Paliperidone palmitate LAI
INVEGA SUSTENNA
What it isLong-acting D2 and 5-HT2A antagonist; maintenance treatment of schizophrenia and schizoaffective disorder.
Why this oneIts deltoid loading regimen on days 1 and 8 means no oral overlap at all; it is the only LAI labeled for schizoaffective disorder.
What limits itPaliperidone is renally cleared, so dosing falls with kidney impairment, and prolactin elevation is the class-typical liability.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Schizophrenia | adults | 234 mg deltoid Day 1, 156 mg deltoid Day 8 | 117 mg monthly (39–234 mg) | 234 mg monthly |
| Schizoaffective disorder (monotherapy or adjunct) | adults | 234 mg deltoid Day 1, 156 mg deltoid Day 8 | 78–234 mg monthly | 234 mg monthly |
Titration Maintenance dose adjustments may be made monthly.
Renal Mild (CrCl 50–<80): 156 mg Day 1, 117 mg Day 8, then 78 mg monthly (max 156 mg monthly). Moderate–severe (CrCl <50): not recommended.
Hepatic No adjustment for mild–moderate; not studied in severe.
Prolonged-release; full effect of a dose change may not be evident for several months.
Instructions
- IM only (deltoid or gluteal); administer by a healthcare professional.
- Establish tolerability with oral paliperidone or oral risperidone before initiating in patients naive to these.
- Shake syringe vigorously ≥10 seconds; give as a single injection.
Cautions
- Cerebrovascular reactions/stroke in elderly with dementia-related psychosis
- Neuroleptic malignant syndrome
- QT prolongation
- Tardive dyskinesia
- Metabolic changes (hyperglycemia/diabetes, dyslipidemia, weight gain)
- Orthostatic hypotension and syncope
- Falls
- Leukopenia, neutropenia, agranulocytosis
- Hyperprolactinemia
- Cognitive/motor impairment
- Seizures
- Dysphagia
Adverse reactions
- Injection site reactions
- Somnolence/sedation
- Dizziness
- Akathisia
- Extrapyramidal disorder
Pregnancy No established drug-associated risk of major birth defects; third-trimester exposure risks extrapyramidal and/or withdrawal symptoms in neonates.
Lactation Paliperidone present in breast milk; monitor infant for sedation, failure to thrive, jitteriness, and extrapyramidal symptoms.
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Classes and tags
Clinical profile
Mechanism of action: Paliperidone palmitate LAI ballicule
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