What Is Invega?
Invega, generic paliperidone, is an oral extended-release tablet or injectable antipsychotic medication used in the treatment of schizophrenia in adolescents and adults.1
Neither the monthly injectable form, Invega Sustenna©, or the 3-month injectable Trinza©, or the oral daily form is approved for elderly patients with dementia-related psychosis due to increased risk of death, according to the FDA black box warning for the drug. When possible, it is always advisable before beginning treatment with a potent medication, to research the side effects, possible withdrawal symptoms, and other health-related information as thoroughly as you can. In a crisis situation, this is often not possible. But after such a crisis has passed, and before attempting to withdraw from such medication, it may become clear that the benefits are outweighed by the risks of continuing such medication. In that case, the medication should be at least reduced or stopped, or other alternatives should be employed, according to research published by the Official World Psychiatry Journal.20 We provide information for personal research and discussions with your prescriber about how to approach Invega withdrawal. Medication withdrawal must be uniquely programmed for any individual, and methods such as cross-tapering, transitioning from an injectable to a capsule or tablet version, or other interventions may be possible.
Discontinuing/Quitting Invega
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 suddenly is not recommended except if medically necessary. For example, if tardive dyskinesia emerges, the condition can become permanent but has reversed in some cases when the drug was immediately withdrawn. Another adverse reaction is named neuroleptic malignant syndrome.12 NMS has been reported with Invega and other antipsychotic medications, and the severity of symptoms can quickly become life-threatening. The appropriate medical response is to immediately discontinue Invega and seek emergency hospital care.1,11-13
At times, it may be deemed necessary to switch one antipsychotic (one that is not working) to another, with no gradual reduction attempted — but this would only be done in a clinical setting, under cautious, careful observation.14
We must stress that outside of these medical emergencies, Invega withdrawal should be done very very slowly, with careful and attentive medical monitoring in place. An inpatient setting such as Alternative to Meds Center is our best recommendation for stabilized candidates who seek treatment for Invega withdrawal as we have over 40 clinical, medical, and support staff ready to assist our clients 24/7.
Dopamine and Coming Off Antipsychotic Medications
In looking at reasons why Invega withdrawal needs such careful monitoring and management, perhaps the most troubling one is what is called antipsychotic-induced dopamine supersensitivity psychosis.6,7 Despite the complex-sounding name, a rough analogy for this phenomenon might be how firefighters manage the terrific force of a working firehose. When the valve is opened, it takes at least 2 firefighters shoulder-to-shoulder to control the explosive force of the water. A similar thing happens when you reduce antipsychotic medications (that dampen dopamine expression) too quickly. Reducing the medication releases the “clampdown” effect which prompts a sudden upsurge of dopamine. This is best managed by very, very, slow reduction rates, with ample time to settle out between incremental dosage cuts. When the drug is reduced, dopamine expression returns and if this happens too quickly, returning manic symptoms may result.
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.
Sometimes a “Ulysses contract” may be advised, where a signed agreement is made between the person wanting to reduce their antipsychotic medication and a trusted friend or caregiver involved or guiding them through treatment. In the voluntary agreement, it is stipulated that if the person suddenly decides to just stop the medication suddenly, or take an unplanned vacation from supervised treatment, and that they understand that the police or hospitalization may have to become involved.9
What Invega Is Used For
Invega (paliperidone) and Invega Sustenna are FDA approved to be used in the treatment of schizophrenia in adolescents and adults. (see cautions below) Other uses include as an adjunct medication to antidepressants and mood stabilizers. These approvals were granted after a small number of very short clinical trials lasting 6 weeks.1
INVEGA CAUTIONS:
1. There is a warning on the FDA label that indicates the drug causes increased mortality in elderly patients with dementia-related symptoms of psychosis.
2. Use in the third trimester of pregnancy and while breastfeeding is associated with neonatal withdrawals and movement disorders in the infant. Human trials have not established safety with regard to birth defects.
3. Safety has not been established for the treatment of persons below the age of 18 for schizoaffective disorders or in patients age 12 or younger in the treatment of schizophrenia.
4. Long-term treatment with antipsychotic medications may see decreasing efficacy, along with some undesirable health consequences, as reported in the Official World Journal of Psychiatry in 2018.17
Invega Alternative Names and Slang
Invega (paliperidone) refers to the oral pill form taken once every morning. The injectable forms, Invega Sustenna, and Invega Trinza are administered by intramuscular injection monthly or every 3 months respectively. No street popularity or slang names for this drug can be found in a broad search of medical literature.
Invega Side Effects 19
The injectable form of Invega commonly causes reactions at the injection site. Antipsychotic medications are associated with extrapyramidal disorders, defined as:
- Acute dyskinesia
- Dystoric reactions
- Tardive dyskinesia
- Parkinsonism
- Akinesia
- Akathisia
- Neuroleptic Malignant Syndrome (NMS)
- Hyperprolactinemia
Invega can cause these common side effects:
- Tremors/shakiness
- Swelling in breast tissue (males and females), discharge from breasts
- Irregular menstrual periods
- Restlessness
- Nausea and vomiting
- Lowered cognitive function
- Drowsiness
- Stomach pain, abdominal cramping
- Headache
- Dizziness, lightheadedness
- Weight gain, constipation
- Dry mouth
- Cough
- Decreased libido, anorgasmia, impotence
- Blurred vision
Severe Invega side effects though rare may require medical attention:
- Drug-induced catatonia, muscle rigidity, akathisia, memory lapse, tachycardia, unresponsive though awake 18,19
- Tardive dyskinesia, uncontrolled motor movements, i.e., smacking lips, rolling tongue, twisting or frowning the face, jerking hands, limbs
- NMS
- Myocarditis
- Agranulocytosis, susceptibility to infection
- Mood swings, i.e., anger to uncontrolled crying spells
- Sudden high fever, sore throat, or other signs of infection or low white blood count
- Profuse sweating
- Impaired cognitive function, confusion
- Feeling like fainting, sudden weakness
- Sudden numbness, especially if on one side only
- Severe or sudden headache
- Sudden problems with vision
- 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 Withdrawal: Stabilization During Invega Tapering
Once the patient is stabilized, slow tapering is possible so 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.
It is recommended to start taking Invega at the lowest possible dose and to take as low a dose as possible during treatment. This is because Invega withdrawal may be easier if the maintenance dose is kept as low as needed to control symptoms. Once a person has stabilized, which can mean eating and sleeping regularly, and not experiencing uncontrolled rage, debilitating hallucinations, mania, or psychosis, Invega withdrawal can become an option to consider. In a review published in the Journal of Psychiatry Research, over 100 patients who attempted antipsychotic medication withdrawal were surveyed. It was found that the gradual approach to coming off the drugs was associated with much fewer adverse withdrawal symptoms, as well as fewer relapses in the majority of participants responding to the survey.10
One of the most important features of our Invega withdrawal program is the 
