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Invega (Paliperidone) Side Effects, Withdrawal and FAQs

Invega, generic paliperidone, is an oral, daily antipsychotic medication used in the treatment of schizophrenia in adolescents and adults.
Neither the injectable form, Invega Sustenna, or the daily form is approved for elderly patients with dementia-related psychosis due to increased risk of death.

Before beginning treatment with a potent medication, it may be prudent to research the side effects, possible withdrawal symptoms and other health-related information as thoroughly as possible. Below, these and other topics are expanded and may provide pertinent information for such research and consideration.

What Invega is (Paliperidone) Used For

Invega (paliperidone) as well as Invega Sustenna are used in the treatment of schizophrenia in adolescents and adults. Other uses include the treatment of depression, schizoaffective disorder and certain other mental health conditions such as mood disorders.

There is a Black Box warning on the label that indicates the drug causes increased mortality in elderly patients with dementia-related symptoms of psychosis.

Invega (Paliperidone) Alternative Names and Slang

Invega (paliperidone) refers to the oral pill form taken once every morning. The injectable form, Invega Sustenna (paliperidone palmate), is administered by intramuscular injection once a month, and is a longer-acting medication.

Invega (Paliperidone) Side Effects

The injectable form of Invega commonly causes reactions at the injection site, as well as somnolence, sedation, dizziness, akathisia, and extrapyramidal disorders.  Extrapyramidal disorders are defined as:

  • Acute dyskinesia
  • Dystoric reactions
  • Tardive dyskinesia
  • Parkinsonism
  • Akinesia
  • Akathisea
  • Neuroleptic Malignant Syndrome (NMS)

The oral form of Invega is taken once daily, and can cause these common side effects:

  • Tremors/shakiness
  • Swelling in breast tissue
  • Discharge from breasts
  • Irregular menstrual periods
  • Restlessness
  • Nausea
  • Vomiting
  • Drowsiness
  • Stomach pain
  • Abdominal pain
  • Headache
  • Lightheadedness
  • Weight gain
  • Dizziness
  • Dry mouth
  • Cough
  • Decreased libido
  • Anorgasma
  • Impotence
  • Blurred vision

Less frequent severe side effects may require medical attention, such as:

  • Tardive dyskenisia
  • Severe nervous system reaction, muscle rigidity, fast pounding heart beat, fainting, etc.
  • Uncontrolled motor movements, i.e. smacking lips, rolling tongue, twisting or frowning the face, jerking hands, limbs, etc.)
  • Mood swings, i.e. anger to uncontrolled crying spells, etc.
  • Fever, sore throat or other signs of infection or low white blood count
  • Sudden high fever
  • Profuse sweating
  • Impaired cognitive function, confusion
  • Feeling like fainting, sudden weakness
  • Sudden numbness, especially if on one side only
  • Severe or sudden headache
  • Problems with vision that come on suddenly
  • Tachycardia
  • Arrhythmia
  • Difficulty speaking
  • Loss of balance or coordination
  • Flu like symptoms, i.e. chills, aches, etc.)
  • White patches or ulcers on the inside of the mouth or lips

Since a patient on Invega may have limited ability to articulate what may be happening, careful and continuous monitoring of the person by observers is extremely important.

Invega (Paliperidone) Withdrawal Symptoms

It is recommended to start taking Invega at the lowest possible dose, and to take as low a dose as possible during maintenance, as coming off the drug may be easier if the accumulated dosages are as minimal as possible.

Some side effects during withdrawal may be quite severe and long-lasting, such as:

  • Suicidal thoughts
  • Restlessness
  • Insomnia
  • Return of original symptoms, i.e. hallucination, mania, etc.
  • Itching or rashing skin
  • Hot flashes
  • Heart palpitations
  • Appetite changes
  • Weight changes
  • Headache
  • Depression
  • Fatigue
  • Vomiting is common for the first week especially when coming off the oral daily pill form “cold turkey”.
  • Profuse sweating is common both during the day and while sleeping.
  • Tremors can last for a few weeks as the body adjusts to lower levels of the drug in the system. Especially pronounced if quitting all at once, which is not recommended.
  • Sudden mood swings
  • Anger
  • Crying spells
  • Depersonalization
  • Anxiety
  • Trouble concentrating
  • Agitation

Discontinuing/Quitting Invega (Paliperidone)

Discontinuing Invega should be done in close and regular coordination with the prescribing physician who can adjust the dose at intervals to soften the withdrawals that may present.

Quitting Invega cold turkey is not recommended where possible due to the severity of withdrawals that can occur. (1)

In looking at reasons why discontinuing Invega needs such careful monitoring, one important point to take into account is the possibility that Invega deflects dopamine from certain receptors, and this can reduce mania. However, the body’s response to this is to make new dopamine (D2) receptors.

So, when the drug is reduced, dopamine expression returns, and can appear as returning manic symptoms. In some extreme cases, the patient may become resistant to being guided or following directions in treatment, due to the enchantment of this sensation of enhanced sense of reward. Such unwillingness to take pragmatic guidance can make the situation hard to manage well. Working with a physician who has hospital admission privileges would be advised to regain control in a compassionate way, as stabilization may become necessary, for such extreme cases, in a hospital setting.  Where the taper was too rapid or otherwise unstructured, this can be especially relevant to bear in mind.

Once the patient is stabilized, slower tapering can resume, and the patient may be able to transition to becoming medication-free, or to the lowest possible dose that still provides satisfactory quality of life.

It may be easier to find a physician to begin a patient on Invega than to find one who is familiar with helping a patient to come off the drug. When seeking clinical or medical help for tapering, choose a physician with familiarity and confidence in their ability to help.

Invega (Paliperidone) FAQs

Below are some common questions asked about Invega, and some other topics that may be helpful in considering stopping or starting Invega.

What Does Paliperidone Do to the Brain?

Invega acts primarily on the activity of dopamine and dopamine receptors in the brain. Psychosis, as well as schizophrenia, is thought to be related to disturbances affecting certain neurotransmitters. Invega targets such areas of the brain to reduce excess activity of dopamine; the drug is thought to help control the symptoms of psychosis and schizophrenia.

In clinical studies we have seen a correlation between COMT impairment and features of psychosis, mania, and high and low moods that are attributed to bipolar disorders. COMT stands for catecholamine methyl transferase, where catecholamines include norephiephrine, adrenaline, and dopamine. Methyl transferase refers to certain genetic factors relating to metabolizing of catecholamines, i.e. determining how efficient or how impaired the metabolization process may be.

In other words, each of the neurotransmitters mentioned produces excitatory effects on the brain, affecting emotions, and other responses, including the dopaminergic effect on the perception of reward. A person with a low sense of reward might be more inclined toward using stimulants, and conversely, the individual who is experiencing an elevated sense of reward may present mania type symptoms.

More research is needed to understand more about schizophrenia and other disorders and the effects that accompany medications that are used in their treatment.

How Long Does Invega (Paliperidone) Stay in Your System?

We can approximate the half-life of Invega to be roughly 24 hours. Half the drug would be cleared in that period. When the drug is taken by injection it would be much longer, calculated anywhere from 24 to 49 days for half of the drug to be eliminated from the body.

Because of the neuroadaptive effects of the drug the effects of Invega may last much longer. Other factors that would contribute to answering the question might include diet, duration of drug use, genetics, etc. It would be very difficult to predict, but could be reasonably estimated as months or even years.

However, safe withdrawal, along with the use of neurotransmitter precursors has been demonstrated to diminish these time projections considerably.

Is Invega Used for Depression?

Invega is approved by the FDA for treating schizophrenia. However, other off-label uses have developed such as prescribing the drug to treat the symptoms of depression, bipolar disorders or mixed episodes of depression. (2)

When the drug is prescribed for off-label uses, this practice does not preclude the importance of avoiding alcohol, opiates, or any other substances that could interfere or react with Invega causing severe side effects.

Is Invega the Same as Risperdal?

Invega is a derivative produced from an active metabolite of Risperdal (risperidone). Though their effects are similar, they are different in molecular structure.

Both Risperdal and Invega are used in the treatment of schizophrenia.

Treatment for Invega (Paliperidone) Abuse and Addiction?

The Alternative to Meds Center helps patients to make improvements to their mental and emotional health without focusing on medicating or labeling the patient as some permanently broken diagnosis.

As recommended by the APA, there are many investigative actions that can be done before choosing medication for treatment. (3)

However, these investigative efforts have sometimes not been thoroughly done before beginning on a potent medication such as Invega.

In some cases, tapering off medications may be a safe way to proceed with attaining mental health naturally if that is desired. Each of our clients has a unique personal history that must be consulted through every step of the treatment plan that is designed for the person.

One of the most important features of our tapering program is the removal of neurotoxins from the body. This toxic load might comprise many neurotoxic chemicals and substances, heavy metals, accumulated pesticides, drug residues, etc., which when eliminated can bring about many benefits.

Once the cleanse step is complete, typically clients report sleeping better, feeling calmer, brighter, with an improved appetite and other good changes. Using pharmaceutical grade supplements, vitamins, minerals, nebulized glutathione, infra-red sauna, a diet of organic and nutrient-dense foods, chelation and many other therapies, we can help a client to boost their overall health in a positive and non-invasive way.

Inpatient tapering off medication is done under the medical supervision of our medical team, along with our many therapists and caregivers. There is much more information we can provide about our methods and treatment protocols for coming off Invega and improving mental health naturally, by request.


This content has been reviewed, and approved by a licensed physician.

Dr. John Motl, M.D.

Dr Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor’s of Science degree with a major in biology and minors in chemistry and philosophy. He graduated Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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