Invega Sustenna (paliperidone palmitate) is a prescription drug that’s used to treat schizophrenia and schizoaffective disorder. Invega Sustenna is given as an injection into your muscle by a healthcare professional.
To learn more about Invega Sustenna’s uses, see the “What is Invega Sustenna used for?” section.
Invega Sustenna basics
Invega Sustenna contains the active ingredient paliperidone palmitate. It belongs to a group of drugs called antipsychotics.
Invega Sustenna is a brand-name medication. A generic version of the drug isn’t currently available.
Invega Sustenna has a boxed warning. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the “What should be considered before receiving Invega Sustenna?” section.
Your doctor will recommend the dosage of Invega Sustenna that’s right for you. Below are commonly used dosages, but the dosage you receive will be determined by your doctor.
Form and strengths
Invega Sustenna comes as a liquid solution that’s given as an injection into your muscle by your doctor or another healthcare professional.
Invega Sustenna is available in the following strengths:
- 39 milligrams in 0.25 milliliters of liquid suspension (mg/mL)
- 78 mg/0.5 mL
- 117 mg/0.75 mL
- 156 mg/mL
- 234 mg/1.5 mL
Recommended dosages
Invega Sustenna is used for adults with schizophrenia or schizoaffective disorder. Your first two doses of Invega Sustenna are loading doses. This means that a larger amount is given initially to help the drug start working right away. After that, you’ll begin receiving a maintenance (long-term) dose.
The following table includes commonly used dosages for each condition. However, your doctor will determine the dosage you’ll receive.
| Condition | Starting dosage | Maintenance dosage |
|---|---|---|
| schizophrenia | 234 mg given once, then 156 mg given 1 week later | 39 to 234 mg given once monthly, starting 5 weeks after the first dose |
| schizoaffective disorder | 234 mg given once, then 156 mg given 1 week later | 78 to 234 mg given once monthly, starting 5 weeks after the first dose |
Depending on your situation, your doctor may temporarily prescribe a different antipsychotic drug before Invega Sustenna. Examples include oral paliperidone (Invega) and oral risperidone (Risperdal). They’ll do this to see how your body reacts to drugs that are similar to Invega Sustenna.
Details about Invega Sustenna administration
Your doctor will explain how Invega Sustenna will be given to you. They’ll also explain how much you’ll be given and how often.
Invega Sustenna comes as a liquid solution that’s given as an injection into your muscle. You’ll receive these injections at your doctor’s office or a clinic.
To learn more about how you’ll receive Invega Sustenna, talk with your doctor.
Questions about receiving Invega Sustenna
Below are some common questions about receiving Invega Sustenna.
- What if I miss a dose of Invega Sustenna? How a missed dose of Invega Sustenna is handled depends on certain factors. These include how many weeks have passed since your last injection and how many doses you’ve received. If you miss an appointment to receive your Invega Sustenna injection, call your doctor’s office. They’ll recommend next steps and help you reschedule your appointment.
- Will I need to use Invega Sustenna long term? Invega Sustenna is typically used as a long-term treatment. If you and your doctor determine that it’s safe and effective for your condition, you’ll likely receive it long term.
- How long does Invega Sustenna take to work? Invega Sustenna begins to work after your first injection. But it may take several weeks for the drug to fully work for your condition. If you have questions about what to expect from treatment with Invega Sustenna, talk with your doctor.
Invega Sustenna is used to treat schizophrenia and schizoaffective disorder in adults.
Schizophrenia: This mental health condition affects behaviors, emotions, and thoughts. Schizophrenia may cause symptoms such as hallucinations and difficulty with concentration or speech.
Schizoaffective disorder: This mental health condition includes features of schizophrenia and a mood disorder, such as bipolar disorder. Along with schizophrenia symptoms, this condition may cause episodes of high energy or depression.
To treat these conditions, Invega Sustenna may be used by itself or with other drugs for mood disorders. Examples include mood stabilizers and antidepressants.
