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Paliperidone may cause drowsiness, dizziness, lightheadedness, weight gain, or mild pain and swelling at the injection site. While these are common and generally mild, let your healthcare provider know if they persist or worsen. To reduce the risk of falls due to dizziness or lightheadedness, especially when starting or increasing the dosage, rise slowly from sitting or lying positions.

More serious side effects can occur, though they are less common. Notify your healthcare provider immediately if you experience difficulty swallowing, restlessness, muscle spasms, or breathing interruptions during sleep. Seek urgent medical attention if you have fainting, severe dizziness, a slow heartbeat, or seizures.

Paliperidone may infrequently lead to tardive dyskinesia, which involves unusual, uncontrolled movements—especially in the face or limbs—and may be permanent. Another rare but severe condition is neuroleptic malignant syndrome (NMS), characterized by fever, muscle stiffness, confusion, and irregular heartbeat. Seek immediate medical help if these symptoms appear.

Blood sugar levels might rise, potentially leading to or worsening diabetes. Watch for increased thirst or urination and monitor blood sugar levels if you have diabetes. Additionally, significant weight gain and increased cholesterol levels may occur, which can raise heart disease risk, so discuss these with your healthcare provider.

In rare cases, paliperidone can affect hormone levels, leading to unexpected breast milk production, menstrual changes, or fertility issues in females, and sexual dysfunction or breast enlargement in males. Painful or prolonged erections in males demand urgent medical intervention to prevent lasting issues.

Allergic reactions are extremely rare but require immediate medical attention if symptoms like rash, severe dizziness, or breathing difficulties occur. Always report any side effects not listed here to your healthcare provider for further guidance.