13-20(18)31-26-21/h4-5,13,15,19,29H,2-3,6-12H2,1H3

2.1.3 InChI Key

PMXMIIMHBWHSKN-UHFFFAOYSA-N

2.1.4 Canonical SMILES

CC1=C(C(=O)N2CCCC(C2=N1)O)CCN3CCC(CC3)C4=NOC5=C4C=CC(=C5)F

2.2 Other Identifiers

2.2.1 UNII

838F01T721

2.3 Synonyms

2.3.1 MeSH Synonyms

1. 3-(2-(4-(6-fluoro-3-(1,2-benzisoxazolyl))-1-piperidinyl)ethyl)-6,7,8,9-tetrahydro-9-hydroxy-2-methyl-4h-pyrido(1,2-a)pyrimidin-4-one

2. 9 Hydroxy Risperidone

3. 9 Hydroxyrisperidone

4. 9 Oh Risperidone

5. 9-hydroxy-risperidone

6. 9-hydroxyrisperidone

7. 9-oh-risperidone

8. Invega

9. Invega Sustenna

10. Paliperidone Palmitate

11. Palmitate, Paliperidone

12. R 76477

13. R-76477

14. R76477

15. Sustenna, Invega

2.3.2 Depositor-Supplied Synonyms

1. 144598-75-4

2. 9-hydroxyrisperidone

3. Invega

4. 9-oh-risperidone

5. 3-(2-(4-(6-fluorobenzo[d]isoxazol-3-yl)piperidin-1-yl)ethyl)-9-hydroxy-2-methyl-6,7,8,9-tetrahydro-4h-pyrido[1,2-a]pyrimidin-4-one

6. Ro76477

7. C23h27fn4o3

8. R-76477

9. 3-[2-[4-(6-fluoro-1,2-benzoxazol-3-yl)piperidin-1-yl]ethyl]-9-hydroxy-2-methyl-6,7,8,9-tetrahydropyrido[1,2-a]pyrimidin-4-one

10. Ro-76477

11. 3-[2-[4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl]ethyl]-6,7,8,9-tetrahydro-9-hydroxy-2-methyl-4h-pyrido[1,2-a]pyrimidin-4-one

12. Chembl1621

13. 4h-pyrido(1,2-a)pyrimidin-4-one, 3-(2-(4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl)ethyl)-6,7,8,9-tetrahydro-9-hydroxy-2-methyl-

14. Chebi:83804

15. 144598-75-4 (free Base)

16. Nsc-759623

17. (9rs)-3-(2-(4-(6-fluoro-1,2-benzisoxazol-3-yl)piperidin-1-yl))ethyl)-9-hydroxy-2-methyl-6,7,8,9-tetrahydro-4h-pyrido(1,2-a)pyrimidin-4-one

18. 4h-pyrido[1,2-a]pyrimidin-4-one, 3-[2-[4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl]ethyl]-6,7,8,9-tetrahydro-9-hydroxy-2-methyl-

19. 838f01t721

20. Paliperidone [inn]

21. 3-{2-[4-(6-fluoro-1,2-benzoxazol-3-yl)piperidin-1-yl]ethyl}-9-hydroxy-2-methyl-4h,6h,7h,8h,9h-pyrido[1,2-a]pyrimidin-4-one

22. Palliperidone

23. 9-hydroxy Risperidone

24. R 76477

25. Hsdb 8148

26. Rac 9-hydroxy Risperidone

27. Unii-838f01t721

28. 3-(2-(4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl)ethyl)-6,7,8,9-tetrahydro-9-hydroxy-2-methyl-4h-pyrido(1,2-a)pyrimidin-4-one

29. 3-{2-[4-(6-fluoro-1,2-benzoxazol-3-yl)piperidin-1-yl]ethyl}-9-hydroxy-2-methyl-6,7,8,9-tetrahydropyrido[1,2-a]pyrimidin-4-one

