Paliperidone (Trade name: Invega) is an antipsychotic in the atypical antipsychotic class commonly used in the treatment of schizophrenia and bipolar disorder. It is the primary active metabolite (paliperidone is also known as 9-hydroxyrisperidone) of risperidone.
Absorption | |
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Distribution | |
Metabolism | Paliperidone does not undergo extensive metabolism (since it is already the active metabolite of risperidone). |
Elimination | A significant portion of its metabolism occurs in the kidneys, secondary to renal clearance and elimination. |
Half-life |
Substrate of (Metabolized by) | |
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Induces | |
Inhibits |
Starting | 3 mg PO daily |
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Titration | Increase by 3 mg every 7 days |
Maximum | 12 mg PO daily |
Taper |
Invega Trinza is a 3-month injectable form of paliperidone for the treatment of adult schizophrenia. It can only be used after Invega Sustenna (1-month paliperidone palmitate prolonged-release injectable suspension) has been established as an adequate treatment for at least 4 months
The product monograph for paliperidone IM formulations does not recommend PO bridging (in fact, it says “Once treatment with IM paliperidone has been initiated, additional coverage with oral antipsychotics is not required and these medications can be discontinued”). However, this is because the pivotal studies included patients who were already at steady-state/therapeutic levels on PO dosing prior to starting an LAI. Thus, in an acute care setting where patients may be antipsychotic naive, or not adherent to medications, it makes clinical sense to actually continue an oral bridge for 2 loading doses (i.e. - 7 days), as long as there are no concern about side effects.
Paliperidone IM (Invega) has some benefits over a Risperidone IM (Consta):