Background:
Clozapine levels are severely decreased by cigarette
smoke hydrocarbons. A new agent that is unaffected by smoking is
paliperidone palmitate. Objective: The purpose of this study is to retrospectively evaluate
hospital readmission and time until readmission for patients prescribed
paliperidone palmitate intramuscular injection (PP) as an alternative to oral
clozapine for patients with severe
schizophrenia who resume smoking following discharge. A secondary analysis was performed to determine whether smoking status alone affects
hospital readmission rates in both smoking and nonsmoking
clozapine-treated patients. Methods: This was a retrospective analysis of all patients who were positive for smoking at admission and readmission who were prescribed
clozapine and PP. Smokers were identified by concurrent orders for
nicotine replacement. Readmission rates and time until readmission were determined. Data were analyzed utilizing nonparametric statistical methods. Results: A total of 133 subjects were identified, including 108 smokers in PP group, 18 smokers in
clozapine group, and 7 nonsmoking
clozapine patients. Readmission rates were statistically significant between smokers in the
clozapine and PP groups, with significantly lower readmission rates in the PP group (p = .004). In the sub-analysis,
hospital readmissions between smokers and nonsmokers in the
clozapine group were statistically significant (p = .027). Results may be influenced by use of a single hospital site, limits of a retrospective analysis, and variation in pharmaceutical preparation. Conclusion: PP may be a reasonable alternative to
clozapine in severe
schizophrenia for patients who continually resume smoking following discharge. Smoking may also be an important predictor of decompensation in smokers prescribed
clozapine. A further prospective study is warranted.