30. Paliperidone [usan:inn:ban:jan]

31. Invega (tn)

32. Mfcd00871802

33. Paliperidone- Bio-x

34. Risperidone-m 9-hydroxy

35. Paliperidone [mi]

36. Paliperidone [jan]

37. Paliperidone [usan]

38. Paliperidone [vandf]

39. Paliperidone [mart.]

40. Jns-007er

41. Mls004773953

42. Paliperidone [usp-rs]

43. Paliperidone [who-dd]

44. Schembl436689

45. Paliperidone (jan/usp/inn)

46. Gtpl7258

47. Paliperidone [ema Epar]

48. Dtxsid7049059

49. 9-hydroxyrisperidone-d4 Solution

50. Paliperidone, >=98% (hplc)

51. Bcpp000132

52. Hms3261b06

53. Hms3743m09

54. Hms3887k15

55. Paliperidone [orange Book]

56. Amy24885

57. Bcp02338

58. Hy-a0019

59. Paliperidone [usp Monograph]

60. Tox21_500562

61. Bdbm50252513

62. S1724

63. Akos005266713

64. Akos016339656

65. Akos025392164

66. Ac-1282

67. Bcp9001047

68. Ccg-221866

69. Cs-0386

70. Db01267

71. Ks-1279

72. Lp00562

73. Nsc 759623

74. Pb27526

75. Sdccgsbi-0633730.p001

76. Ncgc00186014-01

77. Ncgc00186014-12

78. Ncgc00261247-01

79. 4h-pyrido(1,2-a)pyrimidin-4-one, 3-(2-(4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl)ethyl)-6,7,8-tetrahydro-9-hydroxy-2-methyl-

80. 4h-pyrido(2,1-a)pyrimidin-4-one, 6,7,8,9-tetrahydro-3-(2-(4-(6-fluro-1,2-benzisoxazol-3-yl)-1-piperidinyl)ethyl)-9-hydroxy-2-methyl-

81. As-13860

82. Bp164223

83. Smr001456280

84. Risperidone Impurity, 9-hydroxyrisperidone-

85. 9-hydroxy Risperidone-d4 (paliperidone D4)

86. 9-hydroxyrisperidone 1.0 Mg/ml In Methanol

87. Ft-0600425

88. Ft-0670101

89. Ft-0670102

90. P1897

91. Risperidone Impurity C [ep Impurity]

92. C21516

93. D05339

94. 598p754

95. L023985

96. Q423292

97. Sr-02000000862

98. Q-101425

99. Sr-02000000862-3

100. Brd-a99888680-001-04-6

101. Paliperidone, United States Pharmacopeia (usp) Reference Standard

102. Risperidone Impurity, 9-hydroxyrisperidone- [usp Impurity]

103. (+/-)-3-[2-[4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl]ethyl]-6,7,8,9-tetrahydro-9-hydroxy-2-methyl-4h-pyrido[1,2-a]pyrimidin-4-one

104. (9rs)-3-[2-[4-(6-fluoro-1,2-benzisoxazol-3-yl)piperidin-1-yl]ethyl]-9-hydroxy-2-methyl-6,7,8,9-tetrahydro-4h-pyrido[1,2-a]pyrimidin-4-one (9-hydroxyrisperidone)

105. 3-(2-(4-(6-fluorobenzo[d]isoxazol-3-yl)piperidin-1-yl)ethyl)-9-hydroxy-2-methyl-6,7,8,9-tetrahydropyrido[1,2-a]pyrimidin-4-one

106. 3-[ 2-[4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl]ethyl]-6,7,8,9-tetrahydro-9-hydroxy-2-methyl-4h-pyrido[1,2-a]pyrimidin-4-one

107. 3-[ 2-[4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl]ethyl]-6,7,8,9-tetrahydro-9-hydroxy-2-methyl-4h-pyrido[1,2-a]pyrimidin4-one

108. 3-[2-[4-(6-fluoro-1,2-benzisoxazol- 3-yl)-1-piperidinyl]ethyl]-6,7,8,9-tetrahydro-9-hy Droxy-2-methyl-4h-pyrido[1,2-a]pyrimidin-4-one

109. 3-[2-[4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl]ethyl]-6,7,8,9-tetrahydro-9-hydroxy-2-methyl-4h-pyrido[1,2-a]-pyrimidin-4-one

