Alternative to Meds Editorial Team
Medically Reviewed by ATMC Clinical Review Team
Table of Contents:
- Video: Facts You Need to Know Before Stopping Antipsychotics
- What is Invega?
- Short-Term Effects of Invega Oral Tablets
- Long-Term Effects of Invega
- Tardive Dyskinesia
- NMS: Criteria for Diagnosis
- Suppression of Immune System
- Motor & Cognitive Impairments
- Are There Methods to Safely Taper from a Drug Like Invega?
- FAQs
If you have studied Risperdal, another antipsychotic medication, you may be aware that paliperidone IS the major active metabolite of Risperdal.2 Despite this similarity, there are differences in the mechanisms and side effects of these 2 drugs. Here, we will concentrate mainly on the long-term effects of Invega, but it may be helpful to also take a look at Risperdal Withdrawal Help | Managing Risperidone Challenges for additional information.
Understanding Invega for Optimum Health
What is Invega?
Invega is the brand name of an antipsychotic medication. Earlier antipsychotics that were developed in the 1950s are called “first generation” antipsychotics. The generic name for Invega is paliperidone. It was released along with a group of similar medications in the 1980s and later. These later antipsychotics are called “second generation” antipsychotics.
Invega is available in various formations:
- Oral tablet sustained release form taken daily (Invega or paliperidone oral tablet)
- Long-acting monthly injectable form of the medication (Invega Sustenna)
- 3 month-long injectable form (Invega Trinza)
- Twice yearly injectable form (Invega Hafyera)
There is an important black box warning on the packaging of Invega, which warns that there is an increased risk of death for elderly dementia patients who take this medication. This black box warning appears on all antipsychotic medications. In studies and over time it has been found that in general, people taking antipsychotic medications die earlier on average compared to persons who don’t take antipsychotic medications.1-5
In the pre-sales trials, the deaths in patients taking Invega were nearly twice that of the placebo group. This warning applies to all the various forms of Invega including the extended-release tablets, and the long-acting injectable form. In the oral form of Invega, the recommended daily dose ranges from 3mg daily to 12mg maximum daily. Injectable doses of Invega are much higher, but are designed to be released slowly into the body after the intramuscular injection.
According to the drug label, adverse effects were found to be dose-dependent. For example, some adolescents were given the recommended 3mg daily dose and some were given 6mg or 12 mg doses in clinical testing. No further benefits were found with the higher doses, however, a higher incidence of adverse effects was reported with higher doses.3,5,12,13
Short-Term Effects of Invega Oral Tablets
The oral tablets are designed to be slowly released after swallowing with liquid, and it is clearly stated on the drug label that the tablets should not be chewed, crushed or otherwise divided. The intended sustained-release effect will be lost, and other complications can occur.
The clinical trials before marketing Invega were short-term, and the side effects noted on the FDA drug labels for these medications is quite an extensive list. 3-5,7,12,13
Short-term side effects of Invega can include:
- Anaphylactic reactions: anxiety, abdominal pain, confusion, coughing, rash, trouble breathing, visible facial swelling
- Angioedema (swelling deep under the skin, or under mucous, genital, mouth, or sinus areas)
- NMS (neurologic malignant syndrome) a potentially fatal reaction to medication (see section below for a more detailed description)
- Extrapyramidal (involuntary muscle movement disorders) such as tardive dyskinesia, parkinsonism, dystonia, a twisting or unnatural body posturing, neck or other muscle spasms, tightening of the throat, protrusion of the tongue, difficulty breathing, etc. )
Fatigue, muscle weakness- Akathisia
- Anxiety
- Dizziness
- Headache
- Lethargy
- Somnolence, sedation
- Elevated prolactin causing enlarged male breasts, menstruation irregularity, other sexual dysfunction
- Cardiac disorders such as prolonged QT interval, tachycardia, blockages, stroke
- Increased cholesterol
- Gastrointestinal dysfunction, i.e., abdominal pain, nausea, hyper-salivation, dry mouth
- Weight gain
Long-Term Effects of Invega
