Audit of inpatient and outpatient paliperidone palmitate injection prescribing practices

Abstract

Background: Paliperidone palmitate is marketed as a once-monthly long-acting antipsychotic injection and is expected to provide an avenue for long-term control of symptoms in patients with schizophrenia. Although marketed as once monthly medication, some medication references recommend a dosing interval of every 4 weeks for maintenance doses. Aim: (a) To assess whether the prescribing/administration practices relating to the dosing and dosing interval of paliperidone palmitate are consistent with recommendations outlined in major medication references in Australia and (b) to assess the number of doses and any differences in costs associated with different dosing intervals. Method: A retrospective audit of doses of paliperidone palmitate administered in a regional mental health service in Queensland between 1 October 2011 and 30 October 2013. Results: Twenty-five of the twenty-nine patients who had initiation doses prescribed for days 1 and 8 received the recommended initiation regimen. Sixteen percent of first monthly doses administered to patients were the recommended 75 mg strength; 60% of maintenance doses were administered ≤28 days after the previous dose, and 78% of patients studied for a year or more received at least 13 doses in 1 year, rather than 12 doses. Conclusion: A dosing interval of every 4 weeks resulted in at least one extra injection per patient per year, with associated cost. There is a need for a consensus on the dosing interval of paliperidone palmitate so that there is consistency in the number of doses received per patient, per year.