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DOSING

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Dosing initiation Dosing maintenance Missed doses Transitioning to ERZOFRI® Administering
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HOW TO INITIATE AND MAINTAIN ERZOFRI® THERAPY1

Dosing initiation1
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Day 1:

Administer the initial 351 mg dose in the deltoid muscle.

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No second initiation
 dose required1 

Following the initial dose, monthly doses can be administered in the gluteal or deltoid muscle.1

For patients who have never taken oral or injectable paliperidone, or oral or injectable risperidone: Establish tolerability with oral paliperidone or oral risperidone prior to initiating treatment with ERZOFRI®.

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Dosing maintenance1

General maintenance treatment guidance following initiation dose

For schizophrenia

Monthly doses of 39 mg to 234 mg can be administered 4 weeks after first injection. The recommended monthly dose for schizophrenia is 117 mg.

For schizoaffective disorder

Monthly doses of 78 mg to 234 mg can be administered 4 weeks after first injection*

*The 39 mg strength was not studied in the long-term schizoaffective disorder study.

Support during the transition to ERZOFRI® and throughout treatment is available.

Learn more
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Dosing initiation Dosing maintenance Missed doses Transitioning to ERZOFRI® Administering
Missed doses1
  • To avoid a missed monthly dose, patients may be given the injection up to 7 days before or after the monthly time point
  • If a dose is missed, the below instructions should be followed
Timing of missed dose Dosing

4 to 6 weeks since last injection

Resume regular monthly dosing as soon as possible at the previously stabilized dose, followed by injections at monthly intervals

>6 weeks to 6 months since last injection

Resume the same dose the patient was previously stabilized on (unless the patient was stabilized on a dose of 234 mg, then the first 2 injections should each be 156 mg) in the following manner:

  1. Administer a deltoid injection as soon as possible
  2. Administer a second deltoid injection 1 week later at the same dose
  3. Thereafter, resume administering the previously stabilized dose in the deltoid or gluteal muscle 1 month after the second injection

>6 months since
 last injection

Restart dosing with recommended initiation:

  1. Administer a 351 mg deltoid injection on day 1
  2. Thereafter, resume administering the previously stabilized dose in the deltoid or gluteal muscle 1 month after initial injection
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Transitioning to ERZOFRI®1,2

From paliperidone extended-release (ER) tablets2

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From risperidone tablets2

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From long-acting injectable antipsychotics1

When transitioning patients currently at steady-state on a long-acting injectable antipsychotic to ERZOFRI®:

  • Initiate in place of the next scheduled injection
  • Continue at monthly intervals
  • 351 mg initiation dose is not required for patients at steady state 

Based on previous clinical response and tolerability, some patients may benefit from lower or higher doses within the available strengths (39 mg, 78 mg, 117 mg, 156 mg, and 234 mg):

 

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Administering ERZOFRI®1

Preparation and administration instructions

To be prepared and administered by a
healthcare professional only		 Read the instructions for preparation and administration below for preparation and administration considerations
For deltoid or gluteal intramuscular
injection only		 Do not inject by any other route and, as a universal precaution, always wear gloves
Administer the initial dosage of
ERZOFRI® in the deltoid muscle		 Subsequent monthly dosages may be administered in the deltoid or gluteal muscle
Do not substitute any component The kit contains a prefilled syringe and 2 safety needles (a 1 ½-inch, 22-gauge needle and a 1-inch, 23-gauge needle)
Do not reuse ERZOFRI® is for single use only
As a universal precaution, always wear gloves.

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For complete administration instructions, please see the ERZOFRI® Prescribing Information

Step 1. Select needle1

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For deltoid injection:

If the patient weighs <90 kg, use the 1-inch, 23-gauge needle (needle with blue colored hub).

If the patient weighs ≥90 kg, use the 1 ½-inch, 22-gauge needle (needle with gray colored hub).

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For gluteal injection:

Use the 1 ½-inch, 22-gauge needle (needle with gray colored hub) regardless of patient’s weight.

Step 2. Prepare for injection1

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Open needle pouch.
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Shake vigorously for at least 10 seconds.
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While holding upright, remove the rubber tip cap by twisting counterclockwise.
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Attach needle.

