Background

• Paliperidone palmitate long-acting injection (LAI) labeling does not recommend concurrent oral antipsychotic use when initiating the injection.
• In model-based pharmacokinetic simulations, 84% of patients achieved therapeutic plasma concentrations within the first week following the recommended two-dose injection initiation regimen.
• Despite these recommendations, patients are commonly prescribed oral antipsychotic overlap with paliperidone LAI, with some studies reporting frequencies as high as 59%.
• There is limited evidence for the consequences of this practice;4,5 however, adding oral antipsychotics to the LAI may put patients at risk for adverse effects including extrapyramidal symptoms (EPS) which could lead to LAI discontinuation and ultimately decompensation.

Primary Objective: Compare the time to LAI discontinuation in patients who were initiated on paliperidone LAI and received oral overlap with paliperidone or risperidone versus those who did not receive oral overlap.

Secondary Objectives: Compare the length of stay, rate of psychiatric rehospitalization and emergency visits, and the proportion of patients who received medications for EPS in these two groups.

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