II. Indications
III. Mechanism
- Atypical Antipsychotic, a benzisoxazole derivative, and active metabolite of Risperidone
- Dopamine D2 Receptor Antagonist
- Serotonin 5HT2 Receptor Antagonist
IV. Dosing: Schizophrenia or Schizoaffective Disorder
- Child Oral Dosing (age 12 to 17 years old)
- Start 3 mg orally each morning
- May increase by 3 mg/day up to every 5 days to maximum of 6 mg/day (max 12 mg/day if weight >=51 kg)
- Adult Oral Dosing
- Start 6 mg orally each morning (may consider starting at 3 mg)
- May increase by 3 mg/day up to every 5 days to maximum of 12 mg/day
- Renal Dosing
- Adult Sustained Release Monthly Injection (Invega Sustenna)
- Trial oral dosing before IM dosing
- Start 234 mg IM in Deltoid Muscle or Gluteal Muscle
- Next, in one week, administer 156 mg IM in Deltoid Muscle or Gluteal Muscle
- Next administer 117 mg IM in Deltoid Muscle or Gluteal Muscle every month
- Adjust dose range 78 mg to 234 mg IM monthly depending on response and tolerability
- Doses as low as 39 mg IM monthly may be effective
- Renal Dosing
- Adult Sustained Release Quarterly Injection (Invega Trinza)
- Trial Invega Sustenna IM dosing for at least 4 months before starting Invega Trinza
- Invega Trinza dosing is based on prior Sustenna dosing
- Sustenna 78 mg IM qMonth: Use Trinza 273 mg IM every 3 months
- Sustenna 117 mg IM qMonth: Use Trinza 410 mg IM every 3 months
- Sustenna 156 mg IM qMonth: Use Trinza 546 mg IM every 3 months
- Sustenna 234 mg IM qMonth: Use Trinza 819 mg IM every 3 months
- Renal Dosing
- Adult Extended Release Biannual Injection (Invega Hafyera)
- Trial Invega Sustenna >=4 months (or Trinza >=3 months) before starting Invega Hafyera
- Invega Hafyera dosing is based on prior Sustenna dosing
- Sustenna 156 mg qMonth or Invega 546 q3month: Use Hafyera 1092 mg IM every 6 months
- Sustenna 234 mg qMonth or Invega 819 q3month: Use Hafyera 1560 mg IM every 6 months
V. Adverse Effects
- See Antipsychotic Medication
- Similar adverse effects to Risperidone (Paliperidone's parent drug)
- Increased Serum Prolactin
- Extrapyramidal Side Effects
- Nausea
- Somnolence
- Dizziness
- Tachycardia
- QTc Prolongation
- Weight gain
- Hyperglycemia and increased risk of Diabetes Mellitus
VI. Drug Interactions
- Metabolized by CYP3A4 and CYP2D6
- Inhibits P-Glycoprotein (as does Risperidone)
VII. Safety
- Pregnancy Category C
- Avoid in Lactation
VIII. Resources
- Paliperidone Extended Release Tablet (DailyMed)
- Paliperidone Sustenna Extended Release Monthly IM Injection (DailyMed)
- Paliperidone Trinza Extended Release quarterly IM Injection (DailyMed)
- Paliperidone Hafyera Extended Release Biannual IM Injection (DailyMed)
IX. References
- (2016) Med Lett Drugs Ther 58(1510): 160-5
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 42-3
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
paliperidone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
PALIPERIDONE ER 1.5 MG TABLET | Generic | $2.83 each |
PALIPERIDONE ER 3 MG TABLET | Generic | $3.46 each |
PALIPERIDONE ER 6 MG TABLET | Generic | $3.29 each |
PALIPERIDONE ER 9 MG TABLET | Generic | $3.91 each |
invega (on 7/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
INVEGA ER 3 MG TABLET | Generic | $3.46 each |
INVEGA ER 6 MG TABLET | Generic | $3.29 each |
INVEGA ER 9 MG TABLET | Generic | $3.91 each |
INVEGA SUSTENNA 117 MG/0.75 ML | $2,046.17 per ml | |
INVEGA SUSTENNA 156 MG/ML SYRG | $2,050.54 per ml | |
INVEGA SUSTENNA 234 MG/1.5 ML | $2,046.65 per ml | |
INVEGA SUSTENNA 78 MG/0.5 ML | $2,042.00 per ml | |
INVEGA TRINZA 410 MG/1.32 ML | $3,435.14 per ml | |
INVEGA TRINZA 546 MG/1.75 ML | $3,487.58 per ml | |
INVEGA TRINZA 819 MG/2.63 ML | $3,496.92 per ml |
Ontology: paliperidone (C0753678)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C079150 |
SnomedCT | 426276000, 425483000, 117004004 |
LNC | LP99633-7, LP17865-4, MTHU027456, MTHU035750 |
English | 3-(2-(4-(6-fluoro-3-(1,2-benzisoxazolyl))-1-piperidinyl)ethyl)-6,7,8,9-tetrahydro-9-hydroxy-2-methyl-4H-pyrido(1,2-a)pyrimidin-4-one, 9-hydroxyrisperidone, 4H-Pyrido(1,2-a)pyrimidin-4-one, 3-(2-(4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl)ethyl)-6,7,8,9-tetrahydro-9-hydroxy-2-methyl-, Paliperidone (substance), Paliperidone, Paliperidone (product), paliperidone (medication), 9-hydroxy-risperidone, 9-OH-risperidone, paliperidone, PALIPERIDONE, 9-Hydroxyrisperidone (substance), 9-Hydroxyrisperidone |
Spanish | paliperidona, paliperidona (producto), paliperidona (sustancia), 9-hidroxirrisperidona (sustancia), 9-hidroxirrisperidona |
Ontology: Invega (C1828935)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C079150 |
English | Invega, Janssen brand of paliperidone extended release |
Ontology: paliperidone palmitate (C2719626)
Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
MSH | C548956 |
English | PALIPERIDONE PALMITATE, Paliperidone Palmitate, paliperidone palmitate, Hexadecanoic Acid, 3-(2-(4-(6-fluoro-1,2-benzisoxazol-3-yl)-1-piperidinyl)ethyl)-6,7,8,9-tetrahydro-2-methyl-4-oxo-4H-pyrido(1,2-a)pyrimidin-9-yl Ester |