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Invega Sustenna Side Effects

Generic Name: paliperidone

Note: This document contains side effect information about paliperidone. Some of the dosage forms listed on this page may not apply to the brand name Invega Sustenna.

In Summary

Common side effects of Invega Sustenna include: akathisia, tachycardia, and drowsiness. Other side effects include: basal ganglia disease, dyskinesia, dystonia, orthostatic hypotension, postencephalitic parkinson's disease, sialorrhea, and prolonged qt interval on ecg. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to paliperidone: oral tablet extended release

Along with its needed effects, paliperidone (the active ingredient contained in Invega Sustenna) 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 immediately if any of the following side effects occur while taking paliperidone:

More common
  • Difficulty with speaking
  • drooling
  • fast, pounding, or irregular heartbeat or pulse
  • increase in body movements
  • loss of balance control
  • muscle trembling, jerking, or stiffness
  • restlessness
  • shuffling walk
  • stiffness of the limbs
  • twisting movements of the body
  • uncontrolled movements, especially of the face, neck, and back
Less common
  • Chest pain
  • cold sweats
  • confusion
  • cough
  • difficulty with swallowing
  • dizziness
  • excessive muscle tone
  • fainting
  • inability to move the eyes
  • increased blinking or spasms of the eyelid
  • increased blood pressure
  • loss of balance control
  • mask-like face
  • muscle tension or tightness
  • pain in the arms or legs
  • slow heartbeat
  • slowed movements
  • slurred speech
  • sticking out of the tongue when not meaning to
  • tic-like (jerky) movements of the head, face, mouth, and neck
  • trembling and shaking of the fingers and hands
  • tremors
  • trouble with breathing, speaking, or swallowing
  • uncontrolled twisting movements of the neck, trunk, arms, or legs
  • unusual facial expressions
  • unusual tiredness or weakness

Some side effects of paliperidone 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:

More common
  • Absent, missed, or irregular menstrual periods
  • difficulty having a bowel movement (stool)
  • fear or nervousness
  • headache
  • inability to sit still
  • nausea
  • need to keep moving
  • sleepiness or unusual drowsiness
  • stopping of menstrual bleeding
  • vomiting
  • weight gain
Less common
  • Back pain
  • belching
  • blurred vision
  • changes in appetite
  • dry mouth
  • fever
  • heartburn
  • indigestion
  • lack or loss of strength
  • muscle aches
  • sore throat
  • stomach discomfort, upset, or pain
  • stuffy or runny nose
  • swelling or soreness of the breasts in both females and males
  • swollen tongue
  • unexpected or excess milk flow from breasts
  • upper stomach pain

For Healthcare Professionals

Applies to paliperidone: intramuscular suspension extended release, oral tablet extended release

General

EXTENDED RELEASE TABLETS: The most commonly reported side effects included sedation, extrapyramidal disorder, akathisia, and hyperkinesia.

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION: The most commonly reported side effects included akathisia, parkinsonism, insomnia, and headache.

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION: The most commonly reported side effects included increased weight, insomnia, and use of anticholinergic medications (for extrapyramidal symptoms).[Ref]

Nervous system

EXTENDED RELEASE TABLETS:
Very common (10% or more): Sedation/somnolence (up to 26%), extrapyramidal symptoms/disorder (up to 23%), akathisia (up to 17%), hyperkinesia (up to 17%), parkinsonism (up to 15%), headache (up to 14%), dystonia/acute dystonia (up to 14%), tremor (up to 12%)
Common (1% to 10%): Abnormal gait, dizziness, drooling, dysarthria, dyskinesia, hypertonia, lethargy
Uncommon (0.1% to 1%): Convulsion, disturbance in attention, dysgeusia, hypoesthesia, paresthesia, postural dizziness, syncope, tardive dyskinesia
Rare (0.01% to 0.1%): Abnormal coordination, balance disorder, cerebral ischemia, depressed level of consciousness, diabetic coma, head titubation, loss of consciousness, neuroleptic malignant syndrome, unresponsive to stimuli
Frequency not reported: Abnormal glabellar reflex, akinesia, athetosis, bradykinesia, cerebrovascular accident/disorder, cervical spasm, chorea, choreoathetosis, cogwheel rigidity, emprosthotonus, facial spasm, grand mal convulsion, hypersomnia, hypokinesia, masked facies, movement disorder, myoclonus, myotonia, opisthotonos, parkinsonian gait, parkinsonian rest tremor, pleurothotonus, restless legs syndrome, risus sardonicus, tongue paralysis, vertigo

