paliperidone ER
Invega (paliperidone) is taken by mouth and used to improve mood, thoughts, and behaviors in people who have schizophrenia or schizoaffective disorder. It's available as both brand and generic versions in an extended-release pill, which means the medication is released slowly in your body. It only needs to be taken once a day. Some common side effects include drowsiness and uncontrolled muscle movements. There are long-acting injection forms of this medication available given by a trained healthcare provider.
What is Invega (paliperidone)?
What is Invega (paliperidone) used for?
- Schizophrenia
- Schizoaffective disorder
How Invega (paliperidone) works
Invega (paliperidone) is an atypical antipsychotic. It affects dopamine and serotonin levels in your brain, which helps to control your thoughts, mood, and behaviors.
Drug facts
Side effects of Invega (paliperidone)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Abnormal muscle movements (up to 40%)
- Drowsiness (up to 26%)
- Headache (up to 14%)
- Irregular heart beat (up to 14%)
- Vomiting (up to 11%)
- Anxiety (up to 9%)
Less Common Side Effects
- Weight gain
- Making more saliva
- Dry mouth
- Cough
- Upset stomach
- Constipation
- Dizziness
Invega (paliperidone) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Neuroleptic malignant syndrome: high fever, muscle stiffness, confusion, sweating, changes in pulse, heart rate, changes in blood pressure
- Tardive dyskinesia: uncontrolled muscle movements, such as facial grimacing, lip-smacking, blinking
- Extremely high blood sugar levels: feeling very hungry or thirsty, urinating more often, stomach pain, weakness, fruity-smelling breath
- Priapism: painful erection that that lasts longer than 4 hours
- Difficulty swallowing
- Seizures
The following Invega (paliperidone) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Difficulty with speaking
fast, pounding, or irregular heartbeat or pulse
increase in body movements
loss of balance control
muscle trembling, jerking, or stiffness
shuffling walk
stiffness of the limbs
twisting movements of the body
uncontrolled movements, especially of the face, neck, and back
Less common
cold sweats
confusion
difficulty with swallowing
dizziness
excessive muscle tone
fainting
inability to move the eyes
increased blinking or spasms of the eyelid
increased blood pressure
mask-like face
muscle tension or tightness
pain in the arms or legs
slow heartbeat
slowed movements
slurred speech
sticking out of the tongue when not meaning to
tic-like (jerky) movements of the head, face, mouth, and neck
trembling and shaking of the fingers and hands
trouble with breathing, speaking, or swallowing
uncontrolled twisting movements of the neck, trunk, arms, or legs
unusual facial expressions
unusual tiredness or weakness
Incidence not known
Black, tarry stools
blood in the urine
bloody nose
decrease in the frequency of urination
decrease in urine volume
decreased awareness or responsiveness
difficulty in passing urine (dribbling)
heavier menstrual periods
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
lip smacking or puckering
loss of bladder control
mimicry of speech or movements
peculiar postures or movements, mannerisms, or grimacing
painful or prolonged erection of the penis
pinpoint red spots on the skin
puffing of cheeks
rapid or worm-like movements of the tongue
severe constipation
severe sleepiness
severe vomiting
skin rash
stomach pain
uncontrolled chewing movements
uncontrolled movements of the arms and legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Absent, missed, or irregular menstrual periods
difficulty having a bowel movement
fear or nervousness
headache
inability to sit still
need to keep moving
sleepiness or unusual drowsiness
stopping of menstrual bleeding
vomiting
Less common
Back pain
belching
blurred vision
changes in appetite
indigestion
lack or loss of strength
muscle aches
stomach discomfort or upset
stuffy or runny nose
swelling or soreness of the breasts in both females and males
swollen tongue
unexpected or excess milk flow from breasts
upper stomach pain
Incidence not known
Sleepwalking
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Invega (paliperidone)
Pros
- Available in many different strengths to make it easier to customize your dose
- Can be used in adolescents
- Only need to take the medication once a day
Cons
- You might have to see your provider several times until you find a dose that works best for you
- Can make you feel sleepy or sedated
- Can cause weight gain
Pharmacist tips for Invega (paliperidone)
- You can take Invega (paliperidone) with or without food. Try to remember to take it at the same time everyday.
- Invega (paliperidone) is an extended-release tablet that must be swallowed whole with some fluid. Don't cut, chew, or crush the the tablet because this could change the way it works in your body.
- Don't be alarmed if you see an empty shell in your stool. Invega (paliperidone) has a shell that slowly releases the medication in your body over time. You'll pass this empty shell in your stool because your body won't be able to break it down.
