Medication Guide
Paliperidone (Invega, Invega Sustenna, Invega Trinza) Side Effects and Uses
A plain-language guide to Paliperidone, an atypical antipsychotic. Learn how it helps, what it treats, how to take it and which side effects to know about.
Quick answer. Paliperidone (Invega) is an atypical antipsychotic. Common paliperidone side effects include restlessness, sleepiness or tiredness, weight gain and headache. The rare but serious ones, and when to get help, are listed under paliperidone side effects below. Never stop or change your dose on your own.
How Paliperidone Can Help You
Paliperidone is the active form of risperidone, sold as its own medicine. It calms extra dopamine and serotonin signals. This can ease voices, false beliefs and mixed-up thinking. It is one of the few drugs approved for schizoaffective disorder. In that illness, psychosis and mood symptoms happen together.
The pill usually brings gains over two to six weeks. Sleep and agitation often improve sooner. Its biggest strength is its family of long-acting shots. One is given monthly (Sustenna). One is given every three months (Trinza). One is given every six months (Hafyera). Steady levels without daily pills can mean fewer relapses. It can also mean more freedom to focus on life.
Uses for Paliperidone
- Schizophrenia
- Schizoaffective disorder, alone or with mood drugs or antidepressants
- Relapse prevention with 1, 3 or 6 month shots
- Bipolar disorder (off-label, not FDA approved)
How to Take Paliperidone
The pill is a slow-release tablet. It is usually taken once a day in the morning, with or without food. Swallow it whole. Do not crush or chew it. You may see the empty tablet shell in your stool. That is normal. Your prescriber decides the dose.
Your prescriber will check weight, blood sugar and cholesterol from time to time. They may check prolactin if breast, period or sexual side effects appear. Paliperidone raises it much like risperidone does. Kidney health affects dosing. So share your full health history.
If you miss a pill, take it when you remember, unless the next dose is near. Never double up. If you miss a shot, call your care team soon to reschedule. Do not stop treatment on your own.
Paliperidone Side Effects
Common Side Effects
- Restlessness (akathisia)
- Sleepiness or tiredness
- Weight gain
- Headache
- Fast heartbeat
- Stiff muscles or tremor
- High prolactin (breast or period changes)
- Soreness where the shot was given
Serious: Get Medical Help Promptly
- Death risk in older adults with dementia and psychosis (boxed warning)
- Tardive dyskinesia (movements you cannot control, which may last)
- Neuroleptic malignant syndrome (high fever, stiff muscles, confusion)
- QT prolongation and heart rhythm changes
- High blood sugar or new diabetes
- Fainting from low blood pressure
- Long, painful erection (priapism), an emergency
What Paliperidone Does in the Brain
Paliperidone is a newer, atypical antipsychotic. It is thought to work mainly by blocking dopamine D2 and serotonin 5-HT2A receptors. Too much dopamine signal in some brain pathways is linked to voices and false beliefs. Calming it can help thinking become clearer.
Paliperidone also blocks some histamine and adrenaline receptors. This helps explain side effects such as sleepiness and dizziness when standing up. Movement side effects are less common than with older drugs. But they can still happen. The liver does little to break it down. So it has fewer drug interactions than many others.
How the Paliperidone Injection Is Given
The long-acting forms are called paliperidone palmitate. They are depot shots. That means the medicine sits in the muscle and releases slowly over weeks or months. The shots are given only by a trained health worker. They go into the upper arm or the buttock muscle. They are not self-injected at home.
The monthly form starts with two shots about a week apart. Both go in the upper arm. Then it continues once a month. The 3-month and 6-month forms are used only after a person has done well on the monthly shot for a while. Some people have never taken paliperidone or risperidone. For them, the label advises trying the pill form first to check how you do.
Shots must be given in person. So a telehealth visit cannot provide them. If a shot is part of your care, ask your prescriber how it would be arranged. Your prescriber can still review your symptoms and side effects by video.
Paliperidone Uses, Generic Forms and Bipolar Disorder
In the United States, it is FDA approved for schizophrenia. The pill and the monthly shot are also approved for schizoaffective disorder. It is not FDA approved for bipolar disorder. Some prescribers use it off-label for bipolar symptoms. Several other drugs are approved for that use. Your prescriber explains the reasons for any choice.
