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
- Neuroleptic Malignant Syndrome (NMS)
The oral form of Invega is taken once daily, and can cause these common side effects:
- Swelling in breast tissue
- Discharge from breasts
- Irregular menstrual periods
- Stomach pain
- Abdominal pain
- Weight gain
- Dry mouth
- Decreased libido
- Blurred vision
Less frequent severe side effects may require medical attention, such as:
- Tardive dyskinesia
- Severe nervous system reaction, muscle rigidity, fast pounding heartbeat, 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
- 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.
Softening 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. This is because Invega withdrawal may be easier if the accumulated dosages are as minimal as possible.
Some side effects during Invega withdrawal may be quite severe and long-lasting, such as:
- Suicidal thoughts
- Return of original symptoms, i.e. hallucination, mania, etc.
- Itching or rashing skin
- Hot flashes
- Heart palpitations
- Appetite changes
- Weight changes
- 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
- Crying spells
- Trouble concentrating
Discontinuing/Quitting Invega (Paliperidone)
Invega withdrawal 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 Invega withdrawal 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.
Dopamine and Coming Off Antipsychotic Medications
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 an 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 admitting 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.
Stabilization During Invega Tapering
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.