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Very common (10% or more): Akathisia (up to 18%), parkinsonism (up to 18%), headache (up to 15%), extrapyramidal disorder (up to 12%)
Common (1% to 10%): Dizziness, dyskinesia, dystonia, hyperkinesia, sedation/somnolence, tremor
Uncommon (0.1% to 1%): Abnormal gait, bradykinesia, convulsion, disturbance in attention, drooling, dysarthria, dysgeusia, hypoesthesia, lethargy, oromandibular dystonia, paresthesia, postural dizziness, syncope, tardive dyskinesia, vertigo
Rare (0.01% to 0.1%): Abnormal coordination, balance disorder, cerebral ischemia, cerebrovascular accident/disorder, depressed level of consciousness, diabetic coma, head titubation, loss of consciousness, neuroleptic malignant syndrome, unresponsive to stimuli
Frequency not reported: Abnormal glabellar reflex, akinesia, athetosis, choreoathetosis, cogwheel rigidity, emprosthotonus, facial spasm, grand mal convulsion, hypertonia, hypokinesia, masked facies, myoclonus, myotonia, opisthotonos, oropharyngeal spasm, parkinsonian gait, parkinsonian rest tremor, pleurothotonus, restless legs syndrome, risus sardonicus, tongue paralysis, tongue spasm, transient ischemic attack

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Akathisia, dizziness, dyskinesia, dystonia, extrapyramidal disorder/symptoms, headache, hyperkinesia, parkinsonism, sedation/somnolence, tremor
Uncommon (0.1% to 1%): Abnormal gait, disturbance in attention, dysarthria, dysgeusia, hypoesthesia, paresthesia, postural dizziness, syncope, tardive dyskinesia, vertigo
Rare (0.01% to 0.1%): Balance disorder, cerebral ischemia, convulsion, depressed level of consciousness, loss of consciousness, neuroleptic malignant syndrome, unresponsive to stimuli
Frequency not reported: Abnormal coordination, abnormal glabellar reflex, akinesia, athetosis, bradykinesia, cerebrovascular accident, chorea, choreoathetosis, cogwheel rigidity, diabetic coma, drooling, emprosthotonus, facial spasm, grand mal convulsion, head titubation, hypertonia, hypokinesia, involuntary muscle contractions, lethargy, masked facies, movement disorder, myoclonus, myotonia, on and off phenomenon, opisthotonos, oromandibular dystonia, oropharyngeal spasm, parkinsonian crisis, parkinsonian gait, parkinsonian rest tremor, Parkinson's disease, pleurothotonus, restless leg syndrome, risus sardonicus, tongue paralysis, tongue spasm, transient ischemic attack[Ref]

Extrapyramidal symptoms included oculogyric crisis, muscle rigidity, musculoskeletal stiffness, nuchal rigidity, torticollis, trismus, bradykinesia, cogwheel rigidity, dyskinesia, dystonia, extrapyramidal disorder, hypertonia, hypokinesia, involuntary muscle contractions, parkinsonism gait, parkinsonism, tremor, and restlessness. Somnolence includes the terms somnolence, sedation, and hypersomnia.

Based on pooled data from 6-week fixed dose studies, the following nervous system adverse events appear to be dose-related: akathisia, dystonia, extrapyramidal disorder, hypertonia, and parkinsonism. The increased incidence occurred primarily at the 12 mg dose, although in some cases, also the 9 mg dose.[Ref]

Metabolic

EXTENDED RELEASE TABLETS:
Common (1% to 10%): Decreased appetite, decreased weight, increased appetite, increased weight
Uncommon (0.1% to 1%): Anorexia, diabetes mellitus, hyperglycemia, increased blood triglycerides, increased waist circumference, thirst
Rare (0.01% to 0.1%): Diabetic ketoacidosis, hypoglycemia, increased blood cholesterol, polydipsia, water intoxication
Frequency not reported: Hyperinsulinemia, increased c-peptide, increased fasting glucose, increased HDL, increased LDL, tetany

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Decreased appetite, decreased weight, hyperglycemia, increased blood cholesterol/low density lipoproteins/triglycerides, increased blood glucose, increased weight
Uncommon (0.1% to 1%): Anorexia, diabetes mellitus, hyperinsulinemia, increased appetite, thirst
Rare (0.01% to 0.1%): Diabetic ketoacidosis, hypoglycemia, polydipsia
Frequency not reported: Tetany, water intoxication

