Paliperidone (Invega)

 

HALF-LIFE: 23 hours
STARTING DOSE: 6mg PO daily
TARGET DOSING RANGE: 6mg-9mg per day
BEST TIME TO DOSE: Any
HOW TO DOSE:
>> 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.

 

FDA INDICATIONS:
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

References

  1. Cooper, J. R., Bloom, F. E., & Roth, R. H. (2003). The biochemical basis of neuropharmacology (8th ed.). New York, NY, US: Oxford University Press.
  2. Iversen, L. L., Iversen, S. D., Bloom, F. E., & Roth, R. H. (2009). Introduction to neuropsychopharmacology. Oxford: Oxford University Press.
  3. Puzantian, T., & Carlat, D. J. (2016). Medication fact book: for psychiatric practice. Newburyport, MA: Carlat Publishing, LLC.
  4. J. Ferrando, J. L. Levenson, & J. A. Owen (Eds.), Clinical manual of psychopharmacology in the medically ill(pp. 3-38). Arlington, VA, US: American Psychiatric Publishing, Inc.
  5. Schatzberg, A. F., & DeBattista, C. (2015). Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing.
  6. Schatzberg, A. F., & Nemeroff, C. B. (2017). The American Psychiatric Association Publishing textbook of psychopharmacology. Arlington, VA: American Psychiatric Association Publishing.
  7. Stahl, S. M. (2014). Stahl’s essential psychopharmacology: Prescriber’s guide (5th ed.). New York, NY, US: Cambridge University Press.
  8. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY, US: Cambridge University Press.
  9. Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincotts illustrated reviews: pharmacology. Philadelphia, PA: Wolters Kluwer.