Paliperidone

Invega

Invega is a prescription medication that comes only in the form of extended-release tablets. This FDA-approved medication helps in treating certain types of mental health conditions like schizophrenia and schizoaffective disorders. The ER form of Invega gradually releases the drug into the body, thus making it work effectively. The medication comes in different forms besides tablets under the brand names Invega Hafyera, Invega Sustenna, and Invega Trinza, but the following information will focus on Invega tablets. These tablets are suitable for both adults and children ages 12 years. However, their dosage may vary based on various factors. Therefore, it is advisable to stick to your prescribed dosage to avoid any serious complications in the future.

Invega Overview

Invega, an FDA-approved prescription medication, is primarily used to treat schizophrenia and schizoaffective disorder. The active ingredient in Invega is Paliperidone, which belongs to a class of medications known as atypical antipsychotics and helps restore the balance of neurotransmitters in the brain, thereby improving thinking, mood, and behavior. The medication is known for its distinctive long-acting formulation, which provides a steady release of the medication over an extended period, ensuring consistent therapeutic effects.

Invega is available in both extended-release tablets and long-acting injectable forms. The tablets come in strengths of 1.5 mg, 3 mg, 6 mg, and 9 mg, while the injectable form is available in doses of 39 mg, 117 mg, 78 mg, 156 mg, & 234 mg. The tablets should be taken once daily, with or without food, as instructed by a medical professional. A healthcare professional administers its injectable form. Invega can be prescribed to adults and adolescents over the age of 12. The medication works by adjusting the activity of dopamine and serotonin, which helps manage symptoms of psychosis and mood disorders.

However, Invega has certain side effects, including dizziness, drowsiness, weight gain, and gastrointestinal issues. Therefore, it is important to follow the prescribed dosage and not to miss any dose. If a dose is missed, it should be taken as soon as possible unless it is near the time for the next dose. In case an overdose occurs, get immediate medical help. Store Invega at the specific room temperature that is mentioned on the product’s label and try to keep it away from moisture and heat. Always keep the medication out of reach of children and follow the storage instructions provided by your pharmacist.

Uses of Invega

Invega is used to treat certain types of mental health conditions. These conditions are:

• Schizophrenia in adults and some children
• Schizoaffective disorder in adults only

Invega Dosage

Strengths and Forms

Invega is available in the market as an extended-release oral tablet with the following strengths:

• 1.5 mg
• 3 mg
• 6 mg, and 
• 9 mg

Recommended Dosage for Different Patients

The dosage recommendations of Invega depend on various factors, which may include:

• The severity of the condition
• Age
• Weight for children
• Other medical conditions

There is no loading dose for Invega. Doctors will start the medications on a low dosage and will adjust it gradually if needed. The following Invega information describes dosage recommendations that the patients commonly take. 

Dosage for Schizophrenia

The recommended starting dose of Invega is 6 mg once daily. The usual dose range is between 3 to 12 mg once daily, with a maximum dosage of 12 mg once a day. Your doctor may likely prescribe a different dosing schedule based on certain factors, like kidney disease. 

Dosage for Schizoaffective Disorder

The prescribed starting dose of Invega is 6 mg once a day. The typical dose range is between 3 and 12 mg once daily, and the maximum daily dose is 12 mg, taken once. For this particular medical condition, Invega may be taken in combination or alone with other mood stabilizers, antidepressants, or both at once. Seek expert opinion before combining any medications.

Children’s Dosage

Invega can be given to children 12 years of age or older with Schizophrenia, and the typical starting dose is 3 mg once a day. The usual and maximum dose range of Invega for children depends on their kilograms (kg) body weight. 

• Less Than 51 kg: The usual dose range is between 3 to 6 mg once daily, and the maximum dose is 6 mg every day.
• 51 kg or More: The usual dose range is between 3 to 12 mg once daily, and the maximum dose is 12 mg every day.

[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take Invega?