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Very common (10% or more): Increased weight (up to 21.3%)
Common (1% to 10%): Decreased weight, hyperglycemia, increased blood glucose
Uncommon (0.1% to 1%): Anorexia, decreased appetite, diabetes mellitus, hyperinsulinemia, increased appetite, increased blood cholesterol/triglycerides
Rare (0.01% to 0.1%)K Diabetic ketoacidosis, hypoglycemia, polydipsia, thirst
Frequency not reported: Increased waist circumference, tetany, water intoxication[Ref]

Psychiatric

EXTENDED RELEASE TABLETS:
Common (1% to 10%): Agitation, anxiety, depression, insomnia, mania, sleep disorder
Uncommon (0.1% to 1%): Anorgasmia, confusional state, decreased libido, nervousness, nightmare, psychomotor hyperactivity
Rare (0.01% to 0.1%): Blunted affect, drug withdrawal syndrome, neonatal drug withdrawal syndrome
Frequency not reported: Initial insomnia, middle insomnia, restlessness

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Very common (10% or more): Insomnia (up to 15%), agitation (up to 10%)
Common (1% to 10%): Anxiety, auditory hallucinations, depression, nightmare, suicidal ideation
Uncommon (0.1% to 1%): Confusional state, decreased libido, mania, nervousness, psychomotor hyperactivity, restlessness, sleep disorder
Rare (0.01% to 0.1%): Anorgasmia, blunted affect, drug withdrawal syndrome
Frequency not reported: Initial insomnia, middle insomnia, neonatal drug withdrawal syndrome, psychotic disorder, schizophrenia

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Agitation, anxiety, depression, insomnia, schizophrenia
Uncommon (0.1% to 1%): Blunted affect, decreased libido, irritability, nervousness, nightmare, psychomotor hyperactivity, sleep disorder
Rare (0.01% to 0.1%): Anorgasmia, confusional state, drug withdrawal syndrome, mania
Frequency not reported: Initial insomnia, middle insomnia, neonatal drug withdrawal syndrome, restlessness, suicidal ideation[Ref]

Cardiovascular

In a QT study evaluating the effect of immediate-release oral paliperidone (the active ingredient contained in Invega Sustenna) 8 mg (n=50), a mean placebo-subtracted increase from baseline on day 8 at 1.5 hours postdose was 12.3 milliseconds (ms). The mean steady-state peak plasma concentration achieved with immediate-release paliperidone was determined to be more than twice the exposure expected with the recommended 12 mg dose. None of the subjects had a QTc interval exceeding 60 ms. According to the phase 3 safety database which included double-blind and open-label extension studies (n=2054), 2 patients experienced QTc interval prolongation greater than 500 ms.

In placebo controlled trials with oral paliperidone, orthostatic hypotension increased with increasing doses, primarily at the 12 mg per day dose.[Ref]

EXTENDED RELEASE TABLETS:
Very common (10% or more): Tachycardia (up to 14%)
Common (1% to 10%): Bradycardia, bundle branch block, first-degree atrioventricular block/atrioventricular block, conduction disorder, electrocardiogram QT prolonged, hypertension, orthostatic hypotension, sinus arrhythmia, sinus tachycardia
Uncommon (0.1% to 1%): Abnormal electrocardiogram, chest discomfort/pain, edema, hypotension, palpitations
Rare (0.01% to 0.1%): Atrial fibrillation, flushing, ischemia, postural orthostatic tachycardia syndrome, venous thrombosis/thromboembolism
Frequency not reported: Cardiac arrest, generalized edema, increased blood pressure, increased heart rate, peripheral edema, pitting edema, Torsade de pointes, ventricular arrhythmia, ventricular tachycardia
Postmarketing reports: Deep vein thrombosis

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Bradycardia, electrocardiogram QT prolonged, hypertension, tachycardia/sinus tachycardia/increased heart rate
Uncommon (0.1% to 1%): Abnormal electrocardiogram, atrioventricular block, chest discomfort/pain, conduction disorder, edema, hypotension, orthostatic hypotension, palpitations, postural orthostatic tachycardia syndrome
Rare (0.01% to 0.1%): Atrial fibrillation, flushing, sinus arrhythmia, venous thrombosis/thromboembolism
Frequency not reported: Bundle branch block, cardiac arrest, deep vein thrombosis, first-degree atrioventricular block/atrioventricular block, generalized edema, ischemia, left bundle branch block, peripheral edema, pitting edema, Torsade de pointes, ventricular arrhythmia, ventricular fibrillation, ventricular tachycardia

