side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more

> Invega (paliperidone) Overview


Invega Article Index | Brand and Generic Availability

Brand & Generic Names; Drug Class

US brand name: Invega
Generic name: paliperidone
Drug Class: Antipsychotics
Learn More about Invega’s Generic & Worldwide Availability
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Invega’s Approved & Off-Label Uses (Indications)

US FDA Approved Treatment(s)

Short- (acute) or long-term (maintenance) treatment of schizophrenia; short-term treatment of schizoaffective disorder, either by itself or with other meds.

Popular Off-Label Uses

  • Treatment of bipolar spectrum disorders. (Most likely for management of psychotic symptoms such as hallucinations, delusions, distortions.)
  • And probably everything Risperdal is used to treat, with or without official approval.

Learn More about Invega’s Approved & Off-label Uses

How Long Until Invega Starts Working (Onset of Action)

Like all antipsychotics you’ll feel something the next day. By the time you reach a steady state, usually in 4 to 5 days, you’ll pretty much know if Invega is going to do anything for you. Various studies and trials have shown positive results in 2 to 7 days, with 2 to 4 days being typical.

Invega Sustenna usually takes 4 days.

Likelihood of Working

As the only drug with FDA approval to treat schizoaffective disorder - other than Clozaril’s approval to treat recurrent suicidal behavior - it doesn’t have a lot of competition. Learn how Invega Compares with Other Drugs

How to Take 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.

This is where Invega and Risperdal really differ, as Invega comes in only four dosages (1.5, 3, 6 and 9 mg) and you start right out with what you’re probably going to be taking.

Of course you and your doctor could determine that 3mg a day would be a good starting point, which is Janssen’s recommended low-dosage starting point, even though they now make 1.5mg capsules. Sure, why not? I’m all about starting at lower dosages. And if you need to you can go up to 12mg a day in 1.5 to 3mg increments. 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.

Or you can get a once-a-month shot of Invega Sustenna. How’s that for simple? Of course, if you get side effects that really suck you’re up shit creak without a paddle, so you probably shouldn’t start with the injection in the highly unlikely event that your doctor suggests you do so.

How to Stop Taking Invega (Discontinue, Withdrawal)

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-live of 23 hours.

Learn More about Taking and Discontinuing Invega

Invega’s Pros and Cons

Pros

  • Far fewer drug-drug interactions than Risperdal.
  • Between the lessened metabolization by the liver (most of Invega gets pissed away) and its being packaged in an OROS trilayer capsule, the people in the trials reported far fewer tummy troubles. Not much from the field. What has been reported confirms what is on the PI sheet, you are less likely to puke with Invega than anything else you’ll see listed on Crazymeds.
  • You have to take it only once a day, compared with taking Risperdal one to four times a day.
  • No titration is needed, in that you don’t have to work up to the recommended dosage.
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Cons

  • While Risperdal tablets are small, Invega tablets are about the size of a multivitamin. So if you have trouble swallowing larger tablets (e.g. Depakote, Keppra, Neurontin 800mg tablets, and the larger dosages of Seroquel) you might have problems taking Invega.
  • As you should never, ever cut an extended-release tablet of any medication, you can’t get a price break on buying the 6mg tablets and splitting them in half as you can with buying larger dosage tablets of Risperdal and splitting them in half. Let alone to try to help you swallow them.
  • Invega is just way more expensive than Risperdal. As many doctors are subject to “if a drug is new it must be better” syndrome, you may be better off with Risperdal, or even a dirt-cheap standard antipsychotic than Invega.

Interesting Stuff your Doctor Probably didn’t Tell You about Invega

The capsule will pass out looking whole so don’t be surprised by that - it’s what OROS does. Like many of the other atypical antipsychotics, Invega can cause QT interval prolongation. Also, in the clinical trials 12% - 14% of patients receiving Invega reported tachycardia (rapid heartbeat). So if you have a history of heart problems Invega probably isn’t a good idea. Otherwise if you develop cardiac wackiness, an EKG / ECG is a good idea to find out if you have something that is a problem or just annoying.

Best Known for

Being a patent extender of Risperdal.
In-Depth Pros & Cons

Invega’s Side Effects (Adverse Reactions)

Typical Side Effects

  • Headache
  • Drowsiness (Somnolence)
  • Dizziness
  • Feeling lightheaded
  • Weight gain
  • Restlessness and trouble sitting still (Akathisia)
  • Anxiety
  • Faster or irregular heartbeat (Tachycardia and QT interval prolongation respectively)
  • And if you are incredibly stupid and drink alcohol you will get drunker
  • With Invega Sustenna -
    • Injection site issues
    • Much higher chances of EPS than the oral version

Uncommon Side Effects

  • Trouble walking or standing (Dystonia and “coordination abnormal”)
  • Drooling
  • Fainting (Orthostatic hypotension)
  • Extrapyramidal symptoms (probability and severity of EPS increases along with dosage)
  • “Unusual eye movements”. - A direct quote from the pharmacy handout.