- Carefully monitor your weight while you're taking Invega (paliperidone). Let your provider know if you notice a lot of weight gain because this might lead to other health problems, such as heart or blood sugar conditions.
- Invega (paliperidone) can cause unusual, uncontrolled, or repetitive movements of your eyes, tongue, face, arm, or legs. Contact your healthcare provider right away because these might be signs of tardive dyskinesia, which can become permanent.
- Invega (paliperidone) might make it hard for your body to maintain a normal body temperature. Drink water to stay hydrated, especially if you're out in the sun or exercising. Be careful if you're traveling to a place that is very hot.
- If you're starting Invega (paliperidone) for the first time or if your provider just raised your dose, you might feel dizzy or have a hard time keeping your balance. Make sure to sit up or stand up slowly. This side effect will likely lessen after your body gets used to the medication or the new dose. Talk with your provider if this continues to bother you.
- This medication can make you feel drowsy or sleepy. Be careful and avoid activities that require you to be alert, such as driving a car, until you know how this medication affects you.
- Make sure to chew your food completely and swallow carefully while taking Invega (paliperidone). Rarely, this medication can cause the muscles in your throat to not work well and make it hard for you to swallow food.
- Risperidone (Risperdal) breaks down in your body to Invega (paliperidone). Typically, you're either taking one medication or the other, but not both at the same time. If you have prescriptions for both medications, double check with your prescriber which one you should be taking.
- Tell your provider all of the medications you're taking and ask them to check for interactions before starting any new medications. Invega (paliperidone) can interact with some medications and affect your heart rhythm.
Common questions about Invega (paliperidone)
You might notice your mood getting better within a week of starting Invega (paliperidone). But it can take longer for you to experience the full benefits of this medication. If you aren't noticing improvement, talk to your provider. They might be able to adjust your dose or recommend a different treatment option. Keep in mind that if you're starting Invega (paliperidone) for the first time, it can take a few weeks before you and your provider find the dose that works best for you.
It can. Invega (paliperidone) improves your mood and behavior by changing the level of chemicals in your body. This can also affect your body's ability to control appetite. This might lead you to eat more even when you don't need to, which can cause weight gain. In clinical studies, up to 9% of adults experienced a 7% or greater change from their starting body weight after 6 weeks of taking this medication. But Invega (paliperidone) causes less weight gain compared with some other atypical antipsychotics, such as clozapine (Clozaril) or olanzapine (Zyprexa). Your provider might check your weight regularly to make sure it's within a healthy range.
There's a possibility that Invega (paliperidone) can cause erectile dysfunction (ED). It's because taking Invega (paliperidone) can lead to higher prolactin levels, and one of the symptoms of this problem is ED. But there haven't been any reports of people experiencing ED in clinical trials. One sexual problem that Invega (paliperidone) can cause is priapism, which is an erection that lasts more than 4 hours. Get medical help right away if you experience this because if not treated right away, priapism can cause permanent damage.
After stopping Invega (paliperidone), it can take about 5 days for the majority of the medication to leave your body. But keep in mind that this time frame is estimated based on the half-life of Invega (paliperidone). It can also be affected by your health conditions and genetics, so it can be different for each individual person. Discuss with your healthcare provider if you have questions about how long the medication stays in your body.
Avoid drinking alcohol while taking Invega (paliperidone) because it can worsen some of the side effects, such as dizziness and sleepiness. Alcohol can also worsen mental health conditions, like schizophrenia.
Talk with your provider about the risks and benefits of using Invega (paliperidone) during pregnancy. It's not clear whether or not Invega (paliperidone) causes birth defects. But babies born to mothers who took similar medications during the third trimester of pregnancy have developed uncontrolled muscle movement or withdrawal symptoms at birth, such as tremors, agitation, and problems feeding. There's a National Pregnancy Registry for Atypical Antipsychotics to monitor the safety of certain medications during pregnancy. If you're currently pregnant and taking Invega (paliperidone), it's encouraged that you enroll in the registry by going to the website above or calling 866-961-2388.
Both Invega (paliperidone) and Invega Sustenna (paliperidone) contain the same active ingredient (paliperidone) and treat the same conditions. But they have some differences. The main difference is that Invega (paliperidone) is a tablet that's taken by mouth daily, whereas Invega Sustenna (paliperidone) is an injection that's given monthly by a trained healthcare provider. There are also even longer-acting versions paliperidone injection that are given either once every 3 months (Invega Trinza) or once every 6 months (Invega Hafyera). Your provider might consider longer-acting paliperidone injections for you if you've been taking Invega (paliperidone) tablets and they've been working well for you, and you don't mind receiving regular injections at a provider's office.
