Risk of death is increased in elderly patients with dementia-related psychosis treated with antipsychotic drugs. Paliperidone palmitate is not approved for use in patients with dementia-related psychosis .
Medically reviewed by Drugs.com. Last updated on Mar 3, 2019.
Commonly used brand name(s)
In the U.S.
- Invega Sustenna
- Invega Trinza
Available Dosage Forms:
- Suspension, Extended Release
Therapeutic Class: Antipsychotic
Chemical Class: Benzisoxazole
Uses for paliperidone
Paliperidone injection is used to treat the symptoms of psychotic (mental) disorders, including schizophrenia. Invega Trinza® is used if patients have been treated with Invega Sustenna® for at least 4 months. Invega Sustenna® may also be used alone or in combination with other medicines to treat schizoaffective disorder. Paliperidone should not be used to treat behavioral problems in older adults who have dementia.
Paliperidone is to be given only by or under the direct supervision of your doctor.
Before using paliperidone
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For paliperidone, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to paliperidone or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of paliperidone injection in the pediatric population. Use of Invega Trinza® is not recommended. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of paliperidone injection in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving paliperidone injection.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving paliperidone, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using paliperidone with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using paliperidone with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Inotuzumab Ozogamicin
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- St John's Wort
Using paliperidone with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Interactions with food/tobacco/alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other medical problems
The presence of other medical problems may affect the use of paliperidone. Make sure you tell your doctor if you have any other medical problems, especially:
- Blood or bone marrow problems (eg, leukopenia, neutropenia) or
- Breast cancer, prolactin-dependent or
- Diabetes or
- Dyslipidemia (high cholesterol or fats in the blood) or
- Hyperglycemia (high blood sugar) or
- Hyperprolactinemia (high prolactin in the blood) or
- Neuroleptic malignant syndrome (NMS), history of or
- Priapism (painful or prolonged erection of the penis) or
- Seizures, history of—Use with caution. May make these conditions worse.
- Bradycardia (slow heartbeat) or
- Heart rhythm problems (eg, arrhythmia, QT prolongation), or history of or
- Hypokalemia (low potassium in the blood) or
- Hypomagnesemia (low magnesium in the blood)—Use with caution. May increase risk for more serious side effects.
- Dehydration or
- Dementia or
- Heart attack, recent or history of or
- Heart failure or
- Heart or blood vessel disease or
- Hypotension (low blood pressure) or
- Hypovolemia (low amount of blood) or
- Ischemic heart disease, history of or
- Stroke, history of or
- Trouble with swallowing—May cause side effects to become worse.
- Kidney disease, mild—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
- Kidney disease, moderate to severe—Use is not recommended in patients with this condition.
- Lewy body dementia or
- Parkinson's disease—Use with caution. Patients with these conditions may have increased sensitivity to the effects of paliperidone.
Proper use of paliperidone
A nurse or other trained health professional will give you paliperidone in a medical facility. It is given as a shot into one of your muscles, usually in the arms or buttocks.
Paliperidone should come with a patient information leaflet. Read and follow these instructions carefully. Ask your doctor if you have any questions.
When you receive the first dose of Invega Sustenna®, you will need to get a second dose 1 week later. After that, you will only need to get a dose once a month. You will receive Invega Trinza® once every 3 months.
Precautions while using paliperidone
It is very important that your doctor check your progress at regular visits to make sure that paliperidone is working properly. Blood tests may be needed to check for any unwanted effects.
Paliperidone may raise your risk of having a stroke. This is more likely in people who already have heart or blood vessel disease. Check with your doctor right away if you are having confusion, difficulty in speaking, slow speech, inability to speak or move the arms, legs, or facial muscles, double vision, or headache.
Check with your doctor right away if you have any of the following symptoms while receiving paliperidone: convulsions (seizures), difficulty with breathing, a fast heartbeat, a high fever, high or low blood pressure, increased sweating, loss of bladder control, severe muscle stiffness, unusually pale skin, or tiredness. These could be symptoms of a serious condition called neuroleptic malignant syndrome (NMS).
Paliperidone may cause tardive dyskinesia (a movement disorder). Check with your doctor right away if you have any of the following symptoms while receiving paliperidone: lip smacking or puckering, puffing of the cheeks, rapid or worm-like movements of the tongue, uncontrolled chewing movements, or uncontrolled movements of the arms and legs.
