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Invega Tapering

This entry was posted in Antipsychotic on by .
Medically Reviewed Fact Checked

Last Updated on August 5, 2021 by Diane Ridaeus

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Rarely can you find a medical professional equipped with the confidence and expertise to competently navigate Invega tapering, or weaning & titration programs for the antipsychotics drug class.

Antipsychotics like Invega©, though perhaps properly prescribed during a time of demonstrable crisis, may not mean that a lifetime of being medicated is justifiable as the best way forward.

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Invega Tapering Inpatient Style

Invega tapering done within a nurturing setting such as Alternative to Meds Center is much easier than trying to face what may feel brutal and defeating especially without excellent personal support. Invega users do not have to suffer the often fierce symptoms of weaning off Invega. We have clinically proven effective Invega alternatives to make side effects and symptoms a part of your past. Alternative to Meds Center has shown that there are other ways to ignite feeling good and engaged in life as opposed to continuing on mind-numbing drugs. Done properly, Invega tapering and withdrawal can be done with little discomfort and many benefits to overall health.

About Invega

invega schizophrenia bipolarThe generic name for Invega is paliperidone and is also available under other brand names, in a time-release or injectable form, which may introduce some added complications for Invega tapering. It is one of the atypical antipsychotic medications that have become widely used for treating schizophrenia, schizoaffective and bipolar-related mania, episodes of psychosis, and other critical conditions.

Like all members of this class of medication, there are limitations and risks. Physicians unfamiliar with time-release antipsychotic medications may not be able to completely inform their patients about the range and risks of side effects, due to time restraints or because they have not themselves been informed fully.

Often, the decision to begin taking a neuroleptic drug such as Invega is done under extreme pressure, without a lot of time to study the matter fully. After the crisis passes, one may want to take the opportunity to study the problem in more depth, as part of planning for long-term treatment and improved health. Invega titration should always be slow and gradual. There is much to learn about the process. We hope the following information useful and helpful in this quest.

Invega Tapering Guidelines

The following bullet points are a brief summary, with expanded information given further in the article. Never abruptly discontinue antipsychotic medication, except when a medical reason exists to do so, and only then, with adequate medical oversight and care. The information below is designed to be discussed with your prescriber. Antipsychotic tapering may be the most difficult of all drug classes to navigate and should always be done with careful medical oversight. If an inpatient program is not available to you, please seek out a physician familiar with Invega and who has confidence in their knowledge and ability to help you.

Invega Tapering Guidelines Include:

  • invega tapering guidelinesAim to begin your taper when you are stable, sleeping and eating well, and not experiencing psychotic or other major symptoms– except for life-threatening medical reasons such as NMS. In all cases, medical oversight should guide the starting and stopping of antipsychotic medications.6,7
  • Consider setting up a “contract for safety” with a trusted caregiver or family member.8
  • Inpatient specialist treatment is recommended, but it is reasonable to select a prescriber with confidence they can help.9
  • Caffeine can worsen psychosis in schizophrenia and has been known to cause psychosis in non-schizophrenic persons. Avoid caffeine in coffee, energy drinks, or other sources.10,11
  • Recreational use of cannabis can cause psychosis. Avoid this and other recreational drugs and alcohol, because the combined effects can intensify sedation, can result in CNS suppression, and may shrink grey matter (like the hard drive and core memory processor) and white matter (neuroprotective, communication relay system} in the brain.12,13,14,15
  • A routine of eating a protein-based breakfast and several protein-based meals or snacks over the day can help regulate blood sugar levels. Keeping blood sugar levels balanced is important for both mental and physical health.16,17
  • Regular exercise such as walking or cardio exercise is therapeutic and should not be neglected as a mental health strategy.18,19
  • IMPORTANT:  Invega is extended-release, which comes in tablets that range from 1.5 mg up to 12 mg as well as an injectable form. Before embarking on a tapering plan, discuss the most practical method of gradual reduction with your prescriber, which may involve cross-over tapering or other methods of measuring and managing lower doses safely and accurately for tapering purposes.20
  • Invega can interact with other medications. Some can interfere with how Invega is metabolized and cause relapse-like symptoms when taken concurrently. Do discuss all medications you are taking with your prescriber so that such adverse effects can be prevented. 6,20,21
  • Tapering antipsychotics must be slow and gradual to avoid rebound symptoms associated with abrupt discontinuation that may be worse than initial symptoms. It is reasonable to expect the taper to last 1 month for every one year you have been on the medication.9,24
  • Work closely with your prescriber so that the percentage of reduction and the duration of time between cuts are sufficient to avoid or adequately mitigate withdrawals.9,22
  • It is reasonable to expect, because of neuroadaptation during antipsychotic use, withdrawal symptoms are likely to occur during tapering.9,22
  • During antipsychotic tapering not eating or sleeping can be red flags or predictors showing that the taper must be slowed, especially notable near the end of the taper. 9,22,23
  • The final phase of antipsychotic tapering may be the most challenging. Slow the pace as needed.24
  • Limit stimulating loud noises, repetitive music, television, and even stimulating reading material as these can be risk factors that can worsen psychiatric symptoms in sensitive persons.25
  • Reference our antipsychotic alternatives page, or [your drug name] + alternatives on our website for recommended natural alternatives that may assist your tapering experience.

