Invega Sustenna Side Effects

Generic name: paliperidone

Medically reviewed by Drugs.com. Last updated on Mar 31, 2025.

Note: This document provides detailed information about Invega Sustenna Side Effects associated with paliperidone. Some dosage forms listed on this page may not apply specifically to the brand name Invega Sustenna.

Applies to paliperidone: oral tablet extended release.

Other dosage forms:

• intramuscular suspension extended release

Precautions

It is very important that your doctor check you or your child's progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for any unwanted effects.

This medicine 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 or your child have difficulty with breathing, fast heartbeat, high fever, high or low blood pressure, increased sweating, loss of bladder control, seizures, severe muscle stiffness, unusually pale skin, or tiredness. These could be symptoms of a serious condition called neuroleptic malignant syndrome (NMS).

This medicine may cause tardive dyskinesia (a movement disorder). Check with your doctor right away if you or your child have 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.

This medicine may increase the amount of sugar in your blood. Check with your doctor right away if you or your child have blurred vision, dry mouth, flushed, dry skin, increased hunger, increased thirst or urination, nausea, sweating, trouble breathing, unexplained weight loss, unusual tiredness or weakness, or vomiting. If you have diabetes, you may notice a change in the results of your urine or blood sugar tests. If you have any questions, check with your doctor.

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.

This medicine can cause changes in heart rhythm, including 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 or your child have any symptoms of heart rhythm problems, such as dizziness, feeling faint, or a fast, pounding, or irregular heartbeat.

Paliperidone 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 get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.

This medicine 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 this medicine affects you.

Check with your doctor before using this medicine 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 this medicine, including 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.

This medicine 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 using paliperidone (the active ingredient contained in Invega Sustenna) If you become too cold, you may feel drowsy, confused, or clumsy.

This medicine may increase your or your child's weight. Your doctor may need to check your or your child's weight on a regular basis while you are using this medicine.

This medicine 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.

If you plan to have children, talk with your doctor before using this medicine. Some women using this medicine 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.

Serious side effects of Invega Sustenna

Along with its needed effects, paliperidone 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:

Other side effects of Invega Sustenna

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:

For healthcare professionals

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

General adverse events

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

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]

In a QT study evaluating the effect of immediate-release oral paliperidone 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]

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

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]

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]

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

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]

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]

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

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]

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]

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]

See also:

Frequently asked questions

• How long does Invega Sustenna take to work?
• Can you drink alcohol while taking Invega Sustenna?
• Invega Sustenna vs Invega Trinza vs Invega Hafyera. What's the difference?
• How to transition to Invega Trinza from Invega Sustenna ?
• Does Invega Sustenna need to be refrigerated?
• How do you give an Invega Sustenna injection?
• How to transition to Invega Hayfera from Invega Trinza or Invega Sustenna?

Further information

Invega Sustenna side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer