taking, titrating, and tapering Invega (paliperidone)
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Taking & Titration Overview
One of the most important aspects of any medication is how to go about taking it. This includes:
- how much to take (the dosage or dose)
- when and how often to take it (dosing schedule or doses)
- how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).
Although we often disagree with them, we’ll always give you the manufacturer’s recommendations from Invega’s full US Prescribing Information. If, for some reason, that isn’t available, we’ll use information for patients leaflets, SPCs from overseas, or whatever official sources we can find. Most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.1 As “often” doesn’t mean “always”, whatever is in the PI sheet works for us a lot of the time.
We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage2. More and more doctors are agreeing with us3. You and your doctor can always discuss increasing the dosage when you need to in advance.
And since you never really know how a drug might affect you, it’s best to start when you have some time off of work. Like Friday night / Saturday morning, or your equivalent. Better still would be to get someone to stay with you or at least check on you frequently, especially if you’re the primary caretaker of young children and similar critters.4
Invega (paliperidone) Dosage and Doses
Invega:One 6mg tablet in the morning. There, you’re done. Once a day and you’ve started at the recommended dosage. It doesn’t get any freaking easier in the world of crazy meds.
Of course you and your doctor could determine that 3mg a day would be a good starting point. Sure, why not? I’m all about starting at lower dosages. And if you need to you can go up to 12mg a day. Three, six, nine and twelve milligrams. I think for many people freedom from choice makes their lives much, much simpler, and simpler is way better.
This is where Invega and Risperdal really differ, as Invega comes in only three dosages and you start right out with what you’re probably going to be taking.
Invega Sustenna: One shot, you’re done for the month. Invega Sustenna comes in prefilled syringes with dosages being in 39mg, 78mg, 117mg, 156mg, and 234mg. Shots are given into the muscle either in the arm or the rear. In an ideal world there would be a trial run with regular Invega or Risperdal to make sure you don’t have any reactions to the medication but according to invegasustenna.com it says that your doctor “may give you a test dose”.
Special Instructions/Best Way to Take Invega (paliperidone)
If you’re converting from Risperdal, and aren’t taking a potent inhibitor of CYP2D6 (or weren’t when you were taking the Risperdal), or otherwise have CYP2D6 issues, it’s a 1:2 Risperdal-to-Invega ratio. So..
0.75mg Risperdal = 1.5mg Invega
1.5mg Risperdal = 3mg Invega
3mg Risperdal = 6mg Invega
4.5mg Risperdal = 9mg Invega
6mg Risperdal = 12mg Invega
See our page on Pharmacokinetics and CYP450 enzymes for information about CYP2D6 and why it can be a big deal for some people.
Invega (paliperidone) Titration (Dosage Increase)
At whatever dosage you start, Janssen recommends increasing the dosage by 3mg, and waiting at least 5 days between each increase.
Again: sure, why not? They also make a 1.5mg capsule, and as long as you’re not completely flipping out try waiting as long as you’re comfortable before raising the dosage. Five days is the absolute minimum amount of time to wait.
For Invega Sustenna the PI sheet says the recommended dosing schedule is to start with a 234mg dose on day 1 then one week later to give a second dose of 156mg. After the second dose, the shots will be given monthly with a recommended dose of 117mg. That seems pretty high, especially since they recommend that you should have already taken Invega or Risperdal first but not be taking either when you start. That sounds like a fun few days.
Medicine Is The Best Medicine
Brain Cooties Aren’t Contagious
One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others (most notably SNRIs like Effexor and Cymbalta) it can be a nightmare if not done carefully.
How to Stop Taking Invega (paliperidone)
That’s a good question. When you start at the recommended dosage one would just have to stop taking the one pill a day. Janssen reports not a heck of a lot as happening in Invega’s PI sheet/the PDR. If you were taking 9mg, 12mg (or more) a day, or actually increased from 3mg a day, talk to your doctor about a 3mg a day reduction every five days. Who really knows? This stuff is new. The five days is based on Invega’s half-life of 23 hours.
How to stop taking Invega Sustenna is an even better question. With a half-life of 25–49 days5 it can take between four and nine months to fully clear from your system. While that makes for a theoretically easy answer of “Just don’t get another shot,” what to do if you’re having a bad reaction makes things a bit tricky.
- It’s an antipsychotic, so unless you’re taking another antipsychotic at the same time you’ll probably have a headache, feel spacy (or more so than usual).
- Depending on your condition, why you’re taking Invega, why you’re stopping, and if you’re taking another med or not, your symptoms may return.
- Sometimes when symptoms return they’re worse than before (rebound), but that’s almost always temporary. It’s really rare for rebound symptoms to hang around for longer than one or two weeks.
- The best information we have so far comes from Schizophrenia.emed.tv.com’s page. They list all of two things to be concerned about:
- Return of symptoms
Notes, Tips, Helpful Hints, etc. for Withdrawing Invega (paliperidone)
Although the once-a-month injection of Invega Sustenna is really easy, you should probably see how you do with regular Invega for a year or so before switching to the injection.
The equivalency ratio of Invega Sustenna to oral Invega is:
Invega Sustenna - 39, 78, 117, 156, and 234 mg
Invega oral - 25, 50, 75, 100, and 150 mg
Not that you’d be taking 25mg a day, or more, of Invega. That’s just to give you an idea of how much a month you’re getting.
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- Invega full US Prescribing Information
- Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
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1 And everyone has the time to do their jobs properly, when said time isn't being wasted by idiots asking for grocery store phone numbers** or they aren't playing Angry Farmers on the Faecesbooks.
2 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.
3 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.
4 Assuming you have the luxury of a job, being able to cope with your symptoms not being dealt with for however many days you need to wait in order to do this, and/or someone who can and is willing to stay with you for a few days. Read enough of this site and you can tell what sort of fantasy world I live in.
5 Over twice as long as the longest-lasting Depot injections of first generation antipsychotics. Invega Sustenna has the longest half-life we've seen in all crazy meds.
If you have any questions not answered here, please see the Crazymeds Invega discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.net)
|Last modified on Tuesday, 24 September, 2013 at 17:59:53 by JerodPoore||Page Authors girrl88, Jerod Poore||Date created 10 June 2011 at 17:09:23|
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Invega, and all other drug names on this page and used throughout the site, are a trademark of someone else. Invega’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, and 2015 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
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Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList,
NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.