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Paliperidone side effects: what 23,177 FDA adverse event reports show

Paliperidone · 1,042 reaction terms · 70,680 drug–reaction co-reports · data 2026-09-14
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Drug class

Atypical Antipsychotic

FDA label (Established Pharmacologic Class) · compare the class

Who reports

23,177 reports · 49% serious · 827 with death outcome · 32% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Paliperidone Extended-Release Tablets are an atypical antipsychotic agent indicated for Treatment of schizophrenia ( 1.1 ) Adults: Efficacy was established in three 6-week trials and one maintenance trial. ( 14.1 ) Adolescents (ages 12–17): Efficacy was established in one 6-week trial. ( 14.1 ) Treatment of schizoaffective disorder as monotherapy and as an adjunct to mood stabilizers and/or antidepressants.

FDA label, Indications and Usage

What it is

Paliperidone Extended-Release Tablets contains paliperidone, an atypical antipsychotic belonging to the chemical class of benzisoxazole derivatives. Paliperidone Extended-Release Tablets contains a racemic mixture of (+)- and (-)-paliperidone.

FDA label, Description section

Boxed 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. Paliperidone Extended-Release Tablets are not approved for the treatment of patients with dementia-related psychosis.

FDA label
How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled — boxed warning 2Labeled adverse reaction 6Labeled (related wording) 3Likely indication confounding 5Reporting / coding artifact 2Lab value / disease marker 6Not in label — unassessed 16
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only and flags pairs whose reports are unusually skewed by sex or come mostly from consumers rather than clinicians. 1,002 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Ovarian germ cell cancer stage ii104,457.3
976.7–20,342.3ROR 4,459.2 · χ² 6,701 / p <1e-300
307.0 EB05 178.2 · IC025 +3.3
3/3 methods agree
Not in label — unassessedserious n=10not reported in cached trials
Anosognosia390934.6
811.3–1,076.6ROR 950.6 · χ² 177,112 / p <1e-300
446.7 EB05 410.7 · IC025 +8.0
3/3 methods agree
Not in label — unassessedserious n=382 · ♀ 80% (drug 32%)not reported in cached trials
Blood prolactin abnormal414825.7
722.8–943.2ROR 840.6 · χ² 176,610 / p <1e-300
420.8 EB05 387.8 · IC025 +8.0
3/3 methods agree
Lab value / disease markerserious n=390 · ♀ 82% (drug 32%)not reported in cached trials
Hyperprolactinaemia (high prolactin hormone)1,268219.5
206.7–233.1ROR 232.2 · χ² 221,226 / p <1e-300
175.9 EB05 167.9 · IC025 +7.3
3/3 methods agree
Labeled — boxed warning
exact term
serious n=378 · ♀ 10% (drug 32%) · 82% consumernot reported in cached trials
Personality change due to a general medical condition24214.0
137.1–334.0ROR 214.2 · χ² 3,932 / p <1e-300
152.1 EB05 107.5 · IC025 +4.6
3/3 methods agree
Not in label — unassessedserious n=24 · ♀ 100% (drug 32%) · 100% cliniciannot reported in cached trials
Disturbance in social behaviour391179.1
160.8–199.5ROR 182.2 · χ² 57,526 / p <1e-300
148.2 EB05 136.3 · IC025 +6.8