• Before describing the administration steps, read the patient information leaflet carefully for detailed information.
• Follow your healthcare provider’s advice and adhere to the dosing instructions as they are mentioned on the prescription label. 
• Take this medication by mouth, with or without food, as your medical professional prescribes.
• Swallow the tablets as a whole with water or any liquid. 
• Avoid chewing, breaking, crushing, or splitting the tablets, as it will release all the drugs at once. This can increase the risk of side effects.
• If you are unable to swallow the tablets, visit your medical provider. Discuss the issue with them, and they will surely suggest some alternatives or changes to the treatment. 
• Do not share your medicine with others even if they share the same condition, as the dosage is recommended based on your age, medical condition, and response to the treatment.
• Try to take your medication simultaneously each day to get the most benefit out of it.
• Do not stop taking this medicine without asking your healthcare provider first, even if you feel well. Complete the course of your treatment for effective management of your condition.
• If your condition does not improve or worsens over time, inform your doctor immediately.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Invega Work?

Invega works by controlling the activity of neurotransmitters in the brain, specifically dopamine and serotonin. These neurotransmitters play an important role in influencing mood, behavior, and thinking. By adjusting their levels, this medication helps reduce symptoms of schizophrenia and schizoaffective disorder, such as hallucinations, delusions, and disorganized thinking. The active ingredient, Paliperidone, attaches to receptors in the brain, balancing the chemical signals and improving mental stability. This action helps patients achieve better control over their symptoms, promoting overall mental well-being and improving their ability to function in daily life.

Important Safety Information

Invega Side Effects

Common side effects of Invega may include:

• Increased heart rate
• Sleepiness
• Sudden weight gain
• Upper respiratory infection, like the common cold
• Constipation
• Dizziness
• Indigestion
• Stomach or abdominal pain
• Nausea
• Dry mouth
• Restlessness
• Low sex drive
• Difficulty having an orgasm

Serious side effects of Invega may include:

• Irregular heart rhythm. Some of its signs are:
  • Dizziness
  • Fainting
  • Heart palpitations
• Extrapyramidal Symptoms (Uncontrolled muscle movements). Its symptoms may include:
  • Akathisia (restless feeling)
  • Tremors
  • Muscle stiffness
  • Eye-rolling
• Reduced levels of white blood cells, such as leukocytes, neutrophils & granulocytes. Symptoms are:
  • Infection 
  • Fever
• Neuroleptic malignant syndrome (severe reaction to antipsychotic drugs). Its signs include:
  • Fever 
  • Irritability
  • Confusion
  • Muscle stiffness
• Orthostatic hypotension (sudden decline in blood pressure when standing). Symptom are:
  • Falling
  • Lightheadedness
  • Headache
  • Blurred vision
• Seizures. Its signs are:
  • Loss of consciousness
  • Falling
  • Uncontrolled muscle movement
• Uncontrolled body temperature. Its symptoms may include:
  • Heartburn
  • Choking
  • Coughing
  • Gagging while swallowing
  • Drooling 
• Increased levels of prolactin (a type of hormone that stimulates the body to form breast milk). Its symptoms are:
  • Erectile dysfunction and gynecomastia in males
  • Galactorrhea and irregular periods in females
• Priapism
• Metabolism changes, leading to weight gain, increased levels of triglycerides and cholesterol, including high blood glucose levels
• Risk of death in certain patients
• Tardive dyskinesia (uncontrolled muscle movements that affect the face)
• Allergic reactions
• Shortness of breath
• Nipple discharge
• Skin and mouth sores
• Frequent urination
• Feeling thirsty