Paliperidone can cause changes in heart rhythm, such as a condition called QT prolongation. It may change the way your heart beats and cause fainting or serious side effects in some patients. Call your doctor right away if you have any symptoms of heart rhythm problems, such as dizziness, feeling faint, or a fast, pounding, or irregular heartbeat.
Paliperidone may affect your blood sugar levels. Check with your doctor right away if you have increased thirst or increased urination. If you notice a change in the results of your urine or blood sugar tests, or if you have any questions, check with your doctor.
Paliperidone may increase the amount of cholesterol and fats in your blood. If this condition occurs, your doctor may give you some medicines that can lower the amount of cholesterol and fats in the blood.
Paliperidone may increase prolactin blood levels if used for a long time. Check with your doctor if you have breast swelling or soreness, unusual breast milk production, absent, missed, or irregular menstrual periods, stopping of menstrual bleeding, loss in sexual ability, desire, drive, or performance, decreased interest in sexual intercourse, or an inability to have or keep an erection.
Dizziness, lightheadedness, or fainting may occur, especially when you suddenly get up from a lying or sitting position. Getting up slowly may help. If this problem continues or gets worse, check with your doctor.
Paliperidone injection can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. If you can, avoid people with infections. Check with your doctor right away if you think you are getting an infection, or if you have a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
Paliperidone may cause drowsiness, trouble with thinking, or trouble with controlling body movements, which may lead to falls, fractures, or other injuries. Do not drive or do anything else that could be dangerous until you know how paliperidone affects you.
Paliperidone may cause difficulty swallowing that can cause food or liquid to get into your lungs and a prolonged or painful erection, which can last for more than 4 hours. Talk to your doctor if you have any concerns about this.
Paliperidone may make it more difficult for your body to cool itself down. Use care not to become overheated during exercise or hot weather since overheating may result in heat stroke. Also, use extra care not to become too cold while you are receiving risperidone injection. If you become too cold, you may feel drowsy, confused, or clumsy.
Paliperidone may increase your weight. Your doctor may need to check your weight on a regular basis while you are receiving paliperidone. Talk to your doctor about ways to prevent weight gain.
Check with your doctor before using paliperidone with alcohol or other medicines that affect the central nervous system (CNS). The use of alcohol or other medicines that affect the CNS with risperidone may worsen the side effects of paliperidone, such as dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.
If you plan to have children, talk with your doctor before using paliperidone. Some women using paliperidone have become infertile (unable to have children).
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Paliperidone side effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
- bladder pain
- bloody or cloudy urine
- body aches or pain
- deep or fast breathing with dizziness
- difficult, burning, or painful urination
- difficulty with breathing
- difficulty with swallowing
- dry mouth
- ear congestion
- frequent urge to urinate
- inability to sit still
- irregular heartbeat
- loss of balance control
- loss of voice
- lower back or side pain
- mask-like face
- need to keep moving
- numbness of the feet, hands, and around the mouth
- runny or stuffy nose
- shuffling walk
- slowed movements
- slurred speech
- sore throat
- stiffness of the arms and legs
- tic-like (jerky) movements of the head, face, mouth, and neck
- trembling and shaking of the fingers and hands
- trouble with sleeping
- twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
- unusual tiredness or weakness
- Blurred vision
- difficulty with speaking
- inability to move the eyes
- increase in body movements
- increased blinking or spasms of the eyelid
- loss of balance control
- muscle trembling, jerking, or stiffness
- pounding in the ears
- slow or fast heartbeat
- sticking out of the tongue
- uncontrolled movements, especially of the face, neck, and back
- uncontrolled twisting movements of the neck, trunk, arms, or legs
- unusual facial expressions
Incidence not known
- Change in mental status
- decrease in the amount and frequency of urination
- difficulty speaking
- hives, itching, skin rash
- large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals
- loss of bladder control
- pale color of the skin
- pinpoint red spots on the skin
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- severe constipation
- severe vomiting
- stomach pain
- swollen tongue
- tightness in the chest
- yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
- Back pain
- difficulty with moving
- dry mouth
- increased weight
- lack or loss of strength
- muscle pains, cramps, or stiffness
- pain and swelling in the joints
- pain in the arms or legs
- tearing of the skin
- upper abdominal or stomach pain
Incidence not known
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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