The slow-release tablets are sold as a generic. Invega is the brand name for the pill. The long-acting shots are sold as Invega Sustenna, Invega Trinza and Invega Hafyera. Cost and coverage can differ a lot between these forms.
Interactions to Know About
Paliperidone can affect heart rhythm by lengthening the QT interval. It is usually not mixed with other drugs that do this. Examples are some heart rhythm drugs, some antibiotics and some other antipsychotics. It is not taken with risperidone, since the two are so closely related. Carbamazepine can lower its levels. Alcohol adds to sleepiness.
Like all drugs of its kind, paliperidone has a boxed warning. It is about a higher risk of death in older adults with dementia and psychosis. It can also make it harder for the body to cool down. So drink enough fluids in hot weather. If you are pregnant or planning a pregnancy, talk it through with your prescriber.
Is Paliperidone Right for You?
Only a full evaluation with a prescriber can tell you if Paliperidone fits your symptoms, history and goals. Harpal Singh, PMHNP-BC offers psychiatric evaluations and ongoing medication management by telehealth anywhere in California.
SCHEDULE AN APPOINTMENT CALL (888) 457-8124
Related Medication Guides
Other guides in the same group, written the same simple way. Being in one group does not mean you can swap one medicine for another.
- Quetiapine (Seroquel), atypical antipsychotic
- Risperidone (Risperdal), atypical antipsychotic
- Ziprasidone (Geodon), atypical antipsychotic
- Aripiprazole (Abilify), atypical antipsychotic
- Brexpiprazole (Rexulti), atypical antipsychotic
- Cariprazine (Vraylar), atypical antipsychotic
FAQ
Questions About Paliperidone
What is paliperidone used for?
Paliperidone is FDA approved for schizophrenia. The pill and the monthly shot are also approved for schizoaffective disorder. Your prescriber explains why it fits your plan.
How is paliperidone different from risperidone?
Paliperidone is what your body turns risperidone into. It is the active form sold as its own medicine. The liver does less work to break it down, which can mean fewer drug interactions, and it comes in very long-acting shots.
What are the long-acting injection options?
Invega Sustenna is given monthly, Invega Trinza every three months and Invega Hafyera every six months. People usually start with the monthly form. Once stable, some move to the longer schedules.
Can I give myself the paliperidone injection at home?
No. Paliperidone palmitate shots are given only by a trained health professional into the upper arm or buttock muscle. The first shots go in the upper arm. Your care team sets the schedule and the site for each shot.
What should I do if I miss a paliperidone injection?
Call your care team as soon as you can. What happens next depends on which form you take and how long it has been since your last shot. Sometimes the schedule simply resumes, and sometimes the starting steps need to be repeated.
Is paliperidone approved for bipolar disorder?
No. It is FDA approved for schizophrenia and schizoaffective disorder. It is sometimes used off-label for bipolar symptoms, but many other medicines are approved for bipolar disorder. Your prescriber can explain which options fit your situation.
Is there a generic version of paliperidone?
Yes. The slow-release tablets are sold as a generic of Invega. The long-acting shots are sold as Invega Sustenna, Invega Trinza and Invega Hafyera. Your pharmacy can tell you which versions are covered for you.
I saw a tablet in my stool. Did the medicine not work?
The medicine worked. The extended-release tablet has a shell that lets the medicine out slowly as it passes through you. The empty shell then leaves in the stool, which is expected.
Why choose a shot over pills?
Shots keep medicine levels steady and remove the daily task of remembering pills. Missed pills are one of the biggest causes of relapse. It is a personal choice to make with your prescriber.
Can Mindful Sewa give paliperidone injections?
No. Mindful Sewa gives care by secure telehealth video only, so shots cannot be given during a visit. Your prescriber can review whether paliperidone fits your needs and talk through how in-person shots would be arranged.
How long does paliperidone take to work?
With the pill, sleep and agitation often improve first. Voices and false beliefs usually ease over two to six weeks. With the shots, levels build over the first weeks of the starting schedule.
Can I drink alcohol while taking paliperidone?
It is best to avoid alcohol or keep it to a strict limit. Alcohol adds to sleepiness and dizziness and can make symptoms worse. Talk with your prescriber about what is safe for you.
Will paliperidone affect my hormones?
Paliperidone can raise prolactin. This may cause breast tenderness or discharge, period changes or sexual side effects in some people. Report them rather than putting up with them, since your prescriber can adjust the plan.