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Bradycardia, hypertension, tachycardia/sinus tachycardia
Uncommon (0.1% to 1%): Abnormal electrocardiogram, atrioventricular block, chest discomfort/pain, conduction disorder, edema, electrogram QT prolonged, hypotension, orthostatic hypotension, palpitations, postural orthostatic tachycardia syndrome
Rare (0.01% to 0.1%): Atrial fibrillation, flushing, sinus arrhythmia, venous thrombosis/thromboembolism
Frequency not reported: Bundle branch block, cardiac arrest, deep vein thrombosis, first-degree atrioventricular block, generalized edema, ischemia, left bundle branch block, peripheral edema, pitting edema, Torsade de pointes, ventricular arrhythmias, ventricular fibrillation, ventricular tachycardia[Ref]

Other

EXTENDED RELEASE TABLETS:
Common (1% to 10%): Asthenia, fatigue, pyrexia
Uncommon (0.1% to 1%): Chills, ear infection, ear pain, falls, increased body temperature, malaise, tinnitus
Rare (0.01% to 0.1%): Decreased body temperature, hypothermia
Frequency not reported: Sudden unexplained death

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Asthenia, fatigue, pain, pyrexia
Uncommon (0.1% to 1%): Ear infection, ear pain, increased body temperature, malaise, tinnitus
Rare (0.01% to 0.1%): Chills, decreased body temperature, hypothermia
Frequency not reported: Fall, sudden unexplained death

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Very common (10% or more): Use of anticholinergic medications (up to 11%)
Common (1% to 10%): Asthenia, fatigue, pyrexia
Uncommon (0.1% to 1%): Ear infection, ear pain, fall, increased body temperature, malaise, tinnitus
Rare (0.01% to 0.1%): Chills, hypothermia
Frequency not reported: Decreased body temperature, sudden unexplained death[Ref]

Gastrointestinal

EXTENDED RELEASE TABLETS:
Very common (10% or more): Vomiting (up to 11%)
Common (1% to 10%): Abdominal discomfort/pain, constipation, diarrhea, dry mouth, dyspepsia, nausea, salivary hypersecretion, stomach discomfort, toothache, upper abdominal pain
Uncommon (0.1% to 1%): Dysphagia, flatulence, gastroenteritis, swollen tongue
Rare (0.01% to 0.1%): Cheilitis, fecal incontinence, fecaloma, ileus, intestinal obstruction, pancreatitis
Frequency not reported: Difficulty swallowing, tongue protrusion, tongue spasm, upper abdominal pain/discomfort/stomach discomfort

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Abdominal discomfort/pain, constipation, diarrhea, dry mouth, dyspepsia, gastroesophageal reflux disease, nausea, swallowing difficulty, toothache, vomiting
Uncommon (0.1% to 1%): Dysphagia, flatulence, gastroenteritis, salivary hypersecretion
Rare (0.01% to 0.1%): Cheilitis, fecaloma, fecal incontinence, pancreatitis, swollen tongue
Frequency not reported: Ileus, intestinal obstruction, small intestinal obstruction

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Abdominal pain, constipation, diarrhea, dyspepsia, nausea, toothache, vomiting
Uncommon (0.1% to 1%): Abdominal discomfort, dry mouth, dysphagia, flatulence, gastroenteritis
Rare (0.01% to 0.1%): Cheilitis, difficulty swallowing, fecaloma, fecal incontinence, pancreatitis, swollen tongue
Frequency not reported: Ileus, intestinal obstruction, salivary hypersecretion, small intestinal obstruction, tongue protrusion, upper abdominal pain[Ref]

Local

Redness and swelling were observed in 2% or less of patients receiving the 3-month IM extended-release suspension. Residual injection pain peaked 1 or 6 hours after injection and trended downward 3 days after the injection. Deltoid injections were numerically more painful than gluteal injections.[Ref]

