Invega (Paliperidone) – Oral

Warning:

Invega (paliperidone) can cause an increased risk of death if taken by older individuals (aged 65 years and older) with dementia-related psychosis (losing touch with reality) who are being treated with atypical antipsychotics.

What Is Invega?

Invega (paliperidone) is used to treat schizophrenia in adults and adolescents ages 12–17, schizoaffective disorder in adults, and sometimes other medical conditions. The prescription tablets are taken by mouth.

Invega belongs to a larger group of drugs called atypical antipsychotics. These drugs were developed later than the “typical" antipsychotics first used to treat schizophrenia.

Such atypical antipsychotics may have lower rates of side effects in nerves concerned with motor activity (extrapyramidal side effects). These include parkinsonism (a condition causing movement disorders in people with Parkinson’s disease), dystonia (a movement disorder in which contracted muscles cause repetitive or twisting motions), and akathisia (the inability to remain still). However, rates vary by drug and individual.

The way Invega works is complex. What is known is that it affects the way certain neurotransmitters function. Neurotransmitters are special signaling molecules in your nervous system. Invega works through at least two neurotransmitters, dopamine and serotonin, to decrease symptoms.

Drug Facts

Generic Name: Paliperidone

Brand Name: Invega

Drug Availability: Prescription

Therapeutic Classification: Antipsychotic

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Oral

Active Ingredient: Paliperidone

Dosage Form: Extended-release tablet

What Is Invega Used For?

The Food and Drug Administration (FDA) approved Invega to treat schizophrenia, a psychiatric condition that causes disturbed thinking, feeling, and behaving. 

Invega is also approved to treat a related condition called schizoaffective disorder. People with schizoaffective disorder have many of the same problems as those with schizophrenia. They also have additional problems with their mood, as well as a detachment from reality.

Invega (Paliperidone) Drug Information: A person and their brain with neurotransmitters

Verywell / Zoe Hansen

How to Take Invega

Invega is usually taken once a day, with or without food. Ask your healthcare provider about your specific medication schedule. Do not divide or crush the pills. If you have trouble swallowing pills, ask your provider about other treatment options.

Storage

Store the Invega pills at room temperature, which is about 77 degrees Fahrenheit. It is OK to take the tablets with you on short trips out of the house in temperatures ranging from 59 to 86 degrees. Keep Invega away from excess moisture. Store safely away from small children and pets.

Off-Label Uses

Invega is only FDA approved to treat people who have schizophrenia or schizoaffective disorder. This means it has gone through the full set of studies needed for FDA approval for only these conditions.

However, psychiatrists also sometimes prescribe it for other psychiatric and medical conditions that can cause disturbed thoughts and feelings. In these cases, some evidence suggests that the drug may still help. Some examples are:

Invega is sometimes prescribed to children and is approved to treat schizophrenia in youths ages 12 to 17, in addition to adults.

How Long Does Invega Take to Work?

Invega might not start working right away. You may notice some improvements in your thoughts and your mood within a couple of weeks. However, it can take longer than that before the drug is fully effective. It’s important to be in close contact with your physician about what you are experiencing, especially when you first start taking the drug.

What Are the Side Effects of Invega?

This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Some of the more common potential side effects of Invega are:

  • Problems with movement (e.g., abnormally tight and contracted muscles, tremor, uncontrolled movements)
  • Upset stomach
  • Constipation
  • Sleepiness

Let your healthcare provider know if any symptoms are bothering you. You may be able to take a lower dose of the drug if approved by your provider.

Severe Side Effects

Some people get symptoms from an increase in blood levels of a hormone called prolactin. Women may experience changes in their menstrual cycle, and men may develop impotence. Both men and women can experience increased breast size and leaking from the nipple.

Although rare, one severe and potentially life-threatening side effect is neuroleptic malignant syndrome (NMS). This can cause problems such as:

  • High fever
  • Severe muscle stiffness
  • Increased confusion
  • Very low or very high blood pressure
  • Loss of consciousness
  • Heart rhythm problems

NMS is a potential risk of many different antipsychotic drugs, including Invega. You likely will need to stop taking the medication if you develop NMS, which is a medical emergency. Seek immediate care if you think someone might be experiencing problems associated with NMS.

Other rare but potentially serious symptoms include:

  • Tardive dyskinesia (TD, uncontrollable movements of the face, tongue, and other body parts that may become permanent)
  • Heart rhythm problems (especially from a problem called QT prolongation)
  • Increased risk of stroke or heart attack (especially in people aged 65 years and older)
  • Diabetes causing ketoacidosis or coma
  • Obstruction or narrowing of your gastrointestinal tract
  • Decreased number of certain immune cells, which might increase the risk of infection
  • Seizure

Seek immediate care for any potentially life-threatening symptoms like lack of responsiveness or sudden chest pain.

