Paliperidone Extended‐Release Tablets (Invega)

T he second-generation antipsychotics (SGAs) have become the first-line treatment for schizophrenia. They hold the distinct advantage of fewer unwanted extrapyramidal effects, especially tardive dyskinesia, compared with first-generation antipsychotics (FGAs). They also may produce less worsening of negative symptoms, greater improvement in cognitive impairment, and better relapse prevention. Recently, the Clinical Antipsychotic Trials of Intervention Effectiveness found that while firstand second-generation agents are effective in treating the positive and negative symptoms of schizophrenia, there is a high discontinuation rate. The most common reasons for discontinuation in Phase 1 of this trial were lack of efficacy, intolerability, and patient decision. This emphasizes the need for effective new agents that are more tolerable and will facilitate medication adherence. Paliperidone extended-release tablet (paliperidone ER, Invega, Janssen L.P., Titusville, NJ) is the newest SGA on the U.S. market. INDICATIONS Paliperidone ER is indicated for the acute and maintenance treatment of schizophrenia. The efficacy of paliperidone ER was established in three placebo-controlled trials, each 6 weeks in duration.