Uses

What is Erzofri used for?

Erzofri (paliperidone palmitate) is commonly used to treat schizophrenia and schizoaffective disorder. 

Erzofri may also be used for other conditions as determined by your healthcare provider.

How does Erzofri work (mechanism of action)?

Erzofri belongs to a group of medicines called second-generation (atypical) antipsychotics. It is thought to work by balancing brain chemicals called serotonin and dopamine. These chemicals are known to affect thoughts and mood.

How is Erzofri supplied (dosage forms)?

Erzofri is available in an injectable form that is given by a healthcare provider.

How should I store Erzofri?

Erzofri is usually given by a healthcare provider in a hospital or clinic. You will not store it at home.

Side Effects

What are the most common side effects of Erzofri?

The most common side effects of Erzofri are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Pain at the injection site
  • Drowsiness or sleepiness
  • Dizziness
  • Restlessness
  • Uncontrolled movements, including shakiness, stiffness, or jerkiness (see below)

There may be other side effects of Erzofri that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of Erzofri?

While less common, the most serious side effects of Erzofri are described below, along with what to do if they happen.

Severe Allergic Reactions. Erzofri may cause allergic reactions, which can be serious. Stop using Erzofri and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Neuroleptic Malignant Syndrome (NMS). Antipsychotic medicines, like Erzofri, can cause a rare but serious condition called neuroleptic malignant syndrome. Stop using Erzofri and call your healthcare provider right away if you have any of the following symptoms.

  • High fever
  • Muscle stiffness or rigidity, where it is hard to move
  • Changes in your breathing or heart rate
  • Increased sweating
  • Confusion

Heart Rhythm Changes. Erzofri may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium levels, or who take some medicines for other heart rhythm problems. Tell your healthcare provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat.

Uncontrolled Movements. Erzofri can cause some people to have movements that they cannot control. This condition, called tardive dyskinesia (TD), can cause jerky movements of your face, tongue, or body. TD can be permanent. Call your healthcare provider right away if you have any symptoms of TD.

  • Tongue sticking out
  • Lip smacking or puckering
  • Grimacing
  • Rapid eye blinking
  • Jerking or twisting motion of the arms, legs, or trunk

Metabolism Changes. Receiving Erzofri can cause changes to your metabolism, including an increase in blood sugar levels, diabetes, increase in cholesterol levels, or weight gain. Keep all appointments with your healthcare provider to check your blood work and weight. Call your healthcare provider if you gain weight or develop the following symptoms of high blood sugar.

  • Thirsty more than usual
  • Peeing more than usual
  • Increase in hunger
  • Tiredness
  • Feeling sick to your stomach
  • Confusion
  • Your breath smelling fruity

Low Blood Pressure Upon Standing (Orthostatic Hypotension) and Falls. Erzofri may cause a sudden drop in blood pressure when standing up from a seated or lying position. Some people fall or even faint when this happens, which may cause bone fractures or other injuries. To help prevent this, be careful not to get up too quickly. If you feel dizzy, sit or lie down right away until the dizziness stops, then take your time getting up again. Tell your healthcare provider right away if you have any of the following symptoms of orthostatic hypotension.

  • Dizziness, feeling lightheaded, or fainting upon standing
  • Blurred vision
  • Confusion
  • Feeling weak

Blood Disorders. Erzofri can cause blood disorders, such as low white blood cell levels (leukopenia, neutropenia, or agranulocytosis). Call your healthcare provider right away if you have any of the following symptoms of blood disorders.

  • Fever
  • Shortness of breath
  • Pale or yellowish skin
  • Easy bruising or bleeding
  • Frequent infection
  • Unusual weakness or tiredness
  • Dizziness, lightheadedness, or feeling like you are about to pass out
  • Headache 
  • Fast or abnormal heartbeat

High Prolactin Level (Hyperprolactinemia). Erzofri may cause an increased level of the hormone prolactin in your blood. Increased levels of prolactin could lead to fertility or bone problems. Contact your healthcare provider if you experience any of the following symptoms.

  • Vaginal dryness 
  • Irregular or no periods 
  • Production of breast milk when not pregnant or nursing 
  • Inability to get or keep an erection 
  • Enlarged breast size (gynecomastia) 
  • Decreased muscle and body hair 

Seizures. Some people who have received Erzofri have reported having seizures. Your risk may be higher if you have certain health conditions, some of which may be more common in people 65 years of age or older. There are many different types of seizures and some of them are not easy to recognize. Stop receiving Erzofri and call your healthcare provider if you experience any of the following signs that a seizure is happening or could happen.

  • Muscle twitching, jerking, spasms, tremors, or other uncontrolled movements
  • Stiffening of your arms and legs
  • Feeling anxious, nervous, confused, or a sense of dread
  • Feeling dizzy or lightheaded
  • Falling or losing consciousness

Body Temperature Regulation. Erzofri can affect your ability to regulate your body temperature. This could make you become very hot, especially in hot weather or after exercising a lot. You should drink water and avoid overheating and dehydration. Call your healthcare provider right away if you are severely ill and have the following symptoms.