Long-Term Side Effects

Tardive dyskinesia can become permanent. It is a potential risk not just with Invega but with many other antipsychotic drugs, although the risk is lower for drugs like Invega compared to older, typical antipsychotics. This can cause a person to make uncontrollable movements.

Sometimes symptoms will go away if the drug is stopped, but other times these changes might be permanent. Let your provider know right away about any changes like this.

Report Side Effects

Invega may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Invega Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (extended-release tablets):

For schizophrenia:

  • Adults—At first, 6 milligrams (mg) once a day, every morning. Some patients may need 3 mg per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 12 mg per day.
  • Children 12 to 17 years of age and weighs 51 kg (112 lbs) or more—At first, 3 mg once a day, every morning. Your doctor may increase your dose as needed. However, the dose is usually not more than 12 mg per day.
  • Children 12 to 17 years of age and weighs less than 51 kg (112 lbs)—At first, 3 mg once a day, every morning. Your doctor may increase your dose as needed. However, the dose is usually not more than 6 mg per day.
  • Children younger than 12 years of age—Use and dose must be determined by your doctor. 

For schizoaffective disorder:

  • Adults—At first, 6 milligrams (mg) once a day, every morning. Some patients may need 3 mg per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 12 mg per day.
  • Children—Use and dose must be determined by your doctor.

Modifications

You may need to modify (change) your dose or treatment plan under certain circumstances. Talk to your healthcare provider if you have any health conditions or if you are taking other medications.

Caution should be used for people with kidney problems. Such people may be able to use the drug but at a lower dose.

It is unknown if Invega will cause harm to an unborn baby. Women who are pregnant or plan to become pregnant or are breastfeeding should discuss the potential risks and benefits with their medical providers. For people who really need the medication, these risks may be worth it. 

Missed Dose

If you miss a dose, take it as soon as you think about it. If it is very close to your next dose, skip the missed dose. Do not double up. 

The drug is most effective if you take it exactly as prescribed, every day. Setting a timer may help you remember.

Overdose: What Happens If I Take Too Much Invega?

Overdose symptoms might include trouble with normal movement, unsteadiness on your feet, and sleepiness. If you take a single extra pill, it is unlikely to be a significant problem. However, it is good to check in with your healthcare provider even if you’ve taken only a little more than usual. For any life-threatening symptoms, seek immediate medical attention.

What Happens If I Overdose on Invega?

If you think you or someone else may have overdosed on Invega, call a healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn't breathing after taking Invega, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for any unwanted effects.

This medicine may raise your risk of having a stroke. This is more likely in people who already have heart or blood vessel disease. Check with your doctor right away if you are having confusion, difficulty in speaking, slow speech, inability to speak or move the arms, legs, or facial muscles, double vision, or headache.

Check with your doctor right away if you have difficulty with breathing, a fast heartbeat, a high fever, high or low blood pressure, increased sweating, loss of bladder control, seizures, severe muscle stiffness, unusually pale skin, or tiredness. These could be symptoms of a serious condition called neuroleptic malignant syndrome (NMS).

This medicine may cause tardive dyskinesia (a movement disorder). Check with your doctor right away if you have lip smacking or puckering, puffing of the cheeks, rapid or worm-like movements of the tongue, uncontrolled chewing movements, or uncontrolled movements of the arms and legs.

This medicine can cause changes in heart rhythm, including QT prolongation. It may change the way your heart beats and cause fainting or serious side effects in some patients. Call your doctor right away if you have any symptoms of heart rhythm problems, such as dizziness, feeling faint, or a fast, pounding, or irregular heartbeat.

This medicine may increase the amount of sugar in your blood. Check with your doctor right away if you have blurred vision, dry mouth, flushed, dry skin, increased hunger, increased thirst or urination, nausea, sweating, trouble breathing, unexplained weight loss, unusual tiredness or weakness, or vomiting. If you have diabetes, you may notice a change in the results of your urine or blood sugar tests. If you have any questions, check with your doctor.

This medicine may increase the amount of cholesterol and fats in your blood. If this condition occurs, your doctor may give you some medicines that can lower the amount of cholesterol and fats in the blood.

This medicine may increase prolactin blood levels if used for a long time. Check with your doctor if you have breast swelling or soreness, unusual breast milk production, absent, missed, or irregular menstrual periods, stopping of menstrual bleeding, loss in sexual ability, desire, drive, or performance, decreased interest in sexual intercourse, or an inability to have or keep an erection.

Dizziness, lightheadedness, or fainting may occur, especially when you suddenly get up from a lying or sitting position. Getting up slowly may help. If this problem continues or gets worse, check with your doctor.

Paliperidone injection can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. If you can, avoid people with infections. Check with your doctor right away if you think you are getting an infection, or if you have a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.

