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One of the most important aspects of any medication is how to go about taking it. This includes:

  • how much to take (the dosage or dose)
  • when and how often to take it (dosing schedule or doses)
  • how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).

This information is always in the PI sheet, is usually in the information for patients leaflets, most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.

We here at Crazy Meds often disagree with the official schedules found in the PI sheets. We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage1. More and more doctors are agreeing with us2. You and your doctor can always discuss increasing the dosage when you need to in advance.
And since you never really know how a drug might affect you, it’s best to start when you have some time off of work. Like Friday night / Saturday morning, or your equivalent. Better still would be to get someone to stay with you or at least check on you frequently, especially if you’re the primary caretaker of young children and similar critters.

1.  Invega’s (paliperidone)’s dosage and doses

Invega:One 6mg tablet in the morning. There, you’re done. Once a day and you’ve started at the recommended dosage. It doesn’t get any freaking easier in the world of crazy meds.
Of course you and your doctor could determine that 3mg a day would be a good starting point. Sure, why not? I’m all about starting at lower dosages. And if you need to you can go up to 12mg a day. Three, six, nine and twelve milligrams. I think for many people freedom from choice makes their lives much, much simpler, and simpler is way better.
This is where Invega and Risperdal really differ, as Invega comes in only three dosages and you start right out with what you’re probably going to be taking.

Invega Sustenna: One shot, you’re done for the month. Invega Sustenna comes in prefilled syringes with dosages being in 39mg, 78mg, 117mg, 156mg, and 234mg. Shots are given into the muscle either in the arm or the rear. In an ideal world there would be a trial run with regular Invega or Risperdal to make sure you don’t have any reactions to the medication but according to invegasustenna.com it says that your doctor “may give you a test dose”.

2.  Best way to take / special instructions for taking Invega (paliperidone)

If you’re converting from Risperdal, and aren’t taking a potent inhibitor of CYP2D6 (or weren’t when you were taking the Risperdal), or otherwise have CYP2D6 issues, it’s a 1:2 Risperdal-to-Invega ratio. So..

0.75mg Risperdal = 1.5mg Invega
1.5mg Risperdal = 3mg Invega
3mg Risperdal = 6mg Invega
4.5mg Risperdal = 9mg Invega
6mg Risperdal = 12mg Invega

That’s per The Pharmacokinetics of Paliperidone Versus Risperidone.

See our page on Pharmacokinetics and CYP450 enzymes for information about CYP2D6 and why it can be a big deal for some people.

3.  Invega’s (paliperidone)’s titration (dosage increase)

At whatever dosage you start, Janssen recommends increasing the dosage by 3mg, and waiting at least 5 days between each increase.

Again: sure, why not? They also make a 1.5mg capsule, and as long as you’re not completely flipping out try waiting as long as you’re comfortable before raising the dosage. Five days is the absolute minimum amount of time to wait.

For Invega Sustenna the PI sheet says the recommended dosing schedule is to start with a 234mg dose on day 1 then one week later to give a second dose of 156mg. After the second dose, the shots will be given monthly with a recommended dose of 117mg. That seems pretty high, especially since they recommend that you should have already taken Invega or Risperdal first but not be taking either when you start. That sounds like a fun few days.

One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others (most notably SNRIs like Effexor and Cymbalta) it can be a nightmare.

4.  How to stop taking Invega (paliperidone)

That’s a good question. When you start at the recommended dosage one would just have to stop taking the one pill a day. Janssen reports not a heck of a lot as happening in Invega’s PI sheet/the PDR. If you were taking 9mg, 12mg (or more) a day, or actually increased from 3mg a day, talk to your doctor about a 3mg a day reduction every five days. Who really knows? This stuff is new. The five days is based on Invega’s half-life of 23 hours.

How to stop taking Invega Sustenna is an even better question. With a half-life of 25–49 days3 it can take between four and nine months to fully clear from your system. While that makes for a theoretically easy answer of “Just don’t get another shot,” what to do if you’re having a bad reaction makes things a bit tricky.

5.  Discontinuation symptoms

  • It’s an antipsychotic, so unless you’re taking another antipsychotic at the same time you’ll probably have a headache, feel spacy (or more so than usual).
  • Depending on your condition, why you’re taking Invega, why you’re stopping, and if you’re taking another med or not, your symptoms may return.
  • Sometimes when symptoms return they’re worse than before (rebound), but that’s almost always temporary. It’s really rare for rebound symptoms to hang around for longer than one or two weeks.
  • The best information we have so far comes from Schizophrenia.emed.tv.com’s page. They list all of two things to be concerned about:
    • Insomnia
    • Return of symptoms

6.  Notes, tips, helpful hints, etc. for discontinuing Invega (paliperidone)

Although the once-a-month injection of Invega Sustenna is really easy, you should probably see how you do with regular Invega for a year or so before switching to the injection.

The equivalency ratio of Invega Sustenna to oral Invega is:
Invega Sustenna - 39, 78, 117, 156, and 234 mg
Invega oral - 25, 50, 75, 100, and 150 mg

Not that you’d be taking 25mg a day, or more, of Invega. That’s just to give you an idea of how much a month you’re getting.

‹ How Long & How Likely To Work, Comparisons with Other Meds | Invega Index | Pros & Cons, Interesting Stuff Your Doctor Didn’t Tell You ›
Crazy Meds Comprehensive Invega pages

Bibliography

1 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.

2 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy*, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.

3 Over twice as long as the longest-lasting Depot injections of first generation antipsychotics. Invega Sustenna has the longest half-life we've seen in all crazy meds.

*Link to Topiramate in the treatment of partial and generalized epilepsy Scroll down to the section “Practical use of topiramate”


Date created 10 Jun 2011 - 17:09 Page Creator: girrl88? Last edited by:

Crazy Meds’ Suggestions on How Much to Take, How to Increase the Dosage, and How to Stop Taking Invega is copyright 2011 girrl88?


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Almost all of the material on this site is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.

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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]


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