110. 3-[2-[4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl]ethyl]-6,7,8,9-tetrahydro-9-hydroxy-2-methyl-4h-pyrido[1,2-a]pyrimidin-4-one, 9-hydroxyrisperidone

111. 3-[2-[4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl]ethyl]-9-hydroxy-6,7,8,9-tetrahydro-2-methyl-4h-pyrido[1,2-a]-pyrimidin-4-one

112. 3-{2-[4-(6-fluoro-1,2-benzoisoxazol-3-yl)-1-piperidinyl]ethyl}-9-hydroxy-2-methyl-6,7,8,9-tetrahydro-pyrido[1,2-alpha]pyrimidin-4-one

113. 3-{2-[4-(6-fluoro-1,2-benzoxazol-3-yl)piperidin-1-yl]ethyl}-9-hydroxy-2-methyl-6,7,8,9-tetrahydro-4h-pyrido[1,2-a]pyrimidin-4-one

114. 3-{2-[4-(6-fluoro-benzo[d]isoxazol-3-yl)-piperidin-1-yl]-ethyl}-9-hydroxy-2-methyl-6,7,8,9- Tetrahydro-pyrido[1,2-a]pyrimidin-4-one

115. 6,7,8,9-tetrahydro-3-(2-(4-(6-fluro-1,2-benzisoxazol-3-yl)-1-piperidinyl)ethyl)-9-hydroxy-2-methyl-4h-pyrido[2,1-a]pyrimidin-4-one

116. 9-hydroxyrisperidone Solution, 1.0 Mg/ml In Methanol, Ampule Of 1 Ml, Certified Reference Material

2.4 Create Date

2005-08-08

3 Chemical and Physical Properties

Molecular Formula	C₂₃H₂₇FN₄O₃
Molecular Weight	426.5 g/mol
XLogP3	2.2
Hydrogen Bond Donor Count	1
Hydrogen Bond Acceptor Count	7
Rotatable Bond Count	4
Exact Mass	426.20671890 g/mol
Monoisotopic Mass	426.20671890 g/mol
Topological Polar Surface Area	82.2 Å²
Heavy Atom Count	31
Formal Charge	0
Complexity	764
Isotope Atom Count	0
Defined Atom Stereocenter Count	0
Undefined Atom Stereocenter Count	1
Defined Bond Stereocenter Count	0
Undefined Bond Stereocenter Count	0
Covalently Bonded Unit Count	1

4 Drug and Medication Information

4.1 Drug Information

1 of 4
Drug Name	Invega
PubMed Health	Paliperidone
Drug Classes	Antipsychotic
Drug Label	Paliperidone, the active ingredient in INVEGA Extended-Release Tablets, is a psychotropic agent belonging to the chemical class of benzisoxazole derivatives. INVEGA contains a racemic mixture of (+)- and (-)- paliperidone. The chemical name is (...
Active Ingredient	Paliperidone
Dosage Form	Tablet, extended release
Route	oral; Oral
Strength	9mg; 1.5mg; 12mg; 6mg; 3mg
Market Status	Prescription
Company	Janssen Pharms; Janssen

2 of 4
Drug Name	Invega sustenna
PubMed Health	Paliperidone (Injection)
Drug Classes	Antipsychotic
Active Ingredient	Paliperidone palmitate
Dosage Form	Suspension, extended release
Route	Intramuscular
Strength	234mg/1.5ml (156mg/ml); 156mg/ml (156mg/ml); 117mg/0.75ml (117mg/0.75ml); 39mg/0.25ml (39mg/0.25ml); 78mg/0.5ml (78mg/0.5ml)
Market Status	Prescription
Company	Janssen Pharms

3 of 4
Drug Name	Invega
PubMed Health	Paliperidone
Drug Classes	Antipsychotic
Drug Label	Paliperidone, the active ingredient in INVEGA Extended-Release Tablets, is a psychotropic agent belonging to the chemical class of benzisoxazole derivatives. INVEGA contains a racemic mixture of (+)- and (-)- paliperidone. The chemical name is (...
Active Ingredient	Paliperidone
Dosage Form	Tablet, extended release
Route	oral; Oral
Strength	9mg; 1.5mg; 12mg; 6mg; 3mg
Market Status	Prescription
Company	Janssen Pharms; Janssen