Long-term effects of Invega include everything on the above list. There are some particularly concerning long-term effects associated with paliperidone, and these will be discussed in more detail below.3,5,12,13
Tardive Dyskinesia
Notably, the risks of extrapyramidal disorders such as tardive dyskinesia become elevated the longer the medication is used, and the higher the dose that was prescribed. Tardive dyskinesia is a drug-induced, typically chronic, disability. The person may experience a gradual onset of involuntary muscle movement such as grimacing, lip smacking , protrusion of the tongue, or other repetitive involuntary mouth movements. Torso, foot, jaw, may all be affected such as twisting or writhing movements. It is theorized that these repetitive and irregular movements are associated with irregularities or disruptions in dopamine or other hormonal expression. Over time the movement disorder may continue to worsen, even after the drug is withdrawn. It is estimated that about 20% of patients on older antidepressants such as Haldol, and 10% on the atypical antipsychotics such as Invega, will develop tardive dyskinesia over time.9
NMS Symptoms and Diagnosis Criteria of NMS
NMS stands for “neuroleptic malignant syndrome.” Neuroleptic is a word that stands for any antipsychotic medication. Anyone taking an antipsychotic medication, including Invega, should be aware of signs and symptoms of NMS as this can be life-threatening when it occurs.6
Signs and symptoms for a diagnosis of NMS include these:
- Exposure to a dopamine-blocking drug
- Hyperpyrexia, a life-threatening elevation of body temperature above 106.7 deg.
- Severe muscle rigidity
Two of the following symptoms and signs must also be present for a valid NMS diagnosis:
Excessive sweating(di-aphoresis)- Inability to swallow (dysphagia)
- Tremor
- Cannot speak, mutism
- Elevated heart rate, tachycardia
- Incontinence
- Altered mental state, unconsciousness
- Elevated blood pressure
- Changing blood pressure (labile, erratic)
- Higher than normal white blood count (leukocytosis)
- Elevated creatine phosphokinase, an enzyme that can indicate muscle injury
Suppression of Immune System
There has been inadequate research on how antipsychotic drugs affect the human immune system, especially over time.
In a trial on healthy mice, it was found that risperidone did lower the immune systems of the animals in the trial after only 5 days of exposure to the drug. These effects worsened by the end of the extended 4-week long study. This is an important area to research, and is a complex one.
In humans, the immune system is a key factor in staying healthy and the suppression of the immune system can lead to increased frequency or intensity of inflammation, infections, pneumonia, and similar risks.16
Motor and Cognitive Impairments
Motor and cognitive impairment risks are associated with all antipsychotic medications. This type of effect includes a number of signs and symptoms that are sometimes referred to as “parkinsonism.” In parkinsonism there can be a shuffling type of gait, difficulty in speaking or articulation words and speech.14
Anhedonia is another important symptom of long-term use of Invega. Anhedonia means a flattening of emotional response, loss of joy, drive, and motivation and these can occur with Invega and any of the other antipsychotics in general use today.
Are There Methods to Safely Taper Off a Drug like Invega?
As mentioned earlier, Invega either in the oral tablet form, or the injectable form, are designed to be released into the body slowly over time. The tablets cannot be cut or crushed, and the injectable form of Invega requires its own methods that would allow for safe reduction.
And safe tapering off a neuroleptic must be done extremely slowly. To go too fast is to invite potential catastrophic withdrawal phenomena. Antipsychotics dampen or block the expression of dopamine and other natural neurotransmitters. So, in tapering, you want to avoid a flood of these into the system, which could be extremely stimulating and may induce what is known as withdrawal-induced psychosis.11
So to taper off a drug such as Invega, one strategy that could be workable is to first convert to an equivalent dose of a drug that can be more easily gradually tapered, and transitioning to a drug such as Risperdal or similar may offer such a workable strategy. One would need to seek help from a prescriber who is familiar with these modes of withdrawal, familiar with antipsychotic withdrawal done safely and gradually, and who is sympathetic to your health goals.
