Paliperidone: a new atypical antipsychotic or more of the same?

A number of conventional and atypical antipsychotic drugs are available for the treatment of psychoses such as schizophrenia, and schizoaffective and bipolar disorders. Conventional antipsychotics are now used less frequently because of their propensity to cause extrapyramidal side effects (EPS) at therapeutically effective doses. Atypical antipsychotics are far less likely to cause EPS but have their own problems with respect to side effects and pharmacokinetic characteristics.

Paliperidone has now been approved in Australia and was listed on the PBS in April 2008 (authority required) for the treatment of schizophrenia (including acute treatment and recurrence prevention). It is related to an existing antipsychotic risperidone. The key question is whether paliperidone is a new therapeutic option or a risperidone analogue.