Prescribers generally have minimal exposure to Invega withdrawal — it just isn’t their scope. Invega is an antipsychotic that is utilized during a time of crisis. Long-term ramifications and side effects of Invega shouldn’t be discounted.
Unskilled withdrawal from Invega, after the dopamine receptors have upregulated, can put a person right back into crisis. The supervision must be handled with extreme care.
Do Your Symptoms
Alternative to Meds has been an expert on antipsychotics withdrawal and Invega alternatives for over 15 years. We have published evidence regarding our success. Most of the time, there are other contributors like drug use, tragic diet choices, and genetic variabilities that played a part in the original diagnosis. We attend to those aspects in both a comprehensive medical and holistic fashion. Many of our staff painfully had to confront similar issues and come from an experiential place of conviction and compassion.
15 Years Experience by Professionals Who Understand Your Journey.
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
An extensive review of the medical literature on antipsychotic withdrawals was analyzed by Brandt et al in their study published in Sept 2020 in the Frontiers in Psychiatry Journal. The authors reported that fast or abrupt antipsychotic withdrawal by far produces more intense withdrawals, and that slow reductions produce less severe reactions as a general rule. Of note, women and older populations suffered greater intensity of withdrawal phenomena in some of the trials analyzed. The list of withdrawal symptoms below is drawn from this study,14, and several other sources as indicated, though this may not be a complete list.
Depression, mania, psychosis, hallucinations, or other returning or rebound symptoms which can be more severe than before starting medication.15,16
*Akathisia is receiving attention and new research since it is a common side effect of withdrawal from several types of psychiatric medications, including antipsychotics.13
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, 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
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:
Neuroleptic Malignant Syndrome (NMS)
Invega can cause these common side effects:
Swelling in breast tissue (males and females), discharge from breasts
Irregular menstrual periods
Nausea and vomiting
Lowered cognitive function
Stomach pain, abdominal cramping
Weight gain, constipation
Decreased libido, anorgasmia, impotence
Severe Invega side effects though rare may require medical attention:
Tardive dyskinesia, uncontrolled motor movements, i.e., smacking lips, rolling tongue, twisting or frowning the face, jerking hands, limbs
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
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
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.
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.
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?
It has not been entirely established what antipsychotic medications do to the brain. It is thought that Invega acts primarily on the activity of dopamine and possibly other receptors in the brain. Of historic note, this idea was first proposed after Swiss chemist Albert Hoffman’s own reactions to taking LSD back in the 40s 22 where he developed this theory about imbalances of serotonin, dopamine, glutamate, and other molecules in the brain. Invega and other antipsychotics are thought to reduce the excess activity of dopamine. The idea really caught fire in the 80s when the manufacturing of atypical antipsychotic drugs really took off. Thus, Invega is thought able to help control the symptoms of psychosis and schizophrenia by dampening the expression of dopamine. There may be other molecules and other areas of interest that need studying to really be able to treat mental illness, in its broader context as a complex aspect of human health.
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 disorder, drug-induced mania, and other disorders.21,23 COMT stands for catecholamine methyltransferase, where catecholamines include norepinephrine, adrenaline, and dopamine. Methyltransferase refers to certain genetic factors relating to the metabolizing of catecholamines, i.e., determining how efficient or how impaired the metabolization process may be. More research is ongoing on these and related areas.
Notes on Schizophrenia and Excitatory Neurotransmitters
Excitatory neurotransmitters such as dopamine produce 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 on neurotransmitters, that medications cause in the brain and CNS.
How Long Does Invega (Paliperidone) Stay in Your System?
We can approximate the half-life of Invega in tablet form 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. 25,26
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 of how long drug effects persist 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 Invega 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 worsen Invega 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.24
Both Risperdal and Invega are used in the treatment of schizophrenia.
Best Treatment for Invega Withdrawal
Alternative to Meds Center helps patients to make improvements to their mental and emotional health without focusing on medicating or labeling the patient as having some permanently broken diagnosis.
While medication can play a necessary role in reducing symptoms, the authoritative textbook The Clinical Handbook of Schizophrenia states that “medications alone are inadequate to manage schizophrenia.” 3
There are many additional treatment options such as CBT and other forms of psychological counseling that can be recommended as part of an effective Invega withdrawal treatment plan. Holistic treatment options designed to support mental health naturally are described in more detail on Alternative to Med’s services overview page. Some candidates may be able to reduce medication and some may be able to discontinue Invega altogether. The individualized plan for each client addresses these unique needs and circumstances.
Attaining Mental Health Naturally
In some cases, Invega withdrawal may be a safe way to attain mental health naturally, supporting the transition with alternative treatments. 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 Invega withdrawal 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. Testing will show the presence of these and other toxic accumulations, and also confirm their reduction or absence after cleansing.4,5
Once the cleanse step is complete, typically clients report sleeping better, feeling calmer, brighter, with improved appetite and other good changes. While in the program, clients use pharmaceutical-grade supplements, vitamins, minerals, nebulized glutathione, a correctly designed diet of organic and nutrient-dense foods, and many other therapies. We offer inpatient counseling, Equine therapy, educational components on self-care, IV and NAD treatments, and much, much more. We can help a client to boost their overall health in positive and non-invasive ways, even before the Invega withdrawal process is initiated. Some candidates will be able to safely reduce their medication to improve their quality of life and some may be able to discontinue their medication entirely if medically advised, and with an adequate length of time that can be devoted to the program.
Inpatient Invega withdrawal is done under the medical supervision of our medical team, along with our many therapists and caregivers. Please contact us directly at Alternative to Meds Center for more information on the Invega withdrawal treatment programs we offer that may benefit you or your loved one more than you thought possible.
6. Chouinard G, Samaha AN, Chouinard VA, Peretti CS, Kanahara N, Takase M, Iyo M. Antipsychotic-Induced Dopamine Supersensitivity Psychosis: Pharmacology, Criteria, and Therapy. Psychother Psychosom. 2017;86(4):189-219. doi: 10.1159/000477313. Epub 2017 Jun 24. PMID: 28647739. [cited 2021 July 23]
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.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.