This medicine may cause drowsiness, trouble with thinking, or trouble with controlling body movements, which may lead to falls, fractures, or other injuries. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

This medicine may cause difficulty swallowing that can cause food or liquid to get into your lungs and a prolonged or painful erection, which can last for more than 4 hours. Talk to your doctor if you have any concerns about this.

This medicine may make it more difficult for your body to cool itself down. Use care not to become overheated during exercise or hot weather since overheating may result in heat stroke. Also, use extra care not to become too cold while you are receiving risperidone injection. If you become too cold, you may feel drowsy, confused, or clumsy.

This medicine may increase your weight. Your doctor may need to check your weight on a regular basis while you are receiving this medicine. Talk to your doctor about ways to prevent weight gain.

Check with your doctor before using this medicine with alcohol or other medicines that affect the central nervous system (CNS). The use of alcohol or other medicines that affect the CNS with risperidone may worsen the side effects of this medicine, including dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.

If you plan to have children, talk with your doctor before using this medicine. Some women using this medicine have become infertile (unable to have children).

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Invega?

Invega should not be used to treat older adults (65 years and older) with disturbed thoughts due to dementia, as it can increase the risk of death. The FDA has issued a boxed warning, its strictest warning label, advising against Invega's use in this way. In general, caution should be used in taking Invega if you are 65 years or older due to the increased risk of stroke or heart attack.

You should also not take Invega if you:

  • Are allergic to it or a similar drug called Risperdal (risperidone)
  • Have previously had abnormal heart rhythms or other heart problems

What Other Medications Interact With Invega?

Like many other drugs, Invega can sometimes affect other medications that you might be taking. In some cases, this might make Invega less effective or might increase the risk of side effects from it. It might change the effectiveness or risk of side effects of other medications.

Drugs that can interact with Invega include:

  • Medications for Parkinson’s like Sinemet (levodopa)
  • Some medications for epilepsy, like Tegretol (carbamazepine)
  • Drugs used to prevent abnormal heart rhythms, like Cordarone (amiodarone)
  • Drugs that lower your blood pressure

You might be better off not taking Invega if you need to use one of these other medications. In other cases, you might need to use caution or a lowered dose. Discuss your options with your healthcare provider.

It is also important to avoid alcohol while you are taking Invega.

Make sure your provider knows about all your medications before you start on Invega, including over-the-counter (OTC) or prescription medications, vitamins, supplements, and herbal products. These also may cause drug interactions.

What Medications Are Similar?

Other medications that are similar to Invega include:

  • Sustenna (paliperidone palmitate): An alternative to the pill form of Invega, Sustenna has the same active ingredient but is an injectable medication taken about once a month. Like the oral form, it is FDA approved for schizophrenia and schizoaffective disorder.
  • Trinza (paliperidone palmitate): Trinza is a longer-lasting injectable given once every few months. You may be able to switch to this medication if you find the other injectable version is working well for you.
  • Risperdal (risperidone): Risperdal is another atypical antipsychotic. Its chemical structure is similar to Invega's, but not exactly the same. Like Invega, it is available in pill form but can also come as an injectable.

The injectable versions may provide a more even dosing of the drug, which might reduce side effects. On the other hand, some people don’t like getting shots. 

In treating these sorts of problems, clinicians sometimes must try more than one type of drug to see what works. Fortunately, there are many other types of drugs that might help decrease your symptoms. You might take one of these drugs in addition to Invega. Your clinician will help you work out your exact medication schedule.

Frequently Asked Questions

  • Is Invega just for people with schizophrenia?

    Invega is FDA approved to treat people with schizophrenia and schizoaffective disorder. However, it is sometimes also helpful for people with other medical conditions that affect how they think and feel.

    For example, it is sometimes helpful as a part of treatment for bipolar illness or for symptoms of Tourette's syndrome. Not all people who use Invega have symptoms of psychosis.

  • Are there alternatives to oral treatment?

    Yes. Two longer-acting formulations of paliperidone are available. These are given as a shot in the muscle. This can be especially helpful for a person who is having trouble remembering to take their medication every day.

  • If I don’t like the side effects of Invega, should I just stop taking it?

    Talk with your health care professional if the side effects of your treatment are bothering you. You may be able to use a lower dose of the drug with less risk of side effects. Or you might be able to switch to a different medication. Do not stop taking your medication without first consulting your clinician, as this may make your condition more unstable.

How Can I Stay Healthy While Taking Invega?

The term "antipsychotic" can sound frightening when attached to a medication that you need. However, antipsychotic drugs like Invega are extremely helpful in bringing people more clarity, enjoyment, and autonomy in their lives. 

Taking your medication every day is the best way to stay healthy while taking Invega. For any unusual symptoms, see your healthcare provider right away. You might need a dose adjustment or treatment for a rare side effect from the drug.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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By Julie Scott, MSN, ANP-BC, AOCNP
Julie is an Adult Nurse Practitioner with oncology certification and a healthcare freelance writer with an interest in educating patients and the healthcare community.