For more information, here is some additional recommended reading you may find helpful:
• Antipsychotic tapering
• Antipsychotic withdrawal, alternatives, and tapering
for Help with Invega Long-Term Effects
[ =” “]Ingeva FAQs
Sources:
1. Risperdal Withdrawal [cited 2026 Feb 3 ]
2. Corena-McLeod M. Comparative Pharmacology of Risperidone and Paliperidone. Drugs R D. 2015 Jun;15(2):163-74. doi: 10.1007/s40268-015-0092-x. PMID: 25943458; PMCID: PMC4488186. [cited 2026 Feb 3 ]
3. FDA drug label Invega – indications, Uses, Precautions published by National Drug Codes last updated January 16 2026 [cited 2026 Feb 3 ]
4. FDA drug label Invega Sustenna (injectable form) first approval 2006 [cited 2026 Feb 3 ]
5. FDA drug label Invega (paliperidone) Extended-Release Tablets initial approval 2006 [cited 2026 Feb 3 ]
6. Simon LV, Hashmi MF, Callahan AL. Neuroleptic Malignant Syndrome. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan [cited 2026 Feb 3 ]
7. FDA drug label Risperdal (risperdone tablets for oral use) and risperdone (oral solution) and Risperdal (oral disintegrating tablets) approval 1993 [cited 2026 Feb 3 ]
8. Fagiolini A, Barone P, Bellomo A, Bondi E, Colosimo C, Fabbrini G, Maina G, Pompili M, Tinazzi M, Vita A, Cuomo A. Diagnosis and management of tardive dyskinesia: from research to clinical practice. Riv Psichiatr. 2025 Mar-Apr;60(2):51-60. doi: 10.1708/4487.44874. PMID: 40242923. [cited 2026 Feb 3 ]
9. Carbon M, Kane JM, Leucht S, Correll CU. Tardive dyskinesia risk with first- and second-generation antipsychotics in comparative randomized controlled trials: a meta-analysis. World Psychiatry. 2018 Oct;17(3):330-340. doi: 10.1002/wps.20579. PMID: 30192088; PMCID: PMC6127753. [cited 2026 Feb 3 ]
10. Shrimanker I, Tadi P, Schoo C, Sánchez-Manso JC. Parkinsonism. 2024 Mar 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 31194381. [cited 2026 Feb 3 ]
11. Moncrieff J. Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse. Acta Psychiatr Scand. 2006 Jul;114(1):3-13. doi: 10.1111/j.1600-0447.2006.00787.x. PMID: 16774655. [cited 2026 Feb 3 ]
12. FDA drug label Invega Trinza (paliperidone palmitate) approval 2006 [cited 2026 Feb 3 ]
13. FDA drug label Invega Hafyera (paliperidone palmitate) injectable package insert approval 2006 [cited 2026 Feb 3 ]
14. Shrimanker I, et al, Parkinsonism published online by Stat Pearls January 2025 [cited 2026 Feb 3]
15. Aftab A. Making sense of the literature on antipsychotics and long-term functioning: taking natural history and personalization seriously. Psychol Med. 2024 Dec 9;54(16):1-8. doi: 10.1017/S003329172400312X. Epub ahead of print. PMID: 39651590; PMCID: PMC11769896. [cited 2026 Feb 3]
16. May M, Beauchemin M, Vary C, Barlow D, Houseknecht KL. The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice. PLoS One. 2019 Jun 26;14(6):e0218937. doi: 10.1371/journal.pone.0218937. PMID: 31242264; PMCID: PMC6594635. [cited 2026 Feb 3]
17. Einarson A, Boskovic R. Use and safety of antipsychotic drugs during pregnancy. J Psychiatr Pract. 2009 May;15(3):183-92. doi: 10.1097/01.pra.0000351878.45260.94. PMID: 19461391.[cited 2026 Feb 3]
Originally Published February __, 2026 by Diane Ridaeus
ATMC Clinical Review Team
The ATMC Clinical Review Team includes licensed physicians and experienced healthcare professionals dedicated to ensuring the accuracy, quality, and integrity of our medical content. The team reviews articles for clinical accuracy, evidence-based guidance, and relevance while supporting Alternative to Meds Center’s whole-person approach to mental health, recovery, and long-term wellness.
Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.