4 of 4
Drug Name	Invega sustenna
PubMed Health	Paliperidone (Injection)
Drug Classes	Antipsychotic
Active Ingredient	Paliperidone palmitate
Dosage Form	Suspension, extended release
Route	Intramuscular
Strength	234mg/1.5ml (156mg/ml); 156mg/ml (156mg/ml); 117mg/0.75ml (117mg/0.75ml); 39mg/0.25ml (39mg/0.25ml); 78mg/0.5ml (78mg/0.5ml)
Market Status	Prescription
Company	Janssen Pharms

4.2 Therapeutic Uses

Antipsychotic Agent

National Library of Medicine's Medical Subject Headings. Paliperidone. Online file (MeSH, 2014). Available from, as of November 19, 2013: https://www.nlm.nih.gov/mesh/2014/mesh_browser/MBrowser.html

Invega (paliperidone) Extended-Release Tablets are indicated for the treatment of schizophrenia. The efficacy of Invega in schizophrenia was established in three 6-week trials in adults and one 6-week trial in adolescents, as well as one maintenance trial in adults. /Included in US product label/

US Natl Inst Health; DailyMed. Current Medication Information for INVEGA (paliperidone) tablet, extended release (June 2011). Available from, as of November 12, 2013: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=7b8e5b26-b9e4-4704-921b-3c3c0d159916

Invega (paliperidone) Extended-Release Tablets are indicated for the treatment of schizoaffective disorder as monotherapy and an adjunct to mood stabilizers and/or antidepressant therap. The efficacy of Invega in schizoaffective disorder was established in two 6-week trials in adults. /Included in US product label/

Invega Sustenna (paliperidone palmitate) is indicated for the treatment of schizophrenia. Efficacy was established in four short-term studies and one longer-term study in adults. /Paliperidone palmitate; Included in US product label/

US Natl Inst Health; DailyMed. Current Medication Information for IINVEGA SUSTENNA (paliperidone palmitate) injection (October 2012). Available from, as of November 15, 2013: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=1af14e42-951d-414d-8564-5d5fce138554

4.3 Drug Warning

/BOXED WARNING/ WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of 17 placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Invega (paliperidone) Extended-Release Tablets is not approved for the treatment of patients with dementia-related psychosis.

/BOXED WARNING/ WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS: Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Invega Sustenna is not approved for use in patients with dementia-related psychosis. /Paliperidone palmitate/

Hypersensitivity reactions, including anaphylactic reactions and angioedema, have been observed in patients receiving risperidone or paliperidone. Paliperidone is therefore contraindicated in patients with a known hypersensitivity to paliperidone, risperidone, or any ingredient in the paliperidone formulation.

American Society of Health-System Pharmacists 2013; Drug Information 2013. Bethesda, MD. 2013, p. 2504

An increased incidence of adverse cerebrovascular events (cerebrovascular accidents and transient ischemic attacks), including fatalities, has been observed in geriatric patients with dementia-related psychosis treated with certain atypical antipsychotic agents (aripiprazole, olanzapine, risperidone) in placebo-controlled studies. The manufacturer states that paliperidone is not approved for the treatment of patients with dementia-related psychosis.

American Society of Health-System Pharmacists 2013; Drug Information 2013. Bethesda, MD. 2013, p. 2504

For more Drug Warnings (Complete) data for Paliperidone (32 total), please visit the HSDB record page.

4.4 Drug Indication

As an oral extended-release tablet and a once-monthly extended-release suspension for intramuscular injection, paliperidone is indicated for the treatment of adults and adolescents with schizophrenia and in the treatment of schizoaffective disorder in combination with antidepressants or mood stabilizers. Paliperidone is also available in both an every-three-month and twice-yearly extended-release suspension for intramuscular injection for the treatment of schizophrenia.

Invega is indicated for the treatment of schizophrenia in adults and in adolescents 15 years and older.

Invega is indicated for the treatment of schizoaffective disorder in adults.