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Very common (10% or more): Injection site reactions (up to 10%)
Common (1% to 10%):
Rare (0.01% to 0.1%): Injection site abscess, injection site cellulitis, injection site cyst, injection site hematoma/bruising
Frequency not reported: Injection site extravasation, injection site induration, injection site irritation/pruritus/erythema/discomfort, injection site joint pain, injection site mass, injection site necrosis, injection site nodule, injection site pain, injection site swelling/edema/inflammation, injection site ulcer

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Injection site induration, injection site pain, injection site reaction
Rare (0.01% to 0.1%): Injection site abscess, injection site cellulitis, injection site cyst, injection site hematoma
Frequency not reported: Injection site erythema, injection site extravasation, injection site inflammation, injection site necrosis, injection site nodule/mass, injection site ulcer[Ref]

Musculoskeletal

EXTENDED RELEASE TABLETS:
Common (1% to 10%): Arthralgia, back pain, extremity pain, musculoskeletal pain, musculoskeletal stiffness, myalgia
Uncommon (0.1% to 1%): Increased blood creatine phosphokinase, joint stiffness/swelling, muscle spasms, muscular weakness, neck pain
Rare (0.01% to 0.1%): Abnormal posture, rhabdomyolysis
Frequency not reported: Involuntary muscle contractions, muscle contracture, muscle rigidity/tightness/twitching, neck muscle spasm, nuchal rigidity, torticollis, trismus

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Arthralgia, back pain, musculoskeletal pain
Uncommon (0.1% to 1%): Increased blood creatine phosphokinase, joint stiffness, muscle rigidity/tightness, muscle spasms/twitching, muscular weakness, neck pain
Rare (0.01% to 0.1%): Abnormal posture, joint swelling, nuchal rigidity, rhabdomyolysis
Frequency not reported: Involuntary muscle contractions, muscle contracture, musculoskeletal stiffness, neck muscle spasm, torticollis, trismus

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Arthralgia, back pain, musculoskeletal pain
Uncommon (0.1% to 1%): Increased blood creatine phosphokinase, joint stiffness, muscle spasms/twitching, muscular weakness, neck pain
Rare (0.01% to 0.1%): Joint swelling
Frequency not reported: Abnormal posture, cervical spasm, extremity pain, muscle contracture, muscle rigidity, muscle tightness, musculoskeletal stiffness, myalgia, neck muscle spasm, nuchal rigidity, rhabdomyolysis, torticollis, trismus[Ref]

Respiratory

EXTENDED RELEASE TABLETS:
Common (1% to 10%): Bronchitis, cough, epistaxis, nasal congestion, nasopharyngitis, pharyngolaryngeal pain, rhinitis, sinusitis, upper respiratory tract infection
Uncommon (0.1% to 1%): Dyspnea, pneumonia, respiratory tract infection, tonsillitis, wheezing
Rare (0.01% to 0.1%): Aspiration pneumonia, dysphonia, hyperventilation, pulmonary embolism, respiratory tract congestion, sleep apnea syndrome
Frequency not reported: Difficulty breathing, laryngospasm, nasal congestion, oropharyngeal spasm, pulmonary congestion, rales, throat tightness

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Cough, dyspnea, nasal congestion, nasopharyngitis, oropharyngeal pain, upper respiratory tract infection
Uncommon (0.1% to 1%): Bronchitis, epistaxis, pharyngolaryngeal pain, pneumonia, respiratory tract congestion, respiratory tract infection, sinusitis, tonsillitis, wheezing
Rare (0.01% to 0.1%): Pulmonary congestion syndrome, rales, sleep apnea syndrome
Frequency not reported: Aspiration pneumonia, difficulty breathing, dysphonia, hyperventilation, laryngospasm, pulmonary embolism, rhinitis, rhinorrhea, throat tightness, tongue protrusion

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Cough, nasal congestion, nasopharyngitis, upper respiratory tract infection
Uncommon (0.1% to 1%): Bronchitis, dyspnea, epistaxis, pharyngolaryngeal pain, pneumonia, respiratory tract infection, sinusitis, tonsillitis
Rare (0.01% to 0.1%): Pulmonary congestion, respiratory tract congestion, sleep apnea syndrome, wheezing
Frequency not reported: Aspiration pneumonia, difficulty breathing, dysphonia, hyperventilation, laryngospasm, pharyngitis, pulmonary embolism, rales, rhinitis, throat tightness[Ref]