3/3 methods agree
Reporting / coding artifactserious n=376 · ♀ 80% (drug 32%)not reported in cached trials
Galactorrhoea1,057176.4
165.4–188.2ROR 184.8 · χ² 153,813 / p <1e-300
147.1 EB05 139.8 · IC025 +7.0
3/3 methods agree
Not in label — unassessedserious n=186 · 73% consumernot reported in cached trials
Metamyelocyte count increased21147.4
92.9–233.9ROR 147.5 · χ² 2,496 / p <1e-300
113.8 EB05 78.5 · IC025 +4.3
3/3 methods agree
Lab value / disease markerserious n=21not reported in cached trials
Gynaecomastia (male breast enlargement)3,665120.0
116.2–123.9ROR 142.3 · χ² 381,614 / p <1e-300
105.8 EB05 103.0 · IC025 +6.7
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 98.4 · ♀ 0% (drug 32%) · 92% consumernot reported in cached trials
Myelocyte count increased22119.6
76.6–186.6ROR 119.7 · χ² 2,178 / p <1e-300
96.9 EB05 67.5 · IC025 +4.3
3/3 methods agree
Lab value / disease markerserious n=22not reported in cached trials
Schizoaffective disorder bipolar type2190.4
57.7–141.7ROR 90.5 · χ² 1,606 / p <1e-300
76.7 EB05 52.9 · IC025 +4.1
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=20 · ♀ 55% (drug 32%)not reported in cached trials
Blood prolactin increased39482.3
74.3–91.1ROR 83.7 · χ² 28,886 / p <1e-300
75.1 EB05 69.1 · IC025 +5.9
3/3 methods agree
Lab value / disease markerserious n=162 · ♀ 58% (drug 32%)not reported in cached trials
Jaw clicking1573.5
43.4–124.4ROR 73.5 · χ² 925 / p 2e-203
62.8 EB05 40.4 · IC025 +3.6
3/3 methods agree
Not in label — unassessedserious n=15not reported in cached trials
Illiteracy1163.3
34.3–116.6ROR 63.3 · χ² 573 / p 8e-127
53.9 EB05 32.1 · IC025 +3.0
3/3 methods agree
Not in label — unassessedserious n=10not reported in cached trials
Injury4,32959.0
57.4–60.7ROR 72.3 · χ² 232,248 / p <1e-300
55.4 EB05 54.0 · IC025 +5.7
3/3 methods agree
Not in label — unassessedserious PRR 0.5 · ♀ 1% (drug 32%) · 100% consumernot reported in cached trials
Schizophrenia66952.6
48.7–56.8ROR 54.2 · χ² 31,959 / p <1e-300
49.7 EB05 46.6 · IC025 +5.5
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious PRR 59.1 · ♀ 52% (drug 32%)NCT00589914: 15/606 (2.5%) on Paliperidone (serious AE)
Schizoaffective disorder9349.4
40.1–60.9ROR 49.6 · χ² 4,136 / p <1e-300
46.5 EB05 39.1 · IC025 +4.9
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious n=93 · ♀ 61% (drug 32%)NCT01662648: 1/587 (0.2%) on Paliperidone (serious AE)
Hypometabolism1844.8
27.9–72.0ROR 44.9 · χ² 693 / p 5e-153
41.0 EB05 27.4 · IC025 +3.5
3/3 methods agree
Not in label — unassessedserious n=16not reported in cached trials
Breast discharge7942.7
34.1–53.5ROR 42.8 · χ² 3,029 / p <1e-300
40.4 EB05 33.5 · IC025 +4.7
3/3 methods agree
Not in label — unassessedserious n=26 · ♀ 75% (drug 32%)not reported in cached trials
Schizophreniform disorder1142.5
23.2–77.7ROR 42.5 · χ² 386 / p 3e-86
38.1 EB05 22.7 · IC025 +2.9
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=10not reported in cached trials
Sexual dysfunction48439.1
35.7–42.8ROR 39.9 · χ² 17,179 / p <1e-300
37.4 EB05 34.7 · IC025 +5.0
3/3 methods agree
Not in label — unassessedserious PRR 60.7 · ♀ 69% (drug 32%)not reported in cached trials