5 Pharmacology and Biochemistry

5.1 Pharmacology

Paliperidone is an atypical antipsychotic developed by Janssen Pharmaceutica. Chemically, paliperidone is primary active metabolite of the older antipsychotic risperidone (paliperidone is 9-hydroxyrisperidone). The mechanism of action is unknown but it is likely to act via a similar pathway to risperidone.

5.2 MeSH Pharmacological Classification

Serotonin 5-HT2 Receptor Antagonists

Drugs that bind to but do not activate SEROTONIN 5-HT2 RECEPTORS, thereby blocking the actions of SEROTONIN or SEROTONIN 5-HT2 RECEPTOR AGONISTS. Included under this heading are antagonists for one or more specific 5-HT2 receptor subtypes. (See all compounds classified as Serotonin 5-HT2 Receptor Antagonists.)

Antipsychotic Agents

Agents that control agitated psychotic behavior, alleviate acute psychotic states, reduce psychotic symptoms, and exert a quieting effect. They are used in SCHIZOPHRENIA; senile dementia; transient psychosis following surgery; or MYOCARDIAL INFARCTION; etc. These drugs are often referred to as neuroleptics alluding to the tendency to produce neurological side effects, but not all antipsychotics are likely to produce such effects. Many of these drugs may also be effective against nausea, emesis, and pruritus. (See all compounds classified as Antipsychotic Agents.)

Dopamine D2 Receptor Antagonists

Compounds and drugs that bind to and inhibit or block the activation of DOPAMINE D2 RECEPTORS. (See all compounds classified as Dopamine D2 Receptor Antagonists.)

5.3 FDA Pharmacological Classification

5.3.1 Active Moiety

PALIPERIDONE

5.3.2 FDA UNII

838F01T721

5.3.3 Pharmacological Classes

Atypical Antipsychotic [EPC]

5.4 ATC Code

N05AX13

N - Nervous system

N05 - Psycholeptics

N05A - Antipsychotics

N05AX - Other antipsychotics

N05AX13 - Paliperidone

5.5 Absorption, Distribution and Excretion

Absorption

The absolute oral bioavailability of paliperidone following paliperidone administration is 28%.

Route of Elimination

One week following administration of a single oral dose of 1 mg immediate-release 14C-paliperidone to 5 healthy volunteers, 59% (range 51% 67%) of the dose was excreted unchanged into urine, 32% (26% 41%) of the dose was recovered as metabolites, and 6% 12% of the dose was not recovered.

Volume of Distribution

487 L

The absolute oral bioavailability of paliperidone following Invega administration is 28%. Administration of a 12 mg paliperidone extended-release tablet to healthy ambulatory subjects with a standard high-fat/high-caloric meal gave mean Cmax and AUC values of paliperidone that were increased by 60% and 54%, respectively, compared with administration under fasting conditions. Clinical trials establishing the safety and efficacy of Invega were carried out in subjects without regard to the timing of meals. While Invega can be taken without regard to food, the presence of food at the time of Invega administration may increase exposure to paliperidone. Based on a population analysis, the apparent volume of distribution of paliperidone is 487 L. The plasma protein binding of racemic paliperidone is 74%.

Following a single dose, the plasma concentrations of paliperidone gradually rise to reach peak plasma concentration (Cmax) approximately 24 hours after dosing. The pharmacokinetics of paliperidone following Invega administration are dose-proportional within the available dose range. The terminal elimination half-life of paliperidone is approximately 23 hours. Steady-state concentrations of paliperidone are attained within 4-5 days of dosing with Invega in most subjects. The mean steady-state peak:trough ratio for an Invega dose of 9 mg was 1.7 with a range of 1.2-3.1.

One week following administration of a single oral dose of 1 mg immediate-release (14)C-paliperidone to 5 healthy volunteers, 59% (range 51% - 67%) of the dose was excreted unchanged into urine, 32% (26% - 41%) of the dose was recovered as metabolites, and 6% - 12% of the dose was not recovered. Approximately 80% of the administered radioactivity was recovered in urine and 11% in the feces.

Paliperidone is excreted in human breast milk.

For more Absorption, Distribution and Excretion (Complete) data for Paliperidone (7 total), please visit the HSDB record page.