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Risks and warnings for Invega (paliperidone)
Invega (paliperidone) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Higher risk of death in older adults with dementia-related psychosis
- Risk factors: Older adults with dementia-related psychosis
Older adults who also have dementia sometimes have some of the symptoms of schizophrenia, like hallucinations and delusions. This is called dementia-related psychosis, and it shouldn't be treated with Invega (paliperidone). If Invega (paliperidone) is used for dementia-related psychosis, it can cause death. The cause of death is typically from heart problems, stroke, or infections. Let your provider know if you or your loved one has dementia before starting Invega (paliperidone).
Neuroleptic malignant syndrome (NMS)
- Risk factors: Taking antipsychotic medications
Invega (paliperidone) can cause neuroleptic malignant syndrome (NMS), which is a rare but serious condition that can lead to death. Be careful using Invega (paliperidone) if you're also on other medications that might cause NMS. Symptoms include a very high fever, stiff muscles, problems thinking clearly, a very fast or uneven heartbeat, and sweating. Stop taking Invega (paliperidone) and get medical attention right away if you experience these symptoms.
High blood sugar, high cholesterol, and weight gain
- Risk factors: History of diabetes | History of high cholesterol
Invega (paliperidone) can raise your blood sugar, sometimes to dangerous levels resulting in coma or death. Let your provider know if you have symptoms of high blood sugar, such as feeling very hungry or thirsty, urinating more often, stomach pain, weakness, or fruity-smelling breath.
Invega (paliperidone) can also cause high cholesterol and weight gain. Your provider might check your weight and order blood tests regularly to make sure your blood sugar, cholesterol, and weight aren't too high.
Difficulty controlling muscle movements (tardive dyskinesia)
- Risk factors: Older adults | Female and 65 years or older | High doses of Invega (paliperidone) | Taking Invega (paliperidone) for a long time
Invega (paliperidone) can cause uncontrolled and possibly permanent muscle movements in the tongue, face, mouth, lips, neck, hands, arms, legs, and feet (tardive dyskinesia). To lower your risk of tardive dyskinesia, your provider will have you take the lowest dose that treats your symptoms. Get medical help right away if you notice any unusual movements you can't control. This side effect can sometimes occur even after you stop the medication.
Higher risk of falls
- Risk factors: Starting Invega (paliperidone) for the first time | Recent rise in Invega (paliperidone) dose | Older adults | Not enough fluids in your body | History of heart problems | History of low blood pressure | Taking medications that lower blood pressure
Invega (paliperidone) can cause sleepiness, dizziness, difficulties keeping your balance, and drops in blood pressure when you sit up or stand too quickly. This can result in fainting and falling. Sit up or stand up slowly, especially during the first few days after you start Invega (paliperidone) or when your provider raises your dose. Your risk of falls is higher if you have heart problems or if you don't have enough fluids in your body. Talk to your healthcare provider if you continue to experience dizziness while taking Invega (paliperidone).
High prolactin levels
Invega (paliperidone) can cause prolactin levels in the blood to go up. High prolactin levels can lead to fertility problems, enlarged male breasts, sexual dysfunction, absent or irregular menstrual periods, and weak bones. Your provider might recommend regular blood tests for you to make sure your prolactin levels are within normal range.
Higher risk of infections
- Risk factors: History of low white blood cell counts | Taking other medications that lower white blood cell counts
Invega (paliperidone) can lower the amount of white blood cells in your body and put you at higher risk for serious infection. You might need to get lab work done regularly to make sure your white blood cell count is healthy. If the levels are too low, your provider might stop your medication. Talk to your provider right away if you experience symptoms of an infection, including fever, weakness, or sore throat, while taking Invega (paliperidone).
Not for people with gut problems
If you have gut-related problems, such as inflammatory bowel disease (IBD), let your provider know. The outer shell of the Invega (paliperidone) doesn't dissolve, but remains intact as it passes through your body. This can raise the risk for blockages in the gut in people with gut problems.