  • Excessive or no sweating
  • Dry mouth
  • Feeling very hot
  • Feeling thirsty 
  • Not able to pee

Trouble Swallowing. Erzofri can cause trouble swallowing (dysphagia), which can increase your risk of choking while eating or drinking. Get help right away if you are choking or have food stuck in your esophagus that is not passing.

Painful, Prolonged Erection (Priapism). Erzofri may cause an unwanted erection that is persistent, painful, and that may occur without sexual arousal. Permanent damage to the penis may occur if priapism is not treated quickly. Stop using Erzofri and get emergency help right away if you have any of the following symptoms of priapism. 

  • Erection lasting for more than 4 hours 
  • Erection that is unrelated to sexual stimulation
  • Painful or tender penis

Decreased Alertness or Coordination. Erzofri can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how Erzofri affects you.

Warnings & Precautions

Who should not use Erzofri?

Allergies to Ingredients. People who are allergic to any of the following should not use Erzofri.

  • Erzofri
  • Paliperidone
  • Risperidone
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in Erzofri.

Kidney Problems. Erzofri should not be used if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your healthcare provider may do tests to determine if they are working well enough to use this medicine.

What should I know about Erzofri before using it?

Erzofri is given to you by your healthcare provider as a once-a-month injection in your arm or butt.

Because Erzofi can cause your body temperature to increase, try to avoid becoming too hot or dehydrated. Try to drink plenty of water, limit your exposure to the heat and sun, limit your exercise, and wear light and breathable clothing.

Erzofri can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how Erzofri affects you.

You may be less likely to be able to get pregnant while using Erzofri. These effects go away after you stop using Erzofri.

What should I tell my healthcare provider before using Erzofri?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if Erzofri is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • Never taken paliperidone or risperidone before
  • Neuroleptic malignant syndrome
  • Heart problems, including a heart attack, heart failure, abnormal heart rhythm, or long QT interval
  • Low potassium or magnesium levels
  • Tardive dyskinesia (grimacing, jerky movements, lip smacking, etc)
  • Kidney or liver problems
  • High blood sugar, diabetes, or a family history of diabetes
  • High cholesterol or triglyceride levels
  • Parkinson’s disease
  • Lewy body dementia
  • Dizziness or fainting
  • Being treated for high blood pressure
  • Low white blood cell counts
  • Seizures or epilepsy

Psychosis Related to Dementia. There is a higher risk of death, stroke, and transient ischemic attack (TIA) in older adults who use Erzofri or another antipsychotic and have memory loss or psychosis related to dementia. Erzofri is not approved to treat dementia-related psychosis.

Other Medicines and Supplements. Erzofri may interact with other medicines and supplements. Before using Erzofri, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details. 

Pregnancy. Using Erzofri during the third trimester may cause your newborn baby to have muscle problems or withdrawal symptoms. Tell your healthcare provider if you are or plan to become pregnant. Your healthcare provider will advise you if you should use Erzofri while you are pregnant or trying to get pregnant. If you become pregnant while using Erzofri, you can register for the National Pregnancy Registry for Atypical Antipsychotics by calling 866-961-2388 or at womensmentalhealth.org/research/pregnancyregistry/atypicalantipsychotic. This registry collects safety information about the use of atypical antipsychotics during pregnancy.

Breastfeeding. Erzofri passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should use Erzofri while breastfeeding.

Interactions

Does Erzofri interact with foods or drinks?

There are no known interactions between Erzofri and foods or drinks.

You should avoid drinking alcohol while using Erzofri. The risk of dizziness and sleepiness may be increased if you drink alcohol while using Erzofri.

Does Erzofri interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

  • In particular, make sure that you discuss if you are using any of the following before using Erzofri.
  • Medicines that can cause QT prolongation, which is a potentially dangerous heart rhythm problem
  • A dopamine agonist, such as pramipexole (Mirapex), ropinirole, rotigotine (Neupro), or apomorphine (Apokyn), which is a medicine that may be used for Parkinson’s disease, restless legs syndrome, and other conditions
  • Levodopa, a medicine commonly used for Parkinson’s disease
  • Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, and medicines for anxiety
  • An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems
  • A medicine for high blood pressure
  • A nitrate, such as Isordil, Nitro-Dur, NitroMist, or Nitrostat, which is a medicine used to prevent chest pain caused by a type of heart disease
  • An alpha blocker, such as terazosin, doxazosin, alfuzosin, or prazosin, which is a medicine that may be used for high blood pressure and difficulty peeing due to an enlarged prostate
  • A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure

Many other medicines may alter the blood levels of Erzofri. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with Erzofri. Always check with your healthcare provider.

Does Erzofri (paliperidone) interact with other drugs you are taking?
Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much Erzofri?

If you or someone else has used too much Erzofri, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of Erzofri?

If you miss an appointment to get your Erzofri, call to make another appointment as soon as possible.

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