From the Research
Tapering oral paliperidone (Invega) 0.25mg daily should be done gradually over several months, reducing the dose by one quarter of the most recent dose every 3-6 months, to minimize withdrawal symptoms and risk of relapse. This approach is supported by the most recent and highest quality study 1, which suggests that slower tapering of antipsychotics is associated with a lower relapse rate than quicker tapering. The study also notes that smaller dose reductions, especially at lower doses, made very gradually, may minimize the risk of psychotic symptoms.
Key Considerations
- The patient's dose is already relatively low, so complete discontinuation may be achievable with a gradual taper
- Regular follow-up appointments are essential to assess for signs of relapse, withdrawal symptoms such as insomnia, anxiety, or psychotic symptoms
- Paliperidone has a relatively long half-life, which helps minimize withdrawal effects, but slow tapering is still preferred
- If symptoms emerge during the taper, temporarily returning to the previous dose and slowing the taper schedule may be necessary
Tapering Schedule
- Reduce the dose by one quarter of the most recent dose every 3-6 months
- Monitor for any return of symptoms or withdrawal effects
- Adjust the taper schedule as needed to minimize withdrawal symptoms and risk of relapse
Supporting Evidence
The study by 2 also supports the idea of gradual tapering, suggesting that adaptations to antipsychotic exposure can persist for months or years after stopping the medication. The study by 3 provides additional insight into the importance of slow tapering, noting that exponential tapering programs can help minimize withdrawal symptoms. However, the most recent and highest quality study 1 provides the strongest evidence for the recommended tapering schedule.