Palimax ER 3 | 1 Strip

✔️ Palimax ER 3 (Paliperidone ER 3 mg)

• Schizophrenia
• Schizoaffective disorder
• Mania (as part of mood stabilization)

✔️ Dosage & Administration

Adult

Schizophrenia: Start 6 mg PO once daily in the morning; adjust in 3 mg increments at ≥5-day intervals. Max: 12 mg/day.

Schizoaffective disorder: 6 mg PO daily (range 3–12 mg/day). Dose adjustment in 3 mg increments, if needed.

Pediatric (>12 years)

<51 kg: Start 3 mg/day; titrate up to max 6 mg/day.

>51 kg: Start 3 mg/day; titrate up to max 12 mg/day.

<12 years: Safety/efficacy not established.

Renal Impairment

CrCl 50–79 mL/min: 3 mg/day (max 6 mg/day).

CrCl 10–49 mL/min: 1.5 mg/day (max 3 mg/day).

CrCl <10 mL/min: Not recommended.

Administration

Swallow whole with water. Do not chew, crush, or split.

May be taken with or without food, but at a consistent time daily.

✔️ Drug Interactions

• ↑ QT prolongation with class IA & III antiarrhythmics.
• Additive hypotension with antipsychotics, TCAs.
• Antagonizes effects of levodopa/dopaminergics.
• ↑ Seizure risk with SSRIs, clozapine, tramadol, mefloquine.
• ↓ Levels with carbamazepine.
• ↑ Levels with valproate.
• Enhanced CNS depression with alcohol, sedatives.

✔️ Monitoring Parameters

• Mental status, EPS, and tardive dyskinesia.
• Weight, BMI, BP, lipid profile, and blood glucose.
• Renal and hepatic function.
• ECG (in patients at risk for QT prolongation).

✔️ Patient Counseling Points

• Take once daily, preferably in the morning.
• Do not stop abruptly without medical supervision.
• Rise slowly from sitting/lying to avoid dizziness.
• Avoid alcohol and activities requiring alertness (driving, operating machinery) until drug effects are known.
• Report any severe muscle stiffness, fever, confusion (NMS), irregular heartbeat, or sudden mood changes immediately.

✔️ Adverse Effects

Common (>10%)

• Akathisia, somnolence, insomnia
• Parkinsonism, tachycardia
• Hyperprolactinemia (→ galactorrhea, amenorrhea, gynecomastia)

Less common (<10%)

• Extrapyramidal symptoms, dystonia
• Orthostatic hypotension, QT prolongation
• Weight gain, constipation, dyspepsia, nausea
• Rash, xerostomia, sialorrhea, extremity pain
• Rare but serious: NMS, anaphylaxis, priapism

✔️ Contraindications

Hypersensitivity to paliperidone or risperidone.

✔️ Use cautiously in patients with:

• Cardiovascular disease, QT prolongation risk.
• Seizure history.
• Parkinson’s disease.
• GI obstruction risk.
• Prolactin-dependent tumors.
• May cause weight gain, hyperglycemia, and dyslipidemia → monitor metabolic profile.
• Monitor for neuroleptic malignant syndrome (NMS), tardive dyskinesia, mood changes, or suicidal thoughts.
• Elderly with dementia-related psychosis: ↑ risk of cerebrovascular events & mortality.
• Pregnancy & lactation: Use only if clearly needed; excreted in breast milk → avoid nursing.

✔️ Storage:

Store in a cool and dry place, away from light. Keep out of reach of children.