It’s not fully known how Invega Sustenna works to treat these conditions. However, it’s thought that the drug may affect the levels of certain chemicals in the brain. In doing so, the drug may help manage symptoms of schizophrenia and schizoaffective disorder.
Like most drugs, Invega Sustenna may cause mild to serious side effects. The lists below contain some of the more common side effects Invega Sustenna may cause, but they don’t include all possible side effects.
Keep in mind that side effects of a drug can depend on:
- your age
- other health conditions you have
- other medications you take
Your doctor or pharmacist can tell you more about the potential side effects of Invega Sustenna. They can also suggest ways to help reduce side effects.
Mild side effects
Here’s a list of some of the mild side effects that Invega Sustenna can cause. To learn about other mild side effects, talk with your doctor or pharmacist or read Invega Sustenna’s prescribing information.
Mild side effects of Invega Sustenna that have been reported include:
- sleepiness
- injection site reactions, such as swelling or pain
- dizziness
- headache
- upper respiratory tract infection
Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.
Serious side effects
Serious side effects from Invega Sustenna can occur, but they aren’t common. If you have serious side effects from Invega Sustenna, call your doctor right away. But if you think you’re having a medical emergency, you should call 911 or your local emergency number.
Serious side effects of Invega Sustenna that have been reported include:
- changes in metabolism (chemical processes in your body), which may lead to:
- low level of white blood cells
- high prolactin levels
- orthostatic hypotension (a sudden drop in blood pressure when standing up)
- extrapyramidal symptoms (a group of movement disorders), which may include:
- akathisia (restlessness)
- tardive dyskinesia (repetitive movements that typically affect your face)
- parkinsonism (repetitive movements that typically affect your whole body)
- long QT syndrome (a type of irregular heart rhythm)
- neuroleptic malignant syndrome (a rare reaction to medication that affects your nervous system)
- priapism (painful and long-lasting erection)
- seizures
- difficulty with movement or thinking, which may affect your ability to drive
- difficulty swallowing
- difficulty managing your body temperature
- boxed warning: increased risk of death in older adults with dementia-related psychosis*
* For more information, see the “What should be considered before receiving Invega Sustenna?” section.
ALLERGIC REACTIONFor some people, Invega Sustenna can cause an allergic reaction. But it’s not clear whether this side effect occurred in the drug’s studies.
In general, symptoms of allergic reaction can be mild or serious.
What might help
If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms and can determine whether you should continue receiving Invega Sustenna.
If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.
If your doctor confirms you’ve had a serious allergic reaction to Invega Sustenna, they may have you switch to a different treatment.
Below is important information you should consider before receiving Invega Sustenna.
Interactions
Taking a drug with certain medications, vaccines, foods, and other things can affect how the drug works. These effects are called interactions.
Invega Sustenna can interact with several other medications and certain supplements. But the drug is not known to interact with any foods.
Before starting Invega Sustenna treatment, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also, tell them about any vitamins, herbs, and supplements you take. Sharing this information can help you avoid potential interactions.
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
Drug interactions
The following table lists medications that can interact with Invega Sustenna. This list does not contain all drugs that may interact with Invega Sustenna. If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
| Drug group or drug name | Drug examples |
|---|---|
| certain other antipsychotic drugs | • thioridazine • chlorpromazine |
| certain Parkinson’s drugs | • carbidopa/levodopa (Rytary, Sinemet, others) • levodopa (Inbrija) |
| certain irregular heart rhythm drugs | • amiodarone (Nexterone, Pacerone) • quinidine |
| certain seizure drugs | • carbamazepine (Carbatrol, Tegretol, others) • phenytoin (Dilantin, Phenytek) |
| certain antibiotics | • azithromycin • levofloxacin |
| muscle relaxers | • carisoprodol (Soma) • metaxolone |
| blood pressure drugs | • amlodipine (Norliqva, Norvasc, others) • metoprolol (Lopressor, Toprol XL, others) |
| benzodiazepines | • alprazolam (Xanax) • lorazepam (Ativan, Loreev XR) |
Invega Sustenna and alcohol
It may not be safe to consume alcohol during your Invega Sustenna treatment. This is because alcohol may worsen certain side effects of the drug, such as sleepiness or dizziness. For this reason, your doctor may advise you to avoid alcohol while you’re receiving Invega Sustenna.
