From the Research
Reducing paliperidone (Invega) 3mg should be done gradually under medical supervision, typically decreasing by one quarter of the most recent dose, equivalent to a reduction of 5 percentage points of its D2 blockade, at intervals of 3-6 months, titrated to individual tolerance, as suggested by the most recent study 1.
Tapering Process
To minimize withdrawal symptoms and reduce the risk of psychosis relapse, it is essential to taper paliperidone slowly. The process involves:
- Decreasing the dose by one quarter of the most recent dose, which is equivalent to a reduction of 5 percentage points of its D2 blockade
- Reducing the dose at intervals of 3-6 months
- Titration to individual tolerance
- Maintaining regular contact with the healthcare provider to monitor for any symptom recurrence or withdrawal effects
Importance of Gradual Reduction
The gradual reduction allows the brain to adjust to decreasing levels of the medication, as paliperidone works by blocking dopamine and serotonin receptors. If troublesome symptoms occur during the taper, the doctor might slow the reduction rate or temporarily return to a slightly higher dose before proceeding more slowly.
Key Considerations
- Never stop paliperidone suddenly, as this can cause withdrawal symptoms like insomnia, anxiety, nausea, and potentially psychotic symptoms
- The tapering process should be individualized, taking into account the patient's tolerance and response to the dose reduction
- Regular monitoring by the healthcare provider is crucial to ensure a safe and effective tapering process
Evidence-Based Recommendation
The recommendation to taper paliperidone gradually is based on the most recent study 1, which suggests that a gradual reduction in dose can minimize the risk of relapse and withdrawal symptoms. This approach is also supported by other studies, including 2, which reported a case of a patient with schizophrenia who showed reduced drug-induced extrapyramidal symptoms with an alternative regimen of treatment with paliperidone 3 and 6 mg every other day. However, the most recent and highest-quality study 1 provides the strongest evidence for the recommended tapering process.