Invega Tapering Treatment Results Overview

As mentioned above, doctors typically prescribe medications such as Invega in a time of desperate need. For example, to bring a critical situation such as acute psychosis safely and immediately under control. Options can seem extremely limited at such a juncture. However, once the crisis has passed, researchers have found there can be positive effects from nonpharmacological treatments such as modified diet, and cognitive-behavioral counseling, for example, that may be options to consider rather than focusing only on long-term antipsychotic use.26,27

It is clear that the more one can learn about medication effects, the better one is equipped to deal with them. Just as important is the knowledge that drug-free treatment methods can lead to a sustainable recovery. A person can learn about these methods to provide a pathway for a bettered quality of life. In this way, one can begin to achieve very real overall improvements in one’s mental and physical health.1

More research is needed as the effects of long-term antipsychotic use are generally under-studied. However, a study was run in the Netherlands that reported on a seven-year follow-up that persons who had suffered a schizophrenic or schizophrenic-related disorder who had discontinued their medication had achieved twice the functional recovery rate as compared to those who were still on maintenance medication treatment plans for the same time period.2

Often, a single antipsychotic drug does not provide reduction of symptoms as well as was hoped, and second or even multiple medications may be added. Research by Barnes and Paton published in the Journal of CNS Drugs expressed concern about the very common use of polypharmacy in mental illness because the risks have not been adequately studied in clinical trials.27  A randomized controlled trial on individuals with schizophrenia published in the Journal of Clinical Psychiatry observed that switching from 2 down to 1 antipsychotic medication for the majority, produced no clinical worsening, and was associated with less frequent and severe adverse effects.28 Since Invega and polypharmacy treatments may not be the most efficacious choice for long-term treatment in all cases, learning about safe and gentle methods for Invega tapering may be a beneficial option to consider.

Concerns with Invega

tardive dyskinesia side effectsAntipsychotic drugs are most concerning because they are noted for causing significant side effects, especially after long-term usage. Tardive dyskinesia, for example, has been observed in 16-50% of patients on antipsychotic medications, a number according to research by Loughlin et al published in the 2019 Journal of PLoS One is likely underestimated.29 Other adverse effects include elevated blood sugar levels, weight gain, high cholesterol, Parkinson’s disease or Parkinson’s-like conditions, dystonia, cogwheel rigidity (rigid limbs/muscles), and akathisias as mentioned on Invega’s label insert. Also of concern, antipsychotics may precipitate or aggravate certain heart problems such as cardiac arrest, stroke, and long QT syndrome.6 This type of drug can cause many other potential side effects that can negatively impact a person’s health and reduce their quality of life. When the initial crisis of a psychotic episode or other mental health event has passed, a person may consider Invega tapering and the use of Invega alternatives to avoid these types of risks.

Of concern, tardive dyskinesia is widely considered persistent and even permanent once it has developed. A clinical study published in JAMA studied 50 participants with TD in a 13-month trial. Nine participants had persistent TD symptoms 3 months after the drug was withdrawn. 12 had reversible TD symptoms, 3 months after withdrawal – although the study does not say what happened to the other 29 patients. The group with persistent TD had been on antipsychotics the longest.30 Weaning off Invega and similar drugs early rather than after long-term use is a strategy that may be able to avoid such negative health risks.

Tardive dyskinesia is not a disease but a side effect of neuroleptic medications. The condition is not known to occur in any other circumstances. There are more than 50 drugs that are known to induce tardive dyskinesia, a great proportion of which are in the class of antipsychotics, such as Invega.3

How Antipsychotic Drugs Work — Known or Unknown?

