Comparative Pharmacology
Head-to-head clinical analysis: PALIPERIDONE versus SEROQUEL XR.
Peer-Reviewed Evidence
Head-to-head clinical analysis: PALIPERIDONE versus SEROQUEL XR.
PALIPERIDONE vs SEROQUEL XR
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Paliperidone is an atypical antipsychotic that exerts its effects primarily through antagonism of central dopamine D2 receptors and serotonin 5-HT2A receptors. It also antagonizes alpha-1 and alpha-2 adrenergic receptors, and H1 histaminergic receptors. Paliperidone is the major active metabolite of risperidone.
SEROQUEL XR (quetiapine fumarate) is an atypical antipsychotic that acts as an antagonist at multiple neurotransmitter receptors: serotonin 5-HT1A and 5-HT2A, dopamine D1 and D2, histamine H1, and adrenergic α1 and α2 receptors. It also has partial agonist activity at 5-HT1A receptors. The therapeutic efficacy in schizophrenia and bipolar disorder is primarily attributed to dopamine D2 and serotonin 5-HT2A antagonism.
6 mg orally once daily, with dose adjustments in 3 mg increments at intervals of 5 days or more; usual effective range 3-12 mg/day.
Initial: 300 mg orally once daily; may increase by 300 mg/day every 2-3 days. Target dose: 400-800 mg/day for schizophrenia; 300-600 mg/day for bipolar depression; 400-800 mg/day for acute mania. Maximum: 800 mg/day.
None Documented
None Documented
Clinical Note
moderatePaliperidone + Levofloxacin
"Paliperidone may increase the QTc-prolonging activities of Levofloxacin."
Clinical Note
moderatePaliperidone + Norfloxacin
"Paliperidone may increase the QTc-prolonging activities of Norfloxacin."
Clinical Note
moderatePaliperidone + Gemifloxacin
"Paliperidone may increase the QTc-prolonging activities of Gemifloxacin."
Clinical Note
moderatePaliperidone + Fluticasone propionate
Approximately 23 hours for the extended-release oral formulation; provides steady trough concentrations with once-daily dosing
Terminal elimination half-life: approximately 7 hours (range 6-9 hours) for the extended-release formulation. Clinical context: once-daily dosing achieves steady-state within 2 days.
Renal (approximately 80% as unchanged drug and glucuronide conjugate), biliary/fecal (approximately 11%)
Primarily hepatic; 70-73% excreted in urine as metabolites (mostly inactive), 20-24% in feces. Less than 1% excreted unchanged in urine.
Category A/B
Category C
Atypical Antipsychotic
Atypical Antipsychotic
"The risk or severity of adverse effects can be increased when Paliperidone is combined with Fluticasone propionate."