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Risperidone / Paliperidone LAI conversion tables, and why I'm favoring Uzedy

Updated: 5 days ago

Equivalent dosing for risperidone and paliperidone formulations

Equipotent dose comparison chart / table. How to convert between doses of risperidone, paliperidone, Uzedy, Perseris, Invega Sustenna,

Risperidone and Paliperidone Long-Acting Injectable (LAI) products


Uzedy


My mascot for Uzedy derives from the Frankenstein mascot for risperidone. See here for all of the risperidone and paliperidone mascots.

How to convert dose of risperidone oral to Uzedy.

Uzedy is becoming my risperidone/paliperidone LAI product of choice for inpatient administration.


The success rate of intended intramuscular injections is between 32% and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition (Soliman et al, 2018). The success rate is even lower in obese patients and women. The LAIs intended for muscles do not release well when deposited outside of muscle. I have seen shockingly low serum drug levels with IM LAIs (not with our nurses, they never miss ☺).


If an injection will likely end up SQ anyhow, why not choose a medication intended for SQ placement?


Advantages of Uzedy (SQ) over Perseris (SQ)

  • The volume of injection is less with Uzedy

  • Nurses tell me it is easier to administer Uzedy

  • Options for 1-month or 2-month treatments (vs 10month with Perseris)

Although Uzedy is available in 50, 75, 100, 125, 250, 200 and 250 mg strengths, I anticipate using mostly 100 mg in the inpatient setting. The 100 mg dose is appropriate for either q1mo (4 mg PO equivalent) or q2mo (2 mg PO equivalent) dosing, and the frequency of treatment can be decided by the outpatient provider.


Disadvantages of Risperdal Consta (generic version), the cheaper option

  • Consta must be administered every two weeks--the patient is "CONSTAntly getting injections".

  • A 3-week PO overlap is needed. The patient needs to keep taking oral risperidone beyond the second injection of Risperdal Consta!

  • Consta is intended for IM injection (see above)

With Uzedy, PO overlap is usually not necessary because serum levels are therapeutic within 6-24 hours of the injection.


What about Invega Trinza (q3 mo) and Invega Hafyera (q6 mo)? There are use cases, but I prefer the flexibility of not being locked into a medication for longer than 2 months.


Disclosures: No current pharmaceutical industry sponsorship


Copyright 2023, CaferMed Publishing

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