Do not remove the pouch until the syringe and needle are securely attached.

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Remove needle sheath with a straight pull. Do not twist.
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Remove air bubbles.

Step 3. Inject1

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Inject slowly, deep into the deltoid or gluteal muscle.

Step 4. After injection1

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Secure needle.
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Dispose properly in a sharps container.
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No refrigeration or warming are required in preparing or administering ERZOFRI®1

Efficacy in

Schizoaffective Disorder Support & Resources
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INDICATIONS AND USAGE:

INDICATIONS AND USAGE: ERZOFRI® (paliperidone palmitate) extended-release injectable suspension for intramuscular use is an atypical antipsychotic indicated for the treatment of:

  • schizophrenia in adults
  • schizoaffective disorder in adults as monotherapy and as an adjunct to mood stabilizers or antidepressants

IMPORTANT SAFETY INFORMATION FOR ERZOFRI

WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. ERZOFRI is not approved for use in patients with dementia-related psychosis.

CONTRAINDICATIONS

ERZOFRI is contraindicated in patients with known hypersensitivity to paliperidone, risperidone, or to any excipients in ERZOFRI.

WARNINGS AND PRECAUTIONS

  • Cerebrovascular Adverse Reactions, Including Stroke, in Elderly Patients with Dementia-Related Psychosis: Increased incidence of cerebrovascular adverse reactions (e.g., stroke, transient ischemic attacks) including fatalities.
  • Neuroleptic Malignant Syndrome (NMS): NMS, a potentially fatal symptom complex, has been reported in association with antipsychotic drugs. Manage with immediate discontinuation and close monitoring.
  • QT Prolongation: Avoid use with drugs that also increase QT interval and in patients with risk factors for prolonged QT interval and patients with a history of cardiac arrhythmias.
  • Tardive Dyskinesia (TD): TD, a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements, may develop in patients treated with antipsychotic drugs. ERZOFRI should be prescribed in a manner that is most likely to minimize occurrence of TD. Chronic antipsychotic treatment should generally be reserved for patients: (1) who suffer from a chronic illness that is known to respond to antipsychotic drugs and (2) for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate. In patients who require chronic treatment, use the lowest dose and shortest duration of treatment producing a satisfactory clinical response. Periodically reassess the need for continued treatment.

    If signs and symptoms of TD appear in a patient treated with ERZOFRI, drug discontinuation should be considered. However, some patients may require treatment with ERZOFRI despite the presence of the syndrome.

