Skip to main content

Paliperidone (injection)

Generic name: paliperidone (injection) [ PAL-ee-PER-i-DONE ]
Brand names: Invega Sustenna, Invega Trinza
Dosage form: intramuscular suspension, extended release (117 mg/0.75 mL; 156 mg/mL; 234 mg/1.5 mL; 273 mg/0.88 mL; 39 mg/0.25 mL; 410 mg/1.32 mL; 546 mg/1.75 mL; 78 mg/0.5 mL; 819 mg/2.63 mL)
Drug class: Atypical antipsychotics

Medically reviewed by on Jan 26, 2023. Written by Cerner Multum.

What is paliperidone?

Paliperidone is an antipsychotic medicine that is used to treat schizophrenia in adults. Paliperidone is also used alone or with other medicines to treat schizoaffective disorder in adults.

Paliperidone may also be used for purposes not listed in this medication guide.


Paliperidone is not approved for use in older adults with dementia-related psychosis.

Before taking this medicine

You should not use paliperidone if you are allergic to paliperidone or to risperidone (Risperdal).

Paliperidone may increase the risk of death in older adults with dementia-related psychosis and is not approved for this use.

High doses or long-term use of paliperidone can cause a serious movement disorder that may not be reversible. The longer you use paliperidone, the more likely you are to develop this disorder, especially if you are a woman or an older adult.

Before you receive your first injection, tell your doctor if you have never taken oral (by mouth) paliperidone or risperidone.

Tell your doctor if you have ever had:

  • heart problems, or a heart attack;

  • long QT syndrome (in you or a family member);

  • high or low blood pressure, or fainting spells;

  • low white blood cell (WBC) counts;

  • a serious neurologic disorder caused by taking an antipsychotic medicine;

  • uncontrolled muscle movements in your face;

  • liver or kidney disease;

  • seizures or epilepsy;

  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  • diabetes (paliperidone may raise your blood sugar); or

  • breast cancer.

Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

Using antipsychotic medicine in the last 3 months of pregnancy may cause breathing problems, feeding problems, or withdrawal symptoms in the newborn. However, you may have withdrawal symptoms or other problems if you stop using your medicine during pregnancy. If you get pregnant, tell your doctor right away. Do not stop using paliperidone without your doctor's advice.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of paliperidone on the baby.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

Paliperidone injection is not approved for use by anyone younger than 18 years old.

How is paliperidone given?

Paliperidone is injected into a muscle. A healthcare provider will give you this injection.

Invega Sustenna is usually given only once per month, but the first two doses are given 1 week apart. Invega Trinza is usually given once every 3 months, after you have used Invega Sustenna for at least 4 months in a row.

Follow your doctor's dosing instructions very carefully. Get your paliperidone injections regularly to get the most benefit.

Your doctor will need to check your progress while you are using paliperidone.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your paliperidone injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include a headache with chest pain, fast or pounding heartbeats, and severe dizziness.

What should I avoid while using paliperidone?

Avoid drinking alcohol. Dangerous side effects could occur.

While you are using paliperidone, you may be more sensitive to very hot conditions. Avoid becoming overheated or dehydrated. Drink plenty of fluids, especially in hot weather and during exercise.

Avoid driving or hazardous activity until you know how paliperidone will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Paliperidone side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Tell your doctor right away if you have any of these signs of a serious movement disorder:

  • tremors or shaking in your arms or legs;

  • uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement); or

  • any new or unusual muscle movements you cannot control.

Paliperidone may cause serious side effects. Call your doctor at once if you have:

  • fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);

  • trouble swallowing;

  • a seizure (convulsions);

  • breast swelling (in women or men), nipple discharge;

  • changes in menstrual periods;

  • impotence, or penis erection that is painful or lasts 4 hours or longer;

  • weight gain;

  • fever, chills, sore throat, mouth sores, feeling light-headed;

  • high blood sugar--increased thirst, increased urination, hunger, fruity breath odor; or

  • severe nervous system reaction--very stiff (rigid) muscles, high fever, fast or pounding heartbeats, fainting.

Common side effects of paliperidone may include:

  • dizziness, drowsiness;

  • cold symptoms such as stuffy nose, sneezing, sore throat;

  • feeling restless or anxious;

  • muscle stiffness, tremors or shaking;

  • uncontrolled muscle movements, trouble with walking, balance, or speech;

  • abnormal movements of your eyes;

  • weight gain;

  • upset stomach, constipation;

  • fast heart rate; or

  • pain or tenderness where the medicine was injected.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect paliperidone?

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Many drugs can affect paliperidone. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.

Popular FAQ

You should avoid the use of alcohol while being treated with Invega Sustenna (paliperidone palmitate). Combining alcohol with Invega Sustenna can increase side effects like dizziness, drowsiness, and trouble concentrating. This may also affect your ability to make decisions, think clearly, or react quickly.  Continue reading

The difference between Invega Sustenna, Invega Trinza, and Invega Hayfera is the length of time they last in the body. Invega Sustenna lasts for 1 month, Invega Trinza lasts for 3 months, and Invega Hayfera lasts for 6 months and only needs to be given twice a year. Before transitioning to Invega Hayfera, patients must be adequately treated with Invega Sustenna for at least 4 months, or Invega Trinza for at least one 3-month injection cycle. Continue reading

Before people transition to Invega Trinza, they need to have been administered Invega Sustenna for at least 4 months and tolerated it well. For a seamless transition, it is recommended that the last two doses of Invega Sustenna are the same dosage strength before starting Invega Trinza. Start Invega Trinza up to 7 days before, on, or 7 days after the day the next 1-month Invega Sustenna dose was due. Choose a starting dose of Invega Trinza that is 3.5-fold higher than the last Invega Sustenna dose. Continue reading

Before transitioning to Invega Hayfera, a person must have been administered Invega Sustenna for at least 4 months or Invega Trinza for at least one three-month cycle and tolerated either of them well. Continue reading

Invega Sustenna is administered by a healthcare professional into either the deltoid muscle of the arm or the gluteal muscle of the buttocks once a month following an initial loading dose period. Invega Sustenna is usually started with a dose of 234mg given IM, followed by 156mg IM one week later. Thereafter, monthly injections of 39mg to 234mg IM are given, depending on the condition being treated, individual dosage requirements, and how well the person tolerates Invega Sustenna. Continue reading

Invega Trinza (paliperidone palmitate) is a long-acting injection given into the muscle of your upper arm (deltoid muscle) or buttock (gluteal muscle). It is given once every 3 months for the treatment of schizophrenia. Your healthcare provider will give you this injection each time. Continue reading

View more FAQ

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.