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Risk of Cardiovascular Morbidity With Risperidone or Paliperidone Treatment: Analysis of 64 Randomized, Double-Blind Trials

Gopal, Srihari MD, MHS*; Hough, David MD*†; Karcher, Keith MS*; Nuamah, Isaac PhD*; Palumbo, Joseph MD*‡; Berlin, Jesse A. ScD*; Baseman, Alan MD*; Xu, Yimei MD*; Kent, Justine MD*

Journal of Clinical Psychopharmacology: April 2013 - Volume 33 - Issue 2 - p 157–161
doi: 10.1097/JCP.0b013e318283983f
Original Contributions

A post hoc analysis of the risperidone (RIS)/paliperidone (Pali) clinical trials database comprising 64 studies was conducted. Risk of sudden death, cardiovascular (CV), and cerebrovascular events during RIS or Pali treatment was estimated. Treatment emergent CV adverse events were identified using 7 prespecified Standardised MedDRA Queries as follows: embolic/thrombotic events, cerebrovascular disorders, ischemic heart disease, cardiac arrhythmias, cardiac failure, torsades/QT prolongation, and convulsions. Risk in the RIS/Pali pooled group was significantly increased compared to placebo for the following adverse events: syncope, tachycardia, palpitations, edema peripheral, dysarthria, and transient ischemic attack. Incidence of death related to CV events was low and similar across groups. Consistent with the known pharmacologic profile and product information, this analysis of treatment emergent adverse event data from a large, randomized, controlled clinical trials database described increased risk versus placebo for several specific CV events. Apart from events described in existing product labeling, no new safety findings emerged.

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From *Johnson & Johnson Pharmaceutical Research & Development, LLC, Raritan, NJ; †Uniformed Services University of the Health Sciences, Bethesda, MD; and ‡Department of Psychiatry, Yale University School of Medicine, New Haven, CT.

Received October 10, 2011; accepted after revision June 21, 2012.

Reprints: Srihari Gopal, MD, MHS, Johnson & Johnson Pharmaceutical Research & Development, LLC, 1125 Trenton Harbourton Rd, Titusville, NJ (e-mail:

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© 2013 by Lippincott Williams & Wilkins.