5.6 Metabolism/Metabolites

Although in vitro studies suggested a role for CYP2D6 and CYP3A4 in the metabolism of paliperidone, in vivo results indicate that these isozymes play a limited role in the overall elimination of paliperidone. Four primary metabolic pathways have been identified in vivo, none of which could be shown to account for more than 10% of the dose: dealkylation, hydroxylation, dehydrogenation, and benzisoxazole scission. Paliperidone does not undergo extensive metabolism and a significant portion of its metabolism occurs in the kidneys.

Four primary metabolic pathways have been identified in vivo, none of which could be shown to account for more than 10% of the dose: dealkylation, hydroxylation, dehydrogenation, and benzisoxazole scission.

Paliperidone is a known human metabolite of risperidone.

S73 | METXBIODB | Metabolite Reaction Database from BioTransformer | DOI:10.5281/zenodo.4056560

5.7 Biological Half-Life

The terminal elimination half-life of paliperidone is approximately 23 hours.

The median apparent half-life of paliperidone following Invega Sustenna single-dose administration over the dose range of 39 mg - 234 mg ranged from 25 days - 49 days. /Paliperidone palmitate/

The terminal elimination half-life of paliperidone is approximately 23 hours.

5.8 Mechanism of Action

Paliperidone is the major active metabolite of risperidone. The mechanism of action of paliperidone, as with other drugs having efficacy in schizophrenia, is unknown, but it has been proposed that the drug's therapeutic activity in schizophrenia is mediated through a combination of central dopamine Type 2 (D2) and serotonin Type 2 (5HT2A) receptor antagonism.

The exact mechanism of paliperidone's antipsychotic action, like that of other antipsychotic agents, has not been fully elucidated, but may involve antagonism of central dopamine type 2 (D2) and serotonin type 2 (5-hydroxytryptamine [5-HT2A]) receptors.1 39 41 Antagonism at a1- and a2-adrenergic and histamine (H1) receptors may contribute to other therapeutic and adverse effects observed with the drug.1 2 39 Paliperidone possesses no affinity for cholinergic muscarinic and beta1- and beta2-adrenergic receptors.

American Society of Health-System Pharmacists 2013; Drug Information 2013. Bethesda, MD. 2013, p. 2506

Paliperidone is an active metabolite of the second-generation atypical antipsychotic, risperidone recently approved for the treatment of schizophrenia and schizoaffective disorder. Because paliperidone differs from risperidone by only a single hydroxyl group, questions have been raised as to whether there are significant differences in the effects elicited between these two drugs. /The researchers/ compared the relative efficacies of paliperidone versus risperidone to regulate several cellular signalling pathways coupled to four selected GPCR targets that are important for either therapeutic or adverse effects: human dopamine D2 , human serotonin 2A receptor subtype (5-HT2A ), human serotonin 2C receptor subtype and human histamine H1 receptors. Whereas the relative efficacies of paliperidone and risperidone were the same for some responses, significant differences were found for several receptor-signalling systems, with paliperidone having greater or less relative efficacy than risperidone depending upon the receptor-response pair. Interestingly, for 5-HT2A -mediated recruitment of beta-arrestin, 5-HT2A -mediated sensitization of ERK, and dopamine D2 -mediated sensitization of adenylyl cyclase signalling, both paliperidone and risperidone behaved as agonists. These results suggest that the single hydroxyl group of paliperidone promotes receptor conformations that can differ from those of risperidone leading to differences in the spectrum of regulation of cellular signal transduction cascades. Such differences in signalling at the cellular level could lead to differences between paliperidone and risperidone in therapeutic efficacy or in the generation of adverse effects.

PMID:23826915 Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791992 Clarke WP et al; Br J Pharmacol 170 (3): 532-45 (2013)

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Paliperidone

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DMF Review : Complete

Rev. Date : 2017-02-27

Pay. Date : 2016-12-01

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DOSAGE - TABLET, EXTENDED RELEASE;ORAL - 1.5M...DOSAGE - TABLET, EXTENDED RELEASE;ORAL - 1.5MG **Federal Register determination that product was not discontinued or withdrawn for safety or effectiveness reasons**