A Pharmacokinetics and Pharmacodynamics Study Under Fasting and Fed Conditions With Paliperidone Extended-release and Immediate-release Formulations

The purpose of this study is to evaluate the pharmacokinetics of 2 extended-release (ER) formulations of 2 mg-eq paliperidone in comparison to the 2 mg immediate-release (IR) paliperidone oral solution and to evaluate the effect of food on the pharmacokinetics of these ER formulations. Additional objectives are to compare the pharmacodynamic effects (postural changes in blood pressure and heart rate), safety, and tolerability are to be evaluated in addition to exploring the relationship between CYP2D6 and CYP3A4/5genotype and paliperidone exposure.

This study is designed as a single-center, open-label, randomized, 5 treatment-period, crossover study in healthy adults. The study consists of a screening phase and a treatment phase during which each volunteer will receive 5 treatments of study drug in a random order and separated by a washout period of at least 7 to 14 days. Treatments consist of a single oral dose of: A) paliperidone ER pellet formulation, (2 mg-eq) as 1 capsule of 2.5 mg, fasted; B) the same formulation as A but with food; C) paliperidone-coated ER OROS formulation (2 mg eq) as 2 tablets of 2 mg, fasted; D) the same formulation as C but with food; E) IR paliperidone oral solution, 2 mg (2 mL) of a 1 mg/mL solution, fasted. Alternative paliperidone ER formulations are being developed with the aim to increase the bioavailability without compromising the favorable effect on the orthostatic hypotension as seen with ER OROS paliperidone. Therefore, in this study, the pharmacokinetic and pharmacodynamic properties, as well as the effect of food, of 2 alternative paliperidone ER formulations using different mechanisms to achieve extended release of the drug will be investigated: a multiparticulate ER capsule formulation, containing coated pellets comprised of 3 coating layers, with both immediate and extended drug-release properties (pellet formulation; drug ratio extended- versus immediate-release layer: 9:1), and an OROS trilayer longitudinally compressed tablet formulation (Push-Pull delivery system) (overcoated-OROS formulation). Safety and tolerability will be monitored throughout the study. Single doses of paliperidone ER pellet formulation, (2 mg-eq) as 1 capsule of 2.5 mg, fasted; paliperidone ER pellet formulation, (2 mg-eq) as 1 capsule of 2.5 mg with food (high-fat breakfast); paliperidone-coated OROS ER formulation (2 mg-eq) as 2 tablets of 2 mg, fasted; paliperidone-coated OROS ER formulation (2 mg-eq) as 2 tablets of 2 mg with food (high-fat breakfast); IR paliperidone oral solution, 2 mg (2 mL) of a 1 mg/mL solution, fasted.