  • Metabolic Changes: Atypical antipsychotic drugs have caused metabolic changes, including hyperglycemia, diabetes mellitus, dyslipidemia, and body weight gain that may increase the cardiovascular/cerebrovascular risk.
    • Hyperglycemia and Diabetes Mellitus: Monitor for hyperglycemia/diabetes mellitus, dyslipidemia, and weight gain. Patients with an established diagnosis of diabetes mellitus who are started on atypical antipsychotics should be monitored regularly for worsening glucose control. Patients with risk factors for diabetes mellitus (e.g., obesity, family history of diabetes) who are starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the suspect drug.
    • Dyslipidemia: Undesirable alterations in lipids have been observed in patients treated with atypical antipsychotics.
    • Weight Gain: Weight gain has been observed with atypical antipsychotic use. Clinical monitoring of weight is recommended.
  • Orthostatic Hypotension and Syncope: Paliperidone may induce orthostatic hypotension and syncope in some patients because of its alpha-adrenergic blocking activity. Use ERZOFRI with caution in patients with known cardiovascular disease (e.g., heart failure, history of myocardial infarction or ischemia, conduction abnormalities), cerebrovascular disease, or conditions that predispose the patient to hypotension (e.g., dehydration, hypovolemia, and treatment with antihypertensive medications). Monitoring of orthostatic vital signs should be considered in patients who are vulnerable to hypotension.
  • Falls: Somnolence, postural hypotension, motor and sensory instability have been reported with the use of antipsychotics, including paliperidone palmitate, which may lead to falls, and consequently, fractures or other fall-related injuries.
  • Leukopenia, Neutropenia, and Agranulocytosis: In clinical trial and/or postmarketing experience, events of leukopenia and neutropenia have been reported temporally related to antipsychotic agents, including once-a-month paliperidone palmitate. Agranulocytosis has also been reported. Possible risk factors for leukopenia/neutropenia include pre-existing low white blood cell count (WBC)/absolute neutrophil count (ANC) and history of drug-induced leukopenia/neutropenia. In patients with a history of a clinically significant low WBC/ANC or a drug-induced leukopenia/neutropenia, perform a complete blood count (CBC) frequently during the first few months of therapy. In such patients, consider discontinuation of ERZOFRI at the first sign of a clinically significant decline in WBC in the absence of other causative factors. Monitor patients with clinically significant neutropenia for fever or other symptoms or signs of infection and treat promptly if such symptoms or signs occur. Discontinue ERZOFRI in patients with severe neutropenia (absolute neutrophil count <1000/mm3) and follow their WBC until recovery.
  • Hyperprolactinemia: Paliperidone elevates prolactin levels and the elevation persists during chronic administration. Paliperidone has a prolactin-elevating effect similar to that seen with risperidone, a drug that is associated with higher levels of prolactin than other antipsychotic drugs.  Long-standing hyperprolactinemia, when associated with hypogonadism may lead to decreased bone density in both female and male subjects.
  • Potential for Cognitive and Motor Impairment: Somnolence, sedation, and dizziness were reported as adverse reactions in subjects treated with another once-a-month paliperidone palmitate extended-release injectable suspension. Antipsychotics, including ERZOFRI, have the potential to impair judgement, thinking, or motor skills. Patients should be cautioned about performing activities requiring mental alertness, such as operating hazardous machinery or operating a motor vehicle, until they are reasonably certain that paliperidone therapy does not adversely affect them.
  • Seizures: Like other antipsychotic drugs, ERZOFRI should be used cautiously in patients with a history of seizures or other conditions that potentially lower the seizure threshold.
  • Dysphagia: Esophageal dysmotility and aspiration have been associated with antipsychotic drug use. ERZOFRI and other antipsychotic drugs should be used cautiously in patients at risk for aspiration.
  • Priapism: Drugs with alpha-adrenergic blocking effects have been reported to induce priapism.
  • Disruption of Body Temperature Regulation: Disruption of the body’s ability to reduce core body temperature has been attributed to antipsychotic agents. Appropriate care is advised when prescribing ERZOFRI to patients who will be experiencing conditions which may contribute to an elevation in core body temperature, e.g. exercising strenuously, exposure to extreme heat, receiving concomitant medication with anticholinergic activity, or being subject to dehydration.

ADVERSE REACTIONS

The most common adverse reactions (incidence ≥5% and occurring at least twice as often as placebo) were injection site reactions, somnolence/sedation, dizziness, akathisia, and extrapyramidal disorder.

USE IN SPECIFIC POPULATIONS

Pregnancy Exposure Registry: There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to atypical antipsychotics, including ERZOFRI, during pregnancy. Healthcare providers are encouraged to register patients by contacting the National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or online at http://womensmentalhealth.org/clinicaland-research-programs/pregnancyregistry/.

Risk Summary: Neonates exposed to antipsychotic drugs during the third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery. Overall, available data from published epidemiologic studies of pregnant women exposed to paliperidone have not established a drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes. There are risks to the mother associated with untreated schizophrenia and with exposure to antipsychotics, including ERZOFRI, during pregnancy.

Lactation: Infants exposed to ERZOFRI through breastmilk should be monitored for excess sedation, failure to thrive, jitteriness, and extrapyramidal symptoms (tremors and abnormal muscle movements).

Fertility: Treatment with ERZOFRI may result in an increase in serum prolactin levels, which may lead to a reversible reduction in fertility in females of reproductive potential.

Renal Impairment: Use of ERZOFRI is not recommended in patients with moderate or severe renal impairment (creatinine clearance <50 mL/min).

Patients with Parkinson’s Disease or Lewy Body Dementia: Patients with Parkinson’s Disease or Dementia with Lewy Bodies can experience increased sensitivity to ERZOFRI. Manifestations can include confusion, obtundation, postural instability with frequent falls, extrapyramidal symptoms, and clinical features consistent with neuroleptic malignant syndrome.

Please see full Prescribing Information for ERZOFRI® including BOXED WARNING.