Paliperidone is an atypical antipsychotic medication used for the treatment of schizophrenia and schizoaffective disorder. It is the major active metabolite of risperidone and is available in several formulations to provide flexibility in treatment, including a daily oral tablet and three long-acting injectable suspensions with varying administration frequencies. The choice of formulation depends on a patient's medical history, condition, and treatment preferences, and should be decided in consultation with a healthcare provider.
Extended-Release Oral Tablets (Invega)
Invega is the brand name for the once-daily extended-release oral tablets of paliperidone. These tablets are taken by mouth once a day, and must be swallowed whole to ensure proper drug release. Invega is available in several strengths, from 1.5 mg to 9 mg, with dosage determined by a healthcare provider. Oral paliperidone may be used initially to check for tolerability before using an injectable form.
Long-Acting Injectable Suspensions
For patients who benefit from less frequent dosing, long-acting injectable (LAI) versions of paliperidone are available. These contain paliperidone palmitate and are given as intramuscular injections by a healthcare professional.
Invega Sustenna (Once-Monthly Injection)
Invega Sustenna is a monthly LAI of paliperidone palmitate. Treatment begins with two initial injections a week apart to quickly reach stable drug levels, with maintenance injections given monthly thereafter. Oral supplementation is not typically needed during initiation.
Invega Trinza (Once-Every-Three-Months Injection)
Invega Trinza is an LAI given every three months. Patients must first be stable on Invega Sustenna for at least four months before switching to Invega Trinza. The Trinza dose is based on the previous Sustenna dose.
Invega Hafyera (Once-Every-Six-Months Injection)
Invega Hafyera offers the longest dosing interval, administered once every six months. Prior to starting Invega Hafyera, patients need to be stable on certain doses of either Invega Sustenna (for at least four months) or Invega Trinza (for at least one three-month cycle). This injection is given in the gluteal muscle.
Comparison of Paliperidone Forms
To aid in understanding the differences, the following table provides a comparison of the various paliperidone formulations:
| Feature | Invega (Oral Tablet) | Invega Sustenna (LAI) | Invega Trinza (LAI) | Invega Hafyera (LAI) |
|---|---|---|---|---|
| Form | Extended-Release Tablet | Extended-Release Injectable Suspension | Extended-Release Injectable Suspension | Extended-Release Injectable Suspension |
| Frequency | Once Daily | Once Monthly (after initiation) | Once Every 3 Months | Once Every 6 Months |
| Brand Name | Invega | Invega Sustenna | Invega Trinza | Invega Hafyera |
| Administration | Oral (Swallowed Whole) | Intramuscular (Deltoid or Gluteal) | Intramuscular (Deltoid or Gluteal) | Intramuscular (Gluteal only) |
| Key Dosing Feature | No titration needed, adjust based on response. | Requires 2 initial loading doses on Day 1 and Day 8. | Requires prior stabilization on Invega Sustenna for 4+ months. | Requires prior stabilization on Invega Sustenna or Invega Trinza. |
| Uses | Schizophrenia, Schizoaffective Disorder | Schizophrenia, Schizoaffective Disorder | Schizophrenia | Schizophrenia |
Conclusion
Paliperidone is available as a daily oral tablet and long-acting injectable suspensions given monthly, quarterly, and bi-annually. These options allow for personalized treatment based on patient needs and lifestyle, particularly for those who may benefit from less frequent dosing. Long-acting injectables can help with treatment adherence by providing sustained symptom control. The decision on which form to use should be made with a healthcare provider, considering the patient's individual circumstances and goals. For comprehensive information, consult the official prescribing information.