Self injurious behaviour12638.4
32.1–45.8ROR 38.6 · χ² 4,361 / p <1e-300
36.6 EB05 31.6 · IC025 +4.7
3/3 methods agree
Not in label — unassessedserious n=126not reported in cached trials
Personality change35235.4
31.8–39.3ROR 35.9 · χ² 11,274 / p <1e-300
34.0 EB05 31.1 · IC025 +4.8
3/3 methods agree
Not in label — unassessedserious PRR 52.9 · ♀ 85% (drug 32%)not reported in cached trials
Dystonia71134.3
31.8–36.9ROR 35.3 · χ² 22,100 / p <1e-300
33.0 EB05 31.0 · IC025 +4.9
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 37.9 · ♀ 63% (drug 32%)NCT01662648: 1/512 (0.2%) on Paliperidone (serious AE)
Sedation complication9134.1
27.7–42.1ROR 34.3 · χ² 2,787 / p <1e-300
32.7 EB05 27.4 · IC025 +4.5
3/3 methods agree
Reporting / coding artifactserious n=78not reported in cached trials
Water intoxication1731.1
19.2–50.5ROR 31.1 · χ² 450 / p 3e-100
29.2 EB05 19.3 · IC025 +3.2
3/3 methods agree
Not in label — unassessedserious n=17not reported in cached trials
Schizophrenia, paranoid type1230.7
17.3–54.6ROR 30.8 · χ² 306 / p 1e-68
28.5 EB05 17.3 · IC025 +2.8
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=11NCT00589914: 1/606 (0.2%) on Paliperidone (serious AE)
Hypoaesthesia eye1930.3
19.2–47.9ROR 30.3 · χ² 493 / p 2e-109
28.6 EB05 19.3 · IC025 +3.3
3/3 methods agree
Not in label — unassessedserious n=17not reported in cached trials
Obesity51430.1
27.6–32.8ROR 30.7 · χ² 13,961 / p <1e-300
29.1 EB05 27.1 · IC025 +4.7
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 30.7 · ♀ 5% (drug 32%) · 81% consumernot reported in cached trials
Sedation75326.9
25.0–28.9ROR 27.7 · χ² 18,209 / p <1e-300
26.1 EB05 24.6 · IC025 +4.6
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 34.9 · ♀ 59% (drug 32%)not reported in cached trials
Akathisia (inner restlessness)39226.7
24.2–29.5ROR 27.2 · χ² 9,404 / p <1e-300
25.9 EB05 23.9 · IC025 +4.5
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 30.8NCT01662648: 1/587 (0.2%) on Paliperidone (serious AE)
Antipsychotic drug level decreased1526.2
15.7–43.8ROR 26.2 · χ² 329 / p 7e-74
24.8 EB05 15.8 · IC025 +3.0
3/3 methods agree
Lab value / disease markerserious n=15not reported in cached trials
Housebound1125.8
14.2–47.0ROR 25.8 · χ² 231 / p 2e-52
24.0 EB05 14.0 · IC025 +2.6
3/3 methods agree
Not in label — unassessedserious n=11not reported in cached trials
Oculogyric crisis5524.2
18.5–31.7ROR 24.3 · χ² 1,170 / p 8e-257
23.5 EB05 18.7 · IC025 +3.8
3/3 methods agree
Labeled adverse reaction
exact term
serious n=54 · ♀ 70% (drug 32%)not reported in cached trials
Apraxia3823.7
17.2–32.8ROR 23.8 · χ² 784 / p 7e-173
22.9 EB05 17.4 · IC025 +3.6
3/3 methods agree
Not in label — unassessedserious n=38 · ♀ 100% (drug 32%) · 100% cliniciannot reported in cached trials
Blood osmolarity decreased1623.5
14.3–38.5ROR 23.5 · χ² 314 / p 2e-70
22.3 EB05 14.4 · IC025 +2.9
3/3 methods agree
Lab value / disease markerserious n=16not reported in cached trials
Neuroleptic malignant syndrome28922.5
20.0–25.3ROR 22.8 · χ² 5,775 / p <1e-300
21.9 EB05 19.9 · IC025 +4.2
3/3 methods agree
Labeled — boxed warning
exact term
serious PRR 25.7 · 90% cliniciannot reported in cached trials