[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Invega Warnings

• Cerebrovascular Adverse Reactions in Older Adults With Dementia: Clinical trials with aripiprazole, olanzapine, and risperidone in elderly patients with dementia showed a higher rate of cerebrovascular problems, such as strokes and transient ischemic attacks. Invega, although not included in these studies, is not approved for treating dementia-related psychosis.
• Neuroleptic Malignant Syndrome (NMS): Patients using antipsychotic drugs like Paliperidone are likely to experience NMS, which is a potentially life-threatening condition. Symptoms of NMS include high fever, muscle rigidity, altered mental state, and autonomic dysfunction. Additional signs may include elevated creatine phosphokinase, muscle breakdown, and acute kidney failure.
• QT Prolongation: Paliperidone can increase the QTc interval on an ECG. Therefore, it should not be used with other medications that extend the QTc interval, such as certain antiarrhythmics (e.g., quinidine, amiodarone), antipsychotics (e.g., chlorpromazine), and certain antibiotics (e.g., moxifloxacin). This medication is also contraindicated in patients who have congenital long QT syndrome or a history of cardiac arrhythmias. 
• Tardive Dyskinesia: Patients using antipsychotic medications may develop tardive dyskinesia, a syndrome of involuntary, repetitive movements. This condition is more prevalent in the elderly, especially women, but it is unpredictable who will develop it.
• Metabolic Changes: Atypical antipsychotics, including Invega, are likely to cause metabolic changes that can raise cardiovascular and cerebrovascular risks, such as increased blood sugar, abnormal lipid levels, and weight gain. 
• Hyperprolactinemia: Paliperidone, like other drugs that block dopamine D2 receptors, can raise prolactin levels. This expansion can lead to reproductive issues by suppressing gonadal hormone production, causing symptoms like missed menstrual periods, breast enlargement, and impotence. Moreover, long-term high prolactin levels, coupled with low sex hormone levels, may result in decreased bone density.
• Potential for Gastrointestinal Obstruction: Invega tablets do not change shape in the gastrointestinal tract and should not be given to patients with severe preexisting gastrointestinal narrowing. Rare cases of obstructive symptoms have been reported in patients with known strictures who took non-deformable controlled-release medications.
• Orthostatic Hypotension and Syncope: Paliperidone can cause orthostatic hypotension (a sudden decline in blood pressure when standing up) and fainting due to its alpha-blocking properties. Therefore, patients with cardiovascular or cerebrovascular disease or conditions that cause low blood pressure should use Invega with caution. Frequently visit your doctor and closely monitor your blood pressure, especially when changing positions.
• Falls: Studies have reported cases of postural hypotension, somnolence, and motor and sensory instability in patients using antipsychotic drugs, including Invega. Therefore, elderly patients should avoid using such medications as the above conditions can lead to falls and potential injuries like fractures. 
• Leukopenia, Neutropenia, and Agranulocytosis: Some patients taking antipsychotics, including Invega, have experienced reductions in white blood cells (leukopenia and neutropenia) and, in rare cases, severe reductions (agranulocytosis). Patients with a history of low levels of white blood cell or drug-induced reductions should have their blood counts monitored frequently during the initial months of treatment. Discontinue Invega if a significant drop in white blood cells occurs without other causes.
• Potential for Cognitive and Motor Impairment: Drowsiness has been reported in patients taking Invega. Antipsychotics can impair judgment, thinking, and motor skills. Therefore, patients should be warned against engaging in activities that requires full mental alertness, such as driving or operating machinery, until they are certain Invega does not affect them adversely.
• Dysphagia: Antipsychotics, including Invega, can cause difficulty swallowing (esophageal dysmotility) and increase the risk of aspiration pneumonia, particularly in patients with advanced Alzheimer’s dementia. Use with caution in patients at risk for aspiration pneumonia.
• Priapism: Paliperidone, like other drugs with alpha-blocking effects, can cause prolonged erections (priapism), and severe cases may require surgical intervention.
• Thrombotic Thrombocytopenic Purpura (TTP): No cases of TTP were observed in clinical studies with Paliperidone. However, TTP has been reported with risperidone, although its association with the drug is unclear.
• Body Temperature Regulation: Antipsychotics can disrupt the body’s ability to lower core temperature. That’s why doctors exercise caution while prescribing Invega to patients who may be exposed to conditions that elevate body temperature, such as strenuous exercise, extreme heat, anticholinergic medications, or dehydration.
• Antiemetic Effect: Invega has shown antiemetic (anti-nausea) effects in preclinical studies. If these effects occur in humans, they may mask the signs and symptoms of overdosage, like intestinal obstruction, Reye’s syndrome, and brain tumors in humans.

Invega Boxed Warning 

Invega has received a boxed warning from the FDA, which signifies the most serious warning that alerts patients and doctors about the drug’s harmful effects, which can be life-threatening or dangerous. Antipsychotic drugs like Invega are thought to increase the risk of death in older patients who have psychosis related to dementia. Due to this reason, doctors usually do not prescribe this drug for psychosis treatment in older patients with dementia.   

