Is Invega an antipsychotic?

Antipsychotics are grouped into three generations:

  • First‑generation (typical) antipsychotics, developed in the 1950s, primarily block dopamine receptors. Examples: fluphenazine, haloperidol, loxapine.
  • Second‑generation (atypical) antipsychotics, introduced in the 1980s, block both dopamine and serotonin receptors. Examples: paliperidone (Invega), risperidone, quetiapine.
  • Third‑generation antipsychotics modulate multiple dopamine receptor subtypes and some serotonin receptors. Examples: aripiprazole, brexpiprazole, cariprazine.

Invega (paliperidone) is a second‑generation atypical antipsychotic.

What is Invega used to treat?

  • Schizophrenia in adults and adolescents (12 years and older)
  • Schizoaffective disorder in adults, alone or with mood stabilizers and/or antidepressants
  • Off‑label use in bipolar disorder

It is available as extended‑release tablets and as long‑acting injectables dosed monthly, every three months, or every six months.

How does Invega work?

Paliperidone adjusts serotonin and dopamine receptor activity, relieving both positive and negative symptoms of schizophrenia.

Common side effects

  • Extrapyramidal symptoms: restlessness, tremor, stiffness
  • Akathisia: uncontrollable urge to move
  • Drowsiness or sedation
  • Weight gain and metabolic changes
  • Increased heart rate
  • Anxiety and headache

Other possible side effects

  • Changes in cholesterol or triglycerides
  • High blood sugar
  • Nasopharyngitis (cold symptoms)
  • Constipation, abdominal pain, drooling, dry mouth
  • Injection site reactions (for injectable forms)

Rare but serious side effects

  • Increased risk of death in elderly patients with dementia‑related psychosis
  • Heart rhythm abnormalities (QT prolongation)
  • Severe allergic reactions: hives, facial swelling, breathing difficulty
  • Tardive dyskinesia: involuntary muscle movements
  • Neuroleptic malignant syndrome: high fever, muscle rigidity, confusion
  • Priapism: painful erection lasting more than 4 hours
  • Orthostatic hypotension: faintness on standing
  • Low white blood cell counts

Drug interactions

  • Other QT‑prolonging medications
  • Alcohol and other central nervous system depressants
  • Dopamine agonists such as levodopa
  • Strong CYP3A4 or P‑glycoprotein inducers: carbamazepine, rifampin, St. John’s Wort

Before starting Invega

Tell your doctor if you have any of the following:

  • Heart conditions: arrhythmias, blood pressure issues, past heart attack
  • Diabetes or high blood sugar
  • Kidney impairment
  • Lewy body dementia or Parkinson’s disease
  • History of seizures
  • Difficulty swallowing
  • High cholesterol
  • Pregnancy or plans to become pregnant (risk of newborn withdrawal)
  • Breastfeeding (unknown if excreted in milk)

Missed dose

Take as soon as you remember. If it is nearly time for your next dose, skip the missed one—do not double up.

Pregnancy considerations

Discuss risks and benefits with your provider. Newborns exposed late in pregnancy may show movement disorders or withdrawal symptoms. Consider enrolling in the National Pregnancy Registry for Atypical Antipsychotics at 866‑961‑2388.

Related Medications

  • Abilify (aripiprazole)
  • Risperdal (risperidone)
  • Seroquel (quetiapine)
  • Vraylar (cariprazine)
  • Zyprexa (olanzapine)
  • Invega Sustenna, Trinza, Hafyera