Genitourinary

EXTENDED RELEASE TABLETS:
Common (1% to 10%): Amenorrhea, galactorrhea, urinary tract infection
Uncommon (0.1% to 1%): Breast discomfort/pain/tenderness, dysuria, ejaculation disorder, erectile dysfunction, menstrual disorder, pollakiuria, sexual dysfunction, urinary incontinence, urinary retention
Rare (0.01% to 0.1%): Breast discharge/engorgement/enlargement, delayed menstruation, priapism, vaginal discharge
Frequency not reported: Breast swelling, irregular menstruation, menstrual disturbances, oligomenorrhea, retrograde ejaculation

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Amenorrhea, galactorrhea, urinary tract infection
Uncommon (0.1% to 1%): Breast pain, delayed menstruation, dysuria, ejaculation disorder, erectile dysfunction, irregular menstruation, menstrual disorder, pollakiuria, sexual dysfunction, urinary incontinence, vaginal discharge
Rare (0.01% to 0.1%): Breast discharge, breast discomfort/engorgement/enlargement, urinary retention
Frequency not reported: Oligomenorrhea, priapism, retrograde ejaculation

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Amenorrhea, menstrual disorder, urinary tract infection
Uncommon (0.1% to 1%): Breast discomfort/pain, delayed menstruation, dysuria, ejaculation disorder, erectile dysfunction, galactorrhea, pollakiuria, sexual dysfunction, urinary incontinence
Rare (0.01% to 0.1%): Breast engorgement/enlargement, urinary retention, vaginal discharge
Frequency not reported: Breast discharge, delayed menstruation, irregular menstruation, oligomenorrhea, priapism, retrograde ejaculation[Ref]

Galactorrhea, amenorrhea, and impotence have been reported in patients receiving prolactin-elevating compounds.[Ref]

Dermatologic

EXTENDED RELEASE TABLETS:
Common (1% to 10%): Pruritus, rash
Uncommon (0.1% to 1%): Acne, alopecia, eczema, face edema, urticaria
Rare (0.01% to 0.1%): Acrodermatitis, cellulitis, dandruff, drug eruption, dry skin, erythema, hyperkeratosis, induration, onychomycosis, seborrheic dermatitis, skin discoloration

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Skin laceration
Uncommon (0.1% to 1%): Acrodermatitis, acne, alopecia, cellulitis, dry skin, eczema, erythema, face edema, generalized pruritus, induration, onychomycosis, pruritus, rash, subcutaneous abscess, urticaria
Rare (0.01% to 0.1%): Dandruff, drug eruption, hyperkeratosis, seborrheic dermatitis, skin discoloration
Frequency not reported: Papular rash
Postmarketing reports: Hyperhidrosis, thrombotic thrombocytopenic purpura

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Rash
Uncommon (0.1% to 1%): Acrodermatitis, acne, alopecia, cellulitis, dry skin, eczema, erythema, face edema, induration, onychomycosis, pruritus, urticaria
Rare (0.01% to 0.1%): Dandruff, drug eruption, hyperkeratosis, subcutaneous abscess
Frequency not reported: Generalized pruritus, induration, papular rash, seborrheic dermatitis, skin discoloration
Postmarketing reports: Thrombotic thrombocytopenic purpura[Ref]

Hepatic

EXTENDED RELEASE TABLETS:
Common (1% to 10%): Increased transaminases (ALT, AST)
Uncommon (0.1% to 1%): Gamma-glutamyltransferase increased, increased hepatic enzymes
Rare (0.01% to 0.1%): Jaundice

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Increased transaminases (AST, ALT)
Uncommon (0.1% to 1%): Gamma-glutamyltransferase increased, increased hepatic enzymes
Frequency not reported: Jaundice

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Increased transaminases
Uncommon (0.1% to 1%): Gamma-glutamyltransferase increased, increased hepatic enzymes
Frequency not reported: Jaundice[Ref]

Immunologic

EXTENDED RELEASE TABLETS:
Common (1% to 10%): Influenza

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Influenza

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Influenza[Ref]

Ocular

EXTENDED RELEASE TABLETS:
Common (1% to 10%): Blurred vision, oculogyric crisis
Uncommon (0.1% to 1%): Conjunctivitis, dry eye, photophobia
Rare (0.01% to 0.1%): Eye infection, eye movement disorder, eye rolling, glaucoma, increased lacrimation, ocular hyperemia
Frequency not reported: Blepharospasm, intraoperative floppy iris syndrome, oculogyration