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Paliperidone as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (5 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Injury4,32959.0
57.4–60.7ROR 72.3 · χ² 232,248 / p <1e-300
55.4 EB05 54.0 · IC025 +5.7
3/3 methods agree
Not in label — unassessedserious PRR 0.5 · ♀ 1% (drug 32%) · 100% consumernot reported in cached trials
Gynaecomastia (male breast enlargement)3,665120.0
116.2–123.9ROR 142.3 · χ² 381,614 / p <1e-300
105.8 EB05 103.0 · IC025 +6.7
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 98.4 · ♀ 0% (drug 32%) · 92% consumernot reported in cached trials
Drug ineffective (drug did not work)1,7741.2
1.2–1.3ROR 1.2 · χ² 74 / p 4e-18
1.2 EB05 1.2 · IC025 +0.2Reporting / coding artifactserious PRR 2.9not reported in cached trials
Off label use (used outside approved label)1,5461.6
1.5–1.7ROR 1.7 · χ² 374 / p 2e-83
1.6 EB05 1.5 · IC025 +0.6Reporting / coding artifactserious PRR 1.7not reported in cached trials
Weight increased (weight gain)1,3805.6
5.3–5.9ROR 5.9 · χ² 5,275 / p <1e-300
5.6 EB05 5.3 · IC025 +2.4
3/3 methods agree
Labeled — boxed warning
synonym match
serious PRR 6.5NCT01662648: 1/512 (0.2%) on Paliperidone (serious AE)
Hyperprolactinaemia (high prolactin hormone)1,268219.5
206.7–233.1ROR 232.2 · χ² 221,226 / p <1e-300
175.9 EB05 167.9 · IC025 +7.3
3/3 methods agree
Labeled — boxed warning
exact term
serious n=378 · ♀ 10% (drug 32%) · 82% consumernot reported in cached trials
Galactorrhoea1,057176.4
165.4–188.2ROR 184.8 · χ² 153,813 / p <1e-300
147.1 EB05 139.8 · IC025 +7.0
3/3 methods agree
Not in label — unassessedserious n=186 · 73% consumernot reported in cached trials
Sedation75326.9
25.0–28.9ROR 27.7 · χ² 18,209 / p <1e-300
26.1 EB05 24.6 · IC025 +4.6
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 34.9 · ♀ 59% (drug 32%)not reported in cached trials
Dystonia71134.3
31.8–36.9ROR 35.3 · χ² 22,100 / p <1e-300
33.0 EB05 31.0 · IC025 +4.9
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 37.9 · ♀ 63% (drug 32%)NCT01662648: 1/512 (0.2%) on Paliperidone (serious AE)
Dyskinesia (involuntary movements)70816.1
14.9–17.3ROR 16.5 · χ² 9,821 / p <1e-300
15.8 EB05 14.8 · IC025 +3.8
3/3 methods agree
Labeled — boxed warning
exact term
serious PRR 22.5 · ♀ 71% (drug 32%)NCT01662648: 1/512 (0.2%) on Paliperidone (serious AE)
Treatment noncompliance67611.4
10.6–12.3ROR 11.7 · χ² 6,327 / p <1e-300
11.2 EB05 10.5 · IC025 +3.4
3/3 methods agree
Reporting / coding artifactserious PRR 13.3not reported in cached trials
Suicide attempt67010.1
9.3–10.9ROR 10.3 · χ² 5,421 / p <1e-300
9.9 EB05 9.3 · IC025 +3.2
3/3 methods agree
Not in label — unassessedserious PRR 11.7 · ♀ 69% (drug 32%)NCT00589914: 1/608 (0.2%) on Paliperidone (serious AE)
Schizophrenia66952.6
48.7–56.8ROR 54.2 · χ² 31,959 / p <1e-300
49.7 EB05 46.6 · IC025 +5.5
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious PRR 59.1 · ♀ 52% (drug 32%)NCT00589914: 15/606 (2.5%) on Paliperidone (serious AE)
Product use in unapproved indication6232.3
2.1–2.5ROR 2.3 · χ² 466 / p 1e-103
2.3 EB05 2.2 · IC025 +1.1
3/3 methods agree
Reporting / coding artifactserious PRR 2.4 · 71% consumernot reported in cached trials

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Paliperidone?

In FDA FAERS, the most frequently co-reported reaction terms for Paliperidone are injury, gynaecomastia, abnormal weight gain, weight increased, hyperprolactinaemia, galactorrhoea. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Paliperidone have an FDA boxed warning?

Yes. The current FDA label carries a boxed 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. Paliperidone Extended-Release Tablets are not approved for the treatment of patients with dementia-related psychosis.

Do FAERS signals prove that Paliperidone causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-08. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.