How to give Invega injection: A comprehensive guide for healthcare professionals

October 10, 2025 •

4 min read

According to FDA prescribing information, Invega injections must be administered exclusively by a healthcare professional via deep intramuscular injection. This guide details the proper procedure for preparing and administering different formulations of the medication, explaining how to give Invega injection safely, including specific instructions for Sustenna and Trinza.

Quick Summary

This article outlines the proper procedure for administering various Invega (paliperidone palmitate) long-acting injectable suspensions. It covers syringe preparation, appropriate needle selection based on injection site and patient weight, and the correct intramuscular injection technique, including site selection.

Key Points

HCP Administration: Invega injections must only be administered by a qualified healthcare professional, not by the patient or a caregiver.
Shake Vigorously: The prefilled syringe requires specific and vigorous shaking (e.g., 10-15+ seconds) to ensure the medication is a uniform, milky-white suspension.
Site and Needle Selection: The injection site (deltoid or gluteal) and corresponding needle gauge and length must be chosen based on the specific Invega product, patient weight, and treatment stage.
Deep IM Injection: The medication must be injected slowly and deeply into the muscle to ensure proper absorption and to prevent site reactions.
Needle Safety Activation: Always activate the safety mechanism on the needle after administration to prevent needlestick injuries and ensure proper disposal.
Do Not Re-inject: If a dose is partially administered, do not re-inject the remaining medication from the same syringe. Monitor the patient and supplement with oral medication if needed.

Disclaimer: Information is for general knowledge, should not be taken as medical advice, and should consult with a healthcare provider.

General Principles for All Invega Formulations

Invega (paliperidone palmitate) is a long-acting atypical antipsychotic designed for intramuscular (IM) injection to treat schizophrenia and schizoaffective disorder. The medication is available in different formulations, including Invega Sustenna (monthly), Invega Trinza (every 3 months), and Invega Hafyera (every 6 months). The specific administration procedure varies slightly between these products, particularly regarding preparation, but several core principles apply to all forms.

Key principles for all Invega injections:

Healthcare Professional Only: All Invega injections must be administered by a qualified healthcare professional. Patients should not self-administer this medication.
Intramuscular (IM) Use Only: The injection is for deep intramuscular use only. It must not be administered via any other route, such as intravenously or subcutaneously.
Avoid Blood Vessels: Care must be taken to avoid inadvertent injection into a blood vessel.
Use Provided Needles: Only the safety needles supplied in the Invega kit should be used for administration. Using other needles can lead to blockage.
Single, Undivided Injection: The entire dose must be administered as a single, slow injection. Do not divide the dose into multiple injections.

Step-by-Step Injection Procedure

This general procedure outlines the core steps for administering Invega. Specific variations for different products are noted in the comparison section below.

1. Preparation

Inspect: Visually inspect the prefilled syringe for foreign matter or discoloration. The suspension should be milky white and uniform after shaking.
Shake Vigorously: Shake the syringe vigorously to ensure the medication is evenly suspended. The required shaking time varies by formulation (e.g., Invega Sustenna: at least 10 seconds; Invega Trinza: at least 15 seconds). This step is crucial for resuspension, especially for the more concentrated formulations.
Remove Tip Cap: Hold the syringe upright with the tip pointing up. Twist and pull off the rubber tip cap.
Attach Needle: Peel back the safety needle pouch halfway. Hold the syringe pointing up and attach the appropriate safety needle with a gentle twisting motion to avoid damaging the hub.
De-aerate: Hold the syringe upright and tap gently to make air bubbles rise to the top. Carefully move the plunger rod forward to remove the air until a drop of liquid appears at the needle tip.

2. Administration

Select Injection Site: The site is determined by the specific product and stage of treatment. For example, Invega Sustenna initiation doses are exclusively deltoid injections. Maintenance doses and other formulations may use either the deltoid or gluteal muscle. Alternate injection sites (left vs. right) with each dose.
Cleanse Skin: Cleanse the injection site using a sterile alcohol swab.
Inject Slowly: Inject the entire contents of the syringe deep into the muscle, using slow, steady pressure on the plunger. Administering the medication slowly helps minimize discomfort.
Remove Needle and Apply Pressure: Withdraw the needle from the muscle. Apply pressure with a cotton ball or gauze pad until any bleeding stops. Do not rub the injection site.
Activate Safety Device: After injection, activate the needle protection system. A "click" sound indicates the device is fully activated and locked.

