Recommended Dosage of Invega (Paliperidone) for Schizophrenia and Schizoaffective Disorder
For schizophrenia in adults, the recommended dose of Invega (paliperidone) is 6 mg administered once daily, with a dosage range of 3-12 mg/day based on individual response and tolerability. 1
Dosage Recommendations by Condition and Population
Schizophrenia
Adults:
- Initial dose: 6 mg once daily
- Dose range: 3-12 mg/day
- Maximum recommended dose: 12 mg/day
- No initial titration required
- Dose increases above 6 mg/day should occur at intervals of more than 5 days
- When indicated, dose should be increased in increments of 3 mg/day 1
Adolescents (12-17 years):
- Initial dose: 3 mg once daily
- Dose increases should occur at intervals of more than 5 days
- For adolescents weighing less than 51 kg: maximum 6 mg/day
- For adolescents weighing 51 kg or more: maximum 12 mg/day 1
Schizoaffective Disorder (Adults):
- Initial dose: 6 mg once daily
- Dose range: 3-12 mg/day
- Maximum recommended dose: 12 mg/day
- No initial titration required
- Dose increases should occur at intervals of more than 4 days
- When indicated, dose should be increased in increments of 3 mg/day 1
Special Populations
Renal Impairment:
- Mild impairment (creatinine clearance 50-80 mL/min):
- Initial dose: 3 mg once daily
- Maximum dose: 6 mg once daily
- Moderate to severe impairment (creatinine clearance 10-50 mL/min):
- Initial dose: 1.5 mg once daily
- Maximum dose: 3 mg once daily
- Not recommended for patients with creatinine clearance below 10 mL/min 1
Elderly Patients:
- Same dosing as younger adults with normal renal function
- For elderly with moderate to severe renal impairment, maximum dose is 3 mg once daily 1
Administration Guidelines
- Can be taken with or without food
- Must be swallowed whole with liquids
- Tablets should not be chewed, divided, or crushed 1
Efficacy Considerations
- Clinical efficacy for schizophrenia was established in three 6-week trials in adults and one 6-week trial in adolescents 1
- Clinical efficacy for schizoaffective disorder was established in two 6-week trials in adults 1
- In clinical trials, paliperidone demonstrated significant improvement in PANSS total scores compared to placebo 2, 3
- Higher doses (9-12 mg/day) showed greater effects but must be weighed against increased adverse reactions 1
Important Monitoring and Safety Considerations
- Prescribe at the lowest effective dose for maintaining clinical stability
- Periodically reevaluate the long-term usefulness of the medication
- Monitor for extrapyramidal symptoms, which occur in approximately 25% of patients at higher doses (9-12 mg/day) 3
- Monitor for weight gain, which can occur in 15% of patients during long-term treatment 3
- Monitor for increased prolactin levels, which can occur during both short and long-term treatment 3
Clinical Pearls
- Paliperidone is the major active metabolite of risperidone
- Concomitant use with risperidone should be avoided or carefully monitored due to additive paliperidone exposure 1
- For treatment-resistant cases (failure of two adequate antipsychotic trials), consider switching to clozapine 4
- Ensure adequate duration of treatment (at least 6 weeks) before determining lack of efficacy 5
Paliperidone extended-release provides stable plasma drug concentrations over a 24-hour period and may be initiated at therapeutically effective dosages without the need for titration 3, making it a convenient option for patients with schizophrenia or schizoaffective disorder.