What is the drug Invega used for?

Invega (paliperidone) is a long-acting atypical antipsychotic approved to:

  • Treat schizophrenia in adults and in children ages 12 and older
  • Treat schizoaffective disorder in adults, alone or with mood stabilizers or antidepressants
  • Off-label use for bipolar disorder

How does Invega work?

Paliperidone modulates serotonin and dopamine pathways in the brain to help relieve both positive and negative symptoms of schizophrenia.

Common side effects

  • Extrapyramidal symptoms such as restlessness, tremor, and stiffness
  • Akathisia (need to move constantly)
  • Drowsiness or sedation
  • Weight gain and other metabolic changes
  • Increased heart rate
  • Anxiety or headache
  • Injection site reactions (for injectable forms)

Less common but serious side effects

  • Increased mortality in elderly patients with dementia‑related psychosis
  • QT interval prolongation and risk of arrhythmias
  • Severe allergic reactions with swelling or breathing difficulty
  • Tardive dyskinesia (involuntary movements)
  • Neuroleptic malignant syndrome (high fever, muscle stiffness, confusion)
  • Priapism (painful, prolonged erection)
  • Extreme hyperglycemia (very high blood sugar)
  • Orthostatic hypotension (fainting when standing up)
  • Seizures or difficulty swallowing
  • Low white blood cell count

Drug interactions

  • Other drugs that prolong the QT interval
  • Alcohol and central nervous system depressants
  • Dopamine agonists such as levodopa
  • Strong CYP3A4 or P‑glycoprotein inducers (carbamazepine, rifampin, St John’s Wort)

Precautions before starting Invega

  • Known heart rhythm disorders or blood pressure issues
  • Diabetes or high blood sugar
  • Kidney disease
  • Parkinson’s disease or Lewy body dementia
  • History of seizures
  • Pregnancy or breastfeeding plans

Dosage overview

Oral extended-release tablets

  • Adults with schizophrenia or schizoaffective disorder: 3 mg to 12 mg once daily
  • Adolescents (12–17 years) with schizophrenia: typically 3 mg once daily

Invega Sustenna (monthly injection)

  • Day 1: 234 mg intramuscularly
  • Day 8: 156 mg intramuscularly
  • Maintenance: 39 mg to 234 mg once monthly

Invega Trinza (every 3 months)

Given only after at least 4 months of Sustenna; doses range from 273 mg to 819 mg every three months.

Invega Hafyera (every 6 months)

Dosing based on prior Sustenna or Trinza regimen, administered twice yearly.

Related medications

  • Abilify (aripiprazole)
  • Risperdal (risperidone)
  • Seroquel (quetiapine)
  • Vraylar (cariprazine)
  • Zyprexa (olanzapine)

Sources

  • Invega (paliperidone) extended-release tablets prescribing information (FDA)
  • Invega Sustenna, Trinza, Hafyera product monographs (Janssen Pharmaceuticals)
  • Psychiatr Pol. 2017;51(1):7–21. Paliperidone palmitate effectiveness and safety
  • Int J Clin Pract. 2014;68(12):1514–1522. Tardive dyskinesia incidence