3. Disposal

Discard Safely: Dispose of the used syringe and needle in an approved sharps container immediately after use.

Invega Sustenna vs. Invega Trinza vs. Invega Hafyera

The choice of injection site and needle size depends on the specific Invega formulation, patient weight, and the stage of treatment (initiation vs. maintenance). It is critical to use the correct needles provided with each product kit.

Comparison of Administration Guidelines


Feature	Invega Sustenna (Monthly)	Invega Trinza (3-Monthly)	Invega Hafyera (6-Monthly)
Initiation	Specific initiation dosing schedule required.	Requires transition from Sustenna (at least 4 months).	Requires transition from Sustenna or Trinza.
Injection Site	Deltoid (initiation) or Gluteal (maintenance).	Deltoid or Gluteal.	Gluteal only.
Shaking Duration	At least 10 seconds.	At least 15 seconds, more vigorous.	At least 30 seconds total, very fast, with a brief rest.
Needle Selection (Deltoid)	Specific needle sizes recommended based on weight.	Specific needle sizes recommended based on weight (thin-wall).	Not applicable.
Needle Selection (Gluteal)	Specific needle size recommended regardless of weight.	Specific needle size recommended regardless of weight (thin-wall).	Specific needle size recommended.

Potential Issues and Troubleshooting

While Invega administration is straightforward, some issues can arise. Knowing how to handle them is important for patient safety.

Incomplete Injection: If the needle becomes clogged or the dose is incompletely administered, do not re-inject the remaining medication. Monitor the patient closely and provide oral supplementation if necessary, based on clinical judgment, until the next scheduled injection.
Injection Site Reactions: Pain, redness, or swelling are common side effects. Reassure the patient and, if approved by a doctor, suggest over-the-counter pain relief or a cold pack. Document any adverse reactions.
Missed Doses: The protocols for missed doses vary significantly between the formulations. Detailed guidance is available in the respective prescribing information. Generally, missed doses within a specific window can be given as soon as possible. Longer missed periods may require re-initiation of treatment with a new loading dose regimen.

Conclusion

Proper administration of Invega injections is a vital skill for healthcare professionals managing patients with schizophrenia and schizoaffective disorder. Adherence to manufacturer instructions, including vigorous shaking, correct needle selection based on site and weight, and precise intramuscular technique, is paramount for ensuring optimal drug delivery and patient outcomes. Understanding the differences between the Sustenna, Trinza, and Hafyera formulations, especially regarding preparation and injection sites, is crucial. By following these guidelines, healthcare providers can ensure safe, effective, and consistent medication delivery while minimizing patient discomfort and potential complications.

For more detailed information, always refer to the official prescribing information provided by the manufacturer. A helpful resource for healthcare professionals is often available via the product's official website, such as Janssen Medical Connect.

Disclaimer: This article is intended for informational purposes only and does not substitute for professional medical advice. Always consult official prescribing information and medical protocols before administering medication.

Frequently Asked Questions

No, Invega injections must be administered only by a qualified healthcare professional. The administration process requires specific training and technique to ensure safety and effectiveness.

Before administration, the prefilled syringe must be shaken vigorously for a specific amount of time, depending on the formulation (e.g., Sustenna: 10 seconds, Trinza: 15 seconds). The suspension should appear milky white and uniform.

Invega Sustenna initiation doses are administered into the deltoid muscle. For maintenance doses, either the deltoid or gluteal muscle can be used. Injection sites should be alternated.

For Invega Sustenna deltoid injections, specific needle sizes are recommended based on patient weight. For Invega Trinza, slightly different needles (thin-wall) are used.

The protocol for a missed dose depends on the Invega formulation and the time elapsed. For shorter delays, the dose may be administered late. For longer delays, a re-initiation regimen may be necessary. Consult the prescribing information for specific guidance.

No, it is critical to avoid injecting Invega into a blood vessel. The medication is for deep intramuscular injection only.

If the needle becomes clogged and the dose is incomplete, do not re-inject the remaining medication. The patient should be monitored and may require oral paliperidone supplementation until the next scheduled injection.