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Invega Withdrawal Help, Paliperidone Side Effects, Symptoms, Treatment

This entry was posted in Antipsychotic on by .

Last Updated on March 9, 2021 by Carol Gillette

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Alternative to Meds Editorial Team
Written by Diane Ridaeus Published Sep 13, 2018
Medically Reviewed by Dr John Motl MD

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 properly.

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What Is Invega?

Invega, generic paliperidone, is an oral, daily antipsychotic medication used in the treatment of schizophrenia in adolescents and adults.

Neither the injectable form, Invega Sustenna, or the daily form is approved for elderly patients with dementia-related psychosis due to increased risk of death. Before beginning treatment with a potent medication, it may be prudent to research the side effects, possible withdrawal symptoms, and other health-related information as thoroughly as possible. Below, these and other topics are expanded and may provide pertinent information for such research and consideration about Invega withdrawal.

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.

Invega Withdrawal Symptoms Include:

  • Suicidal thoughts
  • Restlessness, akathisia*
  • Movement disorders, i.e., tardive dyskinesia
  • Insomnia
  • Return of original symptoms, i.e., hallucination, mania, etc.
  • Itching or rashing skin, odd skin sensations
  • Hot flashes
  • Heart palpitations, racing heart rate
  • Appetite changes
  • Weight changes
  • Headache
  • Depression
  • Anxiety
  • Dizziness, vertigo
  • Fatigue
  • 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.
  • Depersonalization
  • Trouble concentrating

*Akathisia is receiving attention and new research since it is a common side effect of withdrawal from several types of psychiatric medications, including antipsychotics.

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.

What Invega is (paliperidone) Used For

Invega (paliperidone) and 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
  • Parkinsonism
  • Akinesia
  • Akathisia
  • Neuroleptic Malignant Syndrome (NMS)

The oral form of Invega is taken once daily, and can cause these common side effects:

  • Tremors/shakiness
  • Swelling in breast tissue
  • Discharge from breasts
  • Irregular menstrual periods
  • Restlessness
  • Nausea
  • Vomiting
  • Drowsiness
  • Stomach pain
  • Abdominal pain
  • Headache
  • Lightheadedness
  • Weight gain
  • Dizziness
  • Dry mouth
  • Cough
  • Decreased libido
  • Anorgasmia
  • Impotence
  • 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
  • Sudden problems with vision
  • Tachycardia (fast heart rate when the body is at rest)
  • 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.

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.

Invega (paliperidone) FAQs

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?

Invega acts primarily on the activity of dopamine and dopamine receptors in the brain. Psychosis, as well as schizophrenia, is thought to be related to disturbances affecting certain neurotransmitters. Invega targets such areas of the brain to reduce the excess activity of dopamine; the drug is thought to help control the symptoms of psychosis and schizophrenia.

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 disorders. 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.

Notes on Schizophrenia and Excitatory Neurotransmitters

In other words, each of the neurotransmitters mentioned produces 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 that accompany medications that are used in their treatment.

How Long Does Invega (Paliperidone) Stay in Your System?

We can approximate the half-life of Invega 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.

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 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 interfere or react with 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.

Both Risperdal and Invega are used in the treatment of schizophrenia.

Best Treatment for Invega (paliperidone)

Alternative to Meds Center helps patients to make improvements to their mental and emotional health without focusing on medicating or labeling the patient as some permanently broken diagnosis.

While medication is sometimes necessary, the APA points out that there are many investigative actions that can be done before choosing medication for treatment.3

However, these investigative efforts have sometimes not been thoroughly done before beginning on a potent medication such as Invega.

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.

invega toxicityOne 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.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, infrared sauna, a diet of organic and nutrient-dense foods, and many other therapies. We can help a client to boost their overall health in a positive and non-invasive way.

Inpatient tapering off medication 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.


1. Smith K PhD LPC “Invega (paliperidone)” Psycom, last updated 2018 Nov 25 [cited 2020 Dec 7]

2. Marino J, English C, Caballero J, Harrington C “The role of paliperidone extended release for the treatment of bipolar disorder” NCBI, 2012 Apr 20 [cited 2020 Dec 7]

3. Rehagen T “Psychologist or Psychiatrist: Which Is Right for You?“WebMD (online) [cited 2020 Dec 7]

4. Robertson S, “What is Neurotoxicity?” Life Science online N.D. [cited 2020 Dec 7]

5. U.S. Congress, Office of Technology Assessment, “Neurotoxicity: Identifying and Controlling Poisons of the Nervous System“, OTA-BA-436 (Washington, DC: U.S. Government Printing Office, 1990 Apr) [cited 2020 Dec 7]



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

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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Invega Withdrawal Help, Paliperidone Side Effects, Symptoms, Treatment
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