Freaky Rare Side Effects

Lactation anyone? Guys, you too can experience the joys of new motherhood. Which isn’t even all that freaky (to anyone who it doesn’t happen to), let alone rare as far as antipsychotics are concerned, but Invega still doesn’t have any weird-ass side effects.
Learn More about Invega’s Side Effects.
TMI at times

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What You Really Need to be Careful About

It takes 4 - 8 months for your body to be rid of Invega Sustenna - the long-lasting (no shit) injection. So make sure you’re committed to Invega for the long haul.

Invega’s Black Box and Other Warnings, Pregnancy Category, etc.

Pharmacology

paliperidone’s Half-Life & How Long Until It Clears Your System

Plasma half-life: For the pills - Half-life: An average of 23 hours. Clearance: five days. For Invega Sustenna - Half-life: 25–49 days. Clearance: 125 - 245 days, or 4 - 8 months.

paliperidone’s Pharmacokinetics Information Overload

Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream, so there’s nothing swimming around to attach itself to your brain and start doing stuff1. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood. If we’ve found the complete clearance, or how to calculate it if it requires things like your weight and what your piss looks like, you’ll find that on paliperidone’s pharmacokinetics page.

How paliperidone Works

the current best guess at any rate
So Invega and Risperdal have one of the simplest profiles in which receptors they deal with - mainly the dopamine Type 2 (D2) and serotonin Type 2 (5HT2), with enough of the H1 histamine receptors to help put you to sleep and a light brushing of the α1 and α2 adrenergic receptors thrown in for good measure. They just hit the dopamine receptors harder than most of the other Novel / Atypical Antipsychotics. In some ways Risperdal and Invega act almost like Haldol (halperidol) on steroids, by keeping one’s brain from using too much dopamine and serotonin, thus helping to prevent the positive symptoms in schizophrenia: aggression, conceptual disorganization, hallucinations and hallucinatory behavior, suspiciousness, and unusual thought content. Just replace “conceptual disorganization” with “racing thoughts” and “hallucinatory behavior” with “delusions” and you’ve got symptoms for mania.

Learn More than You Probably Ever Wanted to Know about How paliperidone Works
AKA mechanism/method of action, pharmacodynamics

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Ratings, Reviews, Comments, PI Sheet, and More

Invega Comments

As Invega is merely the active metabolite of Risperdal, so a lot of stuff will be in terms of how it compares with Risperdal.
So if you take Risperdal now or if your doctor thinks that Risperdal is a good fit for you, Invega is going to be better, in terms of side effects, only in that you’re less likely to puke or have other forms of gastric distress. Invega could be better if your liver is mildly impaired (e.g. you have hepatitis), you’re an incredibly poor metabolizer of CYP2D6, and/or you’re taking one or more meds that inhibit CYP2D6.
But if you’re taking Risperdal now, or have taken it in the past, and it didn’t work for you for reasons other than GI-related side effects or CYP2D6 problems, then Invega will be a waste of money and side effects.
Extended Comments
As if I didn’t go on long enough already.

Invega Ratings & Reviews, and Consumer Comments & Experiences

Rate Invega

Give your overall impression of Invega on a scale of 0 to 5. Detailed ratings and reviews are available on the Invega Ratings & Reviews Page.

Get all critical about Invega

3.5 stars Rating 3.2 out of 5 from 25 criticisms.
Vote Distribution: 3 – 2 – 3 – 3 – 5 – 9


Rate this article

If you’re still feeling judgmental as well as just mental3, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Invega (paliperidone) Overview

4 stars Rates 3.8 out of 5 from 12 value judgments.
Vote Distribution: 0 – 0 – 2 – 1 – 4 – 5


Allegedly Useful Links. Mostly official sites, PI sheet-equivalents4 from countries other than the US, and reviews from other consumer review sites.


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It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.



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References

  1. Invega’s Full US Prescribing Information
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.

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Invega Article Index | Brand and Generic Availability

1 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.

2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.

3 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!

4 These include: Canada's Product Monographs (PM), New Zealand's Medicine Data Sheets (MDS), the EU's European Public Assessment Reports (EPAR), and the Summary of Product Characteristics (SPC) used in Britain, Ireland, and many other places.


If you have any questions not answered here, please see the Crazymeds Invega discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher crazymeds.us


Last modified on Tuesday, 08 July, 2014 at 11:31:22 by JerodPoorePage Authors , Jerod PooreDate created 10 June 2011 at 17:09:23
“Invega” by girrl88 is copyright © 2011 girrl88Published online 2011/06/10
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Invega, and all other drug names on this page and used throughout the site, are a trademark of someone else.

will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 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 something along the lines of following disclaimer, I’m usually cool with it.



All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
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Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
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Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
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No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!

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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 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

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