Paliperidone ER Dose Increase from 3 mg
When increasing Invega ER (paliperidone) from 3 mg, the dose should be increased to 6 mg once daily, which is the recommended standard dose for adults with schizophrenia and schizoaffective disorder. 1
Dosing Guidelines for Paliperidone ER
Standard Dosing
- The FDA-approved standard dose for paliperidone ER in adults is 6 mg once daily 1
- Initial dose titration is not required when starting at 6 mg
- For patients currently on 3 mg, increasing to 6 mg is the next appropriate step
Dose Adjustment Considerations
- Dose increases should occur at intervals of more than 5 days for schizophrenia 1
- For schizoaffective disorder, dose increases should occur at intervals of more than 4 days 1
- When dose increases are indicated, increments of 3 mg/day are recommended
Maximum Dosing
- Maximum recommended dose is 12 mg/day 1
- Although higher doses may provide additional benefit for some patients, this must be weighed against dose-related increases in adverse reactions
Special Populations
Renal Impairment
- For patients with mild renal impairment (creatinine clearance ≥50 mL/min to <80 mL/min):
- Initial dose: 3 mg once daily
- Maximum dose: 6 mg once daily 1
- For patients with moderate to severe renal impairment (creatinine clearance ≥10 mL/min to <50 mL/min):
- Initial dose: 1.5 mg once daily
- Maximum dose: 3 mg once daily 1
Elderly Patients
- Elderly patients may have diminished renal function requiring dose adjustments
- For elderly patients with normal renal function, dosing is the same as for younger adults
- For elderly patients with moderate to severe renal impairment, maximum dose is 3 mg once daily 1
Monitoring and Safety Considerations
Common Adverse Effects
- Extrapyramidal symptoms (EPS) - incidence increases in a dose-related manner 2
- Tachycardia
- Somnolence
- Headache and insomnia 3
Important Monitoring Parameters
- Extrapyramidal symptoms
- Cardiovascular parameters (heart rate, blood pressure, QTc interval)
- Prolactin levels (paliperidone ER is associated with increases in serum prolactin) 2
Clinical Pearls
- Paliperidone ER tablets must be swallowed whole with liquids and should not be chewed, divided, or crushed 1
- Can be taken with or without food
- Consider the additive paliperidone exposure if risperidone is co-administered with paliperidone ER 1
- Paliperidone ER follows linear pharmacokinetics at therapeutic doses (3-12 mg) 3
- The majority (59%) of paliperidone is eliminated through the kidneys as unchanged drug 3
By following these guidelines, you can appropriately increase the dose of Invega ER from 3 mg to 6 mg once daily, with careful monitoring for efficacy and adverse effects.