Heart rhythm problem (QT prolongation)
Risk factors: Low potassium or magnesium blood levels | Older age | Female sex | Using other medications that cause QT prolongation | Born with QT prolongation | Hypothyroidism (low thyroid hormone) | History of heart problems or abnormal heart rhythms (arrhythmias) | Slow heart rate
Although rare, Invega (paliperidone) can affect your heart rhythm by lengthening the time period from when the heart pumps and then relaxes. This is known as QT prolongation and it can be life-threatening. Your risk for QT prolongation is higher if you have any of the risk factors listed above. Make sure to tell your provider about all the medications you're taking and don't start any new medications while taking Invega (paliperidone) without talking to your provider or pharmacist first. People who were born with QT prolongation or have a history of arrhythmias should avoid taking Invega (paliperidone). If you feel your chest pounding, have trouble breathing, chest pain, or feel faint or lightheaded while taking Invega (paliperidone), call 911 right away.
Invega (paliperidone) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 1.5mg | 30 tablets | $39.45 | $1.32 |
| 3mg | 30 tablets | $41.03 | $1.37 |
| 6mg | 30 tablets | $38.96 | $1.30 |
| 9mg | 30 tablets | $40.79 | $1.36 |
Typical dosage for Invega (paliperidone)
Adults
- Schizophrenia and schizoaffective disorder: The typical starting dose is 6 mg by mouth once daily. The typical dosing range is 3 mg to 12 mg once daily.
Adolescents ages 12 to 17 years old:
- Schizophrenia only: The typical dose is 3 mg by mouth once daily.
Your dose might differ if you're an older adult or if you have kidney problems.
Interactions between Invega (paliperidone) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Bromopride
- Cisapride
- Dronedarone
- Mesoridazine
- Metoclopramide
- Pimozide
- Piperaquine
- Saquinavir
- Sparfloxacin
- Terfenadine
- Thioridazine
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acecainide
- Ajmaline
- Alfuzosin
- Amiodarone
- Amisulpride
- Amitriptyline
- Amoxapine
- Anagrelide
- Apomorphine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Artemether
- Asenapine
- Azimilide
- Azithromycin
- Bedaquiline
- Bretylium
- Buprenorphine
- Buserelin
- Carbamazepine
- Ceritinib
- Chloroquine
- Chlorpromazine
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clofazimine
- Clomipramine
- Clozapine
- Crizotinib
- Cyclobenzaprine
- Dabrafenib
- Dasatinib
- Degarelix
- Delamanid
- Desipramine
- Deslorelin
- Deutetrabenazine
- Disopyramide
- Dofetilide
- Dolasetron
- Domperidone
- Donepezil
- Droperidol
- Efavirenz
- Encorafenib
- Entrectinib
- Enzalutamide
- Erythromycin
- Escitalopram
- Fingolimod
- Flecainide
- Fluconazole
- Fluoxetine
- Formoterol
- Foscarnet
- Fosphenytoin
- Fostemsavir
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Haloperidol
- Histrelin
- Hydroquinidine
- Hydroxychloroquine
- Hydroxyzine
- Ibutilide
- Iloperidone
- Imipramine
- Inotuzumab Ozogamicin
- Ivabradine
- Ivosidenib
- Ketoconazole
- Lapatinib
- Lefamulin
- Lenvatinib
- Levofloxacin
- Lofexidine
- Lopinavir
- Lumacaftor
- Lumefantrine
- Macimorelin
- Mefloquine
- Methadone
- Metronidazole
- Mifepristone
- Mirtazapine
- Mitotane
- Moxifloxacin
- Nafarelin
- Nilotinib
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Oxymorphone
- Ozanimod
- Panobinostat
- Pasireotide
- Pazopanib
- Phenytoin
- Pimavanserin
- Pitolisant
- Ponesimod
- Posaconazole
- Procainamide
- Prochlorperazine
- Promethazine
- Propafenone
- Protriptyline
- Quetiapine
- Quinidine
- Quinine
- Ranolazine
- Remifentanil
- Ribociclib
- Rifampin
- Selpercatinib
- Sematilide
- Sertraline
- Sevoflurane
- Simeprevir
- Siponimod
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Solifenacin
- Sorafenib
- Sotalol
- St John's Wort
- Sulpiride
- Sunitinib
- Tacrolimus
- Tedisamil
- Telavancin
- Telithromycin
- Tetrabenazine
- Tipranavir
- Toremifene
- Trazodone
- Triclabendazole
- Trifluoperazine
- Trimipramine
- Triptorelin
- Vandetanib
- Vardenafil
- Vemurafenib
- Vinflunine
- Voclosporin
- Voriconazole
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Invega (paliperidone) cost?
Invega (paliperidone) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Invega (paliperidone) will not be safe for you to take.
- History of allergic reaction to risperidone (Risperdal)
What are alternatives to Invega (paliperidone)?
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