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She had been treated with extended release intramuscular paliperidone for several years and had received her last injection 8\u2009days prior to admission. The plasma paliperidone was nearly five times higher than the upper reference range. Paliperidone is a substrate of p\u2010glycoprotein and we therefore aimed to increase its elimination by inducing p\u2010glycoprotein through treatment with St John's wort. This seemed to have a limited effect on paliperidone clearance. Plasma concentration levels decreased with time as did the dystonia. All antipsychotic treatment was discontinued after this unfortunate event, and the patient did specifically not receive any prescriptions of paliperidone or risperidone. However, the plasma paliperidone concentration was in the low end of the normal therapeutic range 2.5\u00a0years after the last dose of paliperidone was administered, and the patient still had some extrapyramidal symptoms.<\/jats:p>","DOI":"10.1111\/bcp.16036","type":"journal-article","created":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T06:05:28Z","timestamp":1709791528000},"page":"1580-1585","source":"Crossref","is-referenced-by-count":4,"title":["Paliperidone poisoning and measurable plasma concentrations 2.5\u00a0years after last administered dose: A case report"],"prefix":"10.1111","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9975-6216","authenticated-orcid":false,"given":"Mariam","family":"Nersesjan","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacology and the Danish Poison Information Centre Copenhagen University Hospital \u2013 Bispebjerg and Frederiksberg  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Copenhagen University Hospital \u2013 Mental Health Services CPH  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim Peder","family":"Dalhoff","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology and the Danish Poison Information Centre Copenhagen University Hospital \u2013 Bispebjerg and Frederiksberg  Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tonny Studsgaard","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology and the Danish Poison Information Centre Copenhagen University Hospital \u2013 Bispebjerg and Frederiksberg  Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren","family":"B\u00f8gevig","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology and the Danish Poison Information Centre Copenhagen University Hospital \u2013 Bispebjerg and Frederiksberg  Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Horwitz","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology and the Danish Poison Information Centre Copenhagen University Hospital \u2013 Bispebjerg and Frederiksberg  Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpdd.144"},{"key":"e_1_2_8_3_1","unstructured":"European Medicines Agency.Xeplion. 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