Paliperidone - Chris Aiken, MD

Paliperidone (Invega)

Second generation antipsychotic (dopamine, serotonin, norepinephrine receptor antagonist (D2, 5-HT2, NE alpha-2))

Schizophrenia³(12+)
Ineffective: Mania

Schizoaffective²

Features

Child-Studied, Generic, Sedating, Medication, Child-Approved, Non-controlled, Bipolar-Safe

Handout

Dosing

FDA approved only for schizophrenia and schizoaffective (3-9 mg/d). Take with food.

Available only as ER form, which improves tolerability and allows it to be started at the treating dose. Food increases serum levels by 50–60%.

INTERACTIONS: Raise by 2-3x if using with carbamazepine.

Management

Metabolite of risperidone. Failed in most studies of mania.

TOLERABILITY: Weight gain, sedation, akathisia, EPS (dystonia, stiffness), anticholinergic.

RISKS: Tardive dyskinesia (25% over 10 years, higher in elderly), metabolic, prolactinemia (can lead to breast cancer, osteopenia, sexual dysfunction), orthostasis (falls), QTc prolongation, temperature imbalance in elderly, NMS (muscle rigidity, fever, tachycardia).

Side Effect Management

EMR Text

Schizophrenia

Paliperidone use based on FDA approval in schizophrenia.

Antipsychotic side effects, including metabolic, prolactinemia, and TD, reviewed with patient.

Schizoaffective

Paliperidone use based on FDA approval in schizoaffective disorder.

Antipsychotic side effects, including metabolic, prolactinemia, and TD, reviewed with patient.

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