There are many theories about how drugs like Invega work and how they affect neurology, but this study is far from complete. One factor that is thought likely is that metabolites from antipsychotic drugs can be toxic to human neurochemistry and injurious to neurons. Studies have been carried out to find out more about this possible antipsychotic effect on the brain.5

invega dopamine blockerAntipsychotics can affect several types of neurotransmitters and their receptors. Regarding dopamine, for example, the drug is thought to create hypersensitive dopamine receptors along the CNS pathways while concurrently setting up a chronic dopamine blockade that is also medication-induced. This can cause a cascade of other responses including oxidative stress and cell death.31

Because of these drug-induced neurochemical manipulations, a person’s moods and other important body and organ functions are also affected by the drug. These should also be monitored during Invega weaning and titration. Certain genetic factors may affect how well or how poorly the body itself is equipped to repair and protect itself from these drug-induced effects.32 More careful study is needed on this topic as the problem of reversing persisting antipsychotic drug side-effects has not yet been satisfactorily understood or resolved in the medical-scientific community. As harsh as it may sound to some, patients are still being asked to play the role of guinea pig for the drug industry.4

Alternative to Meds Center Offers Healthy and Safe Invega Tapering

Perhaps the initial mental health emergency that you or a loved one has suffered has passed and your attention has now turned to the next steps that may help to achieve bettered mental and physical health, and learn the most proven steps for how to prevent relapse, as well as how to improve the quality of life with reduced or eliminated reliance on prescription drugs.

Some persons may be better candidates than others for antipsychotic weaning. We are happy to help you assess your goals in treatment and advise you or your loved one what options may be the best ones to consider.

Please contact us for more information about our educational steps within the program for self-care and neurochemistry support. Alternative to Meds Center has developed a nurturing inpatient Invega tapering program for those looking for ways to safely titrate from or even discontinue neuroleptic medications and to improve mental health naturally, providing another option besides relying on prescription drugs for a lifetime.


1. Shrivastava et al.,  “Atypical antipsychotics usage in long-term follow-up of first episode schizophrenia” 2012 Jul, US National Library of Medicine and Indian Journal of Psychiatry [cited 2021 July 7]

2. Insel T, “Antipsychotics: Taking the Long View” (Thomas Insel, former NIMH Director) 2013 Aug, National Institute for Mental Health [cited 20201 July 7]

3. Klawans et al., “The reversibility of “permanent” tardive dyskinesia” 1984, US National Library of Medicine [cited 2021 July 7]

4. Cornett et al., “Medicine-Induced Tardive Dyskinesia: A Review and Update” National Institute for Mental Health [cited 2021 July 7]

5. Crowley et al., “Brain Levels of the Neurotoxic Pyridinium Metabolite HPP+ and Extrapyramidal Symptoms in Haloperidol-Treated Mice.” Neurotoxicology 2013 Dec., PMID24107597 [cited 2020 Dec 2]

6. FDA drug label Invega (paliperidone} Extended Release Tablets, approved 2006 [cited 2021 Jun 30]

7. NAMI authors, “Paliperidone (Invega) [online] Feb 2020 [cited 2021 Jun 30]

8. Oxford References, “Ulysses contract” [online] 2021 [cited 2021 Jun 30]

9. Keks N, Schwartz D, Hope J. Stopping and switching antipsychotic drugsAust Prescr. 2019;42(5):152-157. doi:10.18773/austprescr.2019.052 [cited 2021 Jun 30]

10. Hedges DW, Woon FL, Hoopes SP. Caffeine-induced psychosis. CNS Spectr. 2009 Mar;14(3):127-9. doi: 10.1017/s1092852900020101. PMID: 19407709. [cited 2021 Jun 30]

11. Wang HR, Woo YS, Bahk WM. Caffeine-induced psychiatric manifestations: a review. Int Clin Psychopharmacol. 2015 Jul;30(4):179-82. doi: 10.1097/YIC.0000000000000076. PMID: 25856116. [cited 2021 Jun 30]

12. NIDA. 2020, May 28. Is there a link between marijuana use and psychiatric disorders? [cited 2021 Jun 30]

13. Henquet C, Di Forti M, Morrison P, Kuepper R, Murray RM. Gene-environment interplay between cannabis and psychosis. Schizophr Bull. 2008;34(6):1111-1121. doi:10.1093/schbul/sbn108. [cited 2021 Jun 30]

14. Nesvåg R, Frigessi A, Jönsson EG, Agartz I. Effects of alcohol consumption and antipsychotic medication on brain morphology in schizophrenia. Schizophr Res. 2007 Feb;90(1-3):52-61. doi: 10.1016/j.schres.2006.11.008. Epub 2007 Jan 10. PMID: 17218084. [cited 2021 Jun 30]

15. Wen Q, Chklovskii DB. Segregation of the brain into gray and white matter: a design minimizing conduction delaysPLoS Comput Biol. 2005;1(7):e78. doi:10.1371/journal.pcbi.0010078 [cited 2021 Jun 30]

