Increasing Invega 156mg IM Monthly Dose
The recommended approach for increasing Invega (paliperidone) 156mg IM monthly dose is to increase to 234mg (150mg eq) IM monthly, which is the maximum approved dose for paliperidone palmitate monthly injections. 1, 2
Understanding Paliperidone Palmitate Dosing
Paliperidone palmitate (Invega Sustenna) is a long-acting injectable (LAI) antipsychotic with a unique pharmacokinetic profile:
- Current dose: 156mg (100mg eq of paliperidone)
- Maximum approved dose: 234mg (150mg eq of paliperidone) 2
- No oral supplementation is required when increasing the dose 2
Dose Increase Protocol
Step 1: Confirm Appropriateness of Dose Increase
- Verify inadequate symptom control at current dose
- Rule out medication non-adherence as cause of symptom breakthrough
- Assess for adverse effects at current dose that might worsen with increase
Step 2: Implement Dose Increase
- Increase directly from 156mg to 234mg at the next scheduled monthly injection
- No need for gradual titration between these doses 2
- Maintain the same injection schedule - the increase can occur at the regular monthly appointment
Step 3: Injection Site Considerations
- For deltoid injection: Use 1-inch 23-gauge needle for patients <90kg; use 1.5-inch 22-gauge needle for patients ≥90kg
- For gluteal injection: Use 1.5-inch 22-gauge needle regardless of weight 2
Monitoring After Dose Increase
- Assess for symptom improvement 1-2 weeks after injection
- Monitor for potential dose-related adverse effects:
Important Clinical Considerations
- The pharmacokinetic profile of paliperidone palmitate is biphasic, with an initial relatively fast release followed by a maintained second-stage release 4
- Timing flexibility: Monthly doses can be administered ±7 days from scheduled date without clinically significant impact on plasma concentrations 2
- If the patient misses a dose by >6 weeks, a re-initiation schedule may be required depending on the duration since last injection 2
Special Populations
- For patients with mild renal impairment (CrCl 50-80 mL/min), dose adjustments may be required
- No dose adjustment needed for mild to moderate hepatic impairment
- For elderly patients with normal renal function, use same dosing as younger adults 2
Paliperidone palmitate's complex pharmacokinetics make proper dosing crucial for maintaining therapeutic plasma levels while avoiding adverse effects related to excessive plasma concentrations 4.