Invega Precautions

• Before starting your treatment with Paliperidone, let your medical provider know if you have any allergies or are allergic to any of the medication’s ingredients. The product may contain some inactive components that can cause harmful allergic reactions.
• When taking this medication, make sure to inform the healthcare provider about your medical history, especially of:
  • Kidney diseases
  • Liver problems
  • Seizures
  • Parkinson’s diseases
  • Eye problems
  • Family history of diabetes
  • High cholesterol or triglyceride levels
  • Heart problems
  • Low levels of white blood cells
  • Sleep apnea
• If you have certain medical conditions or are taking other drugs that may cause QT prolongation, you are highly likely to develop QT prolongation. Therefore, before using Invega, tell your medical practitioner about the drugs you are taking. This may include all prescription drugs, nonprescription drugs, and herbal products.
• Decreased potassium or magnesium levels in the blood may increase the risk of QT prolongation. This risk can get high if you use drugs like water pills or diuretics or have conditions like excessive sweating, vomiting, or diarrhea. 
• Invega can make people dizzy or drowsy, and using alcohol or marijuana while using this medication increases its effects. Therefore, avoid consuming such substances and do not operate heavy machines, drive, or do anything that requires alertness. 
• Patients must inform their surgeon, doctor, or dentist if they have taken this medication earlier when undergoing surgery or any medical procedure. Doing so can prevent future complications. 
• Invega is thought to make people sweat less, leading to heat stroke. So, patients using this medication should avoid activities that can make them feel overheated, including intense exercise, extreme physical activity, or hot tubs. To prevent such situations, drink plenty of fluids and dress lightly, especially in hot weather. If you feel overheated, look for a place to cool down and rest.
• Get medical assistance immediately if you develop a persistent fever, headache, dizziness, or mood changes.
• Pregnant patients should avoid using this drug unless it is clearly needed, as the medication can result in serious complications. Moreover, if you have been using Invega during the last three months of your pregnancy, your newborn may develop symptoms of muscle stiffness, breathing difficulties, drowsiness, and constant crying. Such symptoms should be reported to a professional, especially if they occur during the first month when the baby is born.  
• Schizophrenia and schizoaffective disorders are serious mental problems. Therefore, patients should not discontinue the treatment abruptly. If you are pregnant or a nursing mother, discuss the situation with a medical provider first and then make any decision. 
• Invega can pass into the breast milk of a lactating woman and may have undesirable effects on a nursing infant. Tell your healthcare practitioner immediately if your baby develops unusual signs like difficulty while feeding, muscle stiffness, or unusual sleepiness. Talk to your doctor about whether you should continue breastfeeding.
• If you have any kidney problems, consult with a medical professional before starting your treatment with Invega. They may adjust your dose accordingly to make it safe for use.

Invega Contraindications

Invega is contraindicated in patients who are hypersensitive to Paliperidone/risperidone or are sensitive to any of the medication’s ingredients, as the product may cause severe allergic reactions. Patients have reported angioedema and angioedema reactions with risperidone and Paliperidone, which is a close relative of risperidone.   

Invega Missed Dose

The manufacturer of Invega does not provide any information on missed doses. But here are a few things that you can be mindful of or follow when this situation arises:

• Take the missed dose as soon as possible or whenever you remember.
• If it is almost time for the next dose, skip the missed medicine and continue your regular dosing schedule. 
• Avoid taking double doses simultaneously to catch up for the missed dose.
• Use apps like medication guides or set reminders on your phone to avoid skipping doses.
• Take your medications at the same time each day for effective results.
• If you have any doubts or concerns, you can talk to a medical practitioner for expert guidance. 

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

Invega Overdose

While Paliperidone overdose cases are rare, there are a few patients who have reported an overdose of Invega, with the highest estimated ingestion of 405 mg. The observed signs and symptoms of Invega overdose may include:

• Muscle contractions
• Continuous spasms
• Walking problems
• Drowsiness
• Somnolence (sleepiness)
• Tachycardia
• Hypotension
• QT prolongation
• Ventricular fibrillation, and 
• Torsade de pointes

Moreover, there is no particular antidote for Paliperidone overdose. So, visit your doctor’s clinic and seek their expert assistance. They will take appropriate supportive measures and closely monitor you for any severe side effects until you recover.

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

Invega Storage

• Read the medication guide that comes with the medication thoroughly. 
• Follow the steps carefully as your doctor instructed to avoid damaging the product.
• Store your medication at a temperature up to 25ºC with excursions from 15ºC to 30ºC.
• Ensure that the medicine is protected from any moisture. 
• Do not keep the product under direct sunlight.
• Avoid placing the product in damp or moist areas like the bathroom or near the sink.
• Do not flush the medication down the toilet, and avoid pouring it into the drain.
• Keep the medicines in their original containers.
• Make sure that the container is tightly locked and kept somewhere safe.
• Place safety cap locks, as some medications do not come with child-resistant caps.
• Keep the medication out of reach and out of sight of children and pets.
• Discard the medication when not in use or past its expiration date.
• Do not throw the product in the household garbage or waste, as it can be misused by children or pets.
• Do not open the package unless you are ready to use it immediately.
• Ask your medical professional or pharmacist how you should dispose of the product to avoid any environmental damage.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Invega Interactions

• Adagrasib
• Anagrelide
• Apalutamide
• Alfentanil
• Arsenic trioxide
• Amiodarone
• Amisulpride
• Brexanolone
• Bedaquiline
• Bromocriptine
• Bepridil
• Buprenorphine
• Bupropion
• Butorphanol
• Cabergoline
• Cabozantinib
• Carbamazepine
• Cisapride
• Citalopram
• Ceritinib
• Clozapine
• Codeine
• Chloramphenicol
• Crizotinib
• Chloroquine
• Disopyramide
• Dofetilide
• Dolasetron
• Deutetrabenazine
• Dronedarone
• Droperidol
• Dezocine
• Efavirenz
• Esketamine
• Entacapone
• Etrasimod
• Escitalopram
• Fentanyl
• Fexinidazole
• Fingolimod
• Gatifloxacin
• Grepafloxacin
• Halofantrine
• Haloperidol
• Hydrocodone
• Hydromorphone
• Hydroxychloroquine
• Ibutilide
• Iohexol
• Iomeprol
• Iopamidol
• Ivabradine
• Ivosidenib
• Ketamine
• Levorphanol
• Lefamulin
• Levodopa
• Levoketoconazole
• Levomethadyl acetate
• Metoclopramide
• Metrizamide
• Morphine
• Morphine liposomal
• Moxifloxacin
• Nilotinib
• Nalbuphine
• Oxycodone

[Note: This isn’t a complete list, and there could be other drugs that interact with Invega. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Invega Alternatives

• Seroquel (quetiapine)
• Abilify (aripiprazole)
• Risperidone
• Latuda
• Clozapine
• Olanzapine
• Vraylar
• Zyprexa
• Geodon
• Lamotrigine
• Risperdal

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

Can I treat bipolar disorder with Invega?

Invega (Paliperidone) is primarily used to treat schizophrenia and schizoaffective disorder. While it’s not specifically approved for bipolar disorder, some doctors may prescribe it off-label for managing certain symptoms. Always talk to a medical provider to determine the best treatment plan for bipolar disorder. They can provide guidance based on your particular medical history and condition.

What is the difference between Invega and Invega Trinza injections?

Invega is an antipsychotic medication administered once daily in oral form or as a monthly injection (Invega Sustenna). Invega Trinza, on the other hand, is a long-acting injectable that is given every three months. Both contain the same active ingredient, Paliperidone, but Invega Trinza offers the convenience of less frequent dosing, which is ideal for patients who require long-term, consistent medication management.

What is the dosing window of Invega?

Invega, taken orally, is typically prescribed once daily, with or without food. The dosing schedule for the injectable forms varies: Invega Sustenna is administered once a month, while Invega Trinza is given every three months. Regarding Invega tablets, the manufacturer does not provide any dosing window for this form. To maintain the medication’s effectiveness, it’s essential to follow your healthcare provider’s instructions and not miss scheduled doses.

What happens if I discontinue Invega suddenly?

Abruptly discontinuing Invega can lead to withdrawal symptoms such as nausea, vomiting, insomnia, and a return or worsening of psychotic symptoms. It’s crucial to consult your healthcare professional before stopping Invega. They can create a gradual tapering plan to minimize potential withdrawal effects and ensure a safer transition off the medication.

Is Invega and Risperdal the same?

Invega (Paliperidone) and Risperdal (risperidone) are related antipsychotic medications but are not the same. Invega is the main active metabolite of Risperdal, meaning it’s a byproduct formed when the body processes Risperdal. Both medications treat similar conditions, such as schizophrenia, but they have different formulations and dosing schedules. Your doctor can determine which is more suitable for your needs.

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