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One of the most important aspects of any medication is how to go about taking it. This includes:

  • how much to take (the dosage or dose)
  • when and how often to take it (dosing schedule or doses)
  • how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).

This information is always in the PI sheet, is usually in the information for patients leaflets, most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.

We here at Crazy Meds often disagree with the official schedules found in the PI sheets. We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage1. More and more doctors are agreeing with us2. You and your doctor can always discuss increasing the dosage when you need to in advance.
And since you never really know how a drug might affect you, it’s best to start when you have some time off of work. Like Friday night / Saturday morning, or your equivalent. Better still would be to get someone to stay with you or at least check on you frequently, especially if you’re the primary caretaker of young children and similar critters.

1.  Invega’s dosage and doses

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.
Of course you and your doctor could determine that 3mg a day would be a good starting point. Sure, why not? I’m all about starting at lower dosages. And if you need to you can go up to 12mg a day. 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.

Although the once-a-month injection of Invega Sustenna is really easy. But you should probably see how you do with regular Invega for a year or so before switching to the injection. This is where Invega and Risperdal really differ, as Invega comes in only three dosages and you start right out with what you’re probably going to be taking.

2.  Best way to take / special instructions for taking Invega

If you’re converting from Risperdal, and aren’t taking a potent inhibitor of CYP2D6 (or weren’t when you were taking the Risperdal), or otherwise have CYP2D6 issues, it’s a 1:2 Risperdal-to-Invega ratio. So..

0.75mg Risperdal = 1.5mg Invega
1.5mg Risperdal = 3mg Invega
3mg Risperdal = 6mg Invega
4.5mg Risperdal = 9mg Invega
6mg Risperdal = 12mg Invega

That’s per The Pharmacokinetics of Paliperidone Versus Risperidone.

See our page on Pharmacokinetics and CYP450 enzymes for information about CYP2D6 and why it can be a big deal for some people.

3.  Invega’s titration (dosage increase)

At whatever dosage you start, Janssen recommends increasing the dosage by 3mg, and waiting at least 5 days between each increase.

Again: sure, why not? They also make a 1.5mg capsule, and as long as you’re not completely flipping out try waiting as long as you’re comfortable before raising the dosage. Five days is the absolute minimum amount of time to wait.

One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others (most notably SNRIs like Effexor and Cymbalta) it can be a nightmare.

4.  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.

5.  Discontinuation symptoms

  • It’s an antipsychotic, so unless you’re taking another antipsychotic at the same time you’ll probably have a headache, feel spacy (or more so than usual).
  • Depending on your condition, why you’re taking Invega, why you’re stopping, and if you’re taking another med or not, your symptoms may return.
  • Sometimes when symptoms return they’re worse than before (rebound), but that’s almost always temporary. It’s really rare for rebound symptoms to hang around for longer than one or two weeks.

6.  Notes, tips, helpful hints, etc. for discontinuing Invega

‹ Expanded Side Effects | Invega Index | Expanded Likelihood of Working & Comparisons with Other Meds ›
Crazy Meds Comprehensive Invega pages

Bibliography

1 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.

2 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy*, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.

*Link to Topiramate in the treatment of partial and generalized epilepsy Scroll down to the section “Practical use of topiramate”


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

Crazy Meds’ Recommendations on How Much to Take, How to Increase the Dosage, and How to Stop Taking Invega is copyright 2011 girrl88

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