16. Sahoo S, Mehra A, Grover S. Acute Hyperglycemia Associated with Psychotic Symptoms in a Patient with Type 1 Diabetes Mellitus: A Case Report. Innov Clin Neurosci. 2016;13(11-12):25-27. Published 2016 Dec 1. [cited 2021 Jun 30]

17. Hormone Health Network Non-Diabetic Hypoglycemia EDITOR(S): Prof. Margaret Eckert-Norton, PHD, FNP-BC, CDE, Ramon Martinez, M.D., Susan Kirk, M.D. LAST UPDATED: July 2020. [cited 2021 Jun 30]

18. Sharma A, Madaan V, Petty FD. Exercise for mental healthPrim Care Companion J Clin Psychiatry. 2006;8(2):106. doi:10.4088/pcc.v08n0208a [cited 2021 Jun 30]

19. Callaghan P. Exercise: a neglected intervention in mental health care? J Psychiatr Ment Health Nurs. 2004 Aug;11(4):476-83. doi: 10.1111/j.1365-2850.2004.00751.x. PMID: 15255923. [cited 2021 Jun 30]

20. Janssen drug information Invega “How to take Invega” 2019 [online] [cited 2021 Jun 30]

21. Andrade C. Delayed drug interactions in psychiatry: armodafinil and risperidone as a potential case in point. J Clin Psychiatry. 2015 Dec;76(12):1633-4. doi: 10.4088/JCP.15f10514. PMID: 26717524. [cited 2021 Jun 30]

22. Brandt L, Bschor T, Henssler J, et al. Antipsychotic Withdrawal Symptoms: A Systematic Review and Meta-AnalysisFront Psychiatry. 2020;11:569912. Published 2020 Sep 29. doi:10.3389/fpsyt.2020.569912 [cited 2021 Jun 30]

23. Chemerinski E, Ho BC, Flaum M, Arndt S, Fleming F, Andreasen NC. Insomnia as a predictor for symptom worsening following antipsychotic withdrawal in schizophrenia. Compr Psychiatry. 2002 Sep-Oct;43(5):393-6. doi: 10.1053/comp.2002.34627. PMID: 12216015. [cited 2021 Jun 30]

24. Horowitz MA, Jauhar S, Natesan S, Murray RM, Taylor D. A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse. Schizophr Bull. 2021 Mar 23:sbab017. doi: 10.1093/schbul/sbab017. Epub ahead of print. PMID: 33754644. [cited 2021 Jun 30]

25. Aucoin M, LaChance L, Clouthier SN, Cooley K. Dietary modification in the treatment of schizophrenia spectrum disorders: A systematic review. World J Psychiatry. 2020 Aug 19;10(8):187-201. doi: 10.5498/wjp.v10.i8.187. PMID: 32874956; PMCID: PMC7439299. [cited 2021 Aug 5]  

26. Morrison AK. Cognitive behavior therapy for people with schizophreniaPsychiatry (Edgmont). 2009;6(12):32-39. [cited 2021 Jun 30]

27. Barnes TR, Paton C. Antipsychotic polypharmacy in schizophrenia: benefits and risks. CNS Drugs. 2011 May;25(5):383-99. doi: 10.2165/11587810-000000000-00000. PMID: 21476610. [cited 2021 Jun 30]

28. Borlido C, Remington G, Graff-Guerrero A, Arenovich T, Hazra M, Wong A, Daskalakis ZJ, Mamo DC. Switching from 2 antipsychotics to 1 antipsychotic in schizophrenia: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2016 Jan;77(1):e14-20. doi: 10.4088/JCP.14m09321. PMID: 26845273. [cited 2021 Jun 30]

29. Loughlin AM, Lin N, Abler V, Carroll B. Tardive dyskinesia among patients using antipsychotic medications in customary clinical care in the United States. PLoS One. 2019 Jun 4;14(6):e0216044. doi: 10.1371/journal.pone.0216044. PMID: 31163035; PMCID: PMC6548364. [cited 2021 Jun 30]

30. Jeste et al, “Tardive Dyskinesia-Reversible and Permanent” [online} JAMA May 1979 [cited 2021 Jun 30]

31. Yin J, Barr AM, Ramos-Miguel A, Procyshyn RM. Antipsychotic Induced Dopamine Supersensitivity Psychosis: A Comprehensive Review. Curr Neuropharmacol. 2017;15(1):174-183. doi:10.2174/1570159×14666160606093602 [cited 2021 Jun 30]

32. MacNeil RR, Müller DJ. Genetics of Common Antipsychotic-Induced Adverse Effects. Mol Neuropsychiatry. 2016;2(2):61-78. doi:10.1159/000445802 [cited 2021 Jun 30]


Originally Published Feb 12, 2020 by Diane Ridaeus


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

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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