Paliperidone

For an informed discussion with your doctor or pharmacist. This information collection is not a clinically validated interaction checker. Missing data do not establish safety. Do not change or stop prescribed medicines on the basis of this information. The findings apply to the specific conditions studied; laboratory and animal studies cannot be directly extrapolated to humans.

Active substance: Paliperidone

Examples of brand names: Invega [EU/DE]

ATC code: N05AX13

Main use (for orientation): Schizophrenia

Documented research summary

A delirium case involving olanzapine pamoate, increased paliperidone and known cannabis use is highly confounded; not an isolated paliperidone–cannabis interaction. Registry data on cannabis use disorder and antipsychotic effects provide treatment context, not cannabinoid pharmacokinetics. Renal elimination precludes indiscriminate CYP-based class extrapolation.

Uncertainties and limitations

Oral INVEGA prolonged-release tablet; no pharmacokinetic extrapolation to paliperidone palmitate depots. Case/cohort formulations considered separately.

Shared enzymes must not be equated with clinical evidence of an interaction; CBD/THC findings cannot be extrapolated to other cannabinoids.

Separately recorded findings

2 separately recorded findings. Each statement applies to its documented study context.

Cannabis, non-standardised composition – clinical signals

Finding ID: B0318

Type of result: Clinical multiple-treatment context; no isolated pair causality

Observation: Delirium/anticholinergic symptoms reported after olanzapine pamoate and a higher paliperidone dose.

Mechanism: Combined burden of CNS-active medicines

Study type: 19-year-old woman with known cannabis use

Context studied: Concurrent antipsychotic change; symptom duration approximately 24 hours.

Clinical interpretation: Highly confounded warning signal

Limitations and uncertainties: Cannabis timing/dose and isolated pair effect not established; depot complication/overdose are alternative explanations.

Original sources for this finding: Delirium with anticholinergic symptoms after a combination of paliperidone and olanzapine pamoate in a patient known to smoke cannabis: an unfortunate coincidence. [CA_P_27335358]

Cannabis, non-standardised composition – clinical signals

Finding ID: B0319

Type of result: Treatment context; no direct evidence of a drug–drug interaction

Observation: Long-acting injectable paliperidone associated with fewer hospitalisations for relapse.

Mechanism: Treatment context in first-episode psychosis and cannabis use disorder

Study type: Swedish registry, total n=1820

Context studied: Long-acting injectable paliperidone: adjusted hazard ratio 0.46 (95% CI 0.30–0.69) versus non-use in a within-person model.

Clinical interpretation: Not a cannabinoid pharmacokinetic interaction

Limitations and uncertainties: Not oral INVEGA or randomised co-administration; adherence/disease course, not a cannabis safety guarantee.

Original sources for this finding: Antipsychotic Use and Psychiatric Hospitalization in First-Episode Non-affective Psychosis and Cannabis Use Disorder: A Swedish Nationwide Cohort Study. [BMED38534050]

References and access status

[V2_LABEL_D0122] INVEGA (PALIPERIDONE) TABLET, EXTENDED RELEASE [JANSSEN PHARMACEUTICALS, INC.]

Original source / bibliographic reference

Authors: Janssen Pharmaceuticals, Inc.

Year: 2025

Source type: Official US SPL / DailyMed

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

[BMED38534050] Antipsychotic Use and Psychiatric Hospitalization in First-Episode Non-affective Psychosis and Cannabis Use Disorder: A Swedish Nationwide Cohort Study.

Original source / bibliographic reference

Authors: Denissoff A, Taipale H, Tiihonen J, Di Forti M, Mittendorfer-Rutz E, Tanskanen A, Mustonen A, Niemelä S.

Year: 2024

Source type: Publication; title and abstract reviewed

DOI: 10.1093/schbul/sbae034

PMID: 38534050

Source access – 23 October 2026: Automated direct retrieval was restricted; this does not establish that the link is broken.

Bibliographic attribution or source identity cross-checked.

PubMed – bibliographic reference / abstract

PubMed Central – archived text

DOI – publisher access (access restrictions may apply)

[CA_P_27335358] Delirium with anticholinergic symptoms after a combination of paliperidone and olanzapine pamoate in a patient known to smoke cannabis: an unfortunate coincidence.

Original source / bibliographic reference

Authors: Kokalj A, Rijavec N, Tavčar R.

Year: 2016

Source type: Journal Article; Case Reports; case-report

DOI: 10.1136/bcr-2016-214806

PMID: 27335358

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

Research as of 23 October 2026. Not all original full texts could be reviewed in full. Source accessibility and the strength of scientific evidence must be assessed separately. An accessible link does not establish medical approval; a bibliographic record with an abstract does not replace the original full text.

Drug search and explanation of the evidence · Guide: cannabinoids and medicines · Author and responsibility