Paliperidone, which is known as the active metabolite of risperidone, is one of the antipsychotics available commercially in an oral formulation. Paliperidone is thought to have therapeutic effect due to its high affinities for dopamine type-2 and serotonin type-2 receptors2. This agent was secreted by the kidney and mainly does not undergo liver metabolism.3 There was a reported case of risperidone-induced hepatitis, which remitted after switching to paliperidone,4 but there has been no case reported using paliperidone for schizophrenic patients with liver cirrhosis. We thought there may be two major reasons: First, as above described, when a schizophrenic patient has liver cirrhosis, some psychotic features may mimic encephalopathy. Physicians, especially medical physicians, may forget to check the patient’s psychiatric history. Second, paliperidone is the first antipsychotic agent that has no hepatic burden, but this new agent has provided a new choice for psychosis patients with poor liver function only for a while.
In summary, we suggest that paliperidone may be a safe drug for the management the psychotic symptoms of schizophrenic patients with liver cirrhosis. Otherwise, always remember to check patient’s psychiatric history.