Paliperidone-Induced Acute Dystonia

Background and Objective: Paliperidone is an active metabolite of risperidone which received FDA approval very recently. Because of its unique pharmacologic delivery system and low avidity for D2 receptor lower doses of paliperidone (3 mg & 6 mg) are claimed to be much safer from EPS point of view. We aim to present a case of cervico-oromandibular dystonia in a young adult with schizophrenia temporally related to paliperidone. Case description: Based upon a clinical history of paranoid schizophrenia and no prior history of antipsychotic use paliperidone was introduced at a dose of 6 mg/d in the index case. After receiving the second dose of paliperidone the patient developed cervico-oro-mandibular dystonia which was quite painful and distressing for the patient. It was relieved by intravenous administration of an antihistaminic agent. Conclusion: The index case suggests lower doses of paliperidone may induce acute EPS in susceptible patients (German J Psychiatry 2011; 14: 46-47).