From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
To decrease the oral Invega (paliperidone) dose, work closely with your prescribing healthcare provider to develop a gradual tapering schedule, typically reducing by 3 mg increments every 2-4 weeks, as supported by the most recent study on antipsychotic dose reduction 1. When considering a dose reduction, it's essential to take into account the risk factors for psychotic relapse, such as younger age and short follow-up time, as identified in the study 1. The study suggests that a gradual tapering schedule can help minimize the risk of relapse, and that a minimum dose of 3-5 mg haloperidol equivalent (HE) may be necessary to maintain therapeutic efficacy 1. Some key points to consider when decreasing the oral Invega dose include:
- Gradually reducing the dose by 3 mg increments every 2-4 weeks to allow the brain to adjust to decreasing levels of the medication
- Monitoring for any changes in mental health symptoms and reporting them to the healthcare provider immediately
- Avoiding sudden stops or reductions in Invega, as this can cause withdrawal symptoms or symptom recurrence
- Considering more frequent appointments during the tapering process to closely monitor the patient's response to the dose reduction
- Being aware that some patients may need an even slower taper depending on their individual response, medication history, and the reason for the dose reduction, as noted in the study on paliperidone pharmacokinetics and metabolism 2. It's also important to note that the pharmacokinetic profile of paliperidone is dose-proportional, with a terminal half-life of approximately 23 hours, and that renal excretion is the major route of elimination 2. Overall, a gradual and closely monitored dose reduction schedule is recommended to minimize the risk of relapse and ensure the patient's safety and well-being, as supported by the study on the risk factors for psychotic relapse after dose reduction or discontinuation of antipsychotics 1.