Invega Index | Brand and Generic Availability ›
Crazy Meds Comprehensive Invega pages

This is our summary of Invega. Clicking on a “More…” link will take you to a page with greater detail. The Comprehensive Invega pages contain the information from all of the “More…” pages.

1.  Brand & Generic Names; Drug Class

US brand name:	Invega
Generic name:	paliperidone
What is Invega (paliperidone)?	Invega (paliperidone) is in the Antipsychotics class of drugs.

More about Invega’s generic availability, worldwide trade names, and more

2.  What is Invega (paliperidone) used for

2.1  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.

2.2  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.

More about Invega’s approved & off-label uses

3.  When will Invega (paliperidone) start working?

3.1  How long until Invega starts working

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.

3.2  Will Invega really work for what I have?

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.

More about how long until, and how well will Invega work; and how Invega compares with other drugs

4.  How to take and stop taking Invega (paliperidone)

4.1  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.

4.2  How to stop taking Invega

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.

More about taking and discontinuing Invega

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5.  Invega’s (paliperidone’s) pros and cons

5.1  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 Crazy Meds.
• 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.

5.2  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.

5.3  Interesting stuff your doctor probably didn’t tell you

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.
More of Invega’s pros, cons, and interesting stuff

6.  Invega’s (paliperidone’s) side effects

6.1  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

6.2  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.

6.3  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.
More about Invega’s side effects

7.  What Invega (paliperidone) is best known for

Being a patent extender of Risperdal.
More about Invega’s black box warnings, noted traits & effects

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8.  Invega’s (paliperidone’s) half-life & how long until Invega clears your system

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.
Drugs.com’s drug-drug and drug-food interaction checker
More about Invega’s pharmacokinetics & noted drug-drug & drug-food interactions

9.  How Invega (paliperidone) works (the best current 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.
More about how Invega works. AKA Invega’s mechanism/method of action, or pharmacodynamics.

10.  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.
More comments As if I didn’t go on long enough here.
Consumer/patient comments about & experiences with Invega

11.  Discussion board, PI sheet and other allegedly useful links

Crazy Meds’ Invega discussion board
Invega’s Full US Prescribing Information / PI Sheet
Allegedly Useful Links. Mostly any official sites we could find for this med and PI sheets from countries other than the US.

Invega Index | Brand and Generic Availability ›
Crazy Meds Comprehensive Invega pages

Bibliography

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

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Invega Basic Overview by girrl88? is copyright 2011

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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]