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Eye swelling
Uncommon (0.1% to 1%): Blurred vision, conjunctivitis, dry eye, eye infection
Rare (0.01% to 0.1%): Eye movement disorder, eye rolling, glaucoma, increased lacrimation, ocular hyperemia, photophobia
Frequency not reported: Blepharospasm, intraoperative floppy iris syndrome, oculogyration, oculogyric crisis

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Uncommon (0.1% to 1%): Blurred vision, conjunctivitis, dry eye, increased lacrimation
Rare (0.01% to 0.1%): Eye infection, eye movement disorder, eye rolling, glaucoma, ocular hyperemia, photophobia
Frequency not reported: Blepharospasm, intraoperative floppy iris syndrome, oculogyration, oculogyric crisis[Ref]

Endocrine

Paliperidone (the active ingredient contained in Invega Sustenna) has a prolactin-elevating effect similar to that seen with risperidone. Risperidone is associated with higher levels of prolactin elevation than other antipsychotic drugs.

Hyperprolactinemia may suppress hypothalamic gonadotropin-releasing hormone (GnRH), resulting in reduced pituitary gonadotropin secretion and in turn inhibit reproductive function by impairing gonadal steroidogenesis. Gynecomastia has been reported in patients receiving prolactin-elevating compounds.[Ref]

EXTENDED RELEASE TABLETS:
Uncommon (0.1% to 1%): Hyperprolactinemia
Rare (0.01% to 0.1%): Gynecomastia, inappropriate antidiuretic hormone secretion
Frequency not reported: Increased serum prolactin

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Common (1% to 10%): Hyperprolactinemia
Uncommon (0.1% to 1%): Gynecomastia
Rare (0.01% to 0.1%): Inappropriate antidiuretic hormone secretion

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Uncommon (0.1% to 1%): Gynecomastia, hyperprolactinemia
Rare (0.01% to 0.1%): Inappropriate antidiuretic hormone secretion[Ref]

Hematologic

EXTENDED RELEASE TABLETS:
Uncommon (0.1% to 1%): Anemia, decreased hematocrit, decreased white blood cell count, thrombocytopenia
Rare (0.01% to 0.1%): Agranulocytosis, increased eosinophil count, neutropenia

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Uncommon (0.1% to 1%): Anemia, decreased hematocrit, decreased white blood cell count, increased eosinophil count, thrombocytopenia
Rare (0.01% to 0.1%): Neutropenia
Frequency not reported: Agranulocytosis
Postmarketing reports: Granulocytopenia, leukopenia

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Uncommon (0.1% to 1%): Anemia, decreased white blood cell count, neutropenia, thrombocytopenia
Rare (0.01% to 0.1%): Increased eosinophil count
Frequency not reported: Agranulocytosis[Ref]

Hypersensitivity

There have been postmarketing reports of anaphylactic reaction in patients receiving long-acting injection who had previously tolerated oral risperidone or oral paliperidone (the active ingredient contained in Invega Sustenna) [Ref]

EXTENDED RELEASE TABLETS:
Rare (0.01% to 0.1%): Anaphylactic reaction, angioedema, hypersensitivity

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Uncommon (0.1% to 1%): Hypersensitivity
Frequency not reported: Anaphylactic reaction, angioedema
Postmarketing reports: Anaphylactic shock, anaphylaxis

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Uncommon (0.1% to 1%): Hypersensitivity
Frequency not reported: Anaphylactic reaction, angioedema[Ref]

Renal

EXTENDED RELEASE TABLETS:
Uncommon (0.1% to 1%): Cystitis
Rare (0.01% to 0.1%): Presence of glucose in urine

1-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Uncommon (0.1% to 1%): Cystitis
Rare (0.01% to 0.1%): Presence of glucose in urine

3-MONTH EXTENDED-RELEASE INJECTABLE SUSPENSION:
Uncommon (0.1% to 1%): Cystitis, presence of glucose in urine[Ref]

References

1. "Product Information. Invega (paliperidone)." Janssen Pharmaceuticals, Titusville, NJ.

2. Cerner Multum, Inc. "Australian Product Information." O 0

3. "Product Information. Invega Sustenna (paliperidone)." Janssen Pharmaceuticals, Titusville, NJ.

4. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

5. "Product Information. Invega Trinza (paliperidone)." Janssen Pharmaceuticals, Titusville, NJ.

Some side effects of Invega Sustenna may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

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