If you have other questions about Invega Sustenna and alcohol, talk with your doctor.
Other interactions
Invega Sustenna can interact with St. John’s wort supplements, which are used to ease symptoms of depression and other conditions. Taking this supplement with Invega Sustenna could make Invega Sustenna less effective.
Because of this, your doctor will likely recommend that you avoid taking St. John’s wort during your Invega Sustenna treatment.
Pregnancy and breastfeeding
It’s not known whether it’s safe to receive Invega Sustenna during pregnancy or while breastfeeding.
If given during the last 3 months of pregnancy, Invega Sustenna may increase the risk of side effects in infants after birth. Examples include agitation and difficulty feeding.
If your doctor prescribes Invega Sustenna during pregnancy, they may advise you to join the drug’s pregnancy registry. This registry collects information on how Invega Sustenna may affect pregnancy. To learn more, call 866-961-2388 or visit the registry website.
Invega Sustenna may also pass into breast milk. This could cause side effects, such as tremors and sleepiness, in a child who is breastfed.
If you’re pregnant, breastfeeding, or planning for either, talk with your doctor before starting Invega Sustenna treatment.
Boxed warning
Invega Sustenna has a boxed warning. A boxed warning is the most serious warning from the Food and Drug Administration (FDA) about drug effects that may be dangerous.
Invega Sustenna may increase the risk of death in adults ages 65 years and older who have dementia-related psychosis. Dementia is a condition that affects communication, memory, and thinking. Psychosis is a mental health condition that may lead to a loss of touch with reality.
This risk was not reported in the drug’s studies, but it may occur with antipsychotic drugs. (Invega Sustenna is an antipsychotic drug.)
Antipsychotics may also increase the risk of stroke in older adults with dementia-related psychosis. In some cases, a stroke can be fatal. Symptoms of a stroke may include confusion, headache, and weakness on one side of your body.
If you have stroke symptoms after an Invega Sustenna injection, call 911 or your local emergency number right away.
Due to these risks, doctors typically will not prescribe Invega Sustenna for older adults with dementia-related psychosis. Your doctor can recommend other treatments for this condition.
Other warnings
Invega Sustenna can sometimes cause harmful effects in people who have certain conditions. This is known as a drug-condition interaction. Other factors may also affect whether Invega Sustenna is a good treatment option for you.
Talk with your doctor about your health history before you receive Invega Sustenna. Be sure to tell them if any of the following factors apply to you:
- cerebrovascular disease
- Lewy body dementia or Parkinson’s disease
- diabetes or high blood sugar
- heart or blood pressure problems
- low blood levels of magnesium or potassium
- high levels of triglycerides or cholesterol
- seizures
- kidney or liver problems
- previous allergic reaction to Invega Sustenna
- pregnancy
- breastfeeding
Whether you have health insurance or not, cost may be a factor when you’re considering Invega Sustenna. What you’ll pay for Invega Sustenna may depend on several factors, including your treatment plan.
If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. A program called Janssen CarePath may offer an insurance copay card and other savings opportunities.
Learn more about saving on your prescriptions.
Other drugs are available that can treat schizophrenia or schizoaffective disorder. If you’d like to explore an alternative to Invega Sustenna, talk with your doctor. They can tell you about other medications that might work well for you.
The following drugs are similar to Invega Sustenna:
- other forms of paliperidone (Erzofri, Invega, others)
- aripiprazole (Abilify Maintena, Aristada, others)
- olanzapine (Zyprexa)
- risperidone (Risperdal Consta, Rykindo, others)
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.