Paliperidone (Invega)


HALF-LIFE: 23 hours
TARGET DOSING RANGE: 6mg-9mg per day
>> Initial 6mg PO daily for one week then 9mg starting week two
>> May increase to 12mg PO daily starting week three (if needed)
PREGNANCY: Minimal data on safety.
BREASTFEEDING: Minimal data on safety.


1) Schizophrenia, 12yo and older
2) Schizoaffective disorder


Additional Information

  • Paliperidone is the active metabolite of risperidone (9-hydroxy-risperidone)
  • Unlike risperidone, paliperidone comes in a controlled/sustained-release oral formulation and can be dosed once daily 
  • Not hepatically metabolized; few drug interactions
  • Possibly less sedation, less orthostasis, less extrapyramidal symptoms (i.e., parkinsonism, dystonia)
  • Similar risk to risperidone in terms of weight gain, insulin resistance, diabetes, prolactin elevation
  • Long-acting depot formulations available:
  • Monthly Injection: Sustenna
    • Initiation dose: 234mg IM
    • Booster dose: 156mg IM 4-12 days after initiation dose
    • Maintenance dose: 117mg IM q3-5 weeks
  • Three month Injection: Trinza


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